Molar dis final

MOLAR
DISTALIZATION
www.indiandentalacademy.com

 Correction of class II malocclusion without
extractions requires maxillary molar
distalization by means intraoral or extra-
oral forces

History
 William Kingsley (1892) described for the
first time headgear apparatus with which
class I molar relationship could be
achieved successfully

 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.

 Kloehn in 1947 started a long and
beneficial series of investigations and
clinical applications of cervical anchorage
to the maxillary dentition.

 The headgears over the years have shown
to be effective in maxillary molar
distalization with movements in all planes
of space. With the recent trend been
advocated to distalize molars in the upper
arch

 Molar distalization is a technique that has
added a new column in the practice of
every orthodontist to produce consistent,
predictable and high quality results. The
goals of practicing with efficiency and
profitability are positively affected.

Indications
1. In a growing child
- to relieve mild crowding
- causes permanent increase in arch
length of about 2mm on each side.
2. Late mixed dentition
- When lower E space –utilized for relief of
anterior crowding,
- Upper molars distalized to get a class I
relation

Indications for Molar distalization
3. Non-growing patient
- To regain lost arch length
- Blocking out of canines

INDICATIONS
 Profile - should be acceptable with
minimal facial change or straight profile
 Class I skeletal pattern
- Normal or
short lower face height
-Skeletal closed bite

 Dental
 Class II / end on molar relationship

 Maxillary first molar mesially inclined
 Maxillary cuspids labially displaced
 Loss of arch length due to premature loss of
second deciduous molar
 Mild to moderate arch perimeter discrepancy

UPPER MOLAR POSITION
 This is a linear measurement between the
distal surface of the maxillary first
permanent molar and the pterygoid
vertical line (PTV).
 It is an indication of the forward position
of the upper molar and illustrates to the
clinician whether or not sufficient space is
present for the second and third molars.

 This measurement indicates or
contraindicates molar distalization.
 An interesting aspect of this measurement
is that its mean value is the patient's age
in years plus 3mm until growth is
complete.
 Therefore the mean measurement for ten-
year old child is l3mm

TIMING
 A favorable time to move molars distally
appears to be in mixed dentition, before
the eruption of the second molars, and an
efficient force system to move molars
distally is a continuously acting force.

CONTRAINDICATIONS
 Profile:- convex profile

 Skeletal:- Class II skeletal
- Skeletal open bite
- Excess lower face height
 Functional:-
abnormal temporo mandibular Joint

 Dental:-Class I or III molar relation.
- Dental open bite/shallow bite

Classification
1. Location of appliance
 Extra-oral
 Intra-oral
2. Position of appliance in mouth
 Buccal
 Palatal
3. Type of tooth movement
 Bodily movement
 Tipping movement

4. Compliance needed from patient
 Maximum compliance
 Minimum or No compliance
5. Type of appliance
 Removable
 Fixed
6. Arches involved
Intra-arch
Inter-arch

TYPES OF APPLIANCES
 EXTRAORAL
 INTRA ORAL

EXTRA ORAL
 Bilateral molar distalization
a) Cervical pull head gear.
b) Combi pull head gear.
 Unilateral molar distalization with unilateral face
bows
a) power-arm face bow
b) soldered offset face bow
c) swivel-offset face bow
d) spring-attachment face bow.

Distalization using Headgears
 Very efficient
 Reciprocal forces are not transmitted to other teeth
 Molar movements depends on direction of force in relation to
the C Res of the molar & magnitude of force

Biomechanics of Headgears:
 C Res
 Moments

High pull Headgear
 Produces intrusive &
Posterior direction of
pull
 Long face class II
patients with high MPA
 Force through c res –
Intrusion & distal
movement of molar
 6-8 months – class II-
classI
Adv-effective, no reciprocal forces
Disadv- Patient compliancewww.indiandentalacademy.com

Straight pull headgear
 Class II Malocclusion with
no vertical problems
 Prevent anterior migration
of maxillary teeth, translate
them posteriorly
 Buccal force to molar -
Expansion of inner bow

Cervical Headgear
 Short face Class II
maxillary protrusive
cases with low MPA &
Deepbites
 Extrusive & distalizing
effect

Unilateral molar distalization with
unilateral face bows

INTRA ORAL
 INTRA ARCH
 INTER ARCH

INTERA ARCH
 Researchers have focused on the
simplicity and efficiency of these intra arch
devices, which improves the continuity
and constancy of forces. Oral hygiene is
easier to maintain and the need for patient
compliance is eliminated.

