The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
3. INTRODUCTION
Correction of class II malocclusion without
extractions requires maxillary molar
distalization by means intraoral or extra-
oral forces.
www.indiandentalacademy.com
4. • William Kingsley (1892) described for the
first time headgear apparatus with which
class I molar relationship could be
achieved successfully.
www.indiandentalacademy.com
5. • Oppenheim advocated that position of
mandibular teeth as being the most
correct for individual and use of occipital
anchorage for moving maxillary teeth
distally into correct relationship without
disturbing mandibular teeth.
• In 1944, he treated a case with extra-oral
anchorage for distalizing maxillary molar.
www.indiandentalacademy.com
6. • Kloehn in 1947 started a long and
beneficial series of investigations and
clinical applications of cervical anchorage
to the maxillary dentition.
www.indiandentalacademy.com
7. • The headgears over the years have
shown to be effective in maxillary molar
distalization with movements in all planes
of space. With the recent trend more
towards non extraction treatment, several
inter/intra arch devices have been
advocated to distalize molars in the upper
arch.
www.indiandentalacademy.com
8. • Researchers have focused on the
simplicity and efficiency of these intra arch
devices, which improves the continuity
and constancy of forces. Oral hygiene is
easier to maintain and the need for patient
compliance is eliminated.
www.indiandentalacademy.com
9. • Molar distalization is a technique that has
added a new column in the practice of
every orthodontist to produce consistent,
predictable and high quality results. The
goals of practicing with efficiency and
profitability are positively affected.
www.indiandentalacademy.com
10. • Since space is easier to gain in the
maxillary arch than in the mandible
because of increased trabecular structure
of supporting bone and increased
anchorage afforded by palatal vault, the
distalization of maxillary molar becomes of
significant value for the treatment of cases
with mild to moderate arch discrepancy
and class II molar relationship associated
with a normal mandible.
www.indiandentalacademy.com
11. INDICATIONS
• Profile - should be acceptable with minimal
facial change or straight profile
www.indiandentalacademy.com
18. UPPER MOLAR POSITION
• This is a linear measurement between the
distal surface of the maxillary first
permanent molar and the pterygoid
vertical line (PTV).
• It is an indication of the forward position of
the upper molar and illustrates to the
clinician whether or not sufficient space is
present for the second and third molars.
www.indiandentalacademy.com
19. • This measurement indicates or
contraindicates molar distalization.
• An interesting aspect of this measurement
is that its mean value is the patient's age
in years plus 3mm until growth is
complete. Therefore the mean
• measurement for nine - year old child is
l2mm.
www.indiandentalacademy.com
21. TIMING
• A favorable time to move molars distally
appears to be in mixed dentition, before
the eruption of the second molars, and an
efficient force system to move molars
distally is a continuously acting force.
www.indiandentalacademy.com
39. EXTRA ORAL
• Bilateral molar distalization
a) Cervical pull head gear.
b) Combi pull head gear.
• Unilateral molar distalization with unilateral face
bows
a) power-arm face bow
b) soldered offset face bow
c) swivel-offset face bow
d) spring-attachment face bow.
www.indiandentalacademy.com
46. SPACE REGAINERS
Sling Shot Appliance
Modified Kings Appliance
Removable or fixed lingual arch with
spring
Clasp ring
www.indiandentalacademy.com
65. STANDARD PENDULUM
APPLIANCE
• In 1992, Hilgers
• made of 0.032 TMA wire,
• Springs deliver approximately 230 gms of
force per side.
• Springs have adjustment loop that can be
manipulated to increase molar expansion,
rotation and distal root tip.
www.indiandentalacademy.com
84. K -LOOP
• By Kalra in 1995
• The appliance consists of a K-loop to
provide the forces and moments and
Nance button to resist anchorage
www.indiandentalacademy.com
85. K-loop made of .017”x.025”TMA
wire with each loop 8mm long
and 1.5mm wide
www.indiandentalacademy.com
87. Wire marked at mesial of
molar tube distal of premolar
bracket
www.indiandentalacademy.com
88. Bend placed 1 mm distal to distal1 mm distal to distal
mark and 1 mm mesial to mesialmark and 1 mm mesial to mesial
mark.mark. Stop should be well defined
and about 1.5mm long
www.indiandentalacademy.com
89. K-loop in place with 2mm
activation
www.indiandentalacademy.com
91. Reactivation sequence
Open loop 1mm at (1); Open loop
1mm at (2); Open at (3) to regain the
200
bent of mesial and distal legs
www.indiandentalacademy.com
94. COMPRESSED SPRINGS
• Gianelly and co-workers.
• Springs made from compressed stainless
steel or NiTi.
www.indiandentalacademy.com
95. • NiTi coil is activated to about 10 mm o
produce 100 gm.
• First premolars are anchored by Nance
holding arch.
• Coil springs can also be compressed by
placing a sliding Gurin lock.
www.indiandentalacademy.com
99. REPELLING MAGNETIC
APPLIANCE
• First and second premolar are banded
and an impression is made. A palatal
stabilizing plate is fabricated and
cemented in place. First molars are also
banded.
www.indiandentalacademy.com
100. • An assembly containing repelling magnets
is placed into the molar tubes on maxillary
first molar and magnets are placed in a
repelling portion facing by ligating a sliding
yoke to an eyelet as premolar.
www.indiandentalacademy.com
101. • Activation every two or four weeks.
