CONTINUING EDUCATION

The effect of maxillary first molar derotation on

arch length
Stanley Braun, DDS, MME, a Budi Kusnoto, DDS, b and Carla A. Evans, DDS, DMSc c
Chicago, Ill.

Inthe correction of Class II malocclusions, derotation of the maxillary first molars is required to
obtain an idealized Class I relation. Because of its trapezoidal shape, the maxillary first molar is
believed to provide an arch length gain attendant to its derotation, which may subsequently be
used to resolve deficiencies mesial to it. Two commonly used mechanisms for maxillary first molar
derotation and its associated centers of rotation were studied. A transpalatal arch, when
accompanied by distal force equivalent at the level of the maxillary first molar center of resistance,
can provide a center of rotation approximating the lingual attachment. This produces an arch length
gain of 2.1 mm anterior to the molar, while simultaneously impinging on the maxillary second molar
space 1.2 mm (per side). In reality, this may be a transference of a problem in one area of the
dental arch to another. The 2 × 4 and 2 × 6 arch wires provide for various centers of rotation
along an axis from the molar center of resistance--as projected to the occlusal surface--to the
region of the maxillary first molar distal marginal ridge. These centers of rotation do not provide any
meaningful alteration in arch length. These arch wires are useful, however, for maxillary first molar
derotation necessary to achieve an idealized Class I molar occlusion. It is evident that the arch
length gain related to derotation of the maxillary first molars, irrespective of the center of rotation, is
insufficient to achieve Class I premolar intercuspation. Additional factors as growth, surgical
intervention, or extractions are needed to achieve Class I premolar articulation. (Am J Orthod
Dentofac Orthop 1997;112:538-44.)

I n Class II malocclusions, the mesial Two fundamental mechanisms may be used to

aspect of the maxillary first molar is often rotated
toward the lingual. TM The degree of rotation
appears to be related to the intercuspation of the
opposing dentition. Some early investigators3'5
have developed devices to quantify the molar
rotation. In the correction of Class II malocclu-
sions, maxillary first molar derotation is needed to
achieve an idealized Class I intercuspation with
the opposing molars. 1 Ricketts 6 and Andrews 7
have described the normal angulation of the max-
illary first molar buccal surface related to a pre-
molar/canine line for ideal Class I molar intercus-
pation. Clinicians have noted the trapezoidal
shape of the maxillary first molars and the related
arch length gain associated with its derotation. 8-1°
This is believed to provide arch length that may
subsequently be used to resolve deficiencies me-
sial to the maxillary first molar.
~Clinical Professor of Orthodontics, University of Illinois at Chicago and
Vanderbilt University Medical Center.
bResident in Orthodontics, University of Illinois at Chicago.
CAssociate Professor and Head, Department of Orthodontics, University of
Illinois at Chicago.
Reprint requests to: Dr. Stanley Braun, 7940 Dean Rd., Indianapolis, IN
46240.
Copyright © 1997 by the American Association of Orthodontists.
0889-5406/97/$5.00 + 0 8/1/79596
derotate the maxillary first molar: the transpalatal
lingual arch, or an arch wire. The transpalatal
lingual arch, when properly activated to result in
bilateral equal couples in conjunction with a distal
force, the equivalent of which passes through the
center of resistance of the maxillary first molar,
will produce a molar center of rotation approxi-
mating the lingual bracket or sheath (Fig. 1). 4'10
The 2 × 4 or 2 × 6 arch wires have been
recommended to derotate the first molar, it The
free span of wire distal to the anterior teeth,
bypassing the premolars, provides a reduced load
deflection rate and a long range of activation. If a
symmetric 'V' activation is placed between the
anterior attachment and the first molar, the molar
center of rotation will approximate its center of
resistance in the occlusal view (Fig. 2, A).
Whereas, if an asymmetric 'V' activation is placed in
the arch wire as shown in Fig. 2, B, the attendant force
system will cause the molar center of rotation to
approximate its distal marginal ridge.
It is the purpose of this study to determine the
effect of differing centers of rotation on arch length.
The centers of rotation that will be examined are
located at the lingual attachment, at the center of
resistance (as seen in the occlusal view), and at the distal
marginal ridge of the maxillary first molar (Fig. 3).

