Successfully reported this slideshow.
Efficiency of Pendulum Appliance for
Molar Distalization Related to
Second & Third Molar Eruption Stage


Gero S.M. Kinzi...
Introduction







Head gear, ACCO, Jones jig, Lokar
distalizing apl, distal jet, magnetic modules
Pendulum appl – Hi...
Objectives


To assess this hypothesis.



Discussion of early third molar germectomy.

www.indiandentalacademy.com

3
Material & Methods





Modified Pendulum appl
36 pts – 25 girls, 11 boys
Mean age – 12 years 5 months
3 groups accord...
Material & Methods




PG1 – incomplete or no eruption of M2
PG2 – M2 erupted, M3 in budding stage
PG3 – M1, M2 erupted...
Material & Methods






Pendulum appliance – Pendulum K

Activated intraorally by adjusting distal
screw
Built in stra...
Material & Methods

www.indiandentalacademy.com

7
Material & Methods



Dental casts – T1 & T2
Transverse arch width and magnitude &
direction of molar rotations.

www.in...
Material & Methods



Sagittal plane – cephalograms T1 & T2.
A. Skeletal angles–






SNA
SN-NF
RFA
Facial PA
FMA
...
Material & Methods


B. dental angles & distances –











i CEJ/PTV
M1-CEJ/PTV
M2-CEJ/PTV
M1-CEJ/ANS-PNS
i...
Results


Dental cast measurements



Pre Rx transverse arch width – M2>M1
Gain M2>M1

www.indiandentalacademy.com

11
Results


Mesiobuccal rotations


M1>M2

www.indiandentalacademy.com

12
Results


Analysis of Cephalograms




Mean distal tipping: M1 3.07+-4.02 ; M2 5.3+-4.23
Labial tipping of central inc...
Results




Tipping of erupted second molars markedly
more in PG2 than PG3. ( 7.55+-5.28 & 2+-2)

None of the measured s...
Discussion


In the distalization direction, a tooth bud
acts on the mesial neighboring tooth in the
same way as fulcrum....
www.indiandentalacademy.com

16
www.indiandentalacademy.com

17
Biomechanical analysis

www.indiandentalacademy.com

18
Horizontal plane
Mesiobuccal rotation

www.indiandentalacademy.com

19
Sagittal plane

www.indiandentalacademy.com

21
www.indiandentalacademy.com

22
www.indiandentalacademy.com

23
Conclusions




The best time to start therapy with a
pendulum appliance is before the eruption
of second molars.
In cas...
www.indiandentalacademy.com

25
Bond Strength of Various Bracket
Base Designs


Wei Nan Wang, Chung Hsing & others

www.indiandentalacademy.com

26
Purpose of the study



Size & design of bracket base
Two designs :






A single piece casting with retention groov...
Material & Methods


The brackets were –







Dynalock (Unitek, US)
Accuarch appliance Formula –R (Tomy,Japan)
Ul...
Material & Methods

www.indiandentalacademy.com

29
Material & Methods





120 maxillary premolars fm pts 9-16yrs
Criteria for tooth selection – a. crown with
no defect. ...









Polished with pumice for 10 sec
Etched for 15 sec with 30% phosphoric acid
Outline demarcated with pencil
...
Results

www.indiandentalacademy.com

32
www.indiandentalacademy.com

33
www.indiandentalacademy.com

34
Discussion


Tomy bracket



Dentaurum bracket


Mesh spacing -5.1
www.indiandentalacademy.com

35


Mini mesh – 2.9

www.indiandentalacademy.com

36
Conclusions






The size & design of a bracket base affects
bond strength.
Tomy bracket with circular concave design
...
www.indiandentalacademy.com

38
Distal Movement of Mandibular
Molars in Adult Pts with the
Skeletal Anchorage System


Junji Sugawara, Takayoshi daimaruy...
Introduction







One of the most difficult to achieve
treatment objectives in Orthodontics.
Headgear, lip bumper, d...
Aims