 INTRA ARCH

Distalization of Molars with Repelling
Magnets
 Gianelly et al. (1989) achieved molar
distalization using repelling magnets.
 Presence of second molars delayed molar
distalization
 Anchorage loss in this study was
calculated at 20 per cent.
 Erverdi et al. (1997). Bondemark and
Kurol (1992) reported effective molar
distalisation, together with distobuccal
rotation using magnetic force.

 Bondemark et al. (1994) found that when
comparing magnetic force to super-elastic force
to distalize molars that distal movement was
greater for the supercoils (3.2 versus 2.2 mm).
 Recently, Ormco Corporation have marketed a
new appliance the MagnaforceTM.
 Doanay et al. (1998) examined the effects of
magnetic versus the Wilson bimetric distalizing
arch finding that no bodily movement occurred in
either group, but that significant tipping occurred,
which may result in stability problems

Distalization of Molars with Repelling
Magnets Gianelley etal JCO 1988
 Anchorage – Modified
Nance appliance
 Wire extending from
1st premolars
 Acrylic button
anteriorly contacting
the incisors
 Auxillary wire with a
loop at its end
soldered - premolars
bands

Distalization of Molars with
Repelling Magnets
 Incisor brackets – passive
sectional wire- maintain incisor
alignment
 Repelling surfaces of magnets
brought into contact by passing
an .014 ligature through the loop,
then tying back a washer anterior
to the magnets
 Force- 200-225 gms , dropped as
space opened
 3mm in 7 weeks
 Anchor loss – 1mm www.indiandentalacademy.com

Pendulum Appliance
 Indications
 Distalization of upper first molars before
eruption of second molars.
 Contra-indications.
 Lack of teeth anterior to the first molars to
retain the appliance.
 Upper second molars have erupted.

2. Pendulum Appliance
 Byloff and Darendeliler (1997) and Byloff et al., 1997
showed that the appliance moved molars distally without
creating bite opening, but the molars did tend to tip.
 Ghosh and Nanda (1996) also found that the pendulum
appliance is a reliable method for distalizing maxillary
molars at the expense of moderate anchorage loss..
 Hilgers (1992) reports that when the appliance is placed
before the eruption of the second molars, two-thirds of the
tooth movement is molar distalization, one-third is
experienced as forward shift of the anchor bicuspids and
oppsite occurred if 2 nd molars erupted

JAMES J. HILGERS,JCO 1992
 Nance button
 .032 TMA springs
 Broad swinging arc
(Pendulum) of force from
midline of palate to upper
molars

Fabrication :
Pendulum springs consist of
1. Recurved molar insertion
wire
2. Horizontal adjustment loop
3. Closed helix
4. Loop for retention in acrylic
button
 Springs- close to center of
Nance button
 Anterior portion- retention-
occlusally bonded rests
- Band
upper 1st
premolars, solder
retaining wire to the bands

Preactivation and placement:
 Springs bent parallel to midline of the
palate
 Molar bands cemented
 Anterior portion of appliance later
cemented
 Pendulum spring brought forward &
engaged in lingual sheath
 As molar distalizes, moves on an arc
towards midline- counteracted – opening
horizontal loop

 Nance button- extend to about 5mm
from teeth
 Anterior retention loops fixed on
model, later soldered to bicuspid
bands
 Acrylic pressed against the palatal
vault
 Pendulum springs inserted

Pendulum Appliance
Pend-X
Jack-screw-One-quarter turn
every 3 days

Molar distalization with Superelastic
NiTi wire Gianelly JCO 1992
 100gm Neosentalloy upper
archwire
 3 markings
 Stops crimped, hook added
 Insert wire such that posterior
stop abuts mesial end of molar
tube, anterior stop abuts distal of
premolar
 Anchorage reinforced by class II,
or Nance appliance

