Pendulum appliance versus distal jet distalizing appliance.

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comparison between two molar distalizing appliance.

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Pendulum appliance versus distal jet distalizing appliance.

  1. 1. dital jet versus pendulum appliance
  2. 2. Under the guidance of : Dr. Mohammad Mushtaq, HOD & GUIDE By: Sneh Kalgotra, 2nd Year P.G. Department of Orthodontics & Dentofacial Orthopaedics, GDC&H, Srinagar. dital jet versus pendulum appliance
  3. 3. A comparison of two intraoral molar distalization appliances: Distal jet versus pendulum  Patricia P. Chiu,  James A. McNamara Jr,  Lorenzo Franchic dital jet versus pendulum appliance
  4. 4. About the present article  Year : 2005  Volume : 128  Page number : 353-65 According to the 2010 Journal Citation Reports, published by Thomson Reuters, AJO-DO is the highest ranked orthodontic title, by number of citation and impact factor. AJO-DO ranks 6th out of 74 titles for total citations in the Dentistry, Oral Surgery and Medicine category, and has a five year impact factor of 1.924. dital jet versus pendulum appliance
  5. 5. prolouge  Maxillary molar distalization for non extraction treatment of Class II patients has become increasingly popular in the last 10 years.  Recently, problems related to patient compliance have led many clinicians to prefer intraoral distalizing systems that minimize reliance on the patient and are under the orthodontist’s control. dital jet versus pendulum appliance
  6. 6.  The distal jet and the pendulum are 2 of the more commonly used “noncompliance appliances” for molar distalization. dital jet versus pendulum appliance
  7. 7. Distal jet appliance Pendulum appliance dital jet versus pendulum appliance
  8. 8.  A comparison of two intraoral molar distalization appliances: Distal jet versus pendulum.  Title reflects the aim of the study.  Variables are not clearly mentioned in the title.  Independent variables are: distal jet and pendulum appliance, dependent variables are : molar distalization, skeletal changes, dentoalvelor changes. dital jet versus pendulum appliance
  9. 9. A comparison of two intraoral molar distalization appliances: Distal jet versus pendulum.  It comprises of 10 words- short.  It is not specific.  Title is incomplete as it suggest nothing about the parameters being undertaken in the study. dital jet versus pendulum appliance
  10. 10. Proposed alternative title  A comparison of two intraoral molar distalization appliances: Distal jet versus pendulum with respect to skeletal, dentoalevolar changes, pre and post distalization comparison- A cephalometric study. 20 words. dital jet versus pendulum appliance
  11. 11. INTRODUCTION  Introduction is meaningful.  Introduction is concise.  It is built on the existing literature.  Citations that are reported, are relevant and pertinent to the study and followed with correct references in the list.  Purpose of the study is clearly mentioned in the introduction. dital jet versus pendulum appliance
  12. 12. Material and methods dital jet versus pendulum appliance
  13. 13. Material and methods Inclusion criteria (1) a pretreatment Class II Division 1 malocclusion, defined by at least an end-toend molar relationship; (2) no permanent teeth extracted before or during treatment; (3) good-quality radiographs with adequate landmark visualization and minimal or no rotation of the head; and (4) no other molar distalization procedures (eg, headgear) performed between the T1 and T2 cephalograms. dital jet versus pendulum appliance
  14. 14. Material and methods Sample selection Patient sample  Primary exclusionary criteria 1. Poor film quality/magnification problems 2. Incomplete records  Secondary exclusionary criteria 1. T1 to T2 interval greater than 12 months 2. Non-Class II malocclusion 3. Use of other molar distalization methods between T1 and T2 Final sample dital jet versus pendulum appliance 94 6 13 16 4 23 32
  15. 15. Material and methods  In the patients in the distal jet group, coil springs were activated every 4 to 6 weeks; most patients received 3 to 5 activations. The forces generated by the Ni-Ti coils were recommended by Carano and Testa (240 g).  Once a “super Class I” molar relationship was achieved, the distal jet was converted to a large Nance holding arch by removing the coil springs. The extension arms to the second premolars were cut and removed to allow the premolars to drift back or be actively retracted. dital jet versus pendulum appliance
