Introduction History Indications and contraindications Timing of distalization Second molar extraction Mandibular molar distalization Rickett’s criterion Classification and various distalization appliances References

1. MOLAR
DISTALIZATION
Dr. Miliya Parveen

2. CONTENTS:
• Introduction
• History
• Indications and contraindications
• Timing of distalization
• Second molar extraction
• Mandibular molar distalization
• Rickett’s criterion
• Classification and various distalization appliances
• References

3. INTRODUCTION:
• Distalization is a conservative method that is utilized in orthodontics to
gain space by moving posterior teeth distally.
• May be combined with other space gaining strategies, such as expansion,
or can be used alone.
• Many methods have been used which may differ in their place - extraoral
or intraoral, site of action in upper and/or lower arch, and cooperation
needed by the patient (removable or fixed).

4. HISTORY:
• Kingsley was the first person to try to move the maxillary teeth
backwards in 1892 by means of headgear.
• Oppenheim advocated that position of mandibular teeth as being the
most correct for individual and use of occipital anchorage for moving
maxillary teeth distally into correct relationship without disturbing
mandibular teeth. In 1944, he treated a case with extra-oral anchorage
for distalizing maxillary molar.

5. • Renfroe (1956) reported that lip bumper primarily devised to hold
hypertonic lower lip caused a distal movement of lower molars.
• Gould (1957) was first person to discuss about unilateral distalization of
molars with extra-oral force.
• Kloehn (1961) described the effects of cervical pull headgear.
• Graber T.M. (1969) extracted the maxillary II molar and distalized the
first molar to correct class II div.I.

6. INDICATIONS FOR MOLAR DISTALIZATION:
(i) To mesially position the maxillary first molar
(ii) Preferred in patients with low mandibular plane angle (brachycephalic
type) or normal (mesocephalic type)
(iii) Mild to moderate class II molar relationship, which are not indicated
for extraction
(iv) To correct the second molar position
(v) To achieve ideal overbite and overjet
(vi) To early correct class II pattern
(vii) To regain the lost space (space regainer)

7. CONTRAINDICATIONS FOR MOLAR DISTALIZATION
(i) Patients with high mandibular plane angle and excessive LAFH
(ii) Patients with skeletal or dental open bite
(iii) Severe class II skeletal pattern with an orthognathic maxilla and
retrognathic mandible
(iv) Excessive overjet and proclination of anterior teeth
(v) Crowding in the posterior segment
(vi) Patients with temporomandibular joint problems

8. OTHER CONSIDERATIONS FOR MOLAR
DISTALIZATION :
1. Growth Pattern: unfavorable or vertical growth tendency are
contraindicated.
2. Degree of Overbite: advantage in deep overbite cases is however a
disadvantage in Class III cases and open bite cases.
3. Second Molar: Unerupted second molars rarely create resistance to the
distal movement of the maxillary first molars. Indeed even they move
distally in response to moving first molar

9. 4. Age of the patient: Dewel (1967) and Hass (1970) observed faster rate of molar
distalization in patients in mixed dentition to those in the adult dentition. This is
probably as Armstrong observed that the skeletal system of younger patients is
apparently more dynamic, possessing a greater capacity to remodel.
5. Presence of other force systems: A force system applied for distalization of
first molars may be negated or augmented by the presence of other force systems
like intraoral elastics, arch wires, etc. For example, presence of a tip back bend in
the arch wire mesial to the molar requires a greater compensational distal root
rotation force to cause distalization of first molar by translation.

10. TIMING OF DISTALIZATION:
Different views have been expressed by different authors,
• Joseph M.Sims (1977): suggested that the patient should be treated
before the age of 9yrs as the root of the molar to be moved has not
completed its growth and the orthodontic distal tipping or distal bodily
movement is easier.
• Ottolenguri(1914): suggested that the first molars should be moved
backward against unerupted second molars during orthodontic treatment
with caution as such movement could result in root resorption of the first
molar.

11. • David J.Snodgrass (1996): stated that in the mixed dentition, molar
distalization should not be carried out until full development of the
maxillary first molar roots. In the permanent dentitions, molar
distalization is most effective before the full eruption of the second
molar.
• James J. Hilgers (1992): suggested that the distal movement of the first
molars is most efficient before the eruption of upper second molar.

13. MAXILLARY SECOND MOLAR EXTRACTION IN
MAXILLARY FIRST MOLAR DISTALIZATION:
• Hilgers (1992) suggested that when a great deal of distal movement is
needed and it is preferable not to extract the upper first bicuspids, it is
always beneficial to remove the upper second molars and let the third
molars drift into place.