Molar distalization with Superelastic
NiTi wire
Case report :
 12 yr / F
 Unilateral class II
 Class II against upper 1st
premolar
 Overcorrected- 4 months

NiTi Double Loop system for
simultaneous distalization of first and
second molars Giancotti JCO 1998
 Mandibular molars and 2nd
premolars
banded, other teeth bonded
 Lip bumper- prevent extrusion
 Maxillary molars and bicuspids –
banded, aligned
 80 gm Neosentalloy – maxillary
archwire placed – marked
1. Distal to 1st premolar
2. 5mm distal to 1st
molar tube
 Stops crimped on markingswww.indiandentalacademy.com

second molars
 Sectional NiTi archwires –
crimp stops
1. Mesial and distal to 2nd
premolar
2. 5mm distal to 2nd
molar
tube
 Uprighting springs on 1st
bicuspids
 Class II elastics
 Simultaneous, bodily
movement
24yr/f, class II div I
5months- overcorrected

second molars
 Minimal patient co-operation
 Ideal for simultaneous distalization
 Anchorage easily controlled , without need for TPA/Nance
 Due to streching of transeptal fibres, 1st
molars can be
distalized using lighter 80 gm force

Distal jet Appliance
Aldo Carano, Mauro Testa JCO 1996
 Fixed lingual appliance
Appliance design :
 Wire extending from acrylic
through tube ends in a bayonet
bend-inserted into lingual sheath
 Coil spring
 Clamp
 Anchor wire to 2nd
premolar

Distal jet Applaiance
Aldo Carano, Mauro Testa JCO 1996
 Reactivation- sliding clamp
closer to first molar
 After distalization –
- clamp-spring assembly-
acrylic,
- premolar arms cut off.

Case report
 18/F, Class II divI
 No skeletal abnormalities
 Non-extraction therapy (3rd molars
removed)
 Distal jet
 4 months- Class I ,2mm-L, 3mm-R

Advantages :
 Bodily movement
 Easy insertion
 Well tolerated
 Esthetic
 Unilateral, Bilateral
 Permits simultaneous use of full bonded appliances

1. Heavy round wire
2. Light wire
3. Fixed Sheath
4. Hook
5. Sliding Sheath
6. Open coil spring
3
1
2
5
6
4
Open Coil Jig

Lokar
 A similar mechanism, called the Lokar
distalizing appliance, has been developed by
Ormco Corporation. It has reported
advantages of ease of insertion and ligation.
To date, no published clinical trials have
emerged on either of these appliances.

Lokar Molar Distalizing Appliance
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

Lokar Molar Distalizing Appliance
 Nance button
 Can be used in conjunction with complete edgewise
appliance
 With headgear
 Easy insertion, activation

Sectional Jig Appliance
 Sumit ,o.p..kharbanda and
hari prakesh ajodo (1998).
 A modified nance appliance
,soldered to both the 1 st and
2 nd premolars bands used
for anchorage control
 The niti coil which exerts 70-
75 grams of force over a
compression of 1 to 5 mm .
 The sectional jig assembly was
inserted posteriorly into
double buccal tubes of first
molars.

 The mean distal movement of first molar
was 2.78 mm
 The rate of movement per month was
0.86mm/momth
 Their was increases overjet of 1mm and
2.6 degree mesial tiping of 2 nd premolar.
 But their was distal tipping and clockwise
rotation of molar

First Class Appliance for rapid molar
distalization
 Forniti et al ( ajodo 2004)
 The appliance consists of bands
on 2 nd premolar and molar.
 A Nance palatal used for
anchorage .
 On buccal side a 10mm long
screws with 4 holes for
activation .
 The patient were told to
activate each vestibular screw
a quarter turn in a counter
clockwise direction once daily
(o.1mm).

 In just 2.4 months ,4mm of distal
movement with 4.6 o
tipping occurred .
 Increase overjet of 1.2mm ,and mesial
movement of second premolars of 1.7mm
with 2.2 o
of mesial tipping

Mini –Distalizing Appliance
 One of the
recent
versions of
molar
distalization
 Both
distalization
with
expansion
occurs.