To measure the average amt of distalization
of mandibular molars.
To evaluate the type of tooth movement tha...
Material & Methods



15 adult pts ( 12 women & 3 men )
Criteria –








Having no severe skeletal disharmonies
...
Material & Methods

www.indiandentalacademy.com

43
Material & Methods






Anchor plates ( Leibinger, Germany) – pure
titanium
Monocortical screws – pure titanium –
diam...
Material & Methods

www.indiandentalacademy.com

45
www.indiandentalacademy.com

46
Methods of Distalization


Single molar distalization

www.indiandentalacademy.com

47


En masse distalization of entire buccal
segments

www.indiandentalacademy.com

48







Retention – LBR – 0.0175-in multistranted
flexible wire.
Records – Lat. Ceph, OPG, dental casts &
photographs –...
Crown movement –
occlusograms
 Root – ceph tracing


www.indiandentalacademy.com

50
Results

www.indiandentalacademy.com

51
Results








Mean distal movement : 3.5 +- 1.4 mm at
the crown level.
Max – 7.1 mm , min – 1.0 mm
Root movement –...
Case 3




36 yr Japanese woman
36 months of active treatment
Distal movement – Lt- 7.1 mm, Rt- 5.5 mm

www.indiandenta...


Post treatment

www.indiandentalacademy.com

54
www.indiandentalacademy.com

55
www.indiandentalacademy.com

56
Discussion






Previous modalities disadvantages – pt
compliance, tipping movement, anchorage
loss, incisor flaring.
...


Two distinct advantages of SAS –





It is possible to intrude mand molars
En masse distalization of mandibular buc...
Conclusions








SAS is a viable modality for distalizing
mandibular molars.
It enables en masse movement with only...
www.indiandentalacademy.com

60
www.indiandentalacademy.com

61
Eruption of Third Molars :
Relationship to Inclination of
Adjacent Molars


Jackie Badawi Fayad, J C Levy, et al

www.ind...
Introduction





Most often impacted
Impaction related to available space –
pterygoid vertical & distal border of firs...
Purpose


To determine the relationship between
maxillary molars’ sagittal inclination and the
eruption of third molars w...
Material and Methods




60 subjects ( 30 men, 30 women) with
complete normal permanent dentitions.
2 groups –




Fir...
Material and Methods


Analysis using 2D multiplanar reconstructions

www.indiandentalacademy.com

66


Sagittal inclinations of 1st & 2nd molars were
measured by posteroinferior angle formed
by the molar axis ( intercuspid...
Results




Rt & Lt 1st & 2nd molars were more mesially
inclined in the group with erupting or
erupted third molars than...
www.indiandentalacademy.com

69
Discussion






Sagittal inclination of M1 & M2 was more in
subjects with erupted M3 than in those with
impacted.
Cro...
Conclusions




The vertical position of the 1st maxillary
molar in the sagittal plane is a predictor of
the eruption of...
Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com

72
Upcoming SlideShare
Loading in …5
×

American journal /certified fixed orthodontic courses by Indian dental academy

1,039 views

Published on

Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable.