538
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 112, No. 5
Fx
t:I1
= Center of resistance = center of rotation
F = D i s t a l D i r e c t e d f o r c e at b r a c k e t
= M 1 + F 1 e q u i v a l e n t at m o l a r c e n t e r o f r e s i s t a n c e
(M 1 = F.X)
Fig. 1. Symmetric activation of transpalatal lingual arch with adjunctive distal force
equivalent passing through center of resistance.
METHODS AND MATERIALS
Accurate, scaled duplications of the occlusal surfaces
of the maxillary and mandibular left buccal teeth (premo-
lars through second molars) were excerpted from Wheel-
er's text 12 and each enlarged 650% onto transparent film.
The mandibular teeth and the overlaid maxillary teeth
were articulated to correspond to a full cusp Class II
occlusion. The maxillary first molar was then derotated in
2° increments maximally, as permitted by an ideal Class I
molar intercuspation. Measurements of the change in
arch length, at the mesial and distal dental contact areas,
were made. These measurements were subsequently re-
duced from the 650% enlargement to true millimetric
measurements. This procedure was repeated for each of
the three molar centers of rotation.
A second method was also used in this study. The
outlines of the aforementioned enlarged buccal teeth
were digitized with a Summasketch II digitizer (Summa-
graphics Corp.). Nine hundred points were used to delin-
eate the maxillary first molar occlusal outline. The X and
Y coordinates of these points were inserted into a special
computer program with Borland Turbo Pascal Language
version 5.5 (Borland International Corp.). Each mesial
and distal contact point was identified to specify the
mesial and distal margins of the maxillary first molar. By
using a transformation matrix:
x' = Ixl Icos~ - Sinai
y' l y[ I Sinc~ Cosal
Each of the coordinates were rotated in 2 ° increments,
using the three different centers of rotation as identified in
Braun, Kusnoto, and Evans 539
FI
02
01 ~ 0 2
Fig. 3. The maximum rotation permitted by the intercus-
pation for a center of rotation at the distal marginal ridge
was 14°, and a maximum of 22 ° corresponding to a center
of rotation about the center of resistance projected to the
occlusal surface, and 18° corresponding to a center of
rotation at the center of a lingual attachment.
RESULTS
The data obtained through the engineering
drafting a n d t h r o u g h the c o m p u t e r p r o g r a m m e t h -
ods for e a c h o f t h e c e n t e r s o f r o t a t i o n a r e shown in
T a b l e I. T h e m e a s u r e m e n t s are to the n e a r e s t 0.1
m m , b e c a u s e a g r e a t e r accuracy w o u l d have little
clinical relevance, even t h o u g h the m e t h o d s previ-
ously m e n t i o n e d a r e c a p a b l e o f yielding g r e a t e r
accuracy.
T h e m a x i m u m c h a n g e s in t h e m e s i o d i s t a l width
t h a t c o r r e s p o n d to t h e m a x i m u m r o t a t i o n s p e r m i t -
t e d by t h e m o l a r i n t e r c u s p a t i o n are s u m m a r i z e d in
T a b l e II.
DISCUSSION AND CONCLUSIONS
It is apparent that the centers of rotation (1) about a
vertical axis passing through the center of resistance and
(2) at the distal marginal ridge, produce no clinically
useful alteration in arch length when the 2 × 4 or 2 × 6
arch wires are used. The maximum derotation angle
permitted by the occlusion for these two centers of
rotation is 22 ° and 14°, respectively. The corresponding
540 Braun, Kusnoto, and Evans
2 ¸¸
Mx
A ol
M 2
[ ce S y s t e m on
B o~
Fig. 2. A, Symmetric 'V' activation of 2 × 6 arch wire. B, Asymmetric 'V' activation of 2 ×
6 arch wire.
mean gain in arch length mesial to the first molar is 0.7
mm and 0.8 ram, respectively. It should be noted that, in
the case of the molar rotation about the distal marginal
ridge, there is a 0.2 mm impingement on the adjacent
second molar space. This is due to the contour of the
distal surface of the first molar acting as a cam.
Derotating the maxillary first molar with a 2 × 4, or
2 × 6 arch wire can provide centers of rotation at various
points along a mesiodistal axis from the molar center of
resistance to the distal marginal ridge. The exact location
of the center of rotation is a function of the degree of
imbalance between the anterior and posterior moments
American Journal of Orthodontics and Dentofacial Orthopedics
November 1997
1 ~-02
M I = M 2 = ( M 3 = M 4 on
c o n t r a l a t e r a l side not s h o w n )
= M o l a r c e n t e r of resistance
• ..... . !!. . . . .
side)
= M o l a r center of resistance
caused by the arch wire activation (Fig. 2,A and B). Again,
it is apparent these centers of rotation provide a very
marginal alteration in arch length However, when the
primary objective is molar derotation to accommodate a
Class I intercuspation, these arch wires can be used to
advantage. The clinician should not ignore the side effect
at the reactive anterior teeth that would be an alteration
of the anterior arc with a change in canine width in the
case of the 2 × 6 arch wire.
The mean arch length gain anterior to the maxillary
first molar, when the center of rotation is at the center of
a lingual attachment, is 2.1 mm at a maximal derotation
American Journal of Orthodontics and Dentofacial Orthopedics Braun, K u s n o t o , a n d E v a n s 541
Volume 112, No. 5