 As proper case
selection is ideal for
success with any
appliance .
 MDA should only be
used in strong
muscular patients
where growth and
subsequent
mechanics can
compensate for
transient open bite
that results from
expansion and RMD.

Intraoral Bodily Molar Distalizer
 Ahmet and korkmaz
(Ajodo jan 2000)
 The Nance button was
covered palatal aspect
of incisors and
functioned as as
anterior bite plan to
disclude the posterior
teeth .
 The spring is made up
of 0.032x 0.032 TMA
wire

 The spring has 2
compnents
 1 the distalizer
section of the
spring applied a
crown tipping force
 2 the up righting
section applies up
righting force to the
first molars
 Distal tipping and
extrusion of molars
were not statically

Bimetric system for Molar Distalization
(WDA)
 Dr.Wilson-Tandem yoke
with bimetric arches for
molar distalization (EJO
JUNE 2000)
 Anteir segment made of
0.022’’and posterior
0.040’’.
 Before distalizing a TPA
used to alien the molars

 Coil spring- between molar
tube & the yoke
 5/16 “Elastics- 12 hours a
day
 The Omega adjustable
stop –to modify & control
arch length
 .061 Omega loop
 Coil springs &
intermaxillary hooks.

Trans Palatal Arch
Cetlin & Ten Hoeve, JCO 1983
Palatal bar as an adjunct in space
gaining in the maxillary arch
 Unilateral distalization

K-Loop Molar Distalizing Appliance
Valrun Kalra – JCO 1995
 K-loop – forces - .017 x .025 TMA
 Nance button – anchorage
 8mm long , 1.5 mm wide
 Legs- 20 degree bend
 Inserted into molar and first
premolar tube, marked
 Stops bent 1mm distal , 1mm
mesial
 Stops- 1.5mm long

Unilateral molar distalization

Reactivation sequence
Open loop 1mm at (1); Open loop
1mm at (2); Open at (3) to regain the
200
bent of mesial and distal legs

Fixed piston appliance - Greenfield
 .036 “ tubing- soldered to
biccuspids
 .030 “ ss wires- first molars
 Nance button
 NiTi coil

IMPLANTS
Palatal Implants
 Wehrbein et al. (1996) described the use an endosseous
implant , inserted into the palate, which acts as anchorage
for retraction of the anterior teeth
 Adv: The advantages over the use of headgear are
obvious.
 Dis adv: Problems include cost, failure of implant, difficulty
of removal, and no long-term trial results are available.

 Glatzmaier et al. (1996) described the use
of a biodegradable implant for orthodontic
anchorage in a laboratory study. The
authors suggested that the stability of this
implant it may be clinically sufficient.
 Byloff and colleagues have successful
moved molars distally using Graz-implant
supported pendulum appliance.

 karaman and colleagues have diatalized molars
by implanting a screw 3mm in diameter and
14mm long, which is placed 2-3 mm behind the
incisal canal
 Block and Hoffman (1995) described the use of
onplants for absolute orthodontic anchorage.
 The onplant has an internal thread for placement
of a trans-gingival abutment. The abutment is
designed to receive a 0•051-inch wire. The
onplant has the advantage that it is relatively
easy to place and recover

 Except in the incisal
canal ,the midplate
consists of cortical bone
that is sufficient to support
an entire minis crew
 In addition there are no
roots ,nerves or blood
vessels in the palatal area
to complicate surgical
screw placement
 There is no waiting for
Osseo integration and no
need for additional surgery
because the mini crew is
easily removed

Ajodo april 2002
 Unilateral molar
distalization
 A 14mm length is
placed at anterior or
palatal suture
 Non invasive that is
trans mucosal to ovoid
second surgery and to
facilitate impression
and lab procedure

Mandibular molars with
skeletal anchorage
 The anchor plates are made of
pure titanium plates are placed
behind the second molars at the
anterior border of the mandibular
ramus .
 Implantation was performed under
local anesthesia and the titanium
plates were secured with pure
titanium screws
 The diameter and the length of the
monocortical screws 2 and 5 mm