  16. 16. Material and methods  The pendulum/pendex appliance used in this study was similar to that described by Hilgers.32 With the appliance in place, the 0.032-in TMA springs were placed in the lingual sheaths on maxillary first molar bands. This 60° activation exerted approximately 230 g of distalizing force.  The pendulum appliance was removed when a “super Class I” molar relationship was achieved. A Nance holding arch was placed after molar distalization. Typically, the occlusal rests were removed from the second premolars, and the premolars were allowed to drift posteriorly. dital jet versus pendulum appliance
  17. 17. Material and methods Cephalometric analysis The cephalometric analysis, containin measurement from the analyses of Jacobson, McNamara, Ricketts, and Steiner, consisted of 31 variables (10 angular and 21 linear) foreach tracing. Regional superimpositions were done by hand, and the 78 landmarks and the 4 fiducial markers (anterior and posterior maxilla, anterior and posterior mandible) were digitized with Dentofacial Planner. dital jet versus pendulum appliance
  18. 18. material and methods  The local ethical committee was not consulted.  Informed and written consent was not obtained before the treatment was started. dital jet versus pendulum appliance
  19. 19. Results dital jet versus pendulum appliance
  20. 20. Results 1. Pretreatment to postdistalization. The pendulum group showed a significantly greater correction of molar relationship (6.4 mm) and a significantly larger amount of molar distalization (U6 horizontal, 6.1 mm) compared with the distal jet group (3.8 and 2.8 mm, respectively). The maxillary first molars in the pendulum group, however, experiencedsignificantly more distal tipping (U6 to FH, 10.7°) than the distal jet group (5.0°). The maxillary first molars also extruded slightly in both samples (U6 vertical, 0.5-1.0 mm). dital jet versus pendulum appliance
  21. 21. Results At the end of the first phase of treatment, the pendulum group showed significantly less anchorage loss measured at the first premolars (U4horizontal, 1.4mm mesial movement) than the distal jet group (2.6 mm). The first premolars tended to extrude in both groups (U4 vertical, 1.2-1.3 mm) dital jet versus pendulum appliance
  22. 22. Results The maxillary incisors of the distal jet group. Exhibited significantly more flaring (U1 horizontal, 3.7 v 1.1 mm; U1 to FH, 13.7° v 3.1°) and intrusion (U1 vertical, 1.5 v 0.1 mm) during molar distalization. dital jet versus pendulum appliance
  23. 23. Results  2. Postdistalization to end of orthodontic treatment. During the second phase of treatment with full fixed appliances, the maxillary first molars in the pendulum group showed significantly more mesial movement (5.5 mm) and mesial tipping (13.6°) than the distal jet group (3.4 mm and 7.2°, respectively). There were no significant differences in the horizontal and vertical movements of the first premolars between the 2 groups during the second phase of treatment. dital jet versus pendulum appliance
  24. 24. Results  At the end of treatment, the pendulum group showed significantly more molar distalization (1.2 mm more than the distal jet group). The maxillary first molars were 0.6 mm distal to their original positions for the pendulum group, whereas they were 0.6 mm mesial for the distal jet group. Both appliances, however, induced the same amount of correction in molar relationships (2.9 mm).  After comprehensive treatment, the maxillary incisors of the distal jet subjects were 1.6 mm more labial than those of the pendulum subjects. dital jet versus pendulum appliance
  25. 25. Conclusion  This study compared the treatment effects of the distal jet with concurrent full-fixed appliances and the pendulum appliance followed by fixed appliances. 1. During molar distalization, the pendulum subjects demonstrated significantly more distal molar movement and significantly less anchorage loss at both the premolars and the maxillary incisors than did the distal jet group. dital jet versus pendulum appliance
  26. 26. Conclusion 2. The distal jet used simultaneously with fixed appliances and the pendulum were equal in their abilities to move the molars bodily. 3. At the end of comprehensive treatment, the maxillary first molars were 0.6 mm mesial to their original positions in the distal jet group, and 0.5 mm distal in the pendulum group. Nevertheless, total molar correction was identical in the 2 groups (3.0 mm), and both appliances were equally effective in achieving a Class I molar relationship at the end of treatment. dital jet versus pendulum appliance