14. • According to Samir E. Bishara, various advantages and disadvantages of
second molar extraction are as follows:
Advantages:
1. Facilitation of first molar distal movement
2. Reduction in the amount and duration of appliance therapy
3. Disimpaction of third molars
4. Faster eruption of third molars
5. Less likelihood of relapse
6. Good functional occlusion
Disadvantages:
1. Too much tooth substance removed.
2. Extraction site located far from the area of concern in moderate to
severe anterior crowding.

15. MANDIBULAR MOLAR DISTALIZATION:
Orthodontic displacement of the mandibular molar, other than extrusion,
is reputed to be extremely difficult, due to the large root area and root
anatomy.
Indications -
i. To correct mandibular incisor alveolar protrusion, with or without
associated crowding
ii. To straighten a curve of Spee at the expense of the posterior sectors
iii. Preoperative orthodontic preparation of class III compensation
iv. Dental class III associated with skeletal class I malocclusion
v. Moderate skeletal class III, to be managed non-operatively by
dentoalveolar compensation

17. UPPER MOLAR POSITION:
• Cephalometrically, according to Rickett’s criterion, Upper molar position
is the horizontal distance from Pterygoid Vertical Line or PTV Line to the
distal surface of the maxillary first permanent molar.
• This measurement indicates whether sufficient space is present or not for
the second and third molars.
• The clinical norm is age+3 and clinical deviation is +/-3 mm (in
growing patients). In non-growing patients, the mean value is 18 mm.

18. CLASSIFICATION:
Location of
appliance
• Extra-oral
• Intra-oral
Position of
appliance in
mouth
• Buccal
• Palatal
Type of tooth
movement
• Bodily
movement
• Tipping
movement
Compliance
needed from
patient
• Maximum
compliance
• Minimum or
No
compliance
Type of
appliance
• Removable
• Fixed
Arches
involved
• Inter-arch
• Intra-arch

19. VARIOUS MODALITIES TO DISTALIZE MOLARS:
• Appliances traditionally used to distalize molars can be divided into two
categories:
 Extraoral and
 Intraoral.
A. Extraoral Appliances:
A typical extraoral appliance includes face-bows that attach to tubes on the
upper first molars and headgears that attach to auxiliaries connected to the
arch wires.

20. Bilateral
distalization
High pull
headgear
Straight pull
headgear
Cervical or low
pull headgear
Unilateral
distalization
Power arm
facebow
Swivel offset
facebow
Soldered offset
facebow
Spring attached
facebow

21. B . Intraoral appliances:
Vast number of intraoral appliances also has been advocated for the purpose of
molar distalization. These appliances can be removable or of fixed type and can
be categorized into two groups.
INTER-ARCH:
• Tandem Yoke
• 3 Dimensional Bimetric Distalization Arch
• Modified Herbst Appliance
• Saif Springs
• Klapper Super Springs
• Eureka Springs
• Jasper Jumper

22. INTRA-ARCH:
A. Maxillary Arch
I. Removable Appliance -
• Cetlin appliance
• ACCO (acrylic cervical occipital appliance)
• Modified ACCO appliance
• Removable molar distalization splint
• Molar Distalizing Bow
• Segmented Removable appliance for Distalization (RMD)
• C-space regainer

23. II. Fixed Appliance –
• Transpalatal arch
• Nance palatal appliance
• Modified Nance appliance for molar
distalization
• K loop
• Pendulum appliance and modifications
• Jones jig
• Distal jet and its modifications
• Intraoral Bodily Molar Distalizing
Appliance (IBDA)
• Lokar Molar Distalizer
• Lingual Distalizer System
• Fixed piston appliance
• Greenfield lingual distalizer
• Lingual distalizer system
• “New Distalizer” appliance
• Crozat treatment
• Crickett appliance
• Frog appliance
• Super elastic NiTi wire
• NiTi Coil Springs
• Magnets
• SAS (Skeletal Anchorage System)

24. B. Mandibular Arch
• Franzulum appliance
• Modification of Distal Jet appliance
• Unilateral Frozat Appliance
• SAS (Skeletal Anchorage System)

25. EXTRA-ORAL – BILATERAL DISTALIZATION:
A. CERVICAL PULL (Low Pull or Kloehn) -
• In patients with decreased vertical skeletal dimension.
• Restrict forward growth of maxilla and/or to prevent the forward growth of
maxillary posteriors.
• Force is below the occlusal plane producing both extrusive and distalizing
force.
• Used in deep bite, hypodivergent bases.
• Outer bow is longer than inner and bent upwards so that both point of force
application and line of force lie above the centre of resistance of molar.

27. B. OCCIPITAL PULL -
• Force is above the occlusal plane and is distalizing and intrusive.
• Skeletal or dento-alveolar open bite and/or steep mandibular plane
angle (hyperdivergent) as it provides a vertical force.
• Outer bow is same length as inner and bent upwards so that line of
force is through the centre of resistance of molar.