 Extraction of
3 rd molars
 A- single
molar
distalization
 B- en masse
distalization

Intra Maxillary Appliances
 Herbest appliance :
 Indications.
 Dental Class II malocclusion.
 Skeletal Class II mandibular deficiency.
 Deep bite with retroclined mandibular incisors.
 Cases predisposed to root resorption.
 Dental and skeletal open bites.
 Vertical growth with high maxillomandibular
plane angle and excess lower facial height

 The Herbst appliance is a fixed
functional appliance which has
been popularized by Pancherz
(1979).
 It consists of a bilateral
telescopic mechanism that
maintains the mandible in a
protruded position.
 The Herbst can be a banded,
cast, acrylic splint (McNamara
and Brudon, 1993) or
cantilever bite jumper (CBJ)
appliance

 The cast appliance and bite jumper
designs are cemented and worn full time
negating the need for cooperation.
 However, McNamara and Brudon (1993)
do not advocate the cementing of the
acrylic design and only recommend
cementation of the maxillary splint when
retention is inadequate
 Hansen et al. (1990) found that the
appliance did not have any adverse effects
on the temporomandibular joint (TMJ).

Effects of the Herbst Appliance
 The Herbst appliance can have a restraining effect on
maxillary growth and a stimulating effect on mandibular
growth.
 Sagittal growth may be increased whereas the vertical
growth is unaffected by treatment.
 Pancherz (1979) reported that, with the banded appliance,
sagittal molar correction was 43 per cent due to skeletal
changes and 57 per cent due to dentoalveolar changes..
 Dento-alveolar changes include lower incisor
proclination and maxillary molar distalization and
intrustion. The changes are similar to those produced
by high pull headgear (Pancherz and Anehus-
Pancherz, 1993).

 Pancherz (1995) also recommends its use in
post-adolescent patients, mouth-breathers,
uncooperative patients, and those that do not
respond to removable functional appliances.
 McNamara and Brudon (1993) reported a
rebound effect with the lower incisors retroclining
after treatment with the Herbst appliance.
 The optimal time for treatment is at or just after
the pubertal growth spurt, and when the
permanent dentition is established..

Jasper Jumper
 Indications.
 Skeletal Class II with maxillary excess as opposed to
mandibular deficiency.
 Cases predisposed to root resorption.
 Dental and skeletal open bites.
 Vertical growth with high mandibular plane angle and
excess lower facial height.
 Minimum buccal vestibular space

 The Jasper Jumper consists
of two vinyl coated auxiliary
springs which are fitted to fully banded
upper and lower fixed appliances.
 The flexible springs are attached to the
maxillary first molars posteriorly and to
the mandibular archwire anteriorly with
the springs resting in the buccal sulcus.
 The springs hold the mandible in a
protruded position. The appliance is said
to produce rapid inter-arch changes
similar to those produced by the Herbst
appliance.

 The Jasper Jumper can be used for patients with
Class II malocclusions with deep bites.
 Cope et al. (1994) quantified the action of the
Jasper Jumper showing that the majority of the
action was due to dental, rather than skeletal
change, although the maxilla underwent
significant posterior displacement and the
mandible clockwise rotation.
 Usually, 6–9 months of Jumper wear is necessary
in order to correct a mild Class II problem in
patients who still have some growth remaining.
Additional treatment time may be required in
patients with more severe problems

The Adjustable Bite Corrector
 The Adjustable Bite CorrectorTM (ABC)
appliance introduced by West (1995)
functions in a similar way to the Herbst
appliance and the Jasper Jumper.
 The advantages include universal left and
right sides, adjustable length, stretchable
springs, and easy adjustment of the
attachment parts.
 No long-term studies have been carried
out on this appliance in the present
literature to date

Eureka Spring
 Indications.
 Class III with anterior open bites.
 Procumbant lower incisors.
 Deep buccal overbites or posterior crossbites.
 Extremely tight buccal musculature.
 Minimal buccal vestibular space

 described Devincenzo (1997)
 The main component of the spring
is an open wound coil spring encases
in a telescoping plunger assembly.
The springs rest in the buccal sulcus
and attach posteriorly to headgear
tubes on the upper first molars, and
anteriorly tothe lower archwire
distal to the cuspids.
 The spring exerts 16 g for every millimetre of ram
compression The appliance is designed to be used
in conjunction with fully banded upper and lower
fixed edgewise appliances with heavy rectangular
lower arch in place.

