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Intraoral Distalizing Devices
Nalaka Jayaratne BDS, PhD
Resident in Orthodontics,
University of Connecticut School of Dental Medicine
USA
Why do we use distalizing devices?
• To move molars in a distal direction
Gain space
Avoid extractions
• Useful in treating patients with a normal mandible and a
mild to moderate Class II relationship
• Ideal time – Mixed dentition prior to 2nd molar eruption
Distalizing devices
Extraoral Intraoral
Distalizing devices
Extraoral
• Headgear
Intraoral
Distalizing devices
Extraoral
• Headgear
Most widely used
Esthetically unacceptable
Depends on patient compliance
Intraoral
Distalizing devices
Extraoral
• Headgear
Most widely used
Esthetically unacceptable
Depends on patient compliance
Intraoral
• Pendulum and pendex
appliances
• Distal jet
• Jones jig
• Nickel-titanium coil springs
• Wilson bimetric distalizing
arch system
Intraoral appliances
• Effective distalization without patient compliance
• Normally use a Nance button as anchorage
Intraoral appliances
• Effective distalization without patient compliance
• Normally use a Nance button as anchorage
 Insufficient to neutralize the side effects of anchorage loss
Intraoral appliances
• Effective distalization without patient compliance
• Normally use a Nance button as anchorage
 Insufficient to neutralize the side effects of anchorage loss
 Maxillary anterior crowding, overjet↑, tipping of premolars and canines
Pendulum
Pendulum
Large
Nance
button
Pendulum
Large
Nance
button
TMA
Springs
(0.032”)
Pendulum
Large
Nance
button
TMA
Springs
(0.032”)
Distalization = 3.81 mm
Pendulum
Pendulum
• Continuous force ~
100-200g
Pendulum
• Continuous force ~
100-200g
• Distalization
2.55 – 18.5mm (SR)
4-5mm (text book)
Pendex
www.northstardental.com
Pendex
www.northstardental.com
Jackscrew
Distal Jet
Distal Jet
Large
Nance
button
Distal Jet
Large
Nance
button
Spring
(NiTi or SS)
Distal Jet
Large
Nance
button
Spring
(NiTi or SS)
Parallel to occlusal plane
4-5mm apical to molar centroid
Distal Jet
Distal Jet
Telescopic Unit
Spring sliding on
a 0.036” tube
Distal Jet
Telescopic Unit
Spring sliding on
a 0.036” tube
Activation
Screw
Distal Jet Activation
http://www.perfectfinishortho.com/
Distal Jet Activation
Distalization = 1.9 – 5mm
http://www.perfectfinishortho.com/
Keles Slider
http://www.h-s-dentaltechnik.at/
Keles Slider
http://www.h-s-dentaltechnik.at/
Nance button+ ABP
Keles Slider
http://www.h-s-dentaltechnik.at/
Nance button+ ABP
Activation
Screw
Keles Slider
Keles Slider
SS wire (0.040”)
Keles Slider
SS wire (0.040”)
NiTi Coil Spring
Keles Slider
SS wire (0.040”)
NiTi Coil Spring
Adjustable screw
Keles Slider
SS wire (0.040”)
NiTi Coil Spring
Adjustable screw
Distalization = 0.89 – 4mm
Jones Jig
G
Jones Jig
G
Jones Jig
G
Jones Jig
Jones Jig
Distalization = 2.85 – 4.92mm
Aims of this meta-analysis
• Quantify and to compare the amounts of molar
distalization and anchorage loss of conventional and
skeletal anchorage methods in the correction of Class II
malocclusion with intraoral distalizers
Methods
• Based on the PRISMA guidelines
Preferred Reporting Items for
Systematic Reviews and Meta-
Analyses
Methods
• Based on the PRISMA guidelines
Main question
• Was defined with the PICO format
Main question
• Was defined with the PICO format
PICO format Question
Population Subjects with Class II malocclusion
Intervention Intraoral distalizers with conventional anchorage
Comparison Intraoral distalizers with skeletal anchorage
Outcome Efficiency in the correction of Class II
malocclusion
Main question
• Was defined with the PICO format
PICO format Question
Population Subjects with Class II malocclusion
Intervention Intraoral distalizers with conventional anchorage
Comparison Intraoral distalizers with skeletal anchorage
Outcome Efficiency in the correction of Class II
malocclusion
Search strategy
Database Key words Limits
PubMed Distalizers OR distalization appliance OR orthodontic
distalization OR noncompliance appliances OR first molar
distalization OR upper molar distalization OR maxillary
molar distalization
English language; humans, 1970 to
September 2010
Embase Distalizers OR distalization appliance OR orthodontic
distalization OR noncompliance appliances OR first molar
distalization OR upper molar distalization OR maxillary
molar distalization
Only English; humans, 1970 to
September 2010
Web of Science Distalizers OR distalization appliance OR orthodontic
distalization OR noncompliance appliances OR first molar
distalization OR upper molar distalization OR maxillary
molar distalization
English language; only articles (not
reviews, letters, abstracts, meetings,
and editorials);1970 to September
2010
Scopus Distalizers OR distalization appliance OR orthodontic
distalization OR noncompliance appliances OR first molar
distalization OR upper molar distalization OR maxillary
molar distalization
English language; only articles (not
reviews, letters, abstracts, meetings,
and editorials);1970 to September
2010
Cochrane Library Distalizers; distalization and appliance; orthodontic and
distalization; noncompliance and appliances, first and
molar and distalization; upper and molar and distalization;
maxillary and molar and distalization
Search strategy
Database Key words Limits
PubMed Distalizers OR distalization appliance OR orthodontic
distalization OR noncompliance appliances OR first molar
distalization OR upper molar distalization OR maxillary
molar distalization
English language; humans, 1970 to
September 2010
Embase Distalizers OR distalization appliance OR orthodontic
distalization OR noncompliance appliances OR first molar
distalization OR upper molar distalization OR maxillary
molar distalization
Only English; humans, 1970 to
September 2010
Web of Science Distalizers OR distalization appliance OR orthodontic
distalization OR noncompliance appliances OR first molar
distalization OR upper molar distalization OR maxillary
molar distalization
English language; only articles (not
reviews, letters, abstracts, meetings,
and editorials);1970 to September
2010
Scopus Distalizers OR distalization appliance OR orthodontic
distalization OR noncompliance appliances OR first molar
distalization OR upper molar distalization OR maxillary
molar distalization
English language; only articles (not
reviews, letters, abstracts, meetings,
and editorials);1970 to September
2010
Cochrane Library Distalizers; distalization and appliance; orthodontic and
distalization; noncompliance and appliances, first and
molar and distalization; upper and molar and distalization;
maxillary and molar and distalization
MeSH Terms
MeSH Terms
MeSH Terms
MeSH Terms
MeSH Terms
Meta-Analysis
• Articles divided into 2 groups
Conventional or skeletal
no distinction between different types of distalizers
• Only articles of medium and high quality were included
Forest plots for molar distalization with conventional anchorage
Molar distalization with skeletal anchorage
Premolar movement with conventional anchorage
Premolar movement with skeletal anchorage
Conclusions
• There was scientific evidence that both anchorage
systems are effective for distalization
• However, with skeletal anchorage, there was no
anchorage loss when direct anchorage was used

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