28. EXTRA-ORAL – UNIATERAL DISTALIZATION:
1. Power Arm
• Outer bow is longer and/or wider than other
• Longer bow located on the side to receive greater
distal force.
• Disadvantage - also generates lateral forces (tends
to move the favoured molar into lingual crossbite
and other molar into buccal crossbite)
2. Soldered – Offset Face Bow
• Outer bow is attached to inner bow by a fixed
soldered joint placed on the side favoured to receive
the greater distal force.

29. 3. Swivel-Offset face bow
• Outer bow is attached to inner bow
through a swivel joint located in an offset
partition on the side favoured to receive
the greater force.
4. Spring – Attachment face bow
• An open coil spring is warped around
one of the inner bow terminal and
conventional bilateral face bow. On the
side favoured to receive greater force.

30. INTRAORAL METHODS – INTERARCH DISTALIZATION:
TANDEM YOKE
The Bimetric arch modules are designed for ease of
insertion and removal. They consist of 0.040 inch end
sections (provide rigidity and support), the inter-
maxillary hooks and an anterior arch bar of 0.022 inch
true chrome for flexibility.
The molar buccal tube combines rectangular tube of
0.018 x 0.025 inch or 0.022 x 0.028 inch with the
0.045 inch round tube at the gingival position - key to
successful distalization of upper molars with minimal
tipping.

31. 3D BIMETRIC DISTALIZING ARCH AND 3D
MANDIBULAR LINGUALARCH
• Wilson in 1978 introduced the concept of “modular
orthodontics” and the method of rapid molar distalization
• This treatment approach to distalizing maxillary molars has
been designed using a 3D biometric distalizing arch and a
3D mandibular lingual arch with class II elastics.
• Wilson’s biometric distalizing arch has a 0.022 anterior
section and 0.045” posterior section that fit into the
headgear tube. A 5 mm long, open coil is inserted between
the Omega adjustable stops and buccal tube.
• The coil springs were compressed to 3 mm to produce a
2 mm activation and movement.

32. INTRA-ARCH DISTALIZATION -
MAXILLARY REMOVABLE APPLIANCES:
CETLIN APPLIANCE
• Forward by N.M Cetlin & Ten Hove in 1983.
• The Cetlin appliance utilizes a removable appliance
intraorally to tip the crowns distally and then an
extraoral force to upright the roots.
• Consists of 2 distalizing spring mesial to 1st molars,
anterior bite plate to disocclude the posteriors
• Spring activated to 1-1.5mm

33. ACCO Appliance
• Originally devised by Dr. Herbert Margolis
• The ACCO (Acrylic Cervical Occipital
anchorage) appliance is a removable acrylic
appliance which is used in conjunction with
a Headgear to effect distal mass movement
of buccal segments.
• This removable appliance exerts a
continuous distalizing force on the molars,
with the springs reactive forces dissipated
through the acrylic button into the palate and
the maxillary teeth mesial to the molars.

34. MODIFIED ACCO APPLIANCE
• B.Guliano Maino and Paloa Mura et al., in 2006 introduced a modified version
of ACCO appliance.
• The major difference is that the Adams clasp engaging each first premolar
terminates in a helix embedded in the acrylic plate. When the distal end of the
clasp is cut off, it becomes a finger spring used to distalize the first premolar
• With the original ACCO appliance, distalization ended when the first molar
had been overcorrected into a super Class I relationship and the second
premolar had drifted distally.
• With the modified appliance, treatment continues until both premolars are
Class I and some spontaneous canine distalization has occurred.

35. REMOVABLE MOLAR DISTALIZATION SPLINT
• Ritto A.K. (1995) described use of removable molar
distalizer appliance in both maxillary as well as
mandibular arch - small, comfortable and more esthetic
than conventional removable plates.
• The appliance consists of a clear splint made form 1.5 mm
Biocryl in a Biostar machine.
• If both upper first molars are to be moved distally at the
same time, the spint extends from the area of the upper
left first or second premolar.
• If only one molar is to be moved, the splint extends to the
terminal molar on the opposite side.

36. MOLAR DISTALIZING BOW
• Jeckel and Rakosi (1991)
• The appliance is easy to handle and wear.
• The distalizing bow fits into the anterior slot and
posteriorly into the conventional molar headgear
tubes, which lie in the same plane as the anterior slot
or just above it.
• Consists of 0.8 to 1.5 mm thick thermoplastic splint extending into buccal sulcus.
• To activate the appliance, central section of bow must be pressed and fitted into
anterior slot. This compresses the coils and force is transmitted to molar.