• Not gained wide acceptance because the
magnets tend to be expensive and bulky.
www.indiandentalacademy.com
105. SLIDING JIG
• Auxillary sectional arch wires used to tip or
move one or a group of teeth in buccal
segments distally without disturbing
anteriors.
• Have bent in eyelets on each side.
• To avoid friction or binding they should be
made of 0.022 inch round wire and can
also be made of rectangular wire.
www.indiandentalacademy.com
106. • Location of intermaxillary hook on the jig,
soldered or bent-in, is on the occlusal area
of anterior eyelet of jig.
• To move maxillary molar distally, eyelet on
distal end of jig must but against molar
tube, mesial eyelet is located between
cuspid and first premolar bracket at least 2
mm anterior to premolar bracket.
www.indiandentalacademy.com
110. • Distalizing force on the molars is produced
by compression of push coil spring
anchored by pull of class II elastics. The
force of the elastics counteracts the forces
of the push coil springs so that the anterior
segment of the Wilson arch approximates
the incisor brackets before ligation to the
anterior teeth
www.indiandentalacademy.com
111. • Posterior ends of Omega loop should
contact the face bow tubes on maxillary
first molar, and anterior section of arch
should approximate brackets on maxillary
anterior teeth. 5 mm section of 0.010 x
0.045” open wound coil is placed over end
of William’s arch bilaterally.
www.indiandentalacademy.com
112. • Advocated sequential use of elastics with
decreasing force values i.e. 5/16” 6-oz in
first week, similar size 4-oz in second and
and similar size 2-oz in third and
subsequent weeks of treatment.
www.indiandentalacademy.com
113. • Appliance is activated by placing loop
forming pliers into Omega loop, forcing
posterior leg distally. Elastic sequence
begins again when reactivated.
• Lower arch should have a stiffer
rectangular arch wire or lingual arc.
www.indiandentalacademy.com
117. HERBST APPLIANCE
• Emil Herbst in 1905.
• Original design consisted of placement of
bands on maxillary first premolar and
molar and mandibular first premolar, which
were connected with lingual bar to support
anterior teeth.
www.indiandentalacademy.com
118. • The arches are connected with a
telescopic adjustable piston mechanism to
produce a protrusive force on mandible.
www.indiandentalacademy.com
119. • Class II correction is by equal amounts of
dental and skeletal changes.
• Dental changes include distalization of
maxillary molar and mesial movement of
mandibular molar and incisors.
www.indiandentalacademy.com
120. • Skeletal changes include inhibition of
maxillary antero-posterior growth and to
produce an increase in mandibular length
and lower face height.
www.indiandentalacademy.com
124. LIP BUMPER
• used for molar anchorage, prevention of
poor lip habits and creation of increased
space for mandibular arch.
• Made of 0.045” stainless steel that spans
the facial structures of mandibular arch
without contacting teeth and inserted into
molar tubes.
www.indiandentalacademy.com
125. • Anteriorly wire is covered by plastic tubing
or acrylic shield to hold lip away from
incisors.
• Force from mentalis muscle is transmitted
to molar, enabling them to move to an
upright and distal position
www.indiandentalacademy.com
128. APPLIANCE SELECTION
CRITERIA
• Regardless of approach, one should
ponder several issues before considering
any of these appliances for use
Side effects
Case types
Arch length
Treatment timing
Co-operation
www.indiandentalacademy.com
129. Side Effects
• Did incisors flare?
• If mandible is used as an anchor unit, did
anything occur in that arch?
www.indiandentalacademy.com
130. • Side effects are a fact of life, especially in
orthodontics.
• There are some side effects that would be
favorable in certain cases, while the same
effects may be detrimental in others.
www.indiandentalacademy.com
131. • The key to correct appliance selection is to
know, and be able to predict these effects.
• For this a sound and thorough knowledge
of biomechanics is essential.
www.indiandentalacademy.com
132. Case types
• Consider an individual case at hand and his/her
needs.
• If mandibular dentition can be slightly
mesialized, if this in the case then Herbst or
BDA may be appliance of choice.
• If not pendulum and other intra-arch appliances
can be used.
• If you may not afford flaring of incisors then
headgear would be treatment of choice.
www.indiandentalacademy.com
133. Arch length
How much distalization is required.
TPA has limited application of 2-3 mm, if
in need of greater amount of correction
then Herbst and headgear are of choice
followed by pendulum, Wilson BDA etc.
www.indiandentalacademy.com
134. Treatment timing
Perhaps best time to initiate distalization is
late mixed dentition and it may be too late
after eruption of second molar.
Some synergistic effect as dentition
transits from primary to permanent as
canines and premolars follow molars as
they moved distally. Thus appliances that
requires some anterior anchorage like
pendulum may dilute these results.
www.indiandentalacademy.com
135. Co-operation
• Invariably appliances that require least
co-operation come with side effects that
have to be considered.
www.indiandentalacademy.com
136. CONCLUSION
• 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 .
www.indiandentalacademy.com
137. • Right appliance should be selected for the
right patient and one should not select the
patient for the appliance rather the
appliance should be for the patient
www.indiandentalacademy.com
138. Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com