  27. 27. Conclusion  4. Simultaneous edgewise orthodontic treatment during molar distalization in the distal jet group shortened the overall treatment time but produced significant flaring of both maxillary and mandibular incisors at the end of treatment. dital jet versus pendulum appliance
  28. 28. Review of literature dital jet versus pendulum appliance
  29. 29. Bolla E, Muratore F, Carano A, Bowman SJ. Evaluation of maxillary molar distalization with the distal jet: a comparison with other contemporary methods. Angle Orthod 2002;72:481 The first molars were tipped distally an average of 3.18, however, the amount of tipping in each case was influenced by the state of eruption of the second molar. In subjects whose second molars had erupted only to the level of the apical third of the first molar roots, distal tipping was almost twice that seen when the second molar had completed their eruption. dital jet versus pendulum appliance
  30. 30. Ngantung V, Nanda RS, Bowman SJ. Posttreatment evaluation of the distal jet appliance. Am J Orthod Dentofacial Orthop 2001;120:178-85.  The distal jet also showed less tipping of the maxillary molars and better bodily movement of molars because the force was applied closer to the center of resistance. The observations of treatment outcome indicate that the 1.8-mm mean net anterior movement of the maxillary first molar was more than offset by the 4.8-mm mesial movement of the mandibular first molar dital jet versus pendulum appliance
  31. 31. Ghosh J, Nanda RS. Evaluation of an intraoral maxillary molar distalization technique. Am J Orthod Dentofacial Orthop 1996; 110:639-46. The maxillary molars were predictably distalized in accordance with the individualized treatment goals without regard to patient age and extraction of the third or second molars. dital jet versus pendulum appliance
  32. 32. Byloff FK, Darendeliler MA. Distal molar movement using the pendulum appliance. Part 1: clinical and radiological evaluation. Angle Orthod 1997;67:249-60. The average distal movement of the maxillary molars was 6 mm, and the inclination was 11.3° 6.2°. dital jet versus pendulum appliance
  33. 33. Bussick TJ, McNamara JA Jr. Dentoalveolar and skeletal changes associated with the pendulum appliance. Am J Orthod Dentofacial Orthop 2000;117:333-43. For maximum maxillary first molar distalization with minimal increase in lower anterior facial height, this appliance is used most effectively in patients with deciduous maxillary second molars for anchorage and unerupted permanent maxillary second molars, although significant bite opening was not a concern in any patient in this study dital jet versus pendulum appliance
  34. 34. Critical reflection dital jet versus pendulum appliance
  35. 35. Critical reflection  This article is very relevant for our day to day clinical practice.  Further study with calculated and higher sample size. dital jet versus pendulum appliance
  36. 36. Critical reflection  The authors has mentioned in the article that distal jet was told initially to be used before fixed orthodontic treatment but have failed to quote any references for that.  That can be one field of future research and study. dital jet versus pendulum appliance
  37. 37. References 1. Graber TM. Extraoral force—facts and fallacies. Am J Orthod 1955;41:490-505. 2. Kloehn SJ. Evaluation of cervical traction of the maxilla and upper first permanent molar. Angle Orthod 1961;31:91-104. 3. Poulton DR. The influence of extraoral traction. Am J Orthod 1967;53:8-18. 4. Hilgers JJ. The pendulum appliance for Class II non-compliance therapy. J Clin Orthod 1992;26:700-3. 5. Ghosh J, Nanda RS. Evaluation of an intraoral maxillary molar distalization technique. Am J Orthod Dentofacial Orthop 1996; 110:639-46. 6. Byloff FK, Darendeliler MA. Distal molar movement using the pendulum appliance. Part 1: clinical and radiological evaluation. Angle Orthod 1997;67:249-60. . dital jet versus pendulum appliance
  38. 38.  7. Byloff FK, Darendeliler MA, Clar E, Darendeliler A.        Distal molar movement using the pendulum appliance. Part 2: the effects of maxillary molar root uprighting bends. Angle Orthod 1997;67:261-70 8. Bussick TJ, McNamara JA Jr. Dentoalveolar and skeletal changes associated with the pendulum appliance. Am J Orthod Dentofacial Orthop 2000;117:333-43. 9. Joseph AA, Butchard CJ. An evaluation of the pendulum “distalizing” appliance. Semin Orthod 2000;6:129-35. 10. Chaqués-Asensi J, Kalra V. Effects of the pendulum appliance on the dentofacial complex. J Clin Orthod 2001;35:254-7. dital jet versus pendulum appliance
  39. 39. Thank you. Sneh Kalgotra 2nd year P.G. QAZIGUND-SNOWFALL 2013. dital jet versus pendulum appliance t

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