37. C-SPACE REGAINER
• Kyu-rhim Chung et al., (2000)
• This appliance can be used to intrude teeth
as well as to move them distally or
sagitally.
• And also can be used to achieve bodily
molar movement without significant
incisor flaring
• A 0.010” x 0.040” open coil spring is
soldered immediately distal to the helix and
0.028” ball clasps are used between lateral
incisor and canine to retain the appliance

38. Pendulum Appliance
• Introduced by Dr. Hilger in 1992.
• It is a hybrid appliance that uses a large Nance acrylic button in the palate for
anchorage, along with 0.032” TMA spring that deliver a light, continuous
force to the upper 1Ms.
INTRA-ARCH DISTALIZATION -
MAXILLARY FIXED APPLIANCES:
Fabrication of Active part:
Right and left pendulum springs with 0.032 TMA
wire, consist of a recurved molar insertion wire, a
small horizontal adjustment loop, a closed helix and
a loop for retention in the acrylic button.

39. Activation:
Activated by using a bird beak plier by keeping
the round beak inside and the square beak
outside; the springs are opened and made
parallel to the midline.
Each pendulum spring is brought forward with
finger pressure, the mesial end of the recurved
loop is grasped with a Weingart plier, and the
spring is seated in the lingual sheath.
Reactivation:
Checked about every three weeks and
reactivation is done by holding helix with a
bird beak plier and the spring is reactivated by
pushing it distally toward the midline.

40. M- Pendulum
• In this modification of the pendulum appliance, the
horizontal loops are inverted to allow bodily
distalization of molars.
• Once distal molar movement has occurred, the loop can
be activated simply by opening it. The activation
produces buccal and/or distal uprighting of the molar
roots and thus a true bodily movement rather than a
simple tipping or rotation.
• The preactivation bends given prior to intraoral
placement is also 40 to 45 degree rather than 60 degree
as in conventional or Hilger’s pendulum appliance.
MODIFICATIONS OF PENDULUM APPLIANCE:

41. Modified Pendulum with removable arms
• It has removable TMA arms that can be
reactivated outside the mouth.
• Double over two 7-9mm lengths of .032" TMA
wire to form bayonets. Attach each bayonet to an
M-Pendulum arm, either by using a laser welder
or by wrapping .010" ligature wire around the
arm and soldering the unit together with silver
wire and a miniflame.
• Embed each bayonet in the soft acrylic that will be used to form the Nance
button, producing sheaths in which to insert the removable arms.
• The removable arms can be reactivated during treatment without deboning and
rebonding the occlusal rests of the Nance button.

42. • We modify the M-pendulum by using four removable
arms, for both the first and second molars.
• The pressure exerted by the pendulum will be less,
since the distalization force is used to move the
second molars and first molars sequentially, rather
than simultaneously.
• Once the second molar has been distalized, their arms
are left passively in place for anchorage, and the first
molar arms are activated for distalization and
intrusion.
• After the first molars have been distalized, the
pendulum is replaced with a Nance button.
Modified pendulum appliance for anterior anchorage control

43. • Has a distal screw that divides the Nance palatal button in to 2 parts: the anterior
part, used for anchorage and posterior part with the pendulum springs and thus
the active elements of the appliance.
• Before placement, the pendulum springs are activated for distalization (targeted
force: 180-200 N) and are given additional integrated uprighting activation (30°)
Pendulum K Appliance

44. Bone Supported Pendulum (BSP) Appliance
• In 2007 Andres Escobar et al., introduced a modified pendulum appliance, the
bone supported pendulum appliance (BSP) with 2 endosseus screw for anchorage
in the palatal area was used for maxillary molar distalization (force of approx.
250gm) and prevent the loss of anchorage generally associated with mesial
movement of the premolars and labial movement of maxillary incisors.

46. Crickett Appliance
• Victor C.West (1984)
• Embraces essential features of quadhelix
but replacing palatal and lingual bars of
upper and lower appliances with Quad and
bi-helix respectively.
• Upper palatal and lower lingual bars are
constructed with 0.032” yellow and 0.038”
blue elgiloy respectively. Cribs, clasps and
occlusal rests from 0.028” blue elgiloy
lingual arm from 0.030” yellow and buccal
arm from 0.045” blue elgiloy.
• Effects a variety of tooth movements,
including rotation, torquing, and
distalization of molars.

47. Jones Jig
• In 1992 Richard Jones and Michel White used open coil nickel titanium spring to
deliver 70-75 gm of force, over a compression range of 1-5 mm to the molars.
• Jones Jig assembly consists of bands on the upper second premolars attached to a
Nance Palatal arch. The Jig main was attached through the headgear and bracket
slot to upper first molar bands.
• An eyelet tube is then place anterior to the spring; such that when the eyelet tube
is pushed distally the Ni-Ti coil spring gets compressed exerting a distalization
force on the molars.

