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MOLAR
DISTALIZATION
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Class II Malocclusion
Non-Extraction treatment
Non-Compliance therapies
Treatment - Molar Distalization
Space regaining proce!re
-Mesial migration o" "irst permanent molars
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Inications "or Molar istalization
#$ 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 utili!ed for relief ofanterior crowding"
- #pper molars distali!ed to get a class I
relation
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Inications "or Molar istalization
$. %on-growing patient
-&o regain lost arch length
-'loc(ing out of canines
). #pper second molar extraction
-Lower arch normal
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Inications "or Molar istalization
Class I malocclusion- with highl* placed canine+impactedcanine
Lac( of space for eruption of premolars due to mesial migration
of permanent first molars
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End on molar relationship with
mild to moderate space
re,uirement
Cases with less than a full
cusp class II molar relationship
Inications "or Molar istalization
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Inications "or Molar istalization
ood soft tissue profile
'orderline cases
Mild to moderate space
discrepanc* with missing $rd
molars+2ndmolars not *et erupted
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Inications "or Molar istalization
xial inclination / Mesiall*
angulated upper molars
%ormal or 0*podivergant
growth pattern
Late mixed dentition with mild
crowding of anteriors
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Case selection1. %ormal or near normal mandibular arch
2. Late mixed dentition-ideal
- Earl* permanent dentition-growth still left in maxillar*
tuberosit* area.- 1-13 *rs-males
1)-14 *rs-females
$. Molars placed normall*- buccolinguall*
). $rdmolars-absent stac(ing of upper molars unsuitable
4. 5rofile considerations- well developed nose 6 chin
. 0igh M5- contraindicated-wedging effect
3. 7pace discrepanc*- not ver* severe
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Classi"ication1. Location of appliance
Extra-oral
Intra-oral
2. Position of appliance in mouth
'uccal
5alatal
$. Type of tooth movement
'odil* movement &ipping movement
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Classi"ication
). Compliance needed from patient
Maximum compliance
Minimum or %o compliance
5. Type of appliance
8emovable
9ixed
.Arches involved
Intra-arch
Inter-arch
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%ario!s appliances !se "or Molar
Distalization & 'eagears (ilson )imetric arch esign
ACCO Crozat appliance Cric*ett appliance Moi"ie Nance Ling!al appliance Non-extraction treatment Schm!th an m!ller o!+le plates Molar istalization ,ith magnets
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%ario!s appliances !se "or Molar
Distalization se o" S!per elastic NiTi .ones .ig The /en!l!m appliance
Claspring Remo0a+le molar istalization splint 1ixe piston appliance The 2-loop appliance
The istal 3et sing Implants 1ixe "!nctional appliances
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'iomechanics of 0eadgears/
C 8es Moments
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Cer0ical 'eagear
Short "ace Class II
maxillar4 protr!si0e
cases ,ith lo, M/A 5Deep+ites
Extr!si0e 5 istalizing
e""ect
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'igh p!ll 'eagear
/ro!ces intr!si0e 5
/osterior irection o" p!ll
Long "ace class II patients
,ith high M/A
1orce thro!gh c res 6
Intr!sion 5 istal
mo0ement o" molar
7-8 months 6 class II-classI
A0-e""ecti0e9 no reciprocal "orces
Disa0- /atient compliance
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)imetric s4stem "or Molar Distalization
Dr$(ilson-Tanem 4o*e
,ith +imetric arches "or
molar istalization
Tanem 4o*e-$:;
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Coil spring- between molar
tube 6 the *o(e Elastics- 12 hours a da*
0eadgear at night
&he ;mega adtube
.=1 ;mega loop
Coil springs 6
intermaxillar* hoo(s.
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)imetric arch moi"ie +4 Dr$ .a4ae
Class II correction- Distalization > expans canine-
premolar area- !nloc*s the occl!sion
A mil-moerate class II i0 ? ,ith normal mani+!lar
arch-easil4 correcte
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)imetric arch moi"ie +4 Dr$ .a4ae
Arch,ire esign& $:#7=premi!m ,ire
/remolars +one i"expansion is re@!ire Tearrop shape loop )ite opening +en
Mil toe-in ?mm acti0ation
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Elastic load reduction principle/
Class II elastics used se,uentiall*
&.5 reen 1stwee(
5in( - 2ndwee(
?ellow next 2-$ wee(s
Initial heav* force- to resist forward
pushing force of new wire- force
transferred distall*
Later Molar uprights-mesiall* directed
archwire force decreases- support with
light forces. Extrusive component of class II- (ept to a
minimum
)orerline cases 6Non extraction
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ACCO Appliance .CO#7
8emovable appliance with headgear
@istal mass movement of buccal segments
@r.Leonard Margolis harness growth-
later springs added for distal tooth
movement
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Treatment progression &
. 5lacement of finger springs for first appliance
If 3""4") present" 2 finger springs engaged
'. 7econd appliance fter distali!ation on one side
Leave first appliance as retainer
C. Cuspid retraction &hird appliance to retract both cuspids
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Nonextraction treatment
Cetlin 6 &en 0oeve" C; 1DA$7pace aining in the Mandibular rch With the Lip 'umper
.=)4 77 wire covered with tubing
#-shaped loops ad
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Nonextraction treatment
Cetlin 6 &en 0oeve" C; 1DA$7pace gaining in the maxillar* arch Combination of extraoral force and an
intraoral force
Inraoral nchorage adaptation to palate 6
acr*lic shield around incisors 'ite plane dams clasp on premolars 7prings on molars activated b* 1-1.4
mm force -$= gms
Exraoral Cervical or high pull headgear
14= gms + side 12 -1) hrs+da*
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Nonextraction treatment
Cetlin 6 &en 0oeve" C; 1DA$5alatal bar as an ad
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Moi"ie Nance an Ling!al appliances
"or !nilateral tooth mo0ementhafari C; 1DA4
Nance holdin arch !
5alatal arch attached to first molar
bands " embedded in an acr*lic
FbuttonF
space maintainer in the maxillar*
arch"
support maxillar* posterior
anchorage during tooth movement
"odified Nance holdin arch and
modified linual arch! nchorage for unilateral
distali!ation of posterior teeth %o patient compliance re,uired
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Moi"ie Nance an Ling!al appliances
"or !nilateral tooth mo0ement"odified Linual arch
1$ *r +9
7(eletal class I
Linguall* positioned 8 4 $.2 mm space
Lingual arch from L to 8)
Coil spring from 8 )- on a
segmental .=1D x .=24 %i&i
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2-Loop Molar Distalizing Appliance
%alr!n 2alra 6 .CO #
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