MOLAR

DISTALIZATION

DR.PRASHANTH.G.S
DEPARTMENT OF ORTHODONTICS
BAPUJI DENTAL COLLEGE AND HOSPITAL
 CONTENTS
► INTRODUCTION
► HISTORY
► INDICATIONS AND CONTRAINDICATIONS
► APPLIANCE SELECTION CRITERIA
► SECOND MOLAR EXTRACTION
► UPPER MOLAR POSITIONING
► CLASSIFICATION AND APPLIANCES
► APPLIANCES
► CONCLUSION
► REFERENCES
 INTRODUCTION
► Whenever there is space deficiency, the methods of
gaining space that strikes to our mind first are, extraction,
expansion and stripping.
► Angle, proposed expansion of dental arches for
nearly every patient and extraction for orthodontic purpose
was not necessary for stability of results or for aesthetics.
He believed that when teeth could be saved by dental
treatment, extraction of teeth for orthodontic purpose
seemed particularly inappropriate unacceptable.
► In 1930’s, Charles Tweed observed relapse after
non-extraction expansion treatment and decided to retreat
with extraction.
► In recent years, the percentage of patients having
extraction as a part of orthodontic treatment has
decreased considerably as experiments has shown that
premolar extraction does not necessarily guarantee
stability of teeth alignment.
► Proximal stripping also has it’s own limitation.
► So which one to opt?
► Molar distalization, in recent years is evolved as an
alternative method of gaining space to conventional
methods where ever is indicated.
 HISTORY
► Kingsley was the first person to try to move the
maxillary teeth backwards in 1892 by means of
headgear.
► 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.
► Renfroe (1956) reported that lip bumper primarily
devised to hold hypertonic lower lip caused a distal
movement of lower molars sufficient to change
class I to Class II.
► Gould (1957) was first person to discuss about
unilateral distalization of molars with extra-oral
force.
► Kloehn (1961) described the effects of
cervical pull headgear.
► Graber T.M. (!969) extracted the maxillary II
molar and distalized the first molar to correct class
II div.I.
 INDICATIONS
► Profile :
Straight profile
► Functional
Normal, healthy temperomandibular joint
Correct mandible to maxillary relationship
► Skeletal
Class I skeletal
Normal, short lower face height
Maxilla, normal transverse width
Brachycephalic growth pattern
Skeletal closed bite
► Dental
Class II molar relationship
Deep overbite
Permanent dentition
Maxillary first molar mesially inclined.
Preferably prior to eruption of second
molar.
Maxillary cuspids labially displaced.
Loss of arch length due to premature loss of
second deciduous molar.
 CONTRAINDICATIONS
► Profile :
Retrognathic profile
► Functional :
Numerous signs and symptoms of
temperomandibular joint.
Posteriorly and superiorly displaced condyles.
► Skeletal :
Class II skeletal
Skeletal open
Excess lower face height
Constricted maxillary arch
Dolicocephalic growth pattern
Dental :
Class I or III molar relation.
Dental open bite
Maxillary first molar distally inclined.
 SECOND MOLAR
EXTRACTION
► Extractionof second molar is often use in
conjunction with distillation of first molar.
In last few years the extraction of second
molar has become a matter of great interest
and controversy within dental profession.
Advantages :
Reduction in amount and duration of appliance therapy.
Facilitation of treatment using removable appliance.
Faster eruption of third molar/surgical removal avoided.
Facilitation of first molar distal movement.
Less likelihood of relapse
Good functional occlusion
Mild premolar crowding is corrected without mechanotherapy.
Natural contact area from canine to first molar retained.
Results are stable as tongue space has not been compromised.
Since premolars are not extracted, more teeth available for
chewing.
► Disadvantages :
Too much tooth substance removed.
Extraction site located far from area of cancer in
moderate to severe anterior crowding.
Possible impaction of third molar even with second
molar extraction.
 UPPER MOLAR POSITION
► Itis a linear measurement between distal
surface of maxillary first molar and
pterygoid vertical line (PTV). It is an
indication of the forward position of upper
molar and illustrates the clinician whether or
not sufficient space is present for second
and third molars. This indicates or
contraindicates molar distalization.
► It’s
mean value in patients age in years plus
3 mm until growth is completed.
► In non-growing patients mean value is
18 mm.
 CLASSIFICATION
► Extra – Oral
Bilateral
► Unilateral
Intra-oral
Inter-arch
Intra-arch
 APPLIANCE SELECTION
CRITERIA
► Regardless of approach, one should ponder several
issues before considering any of these appliances
for use :
Side Effects :
► Potential side effects.
► Did incisors flare
► If mandible is to be used as an anchor unit, did
anything occur in that arch.
► Side effects are a fact of life, especially in
orthodontics.
 Case types :
► Consider 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 TPA
or headgear would be treatment of choice.
► 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.
► 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.
► Co-operation :
If one lives by the sword, one dies by
the sword.
Invariably appliances that require least
in co-operation come with side effects that
have to be considered.
 ATKINSON BUCCAL BAR
► Used with minimum amount of class II elastics of
two ounces.
► Move buccal segment posteriorly whether second
molar are present or not.
► Long lever action puts greater force on upper
molar with very little force on anchorage unit.