48. Advantages:
• The extent of forward movement of the anterior
teeth while using the Jones Jig is very minimal.
• Can be used without the need of a full banded
upper arch.
• The coils of Jig can be changed with minimal time
and the use of arch wires and class II elastics can
be avoided
Modification:
• Jones Jig is modified by Dr. Hickory to be usable
without anterior braces.
• Usually a Nance is placed from the first premolars
for anchorage. To avoid braces on the anterior
teeth vacuform aligners are used with bonded
buttons to support Class II elastics.

51. Clinical Distalization with the Distalix
• In 1993, Langlade introduced a new appliance called Distalix, a frictionless
automatic system.
• This appliance was originally designed from the quad helix appliance, from
which it borrows the four helices, and from Hilger’s distalization pendulum
spring.

52. • It is constructed with a 0.032 inch blue Elgiloy round wire and can be welded
on premolar and/or molar bands, or it can be completely removable, with a
palatal tube on molar bands.
• This appliance can be individualized and adapted to the clinical situation to
obtain only a backward movement, an expansion, a molar rotation, or even a
combination of all three movements.
• It produces very light force ranging from 250 to 350gm this is enough to
obtain molar distalization in a growing patient.
• Occasionally, the molars are too far forward and in rotation, in such cases,
the Distalix is well indicated.

53. Distal Jet for upper molar distalization :
• Dr.Carano and Dr.Testa in the year 1996
• It is a fixed palatal appliance that can
produce unilateral or bilateral molar
distalization typically in 4-9 months without
relying on patient cooperation.
• Bilateral tubes of 0.036” internal diameter
are attached to an acrylic Nance button.
• A coil spring and a screw clamp are to slide
over each tube. (NiTi coil springs of 150gms
of children and 250gms for adult, appliance
can be made of stainless steel spring)

54. • The wire extending from the acrylic through each tube ends in a bayonet
bends that is inserted into the lingual sheath of the 1st Molar band. An
anchor wire from the Nance button is soldered to bands on the second
premolars.
• The distal jet is reactivated by sliding the clamp closer to the 1st molar once
a month.

55. Double set screw distal jet
• In 1998 given by Jay Bowman
• This modification incorporates use of two
sets of screw into the activation collar for a
more reliable conversion of Distal Jet to
Nance holding arch.
• Of the two set of screws, the mesial set is
used for active distalization and the distal
set of screw is used to lock on the bayonet
wire to prevent mesial movement of the
molar

56. Modified mandibular distal jet :
It was designed to upright mesially tipped 1st molars, when the original design
is applied to mandibular 2nd molars.

59. Lokar Molar Distalizer
• In 1996 Lokar, had introduced new molar distalizing appliance called
“Lokar molar distalizer”.
• Lokar appliance inserts into the molar attachment with an appropriately
sized rectangular wire.
A- Inserts into molar attachment with a rectangular wire
B- Compression spring
C- Sliding sleeve
D- Groove
E- Flat guiding bar
F- Round posterior guiding bar
G- Immovable posterior sleeve

60. • A compression spring is activated by a sliding sleeve, which is tied to the
most distal tooth mesial of the first molar by a ligature wire going around
the front of the sliding sleeve and is kept in place by resting in the groove,
which is formed by the flat guiding bar and the round posterior guiding
rod.

61. K-Loop
• The appliance based on Burstone's principles was designed by Dr. Varun Kalra
(1995) to achieve bodily movement or controlled or uncontrolled tipping of
molars as required by the case.
• By altering the moment to force ratio, the clinician can achieve bodily
movement.
• For additional molar movement the appliance is reactivated 2 mm after 6-8
weeks. In most cases, one reactivation produces 4 mm of distal movement.
• Made up of 0.017 x 0.025 TMA wire.

62. • Each loop should be 8 mm long 1.5 mm wide. The legs
of K are bent down 20 degrees and inserted into the
molar tube and premolar bracket.
• Stops are bent 1 mm from mesial of the molar tube and
the distal of the premolar bracket.
• These bends help keep the appliances away from the
mucobuccal fold allowing a 2 mm activation of the K
loop.
• The 20 degrees bends in the appliance legs produce
moments that counteract the tipping moments created
by the force of the appliance and these moments are
reinforced by moment of activation, as the loop is
squeezed into place.

