Molar Distalization

Dr.Tahani Jamal Al-semah

INTRODUCTION

• Current orthodontic philosophies have been oriented towards

conservative treatment modalities - to avoid extractions and , at the
same time, to try to eliminate the need for patient cooperation
Indications for Molar Distalization

• Preferred in patients with low mandibular plane angle (brachy-

cephalic type) or normal (meso-cephalic type)
• Mild to moderate class II molar relationship, which are not indicated
for extraction
• To correct the second molar position
• To achieve ideal overbite and overjet
• To early correct class II pattern
• To regain the lost space (space regainer)
The signs of molar distalization can be condensed under the
accompanying headings
•
1) Profile
Straight profile
2) Functional
Normal, solid tempromandibular Joint
Correct mandible to maxillary relationship
3) Skeletal
Class I skeletal
Normal, short lower face height
Maxilla/normal transverse width
Brachycephalic development design
Skeletal closed bite
• Dental
Molar relationship with class II
Deep overbite
Permanent dentition
Upper 1st molar mesially inclined
Prior to emission of 2nd molar
Upper arch cuspids labially dislodged
Loss of arch length because of untimely loss of 2nd
deciduous molar
Contraindications for Molar Distalization

• Patients with high mandibular plane angle and excessive lower

anterior facial height
• Patients with skeletal or dental open bite
• Severe class II skeletal pattern with an orthognathic maxilla and
retrognathic mandible
• Excessive overjet and proclination of anterior teeth
• Crowding in the posterior segment
• Patients with temporomandibular joint problems
Drawbacks
• Several appliances have been introduced to accomplish distal molar
movement with or without the need for patient cooperation.
• Most produce:
• tipping, rotation and extrusion of the molars during distalization therapy.
• some produce a significant amount of incisor flaring due to anchorage loss,
which is seen clinically as increased overjet. After distalization of the
molars, the distalizing
modules and existing palatal anchorage appliances are
removed and a Nance palatal button is delivered to
maintain the first molars in their new positions
Consideration
• After distalization of the molars, the distalizing
modules and existing palatal anchorage appliances are
removed and a Nance palatal button is delivered to
maintain the first molars in their new positions
• According to William Wilson in 1978, molar
distalisation should not be done before 11 years of age as the maxillary
tuberosity enters its rapid growth phase which may lead to second and
third molar impaction.
Case selection criteria
• . The degree of space discrepancy
• and the facial profile characteristics of the patient are the
two main important factors that should be considered in
case selection criteria.
• Patients with mild to moderatespace discrepancy are good
candidates for maxillary molar distalization therapy. A maximum of 8
mm space hasbeen achieved by certain appliances.
Classifications (According to Chandra et al.)

1. Extra-oral: Head gear.

2. Intra-oral:
Extraoral Appliances:headgear

• The amount of the recommended force is about 100 grams, which

allows for a rate of tooth movement of 1 mm per month.
• This duration of wear should be as long as possible as the more the
patient will wear the appliance, the better and faster the expected
results.
• the minimum recommended time for headgear is 14 to 16 hours
daily [14, 15]. Orthopedic force,
• Although headgear is effective in distalization, it is
unesthetic and depends on patient cooperation..
Intraoral appliances :upper arch
• Herbst Appliance:
• This device was originally designed by Emil Herbst in 1909 and it was
popularized by Pancharz in 1979.
• It has the ability to inhibit maxillary anteroposterior growth and to
produce an increase in mandibular length and lower facial height.
• The intrusive and distal movements of maxillary molars
including tipping of crowns distally and mesial drift of
the mandibular anterior and posterior teeth is observed.
• Treatment in mixed dentition is not recommended using
this appliance.
 Intraoral appliances :upper arch
• Jasper Jumper: James J. Jasper made an appliance for correcting class II malocclusion in 1987
• which was identical to the herbst device in terms of
• design and force vectors.
• It consists of two vinyl coated auxillary springs attached to fully banded upper and lower fixed
appliances
• . Posteriorly, the springs were adhered to maxillary first molars whereas anteriorly to mandibular
arch wire, and retain the mandible in a protruded position.
• In both the dental arches, rectangular shaped stainless steel arch wires are used.
• In anterior region of mandibular arch to strengthen lower anchorage, labial root torque is
combined. Transpalatal bar and lower lingual arch are used for anchorage.
• This device is indicated in class II growing patients, with deep bite and retroclined
mandibular incisors.
On the other hand, contraindicated in dental and skeletal open bites with high mandibular plane
angle and increased lower facial height, as the Jasper
• Jumper creates symbolic tipping of molars distally correlates with clockwise
rotation of the mandible
Intraoral appliances :upper arch
• Pendulum Appliance
• : This appliance was designed by Higlers in 1992.
• It is a composite device consisting Nance acrylic button in palate for anchorage
and with
• 0.032" TMA springs which transfers light continuous force to upper first molars.
The force applied on each side is nearly 200-250gms which creates a movement of
• 5mm within 3-4 months of period.
• In case of maxillary arch expansion a midline screw is included into the device
and is known as Pend X-appliance.
• This device is not advised in patients having
dolico-facial types with tongue thrust habit
Intraoral appliances :upper arch
• Distal Jet Appliance:
• Carano and Testa developed this appliance in 1996.
• It is made up of acrylic Nance button which is attached with bilateral
tubes bend is given at the end of the wire which comes out of acrylic
and is inserted into palatal sheath on molar band .
• Wire is attached to NiTi coil spring with the help of screw clamp.
• To provide anchorage wire is soldered on the bands of first and
second premolars from Nance palatal button.
• Reactivation is done once a month by moving the clamp
closer to first molar
Intraoral Appliances:in the Lower Arch.

• Lip bumper :
• is functional distalizing appliance that is composed of a stainless steel wire
covered labially by acrylic to avoid ulceration of the lower lip.
• This appliance is inserted in the tubes of the lower molars and extends anteriorly
to contact the lower lip.
• The labial portion is positioned 2-5 mm from the lower incisors causing distal
forces from the lower lip to the molars.
• It has also an effect on incisor proclination as
it alters the equilibrium between the lower lip and the tongue .
Intraoral Appliances:in the Lower Arch.

• Active lingual arch :

• is another effective method for molar distalization in the lower arch.
• It has many modifications that enable the operator to distalize the
molars unilaterally or bilaterally.
• this may come on the expense of the lower anteriors as it may lead
to a reactive incisor proclination.
• this appliance is usually recommended
when lower incisors are retroclined
and molars are in need of distalization
Intraoral Appliances:in the Lower Arch.

• Franzulum :
• is another appliance, which was introduced by Buyoff et al., in the year 2000.
• It was composed of a button made of acrylic that is situated inferior and lingual
to the lower canine on each side.
• Additionally, there are two rests situated on the first premolar and the canine.
• The appliance utilizes a nickel titanium coil spring as an active component to
produce the forces of distalization
Miniscrews
• Universal Distalizing Methods for Upper and/or Lower Arches.
Miniscrews have been reliably used as a method to gain absolute
anchorage,
• miniscrews in general were able to efficiently distalize both molars
and premolars without affecting the position of anterior teeth and
minimal distal tipping
Case report