molar distalization

8/9/2019 Molar Distalization

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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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$. %on-growing patient

-&o regain lost arch length

-'loc(ing out of canines

). #pper second molar extraction

-Lower arch normal


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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



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ood soft tissue profile

'orderline cases

Mild to moderate space

discrepanc* with missing $rd

molars+2ndmolars not *et erupted


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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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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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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 #

molar distalization

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