63. Asymmetric Maxillary Molar Distalization with the Transpalatal Arch
• In 2001 Massililiano and Laura Balducci introduced the use of Transpalatal arch in
maxillary molar distalization.
• A toe in bend in the Transpalatal arch applies a mesiobuccal rotation to the maxillary
molar on the side of the bend and a distally directed force against the molar on the
opposite side.
• Made from the 0.032”TMA
• The Transpalatal arch is inserted from distal into the tube of the maxillary molar used
as anchorage, and from the mesial into that of the maxillary molar to be distalized.

64. Nance appliance and its modification
• The Nance holding arch consists of a palatal arch attached to first molar bands
and embedded in an acrylic “button” that lies against the palatal rugae.
• Modification - The active, class II side also had an arm bent similar to a
quadhelix with the most anterior terminus soldered to a first Bicuspid band.
• A 0.020 inch omega loop is soldered to the anterior end of the framework
which allowed the distal end of the loop to slide distally as it is opened for
activation.

65. • Gienally et al., in 1988 and Takami Itoh in
1991 had used a repelling type of magnetic
force for distal tooth movement
• In 1988 Anthony Gienally used intra arch
repelling magnets anchored to a modified
Nance appliance cemented on the maxillary
first premolars, were activated against the
maxillary first molars to move them distally.
• Magnets in all patients were activated by tightening of the 0.014 inch ligature wire to
bring the magnets into contact. The procedure of the magnets recommended
reactivation of the magnets once every three weeks.
Molar Distalization with Magnets :

66. Disadvantage -
• Forces exerted by magnets drops significantly as spaces are opened.
• Discomfort to the patient.
• Labial movement of the anterior teeth was observed despite the use of a
nance holding arch.
• Initial discomfort to the patient because of the size of magnets.
• Using repelling force, orthodontic force decreased by 50% to 70% with
every 0.5mm - 1.0mm of movement hence frequent reactivation was
required every two weeks

67. Molar Distalization with Super Elastic NITI Wire
• Use of superelastic nickel titanium wire with shape
memory - Locatelli and Gianelly et al., in 1992.
• The method produces 1-2 mm molar distalization if
the second molars are unerupted and the appliance
is easy to insert.
• Place a 100gm Neo Sentalloy wire with regular
archform over the maxillay arch. Mark wire in three
places on each side (at distal wing of the first
premolar bracket, 5-7 mm distal to the anterior
opening of the molar tube, and between the lateral
incisors and canines.) Crimp a stop to the archwire
at each of the posterior marks, and add hooks for
intermaxillary elastics between the lateral incisors
and canines.

68. Advantages
• This method moves the molars distally by 1-2 mm per month with little
loss of anchorage.
• Neosentalloy is easy to insert even after all the teeth have been bracketed
or banded.
Disadvantages
• Once the second molars are erupted, distal movement of first molars
usually take more time.
• If the first molars do not move by atleast 1mm / month, a 200 gm 0.018 X
0.025 Neosent alloy wire can be placed with increase in force, therby
increasing the chances of loss of anchorage.

69. Fixed Piston Appliance
• The Fixed Piston Appliance (Greenfield Molar
Distalizer) was introduced by Greenfield in 1995
• It is a fixed appliance with buccal and lingual
pistons on each side.
• Placing the pistons at the gingival level reduces
the distance of the applied force from the center
of resistance of the molar, minimizing the crown
tipping moments that are seen with other
distalizer.

70. • So, according to him this appliance produce bodily distal movement of
maxillary first molars without need of extraoral appliance and with no
loss of anterior anchorage.
• Advantages
i. Produces bodily movement of maximum first molars with no
loss of anchorage.
ii. Does not require the need of patient compliance but allows the
use of head gear if required.
iii. Uses a light controlled force of only 1.5-2 Oz/tooth
iv. Does not interfere with occlusal plane thus maintaining control
of vertical dimension.

71. Frog appliance
• Mehmet bayram et al in 2010 gave frog
appliance for upper molar distalization
• A frog appliance kit consists of a screw, a
preformed spring and a screw driver
• Frog Appliance was found to be a simple,
effective, non- invasive, and compliance-free
intraoral distalization appliance for achieving
bilateral molar distalization.

72. Franzulum appliance
• Fridrich Byloff et al., (2000)
• The Franzulum appliance’s anterior anchorage unit is an acrylic button,
positioned lingually and inferiorly to the mandibular anterior teeth, and
extending from the mandibular left canine to the mandibular right canine.
• Tubes between the second premolars and first molars receive the active
components.
• Posterior distalizing unit uses nickel titanium coil springs, about 18 mm in
length, which apply an initial force of 100-120gm per side .

73. • A J-shaped wire passing through each coil is inserted into the corresponding
tube of the anchorage unit.
• The recurved posterior portion of the wire is engaged in the lingual sheath of the
mandibular first molar band.
• During distalization phase, the mandibular molars moved 4.5-5 mm distally
while the incisors moved 1mm anteriorly. The mandibular right molar crown
tipped 4° distally, and the mandibular incisor crowns tipped 1° labially. Thus,
the movement of the incisor crown resulted in an anchorage loss of 1 mm and
1°.