 The mechanics of the appliance has the opposite effect to
that of Class II elastics in that it acts to intrude both the
lower incisors and the upper molars.
 The effects of this appliance are entirely dentoalveolar,
 The dento-alveolar effects achievable with this appliance
include maxillary molar distalization or advancement of the
lower anterior teeth in Class II cases.
 A recent study carried out on 37 consecutive class II
treatments was reported to produce an antero-posterior
correction of 0•7 mm per month with equal amounts of
maxillary and mandibular movement (J. Devincenzo )

Saif Springs
 These are long nickel-titanium closed coil
springs that are used to apply Class II inter-
maxillary traction when fully banded fixed
appliances are in place .
 The springs are tied in place with steel ligatures
and are worn in place of inter-maxillary elastics.
 The springs are available in two lengths 7 and 10
mm.
 No longitudinal research studies on this auxillary
are available in the literature to date.

The mandibular anterior repositioning
appliance (MARA)
 The Mandibular Anterior Repositioning
Appliance consists of cams made from
0•060 square wire attached to tubes (0•062
square) on upper first molar bands or
stainless steel crowns. A lower first molar
crown has a 0•059 arm projecting
perpendicular to its buccal surface, which
engages the cam of the upper molar.
 There have been no studies to date
documenting results achieved with this
appliance.
 The developers of the appliance
recommend a 12-month treatment time to
achieve a bite jumping or orthopaedic effect

The Klapper SUPERspring
 The latest design of the spring requires a special
oval tube to be fitted to the upper first molars.
The springs can be readily removed for
adjustment or activation
 The appliance consists bilaterally of a length
multi-flex nickel-titanium which is bent back on
itself attaching to the upper first molar tube and
attaching to the lower archwire by means of a
helical loop.
 The appliance comes in two sizes, a 27-mm
primarily designed for extraction cases and 40-
mm for non-extraction cases.
 There have been no studies to date documenting
results achieved with this appliance

Mandibular distalization
 Since space is easier to gain in the
maxillary arch than in the mandible
because of increased trabecular structure
of supporting bone and increased
anchorage afforded by palatal vault, the
distalization of mandibular molar becomes
of significant value for the treatment of
cases with mild to moderate arch
discrepancy and class II molar relationship
associated with a normal mandible.

Lip Bumper
Cetlin & Ten Hoeve, JCO 1983
 .045 SS wire covered with tubing
 U-shaped loops – adjustment areas
And stops mesial to the molar tubes.
 Placed on most distal molar
 Recent studies- Ram Nanda etal
- AJO 1991 Jun
Posterior movement of mandibular incisors are very minimal

Distal jet for molar
 For molar uprighting

Franzulum appliance
Friedrich Byloff et al JCO2000 sep
 Anterior anchorage :
acrylic button-5mm wide
 Rests on canine and
premolars - .032 wire
 Tube from acrylic button
to receive active
component
 NiTi coil springs-100-
200g/side
 J-shaped wireinserted
into tube

Franzulum appliance
 Anchor unit bonded with composite
 J-shaped distalizing unit ligated to
lingual sheath
 Active component close to C Res
Case report
 11yrs 10mts / M
 end on molar relationship
 Space deficiency in both the arches
 Premolars blocked out
 Upper pendulum and lower
Franzulum
 Nance holding arch
 Fixed appliance with cervical
headgear and Cl II elastics
 End of treatment; Class I molar
relation, no signficant. Change in
facial profile

Essix based molar distalization appliance
 It is a thermoplastic
appliance made of type A
material which is o.40 inch.
 Expansion screw of either
dentarum turmstrassemor
ispring mesial to molars are
used.
 Fizzy drinks or fruit juices
cause demineralization of
enamel if they are not rinsed
properly .

