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