d
CR

CLS

CR = Occlusal Projection of Center of Resistance

D M R -- Distal Marginal Ridge
CLS = Center of Lingual Sheath or Bracket

Fig. 3. Various centers of rotation studied.

T a b l e I. Maxillary left first m o l a r d e r o t a t i o n with v a r i o u s c e n t e r s o f r o t a t i o n

1st Computer trial 2nd Computer Trial Mean 1st Drafting Trial 2nd Drafting Trial Mean

Rotation Posterior Anterior Posterior Anterior Posterior Anterior Posterior Anterior Posterior Anterior Posterior Anterior
Center (degree) (ram) (ram) (ram) (mm) (mm) (ram) (ram) (ram) (ram) (ram) (ram) (mm)

CR 2 0.0 0.1 0.0 0.0 0.0 0.1 0.0 0.2 0.0 0.0 0.0 0.1
CR 4 0.0 0.I 0.0 0.1 0.0 0.1 0.0 0.2 0.1 0.1 0.1 0.1
CR 6 0.0 0.2 0.0 0.2 0.0 0.2 0.2 0.3 0.2 0.1 0.2 0.2
CR 8 0.1 0.3 0.0 0.2 0.0 0.2 0.2 0.3 0.2 0.3 0.2 0.3
CR 10 0.1 0.3 0.1 0.3 0.1 0.3 0.2 0.3 0.2 0.4 0.2 0.4
CR 12 0.1 0.4 0.1 0.4 0.1 0.4 0.2 0.3 0.3 0.5 0.3 0.4
CR 14 0.2 0.5 0.2 0.4 0.2 0.5 0.2 0.5 0.3 0.5 0.3 0.5
CR 16 0.2 0.5 0.2 0.5 0.2 0.5 0.3 0.5 0.4 0.6 0.4 0.5
CR 18 0.3 0.6 0.2 0.6 0.2 0.6 0.4 0.6 0.4 0.6 0.4 0.6
CR 20 0.3 0.7 0.3 0.6 0.3 0.7 0.4 0.6 0.5 0.7 0.4 0.7
CR 22 0.3 0.7 0.3 0.7 0.3 0.7 0.5 0.6 0.5 0.7 0.5 0.7
DMR 2 0.0 0.1 0.0 0.1 0.0 0.1 0.0 0.2 0.0 0.0 0.0 0.l
DMR 4 -0.1 0.2 -0.1 0.2 -0.1 0.2 0.0 0.2 0.0 0.0 0.0 0.1
DMR 6 -0.1 0.3 -0.1 0.3 --0.1 0.3 -0.1 0.3 -0.1 0.0 -0.1 0.2
DMR 8 -0.1 0.4 -0.1 0.4 -0.1 0.4 0.1 0.3 -0.2 0.5 -0.1 0.4
DMR 10 -0.1 0.5 -0.1 0.5 -0.1 0.5 -0.2 0.5 -0.2 0.6 -0.2 0.5
DMR 12 0.2 0.7 -0.2 0.6 -0.2 0.6 -0.2 0.5 -0.2 0.8 -0.2 0.6
DMR 14 -0.2 0.8 -0.2 0.8 -0.2 0.8 -0.2 0.8 -0.2 0.9 -0.2 0.8
CLS 2 0.1 0.2 -0.2 0.2 -0.2 0.2 0.0 0.0 0.0 0.3 0.0 0.2
CLS 4 -0.3 0.4 -0.3 0.4 -0.3 0.4 -0.2 0.3 -0.2 0.6 -0.2 0.5
CLS 6 -0.4 0.6 -0.5 0.7 -0.5 0.7 0.3 0.6 -0.3 0.8 --0.3 0.7
CLS 8 -0.6 0.9 -0.6 0.9 -0.6 0.9 -0.5 0.8 -0.4 0.9 -0.5 0.9
CLS 10 -0.7 1.1 -0.8 1.1 -0.7 1.1 -0.5 1.0 -0.7 1.2 -0.6 1.1
CLS 12 -0.8 1.3 -0.9 1.4 -0.9 1.4 -0.8 1.4 -0.8 1.5 -0.8 1.4
CLS 14 - 1.0 1.6 -1.0 1.6 -1.0 1.6 - 1.9 1.5 -0.9 1.8 --0.9 1.7
CLS 16 -1.1 1.8 -1.2 1.9 -1.1 1.9 1.1 1.7 -1.1 2.0 -1.1 1.8
CLS 18 -1.2 2.1 -1.3 2.1 -1.3 2.1 -1.1 2.0 -1.1 2.2 -1.1 2.1

CR: Center of resistance (occlusal view).