Frozat Appliance
 2 molars bands soldered
with either 0.38 blue
eligiloy or 0.40 inch ss
wire
 The lingual arch should
touch as many teeth as
possible

 Activated with aderer 3
pong piler
 A force of 180 – 200
gms should be verifed
before placing .

APPLIANCE SELECTION
CRITERIA
 Regardless of approach, one should
consider several issues before considering
any of these appliances for use
 Side effects
 Case types
 Arch length
 Treatment timing
 Co-operation

Side Effects
 Did incisors flare?
 If mandible is used as an anchor unit, did
anything occur in that arch?

 Side effects are a fact of life, especially in
orthodontics.
 There are some side effects that would be
favorable in certain cases, while the same
effects may be detrimental in others.

 The key to correct appliance selection is to
know, and be able to predict these effects.
 For this a sound and thorough knowledge
of biomechanics is essential.

Case types
 Consider an individual case at hand and his/her
needs.
 If mandibular dentition can be slightly mesialized,
if this in the case then Herbst or BDA may be
appliance of choice.
 If not pendulum and other intra-arch appliances
can be used.
 If you may not afford flaring of incisors then
headgear would be treatment of choice.

Arch length
How much distalization is required.
TPA has limited application of 2-3 mm, if
in need of greater amount of correction
then Herbst and headgear are of choice
followed by pendulum, Wilson BDA etc.

Treatment timing
Perhaps best time to initiate distalization
is late mixed dentition and it may be too
late after eruption of second molar.
Some synergistic effect as dentition
transits from primary to permanent as
canines and premolars follow molars as
they moved distally. Thus appliances that
requires some anterior anchorage like
pendulum may dilute these results.

Co-operation
 Invariably appliances that require least
co-operation come with side effects that
have to be considered.

CONCLUSION
 There are many advantages and
disadvantages of both the intra-oral and
extra-oral methods.
 It should be remembered that patient
selection for a particular method of
distalization is of utmost importance and
should not be overlooked .
 Right appliance should be selected for the
right patient and one should not select
the patient for the appliance rather the
appliance should be for the patient.

References :
 Willam R Proffit contempory orthodontics: mosby
 Orthodontics and dentofacill orthopedics James Mcnamra ,Willaim
L Brudon. Needham press
 Blackwood, H. O. (1991) Clinical management of the Jasper Jumper,
Journal of Clinical Orthodontics, 25, 755–760.
 Block, M. S. and Hoffman, D. R. (1995) A new device for absolute
anchorage, American Journal of Orthodontics and Dentofacial Orthopedics,
107, 251–258.
 Bondemark, L. and Kurol, J. (1992) Distalisation of maxillary first and
second molars simultaneously with repelling magnets, European Journal of
Orthodontics, 14, 264–272.
 Bondemark, L., Kurol, J. and Bernhold, M. (1994) Repelling magnets
versus superelastic NiTi in simultaneous distal movement of maxillary first
and second molars, Angle Orthodontist, 64, 189–198.
 Byloff, F. K. and Darendeliler, M. A. (1997) Distal molar movement
using he pendulum appliance, Part 1: clinical and radiological evaluation,
Angle Orthodontist, 67, 249–260.www.indiandentalacademy.com

 Byloff, F. K., Darendeliler, M. A., Clar, E. and Darendeliler, A. (1997)
Distal molar movement using the pendulum appliance, Part 2: the effects
of maxillary molar root uprighting bends, Angle Orthodontist, 67, 261–270
 Carano, A., Testa, M. and Sicikliana, G. (1996) The lingual distaliser
system, European Journal of Orthodontics, 18, 445–448.
 Cope, J. B., Buschang, P. H., Cope, D. D., Parker, J. and Blackwood,
H. O. (1994) Quantitative evaluation of craniofacial changes with Jasper
Jumper therapy, Angle Orthodontist, 64, 113–122.
 Cureton, S. L., Regennitter, F. J. and Yancey, T. M. (1993) The role
of the headgear calender in headgear compliance, American Journal of
Orthodontics and Dentofacial Orthopedics, 104, 387–394.
 Devincenzo, J. (1997) The Eureka Spring: a new interarch force
delivery system, Journal of Clinical Orthodontics, 31, 454–467