74. Unilateral Frozat Appliance
• In 2004 Gero Kinzinger et al., described an
alternative treatment, using an asymmetrically
activated lingual arch that allows an intersegmental
correction of the malocclusion
• A rigid and passive buccal wire segments provides
sufficient anchorage.
• On the anchorage side, the lingual arch is bent into
an occlusal U loop distal to the soldered point on
the molar band, and then curved around to form the
lingual arm of the appliance

75. • Activation is done by using a three prong plier to make a 1st order bend on the
anchor side of the lingual arch, near the molar band
• An anti-rotation bend must then be placed in the lingual arch in the region of
the molar to be distalized.
• This activation eliminates the risk of any contact between the molar root and
the lingual cortical bone, so that the desired distalization takes place in the
cancellous bone

76. The New Distalizer
• The new appliance for molar distalization
originates form a former idea by Dr. Nicola
Veltri in 1999 with subsequent personal
modifications.
• Appliance consists of a palatal sagittal screw for
bilateral molar distalization according to Veltri,
which is connected to bands on maxillary first
molars and on maxillary second premolars.
• Auxiliary device for anchorage is represented
by a Nance button which is soldered to the body
of the screw.

77. Intraoral bodily molar distalizer
• In 2000 Ahmet Keles and Sayinsu has introduced
a new appliance for bodily movement of molars
and eliminated dependence on patient
cooperation and did not require headgear wear
for molar root uprighting.
• Maxillary first molars and premolars were
banded. On the palatal side hinge cap palatal
attachments were welded, and a maxillary
impression was taken. On the model, a wide
acrylic Nance button was constructed and
attached to the first premolar bands with 0.045
inch in diameter stainless steel retaining wires.

78. • Appliance is composed of two components, the distalizing unit and anchorage
unit. The active part of the appliance is made of 0.032 x 0.032 inch TMA
spring.
• The springs have two components - the distalizer section of the spring applies a
crown tipping force, whereas the uprighting section applies a root uprighting
forced to the molars. The spring are activated by pulling from mesial to distal
and then seating into the palatal hinge cap attachments welded to the first molar
bands

79. • In 2002, Keles and Sayinsu developed an appliance
that eliminated patient cooperation, distal tipping of
the molars and anchorage loss - used for both
unilateral and bilateral molar distalization
• Maxillary first molars and first premolars were
banded. First premolar bands were attached to a
wide acrylic Nance button with 1.1 mm diameter
stainless steel retaining wires.
• The acrylic button also consisted of an anterior bite
plane to disocclude the posterior teeth, enhance the
molar distalization and correct the anterior deep bite.
Keles Slider

80. • In the palatal side, 0.9 mm diameter SS wires
were embedded into the acrylic at about 5mm
apical to the gingival margin of the first molars.
These wires passed through the tube and were
oriented parallel to the occlusal plane.
• For molar distalization, a heavy Ni-Ti coil
spring (2cm long, 0.9 mm diameter, and 0.016
inch thick) was placed between the screw on
the wire and the tube, in full compression.
• The amount of force generated with the full
compression of the 2 cm open coil spring was
about 200gm - allows consistent application of
force at the level of the centre of resistance of
the first molars

81. • Luis Carriere in 2004 developed a new distalizer with
advanced computer technology
Carriere Distalizer
• The Carriere Distalizer is designed to create a Class I molar and canine
relationship. The biomechanical objectives of the appliance are as follows:
1. Produce a distal rotational movement of the maxillary first molars.
2. Produce a uniform force for distal molar movement.
3. Independently move each posterior segment, from canine to molar, as a unit.
4. The Distalizer is made of moldinjected, nickel-free stainless steel.
5. It is bonded to the canine and first molar

82. • The canine pad, which allows distal movement
of the canine along the alveolar ridge without
tipping, provides a hook for the attachment of
Class II elastics.
• This pad is the mesial end of an arm that runs
posteriorly over the two upper premolars in a
slight curve. The posterior end of the arm is a
permanently attached ball that articulates in a
socket on the molar pad.
• The ball and socket joint provides 3D control of
both the canine and molar.

83. Skeletal Anchorage System for Distalization
• Sugawara et al., in 2006 developed the
Skeletal Anchorage System (SAS), which is
a noncompliance appliance
• The SAS consists of titanium anchor plates
and monocortical screws that are
temporarily placed in either the maxilla or
the mandible or in both, as absolute
anchorage units

84. • The SAS is a viable modality for
distalizing maxillary molars because it
uses stable and strong anchorage units.
• It enables not only single molar
distalization but also en masse
movement of the maxillary buccal
segments with only minor surgery for
placing the titanium anchor plates at the
zygomatic buttresses.

