different appliances used for molar distalization

1. MOLAR DISTALIZATION
SEMINAR
Preceptor
Dr. PAYAL SHARMA
Presented by
Ankit

2. INTRODUCTION
• A number of nonextraction strategies are available to
resolve Class II malocclusions.
• One is to move the maxillary molars distally in the initial
stages of treatment to convert the malocclusion to a Class I
spacing problem.
• The ability to correct molar relationships by distalizing the
maxillary molars may be associated with the timing of
treatment.

3. • The use of molar distalizing appliances for the treatment of
tooth size/arch size discrepancies at the upper arch should
be based on an accurate cephalometric evaluation of the
individual dentoskeletal relationships.
• A typical nonextraction approach for molar distalization in
hyperdivergent patients.

5. Indications
• Tooth size/arch size discrepancy.
• Class II malocclusion with protrusion of the entire maxillary
dental arch relative to the skeletal portion of the maxilla.
• Skeletal Class II relationships with prevalent maxillary
skeletal protrusion in individuals at the end of growth.
• when the lack of compliance limits the orthopedic therapy.
• Class II malocclusions associated with skeletal and/or
dentoalveolar deep bite.

6. Contraindications
• Severe maxillary protrusion.
• Severe mandibular retrusion.

7. HEADGEAR
• Headgears were first used in the early 1800s, and
modifications have been made throughout time.
• Extraoral traction has been used successfully to correct
Class II malocclusion by distalizing the maxillary molars.
• Extraoral traction should be worn 10 to 12 hours a day and
produce a force of 150 to 200 g/side.

8. Two major components

10. Asymmetric Headgear

11. The Pendulum Appliance
• Nonextraction treatment of Class II malocclusion frequently
requires upper molar distalization into a final Class I
relationship.
• With extraoral mechanisms implementing molar
distalization, the success of the treatment will decisively
rely on the patient’s compliance.
• The Pendulum Appliance (PA) was first introduced by
HILGERS in 1992.

12. The Primary Design

13. Variations with Emphasis on Molar Control
• Byloff & Darendeliler have attempted to correct the molar
tipping by incorporating an uprighting bend (10–15° in the
sagittal plane).
• To maintain molar distalization along a linear course.
• Kinzinger et al presented a modified design named the K-
Pendulum.

15. Variations with Emphasis on Anchorage
Enforcement
• The helix force acting to distalize the molars will generate
reciprocal force acting against the Nance button an
increase of overjet.
• The K-Pendulum Appliance divides the Nance button into
two sections.

17. Working Mechanisms
• In the passive state.
• The springs are activated by attaching their free ends into lingual
sheaths.
•Design by Byloff & Darendeliler, not have the omega-shaped.
•To avoid occlusion interference

18. • Distalization generated by the PA is rapid and a 1–2 mm
space mesial to the first molar can be expected within 6
weeks of insertion.
• Byloff et al describe the working mechanism of their
modified appliance with a two-phase theory.
Distal Molar Crown Movement (Phase 1).
• The springs are activated 45° in the center of the helices on
the sagittal plane until an overcorrected Class I relationship
is obtained.

19. Molar Root Uprighting (Phase 2)
• In order to make the uprighting bends, the angle between
the recurved end of the spring, which is engaged into the
palatal molar sheaths, and the long arm of the spring is
increased intraorally in the sagittal plan 10–15°.
• The forces generated by a pendulum arm are in the range of
3.5 g/degree and the normal amount of activation results in
100–200 g of force on a molar.

20. Activation
Step wise Activation
• Hilgers the PA springs are activated 45 in then center of the
helices on the sagittal plane with an initial force of 200–250
gm.
Single Activation
• Joseph & Butchart recommend that the PA should be
activated only once by bending the springs 90 deg.

21. Influence of the Fully Erupted Second Molars
• Such as the use of the headgear.
• Worms et al. second molar being in contact with the first
molar represents a resistance to distal movement

22. Influences of the Budding of the Second and
Third Molars
• Graber concluded that, when the second molar has not yet
erupted, distalization is by tipping rather than by bodily
movement.
• Gianelly et al, the duration of treatment increases if patients
have their second molars.
• Kinzinger et al In the study, the patients are divided into
three groups (PG 1–3)

23. • PG 1, eruption of the second molars has either not yet taken
place or is not complete.
• In PG 2, the second molars have already developed as far as
the occlusal plane, with the third molars at the budding
stage.
• In PG 3, germectomy of the wisdom teeth has been carried
out, and the first and second molars on both sides have
completely erupted.

24. Anchorage Reinforcement
• Transverse Expansion and Split Distal Screw.
• Increased Coverage of Nance Button
• Careful Case Selection
• Implant-Supportive Anchorage

25. The Penguin Pendulum

26. Distal Jet
• In 1995, Carano & Testa introduced.
FABRICATION

27. The depth of the palate also plays an
important role in determining the
position of this line of action and also
the dimensions of the Nance palatal
button.

29. Implants for Absolute Anchorage
• All the previous studies on molar distalization have shown
some degree of reciprocal (anterior) anchorage loss.
• The use of a mini-screw anchorage system (e.g. palatal
implants) combined with the Distal Jet may represent an
easier solution

30. • An ideal site for the placement of a micro- or mini-screw
implant is the maxillary alveolar process and, more
precisely, the site in between the root of the first and second
premolars.