Published in: Health & Medicine, Business
  • Be the first to comment

American journal /certified fixed orthodontic courses by Indian dental academy

  1. 1. Efficiency of Pendulum Appliance for Molar Distalization Related to Second & Third Molar Eruption Stage  Gero S.M. Kinzinger, Dr med dent et al www.indiandentalacademy.com 1
  2. 2. Introduction     Head gear, ACCO, Jones jig, Lokar distalizing apl, distal jet, magnetic modules Pendulum appl – Hilgers, 1992 Snodgrass, Byloff, Favero, Scuzzo et al and Kinzinger et al. Bussick & McNamara, Ghosh & Nanda, Joseph & Butchart – position of second molar is of little if any import. www.indiandentalacademy.com 2
  3. 3. Objectives  To assess this hypothesis.  Discussion of early third molar germectomy. www.indiandentalacademy.com 3
  4. 4. Material & Methods     Modified Pendulum appl 36 pts – 25 girls, 11 boys Mean age – 12 years 5 months 3 groups according to the stage of second & third molar eruption – patient groups (PG) PG1, PG2, PG3. www.indiandentalacademy.com 4
  5. 5. Material & Methods    PG1 – incomplete or no eruption of M2 PG2 – M2 erupted, M3 in budding stage PG3 – M1, M2 erupted, M3 germectomy www.indiandentalacademy.com 5
  6. 6. Material & Methods    Pendulum appliance – Pendulum K Activated intraorally by adjusting distal screw Built in straightening activatn & toe-in www.indiandentalacademy.com 6
  7. 7. Material & Methods www.indiandentalacademy.com 7
  8. 8. Material & Methods   Dental casts – T1 & T2 Transverse arch width and magnitude & direction of molar rotations. www.indiandentalacademy.com 8
  9. 9. Material & Methods   Sagittal plane – cephalograms T1 & T2. A. Skeletal angles–      SNA SN-NF RFA Facial PA FMA www.indiandentalacademy.com 9
  10. 10. Material & Methods  B. dental angles & distances –           i CEJ/PTV M1-CEJ/PTV M2-CEJ/PTV M1-CEJ/ANS-PNS i/ANS-PNS i/SN M1/ANS-PNS M2/ANS-PNS M1/SN M2/SN www.indiandentalacademy.com 10
  11. 11. Results  Dental cast measurements   Pre Rx transverse arch width – M2>M1 Gain M2>M1 www.indiandentalacademy.com 11
  12. 12. Results  Mesiobuccal rotations  M1>M2 www.indiandentalacademy.com 12
  13. 13. Results  Analysis of Cephalograms    Mean distal tipping: M1 3.07+-4.02 ; M2 5.3+-4.23 Labial tipping of central incisor – 4.51+-3.6 Mean distalization: M1 3.14+-0.92 ; M2 2.56+-0.81 mm. Incisor protrusion 1.33+-0.85    70.25% and 29.75% Time – 0.62 and 0.51mm/month Distal tipping of first molars in PG1 > PG2 & PG3. ( 0.8+-3.4 & 5.36+-3.49) www.indiandentalacademy.com 13
  14. 14. Results   Tipping of erupted second molars markedly more in PG2 than PG3. ( 7.55+-5.28 & 2+-2) None of the measured skeletal changes were significant. www.indiandentalacademy.com 14
  15. 15. Discussion  In the distalization direction, a tooth bud acts on the mesial neighboring tooth in the same way as fulcrum. www.indiandentalacademy.com 15
  16. 16. www.indiandentalacademy.com 16
  17. 17. www.indiandentalacademy.com 17
  18. 18. Biomechanical analysis www.indiandentalacademy.com 18
  19. 19. Horizontal plane Mesiobuccal rotation www.indiandentalacademy.com 19
  20. 20. Sagittal plane www.indiandentalacademy.com 21
  21. 21. www.indiandentalacademy.com 22
  22. 22. www.indiandentalacademy.com 23
  23. 23. Conclusions   The best time to start therapy with a pendulum appliance is before the eruption of second molars. In case of simultaneous distalization of 1st and 2nd molars, prior germectomy of 3rd molar is strongly recommended. www.indiandentalacademy.com 24
  24. 24. www.indiandentalacademy.com 25
  25. 25. Bond Strength of Various Bracket Base Designs  Wei Nan Wang, Chung Hsing & others www.indiandentalacademy.com 26
  26. 26. Purpose of the study   Size & design of bracket base Two designs :    A single piece casting with retention grooves on the base. Mesh or circular,concave form that is laser welded with silver directly to the bracket body. To determine the bond strength and debonding interface distributions of 6 types of brackets. www.indiandentalacademy.com 27