DMR: Distal marginal ridge.
CLS: Center of lingual sheath.
( - ) Indicate encroachment on adjacent tooth space.
542 Braun, Kusnoto, and Evans
Table II. Maximum maxillary left first molar derotation with various centers of rotation corresponding to maximal rotations
permitted by the opposing dental anatomy
Computer Measmt
Rotation Posterior
Center (degrees) (ram)
CR 22 0.3
DMR 14 -0.2
CLS 18 1.3
CR: Center of resistance (occlusal view).
DMR: Distal marginal ridge.
CLS: Center of lingual sheath.
( - ) indicate encroachment on adjacent tooth space.
M1 M2
01 = 0 2
M 1= M 2
~ = M o l a r center of resistance
Fig. 4. Symmetric activation of transpalatal lingual
arch.
angle of 18 ° . However, the distal surface of the maxil-
lary first molar encroaches on the maxillary second
molar space 1.2 ram. Although the arch length gain of
2.1 mm is significant, if the premolars are in a full cusp
Class II relation, 7 mm 12 will be required to provide a
Class I relationship of these teeth. If the premolars are
in an end-on relationship, then 3.5 mm 12 would be
required to achieve a Class I intercuspation of these
teeth. (Although in this case, 18 ° of molar derotation
may not be available because the molars would likely
not be as severely rotated as in a full cusp Class II
relationship.) It is therefore important to have either
differential maxillomandibular growth (natural or sur-
gical) expressed on the occlusal plane. Alteration of the
cant of the occlusal plane to achieve a Class I intercus-
pation engenders instability. 13-t6 A Class I relationship
may also be achieved by extractions in both arches. The
clinician should consider the 1.2 mm impingement on
the adjacent second molar space. Perhaps second molar
derotation will be required to accommodate this. An
American Journal of Orthodontics and Dentofacial Orthopedics
November 1997
Drafting Measmt Combined Mean
Anterior Posterior Anterior Posterior Anterior
(ram) (ram) (ram) (ram) (ram)
0.7 0.5 0.7 0.4 0.7
0.8 -0.2 0.8 0.2 0.8
2.1 -1.1 2.1 1.2 2.1
unerupted second molar will be negatively influenced
by the space loss.
Obtaining a maxillary molar center of rotation at the
center of the lingual attachment is not simply achieved. If the
lingual arch is activated to produce two equal and opposite
moments as shown in Fig. 4, the initial molar centers of
rotation will be on an axis projected occlusally through the
center of resistance of each molar. Over time the centers of
rotation will migrate toward the lingual attachments. The
rapidity of this change is a function of the stiffness of the
cross-arch arc of the lingual arch. The greater the stiffness,
the more rapidly the center of rotation will migrate toward
the lingual attachment. For this reason, loop configurations
in the lingual arch are undesirable. However, a stiff wire will
provide high rotating moments to the molars that will rapidly
diminish, and importantly, it will be clinically difficult to
achieve two equal opposite moments at the molars. Iv If the
moments are not in balance, tmdesirable anteroposterior