 Doanay, A., Kucukkeles, N., Koyutuk, O. and Erverdi, N.
(1998)Comparison of two intraoral molar distalization methods:
magnets versus bimetric distalization arches,European Journal of
Orthodontics, 20, 467–468
 Erverdi, N., Koyuturk, O. and Kucukkeles, N. (1997) Nickel-titanium
coil springs and repelling magnets—a comparison of two different intra-
molar distalization techniques.British Journal of Orthodontics, 24, 47–53
 Ghosh, J. and Nanda, R. (1996) Evaluation of an intraoral maxillary
molar distalisation technique, American Journal of Orthodontics and
Dentofacial Orthopedics, 110, 639–646
 Gianelly, A. A. (1998) Distal movement of maxillary molars, American
Journal of Orthodontics and Dentofacial Orthopedics, 114, 66–72.
 Gianelly, A. A., Vaitas, A. S., Thomas, W. M. and Berger, D. G.
(1989) The use of magnets to move molars distally, American Journal of
Orthodontics and Dentofacial Orthopedics, 96, 161–167.

Hansen, K., Pancherz, H. and Petersson, A. (1990) Long-term effects
of the Herbst appliance on the craniomandibular system with special
reference to the TMJ, European Journal of Orthodontics, 12, 244–253
 Hilgers, J. J. (1992) The pendulum appliance for Class II non-compliance
therapy, Journal of Clinical Orthodontics, 26, 706–714.
 Itoh, T., Tokuda, T., Kiyosue, S., Hirose, T., Matsumato, M. and
Chaconas, S. (1991) Molar distalisation with repelling magnets, Journal
of Clinical Orthodontics, 25, 611–617.
 Jeckel, N. and Rakosi, T. (1991) Molar distalisation by intraoral force
application, European Journal of Orthodontics, 13, 43–45.
 Jones, R. D. and White, J. M. (1992) Rapid Class II molar correction
using an open coil jig, Journal of Clinical Orthodontics, 26, 661–664.
 McNamara, J. A. and Brudon, W. L. (1993)Orthodontic and orthopedic treatment in the
mixed dentition,

 Pancherz, H. (1979) Treatment of Class II malocclusion by
jumping the bite with the Herbst appliance, a cephalometric
investigation, American Journal of Orthodontics and Dentofacial
Orthopedics, 76, 423–442.
 Pancherz, H. (1995)The Herbst appliance,Editorial Aguairam
Sevilla Espana.
 Pancherz, H. and Anehus-Pancherz, M. (1993) The headgear
effect of the Herbst appliance: a cephalometric long term study,
American Journal of Orthodontics and Dentofacial Orthopedics,
103, 510–520.
 Pancherz, H. and Fackel, U. (1990) The skeletofacial growth
pattern pre- and post-dentofacial orthopaedics. A long-term study
of Class II malocclusions treated with the Herbst appliance,
European Journal of Orthodontics, 12, 209–218.

 Pieringer, M., Droschl, H. and Permann, R. (1997) Distalisation with a
Nance appliance and coil springs, Journal of Clinical Orthodontics, 31,
321–326.
 Samuels, R. H. A. (1996) A review of orthodontic facebow injuries and
safety equipment, American Journal of Orthodontics and Dentofacial
Orthopedics, 110, 269–272
 Starnes, L. O. (1998) Comprehensive Phase 1 treatment in the middle
mixed dentition, Journal of Clinical Orthodontics, 32, 98–110.
 Wehrbein, H., Merz, B. R., Diedrich, P. and Glatzmaier, J. (1996)
The use of palatal implants for orthodontic anchorage, Clinical Oral Implant
Research, 7, 410–417.
 West, R. P. (1995) The Adjustable bite corrector, Journal of Clinical
Orthodontics, 29, 650–657.

Molar dis final

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (13)

Similar to Molar dis final

Similar to Molar dis final (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Molar dis final