  27. 27. Material & Methods  The brackets were –       Dynalock (Unitek, US) Accuarch appliance Formula –R (Tomy,Japan) Ultratrimm (Dentaurum, Germany) Minidiagonali Roth (Leone, Italy) Tip-edge Rx-1 (TP Orthodontics, ) Mini Diamond (Ormco) www.indiandentalacademy.com 28
  28. 28. Material & Methods www.indiandentalacademy.com 29
  29. 29. Material & Methods    120 maxillary premolars fm pts 9-16yrs Criteria for tooth selection – a. crown with no defect. b. tooth has never been pretreated with a chemical agent such as H2O2 or formalin. c. contour of labial crown surface was adapted to the base of the bracket before bonding. 6 groups of 20 teeth each. www.indiandentalacademy.com 30
  30. 30.        Polished with pumice for 10 sec Etched for 15 sec with 30% phosphoric acid Outline demarcated with pencil Surface outside coated with red nail polish Bonding agent – Concise, 3M Specimen incubated in 37* water bath for 24 hrs. Tested on Instron universal machine www.indiandentalacademy.com 31
  31. 31. Results www.indiandentalacademy.com 32
  32. 32. www.indiandentalacademy.com 33
  33. 33. www.indiandentalacademy.com 34
  34. 34. Discussion  Tomy bracket  Dentaurum bracket  Mesh spacing -5.1 www.indiandentalacademy.com 35
  35. 35.  Mini mesh – 2.9 www.indiandentalacademy.com 36
  36. 36. Conclusions    The size & design of a bracket base affects bond strength. Tomy bracket with circular concave design produced greater bond strength. Among brackets with mesh type bases, the larger the mesh spacing, greater the bond strength. www.indiandentalacademy.com 37
  37. 37. www.indiandentalacademy.com 38
  38. 38. Distal Movement of Mandibular Molars in Adult Pts with the Skeletal Anchorage System  Junji Sugawara, Takayoshi daimaruya et al www.indiandentalacademy.com 39
  39. 39. Introduction     One of the most difficult to achieve treatment objectives in Orthodontics. Headgear, lip bumper, distal extension lingual arch, Jones jig, Franzulum appliance, multiloop edgewise archwire. Skeletal Anchorage System ( SAS ). Distalization of molars enables the clinician to correct ant crossbites, crowding & dental asymmetry without extracting premolars. www.indiandentalacademy.com 40
  40. 40. Aims    To measure the average amt of distalization of mandibular molars. To evaluate the type of tooth movement that occurs. To determine the stability of the distalized molars 1 year posttreatment. www.indiandentalacademy.com 41
  41. 41. Material & Methods   15 adult pts ( 12 women & 3 men ) Criteria –       Having no severe skeletal disharmonies Sufficient space behind the second molar Treated by distalization of mandibular first molar Followed for at least 1 yr posttreatment. Average age – 26.9 yrs, 16.1 - 43.5 yrs Average t/t time 28.9 months, 21 – 39 mnths www.indiandentalacademy.com 42
  42. 42. Material & Methods www.indiandentalacademy.com 43
  43. 43. Material & Methods    Anchor plates ( Leibinger, Germany) – pure titanium Monocortical screws – pure titanium – diameter – 2.0 mm, length – 5.0 mm. Placed behind second molars under local anaesthesia. www.indiandentalacademy.com 44
  44. 44. Material & Methods www.indiandentalacademy.com 45
  45. 45. www.indiandentalacademy.com 46
  46. 46. Methods of Distalization  Single molar distalization www.indiandentalacademy.com 47
  47. 47.  En masse distalization of entire buccal segments www.indiandentalacademy.com 48
  48. 48.     Retention – LBR – 0.0175-in multistranted flexible wire. Records – Lat. Ceph, OPG, dental casts & photographs – pre Rx, at debonding, 1 yr after debonding. Occlusograms – 1.06 X Tipping ratio - root movement / crown mov   < 25% - tipping >25% - translation www.indiandentalacademy.com 49
  49. 49. Crown movement – occlusograms  Root – ceph tracing  www.indiandentalacademy.com 50