molar tipping forces occur.
To obtain molar centers of rotation at the lingual
attachment, an adjunctive distal force acting through the
center of resistance of each molar must exist in combina-
tion with the couple provided by the lingual arch. If this
distal force is applied to the molar at the buccal attach-
ment, then a moment would be required as seen in Fig. 5,
A. The resulting moment-to-force ratio would provide the
equivalent of a single force acting through the molar
center of resistance, is The force applied at the bracket
would also complement the molar rotation moments of
the lingual arch (Fig. 5, B). Alternatively, a distal force
may be applied at the same level as the center of
resistance of the molars by an extraoral appliance, elimi-
nating the need for the antitipping moment (Fig. 6, A). A
moment will occur as seen in the occlusal view of Fig. 6, B,
which enhances the derotation couple provided by the
lingual arch. This adjunctive extraoral distal force com-
bined with the couple of the lingual arch will provide a
center of rotation approximating the lingual attachment.
This approach is vulnerable to patient compliance. In
addition, the horizontal tube that accepts the inner bow of
the extraoral appliance will be misaligned as the molar
rotates. This will require frequent adjustments of the
American Journal of Orthodontics and Dentofacial Orthopedics Braun, Kusnoto, and Evans 543
Volume 112, No. 5

A B

~: = C e n t e r of resistance
Contralateral force system is identical

F(x) = M o m e n t assists
m o m e n t (M) of
lingual, arch

F ,~Wv
M

M = Required anti-tipping m o m e n t = F(y)

F = Distal Force at buccal attachment

Fig. 5. Lateral (A) and occlusal (B) views of distal force applied at molar bracket.

A B

= Center of resistance
Contralateral force system is identical

Lateral View Occlusal View

Moment of
lingual arch
Extra
oral
force

Extra
oral
force

Fig. 6. Lateral (A) and occlusal (B} views of extraoral force system.

inner bow. Dr. Burstone (verbal personal communication,
1996) has suggested a vertical tube at the molar to accept
the face-bow to minimize this problem.
In summary, it is necessary that the first molar be
derotated when a Class I intercuspation is desired. On
the basis of this investigation, all three centers of
rotation can satisfy this requirement. The largest arch
length gain requires rotation about the lingual attach-
ment. This demands a sophisticated force system be
applied to the molars. However, it is apparent that the
544 Braun, Kusnoto, and Evans American Journal of Orthodontics and Dentofacial Orthopedics
November 1997

arch length gain related to derotation of the maxillary
first molars, irrespective of the center of rotation, does
not provide sufficient arch length gain to obtain Class I
intercuspation of the premolar teeth. Additional factors
as growth, surgical intervention, or extractions are
required to achieve Class I premolar articulation.
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