32. • In a series of studies, the Distal Jet is reported to have
generated 1.9–3.7 mm/side of distal molar movement and
0.4–3.0 mm of anchorage loss per side.
• Therefore, the total amount of space created during
distalization ranged from 2.3 to 6.7 mm (average 5.65 mm).
Anchorage from First or Second Premolars

33. • In a recent study, movement of the molar crown contributed
71% of the 4.5 mm of space created on each side during
distalization, the remaining 29% resulted from mesial
movement of the anchoring premolars.
• From recent studies it appears that greater tipping of the
maxillary first molars (4.3°) was found in patients whose
second molars were unerupted (positioned at the apical third
of the maxillary first molars). When the second molars were
partially or totally erupted, there was significantly less
tipping of the first molar (2°).

34. Sequential Asymmetric Retraction.

35. Keles Slider Appliance

36. Bilateral Distalization
• The cephalometric results of a preliminary investigation on
10 patients showed that the maxillary first molars were
distalized bodily by an average of 4.1 mm.
• Distal tipping and molar extrusion were not observed
during distalization. A Class I molar relationship was
achieved on average in a period of 5.5 months.

37. The Jones Jig
Introduced by Jones & White.
• Nance Appliance includes an acrylic palatal button of at
least 15 mm in diameter, which is stabilized with 0.036′′
stainless steel wires that extend bilaterally and are soldered
to bands on maxillary first or second premolars.
• The Nance button should not be in contact with the anterior
teeth

39. Clinical Management
• Gulati et al recommend the use of bands with gingivally
positioned headgear tubes
Indications and Contraindications
• Bilateral or unilateral distalization of the maxillary first
molars.
• Class II patients with mild anterior crowding.
• Contraindicated in patients with an excessive vertical
growth pattern because the extrusion of the maxillary first
molars.

40. Treatment Effects
• The maxillary first molars were distalized between 1.17 mm
and 2.8 mm, with a monthly rate of 0.83 mm.
• The distal movement of the first molars was in most cases
accompanied with unfavorable distal tipping that varied
between 3.50° and 7.85.
• The maxillary first premolars moved mesially 1.10 mm and
also tipped mesially 2.6°.
• The maxillary incisors were found to move mesially
between 0.25 mm and 0.55 mm and to procline between 1°
and 2°

41. Lokar Appliance
• In 1996 Scott proposed the Lokar Appliance.
• For anchorage, a Nance acrylic button 2–3 mm thick can be
used which is stabilized to the maxillary second premolars
with a 0.040′′ stainless steel wire.
INDICATION
• Class II malocclusion due to maxillary protrusion,
• Canine impaction or ectopic eruption of the maxillary
premolars.
• In any other situation in which first molar distalization is
indicated.

42. Magnets for maxillary molar distalization
• One of the first practical uses of magnets in medicine was in
about 1820 in Paris.
• In dentistry, the use of magnets is quite recent.
• In 1960 Behrman described the use of implanted magnets in
the jaws to aid denture retention.
• Use of magnets for tooth movements was first described by
Crefcoeur.

43. Design of the Intraarch Appliance

45. • Even in the presence of second maxillary molars, can be
distalized with a movement rate of 0.75–1.0 mm/month.
Advantages
• Rapid result in terms of distal molar movement.
• They have constant power over time- . elastics or
elastomeric elements.
• Orthodontic tooth movements may be increased by
accelerated cellular reactions in the periodontal ligament.

46. Disadvantages
• Frequent activation appointments.
• Magnets easily corrode which leads to substance loss and
disturbed physical properties.
• Expensive.
• The magnets are brittle.

47. Modification of the Appliance
• Distal molar tipping of 7–14° has been reported during
distal molar movement.
• To avoid undesirable distal crown tipping, a modified
appliance has been introduced.
• 0- 4 deg.

48. The First Class Appliance
• Knapp in 1899.

49. APPLIANCE DESIGN
• The Bands.
• Vestibular Side.
• Palatal Side

50. Fabrication

51. • The FCA induced an average 4.0 mm/side distal movement
of the crowns of the maxillary first molars during a period
of 2.4 months

52. The use of onplants for maxillary molar
distalization

55. Super elastic NiTi wire
• GIANELLY in 1998.

56. K-loop
• By Kalra in 1995.
• The appliance consists of a K-loop to provide the forces and
moments and Nance button for anchorage.

57. • Made from TMA wire.
• Each loop 8 mm long and 1.5 mm wide.
• 20 deg. Bent is given in legs of loop.
• Mark the wire.

58. FRANZULUM APPLIANCE
• Bayloff et al. (2000)
• It is based on pendulum appliance principal for molar
distalization in mandibular arch.
• Ant. Acrylic button. From canine to canine.
• Rests.
• 18 mm open coil spring.

59. Lip Bumper
0.045 wire
U- loop for adjustent and stops the mesial movement
Sheild 2-3 mm away.
Increase the arch perimeter
Proclination of incisor

60. Conclusion
• Noncompliance intramaxillary molar distalization
appliances all act by distalizing molars with a concomitant
and unavoidable loss of anchorage.
• 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 .
• One should not select the patient for the appliance rather
the appliance should be for the patient