  50. 50. Results www.indiandentalacademy.com 51
  51. 51. Results       Mean distal movement : 3.5 +- 1.4 mm at the crown level. Max – 7.1 mm , min – 1.0 mm Root movement – 1.8 mm Relapse – 0.3 mm , 9% Max relapse – 0.8 mm No correlation betn relapse rate & amount of tooth movement. www.indiandentalacademy.com 52
  52. 52. Case 3    36 yr Japanese woman 36 months of active treatment Distal movement – Lt- 7.1 mm, Rt- 5.5 mm www.indiandentalacademy.com 53
  53. 53.  Post treatment www.indiandentalacademy.com 54
  54. 54. www.indiandentalacademy.com 55
  55. 55. www.indiandentalacademy.com 56
  56. 56. Discussion    Previous modalities disadvantages – pt compliance, tipping movement, anchorage loss, incisor flaring. Endosseous implants – disturbed tooth movement, became loose because of heavy force. SAS – provides rigid anchorage, doesn’t interfere with tooth movement. www.indiandentalacademy.com 57
  57. 57.  Two distinct advantages of SAS –    It is possible to intrude mand molars En masse distalization of mandibular buccal segments or the entire dentition is possible, thus reducing t/t time. SAS might recquire orthodontists to reconsider their thinking regarding arch length discrepency, space analysis & extraction criteria. www.indiandentalacademy.com 58
  58. 58. Conclusions     SAS is a viable modality for distalizing mandibular molars. It enables en masse movement with only a minor surgery to place the anchor plates. Effective in correcting class III malocclusions, mand incisor crowding & dental asymmetries. Premolar extraction can be avoided. www.indiandentalacademy.com 59
  59. 59. www.indiandentalacademy.com 60
  60. 60. www.indiandentalacademy.com 61
  61. 61. Eruption of Third Molars : Relationship to Inclination of Adjacent Molars  Jackie Badawi Fayad, J C Levy, et al www.indiandentalacademy.com 62
  62. 62. Introduction    Most often impacted Impaction related to available space – pterygoid vertical & distal border of first molar. Recent studies have questioned significance of this available space as a predictor for eruption or impaction. www.indiandentalacademy.com 63
  63. 63. Purpose  To determine the relationship between maxillary molars’ sagittal inclination and the eruption of third molars with CT scans www.indiandentalacademy.com 64
  64. 64. Material and Methods   60 subjects ( 30 men, 30 women) with complete normal permanent dentitions. 2 groups –   First group – 28 subjects, mean age 33.3 yrs, range 16-50 yrs. With erupting or erupted third molars. Second group – 32, mean age – 27.6 yrs, range 16-50 yrs. With impacted right and left third molars. www.indiandentalacademy.com 65
  65. 65. Material and Methods  Analysis using 2D multiplanar reconstructions www.indiandentalacademy.com 66
  66. 66.  Sagittal inclinations of 1st & 2nd molars were measured by posteroinferior angle formed by the molar axis ( intercuspid groove bifurcation) and the palatal plane. www.indiandentalacademy.com 67
  67. 67. Results   Rt & Lt 1st & 2nd molars were more mesially inclined in the group with erupting or erupted third molars than in the second group. Inclination of 1st molar was a predictor of eruption of 3rd molar. www.indiandentalacademy.com 68
  68. 68. www.indiandentalacademy.com 69
  69. 69. Discussion     Sagittal inclination of M1 & M2 was more in subjects with erupted M3 than in those with impacted. Cross sectional study Effect of age on sagittal inclinations Measurements on panoramic radiographs not reliable www.indiandentalacademy.com 70
  70. 70. Conclusions   The vertical position of the 1st maxillary molar in the sagittal plane is a predictor of the eruption of the adjacent third molar. The sagittal inclinations of maxillary molars increase with age : it could be the effect of mesial drift. www.indiandentalacademy.com 71
  71. 71. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com 72

×