85. Miniscrew Implant Supported Distalization
System (MISDS)
• Papadopoulos introduced the Miniscrew
Implant Supported Distalization System
(MISDS) in 2008.
• The anchorage unit of this appliance comprised
two miniscrew implants in the paramedian
region of the palate.
• The distalization force was applied by the
palatally positioned open nickel-titanium coil
springs, which pass through the center of
resistance of the maxillary molars.
• Squeezing the coil springs and screwing the
anteriorly positioned stop screws following
cementation activate the appliance.

87. • The main disadvantages of intra-oral distalizing
appliances are that they produce undesirable tipping of
the maxillary molars and loss of anterior anchorage
during distalization.
• To overcome these disadvantages, Gupta et al, in 2015
developed a new appliance – “MK” versatile spring
MK VERSATILE SPRING
• “MK” spring is made from 0.017˝ × 0.025˝ TMA wire in a “M” configuration. It
consists of two helices, one at the central arm, and the other at the arm close to the
tooth being mesialized or distalized

88. • Spring is activated by opening both the helices by 1 mm every 4-6 weeks
till the desired teeth movement is achieved.
• Distalizing force exerted by spring was 60 g/spring upon 1 mm of
activation. Total distal force on molar was 120 gms. Bodily movement of
teeth is achieved by opening both the helices placed opposite to each other.
• The counter clockwise tipping moment created by helix on the first arm is
cancelled out by the clockwise moment created by the helix of the central
arm, preventing the tipping movement.

89. Maxillary molar distalization with MGBM-system
• MGBM-System (G.B Maino, A. Giannelly, R.
Bernard, P. Mura), is a new intraoral device to treat
Class II malocclusions - upper first and second
molar distalization.
• The first phase of Class II treatment by MGBM-
System involves the distalization of the maxillary
molars to an overcorrected Class I relationship.
• Anchorage is provided by a transpalatal bar,
bonded on the occlusal surfaces, of the maxillary
first premolars and connected to two palatal
miniscrews inserted directly between the first
molar and the second premolar

90. • To distalize the first molar before the eruption of the
second molar, we use a sectional SS wire extended
from the first premolar to the first molar and a
compressed 200 g Sentalloy coil spring activated by
10 mm
• The second distalizing component is a shape
memory 018 × 025” SS Nickel Titanium wire with
160 g of force, featuring an excess of length and
crimped mesial and distal stops, extending from the
second molar, looped vertically for 6 mm in the
buccal fold and inserted into the upper tube of the
double tube on the sectional wire.

92. CONCLUSION:
Every few years, newer and better methods of molar distalization are
being developed, especially since the advents of mini-screws into
clinical Orthodontics. However, it is in the hands of the clinician to
thoroughly analyze the clinical picture and select the appropriate molar
distalizing appliance. It’s not just the superiority of the mechanics but
the superior thinking and application of the clinician that can produce
a good and stable result.

93. REFERENCES:
• Charles T Pavlick, Jr. Cervical Headgear Usage and the Bioprogressive Orthodontic Philosophy.
Seminar Orthod 1998; 4:219-230.
• Graber TM. Maxillary second molar extraction in class II malocclusion. Am J Orthod 1969:56(4):331-
353.
• Klohen S J. Evaluation of cervical anchorage force in treatment. Angle Orthod 1961:31:91-104.
• Subtelny, Sakuda M. Muscle function, oral malformation, and growth changes. Am J Orthod
1966:52:495-517.
• Elbel H. Advance Nance Holding appliance. J Clin Orthod 1982:16:604-605.
• Kaprelian G. An effective unilateral face bow. J Clin Orthod 1982:26:60-61.
• Cetlin N and Tenhove A. Non Extraction Treatment. J Clin Orthod 1983:17:396-413.
• Tabash et al., Force measurement and design of a torquing high pull headgear. Am J Orthod
1984:86:74-78
• West VC. The cricket appliance. J Clin Orthod 1984:28:806-810.
• Bondmark L, Kurol J. Distalization of maxillary first and second molar simultaneously with repelling
magnets. Eur J Orthod 1992:14:264-272.
• Locatelli R et al., Molar distalization with super elastic NiTi wire. J Clin Orthod 1992:26:277:279.
• Reiner TJ. Modified Nance appliance for unilateral molar distalization.J Clin Orthod; 1992:26:402-404.
• Jones RD and White MJ. Rapid class II molar correction with open-coil jig. J Clin Orthod.1992:26:661-
664.