► Anchorage preparation is 6 to 6 lingual arch that
touches the lowest area of enamel on four
incisors.
 HERBST APPLIANCE
► Emil Herbst in 1905.
► 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. Skeletal changes
includes inhibition of maxillary antero-
posterior growth and to produce an increase
in mandibular length and lower face height.
► Original design consist of placement of bands on
maxillary first premolar and molar and mandibular
first premolar, which were connected with lingual
bar to support anterior teeth. The aches are
connected with telescopic adjustable piston
mechanism to produce a protrusive force on
mandible.
► New design by Larry white of New Mexico used
stainless steel crown on maxillary first molar and
removable mandibular occlusal coverage acrylic
splint. Which allows temporary removal of
mandibular component to facilitate oral hygiene
and adjustments for erupting teeth.
 JASPER JUMPER
► Flexible fixed appliance that delivers light
continuous force.
► Can be used to move a single tooth or an entire
arch.
► It can deliver functional, bite jumping, distalizing
force, elastic like force or combination of these.
► When appliance is fixed, mastication helps to
deliver intrusive and distalizing force on upper
molar, much as a high pull face bow with
occasional opening of posterior bite similar to that
seen in Herbst.
 SAGITTAL APPLIANCE
► Used to develop arches by actively moving teeth,
in groups or singly in antero posterior direction
along crest of alveolar ridges.
► With proper design can be used unilateral or
bilateral.
► If second molars are intact, the primary direction
of development and arch will be of anterior in an
anterior direction (Class II div II).
► If second molars are removed, primary direction of
movement of teeth will be posterior segment in
distal direction. (severe anterior crowding).
PENDULAM AND PENDEX APPLIANCE
► In 1992, Hilgers
► Consists a large acrylic nance button that covers
midportion of palate. The acrylic pad is connected
to dentition by means of occlusal rests that
extends from lateral aspect of pad and are bonded
to occlusal surfaces of upper first and second
premolars. Posteriorly directed springs, made of
0.032 TMA wire, extends from distal aspect of
palatal acrylic to form a helical loop near the
midline and then extends laterally to insert into
lingual sheath on bands cemented on maxillary
first molar.
► 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.
► Pendix is eventually same as pendulum, except for
addition of palatal expansion screw in midline.
► Used in maxillary constriction.
► This design features two wires that extends from
palatal aspect of maxillary first molars. There
provides stability and are removed when
distalization started.
► Another appliance of pendulum family is termed
the “phd” appliance. This version features an all
metal design with no acrylic palate.
► If midline expansion screw is to be activated, a
one turn per day protocol is followed for initially
for 28 days.
► Because of anchorage considerations, springs for
distalization should be activated at one side at a
time.
► Approximately 5 mm of distal molar movement in
3-4 months.
► Retention by quick nance, utility arch.
 MINI DISTALIZATION APPLIANCE
► Hilgers
► Comprises of small, spindle type expander that is soldered
to bands on maxillary first premolars. Distalizing spring
are made from 0.032 TMA wire secured to palatal side of
spindle with a flattened recurved loop fitted into a braiced
0.036 lingual sheath.
► Once appliance is cemented the lingual arms are bonded
to second premolars or second deciduous molars to
enhance anchorage.
► Clean and rigid
► Should be used in patients with stronger masticatory
muscular pattern (Brachyfacial class II div.2) and in whom
some forward movement of anterior dentition is acceptable
on even desirable.
► Caravo and Testa of Italy.
► Acrylic nance button anchor the appliance against
palatal mucosa. Appliance is anchored to
maxillary dentition by placing bands on maxillary
second premolars.
► Premolar bands are connected to palatal acrylic by
way of 0.036” wire that is soldered to lingual
aspect of bands.
► Bilateral tubes with an internal diameter of 0.036”
are embedded in palatal acrylic. A stainless steel
piston lies within the lumen of the tube and
extends posteriorly making a lateral bayonet bend
and inserting into lingual sheath of maxillary first
molar. An coil spring and an activation collar are
placed over each tube.
► Recommended using nickel titanium springs that
generate 240 gm in adults and 180 gm in children.
► Can also be modified by incorporating helical loops
in bayonet bend just anterior to lingual sheath.
Adjustment of these loops can produce distal
molar rotation or upright mesially tipped maxillary
molars.
► If expansion of molars is desired, appliance should
be constructed parallel to the line of occlusion. If
molars expansion is not necessary, appliance
should be constructed with distalizing mechanisms
5o inward to line of occlusion.
► Activation once in 6 weeks on average, seven
month of molar distalization with four activation is
required
 WILSON’S DISTALIZING ARCH
(BIMETRIC ARCH)
► Developed by Wilson and Wilson.
► Arch is bimetric in that anterior segment is
made from 0.022” stainless steel, where as
posterior segment are attached to elastic
hook in canine region. An omega shaped
stop is located in premolar area. A 0.010 x
0.045” open wound coil spring is placed
between distal leg of Omega stop and face
bow tube.
► Distalizing force on the molars is produced by
compression of push coil spring anchored by
pull of class II elastics.
► 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 coul is placed over end of William’s arch
bilaterally.
► Advocated sequential use of elastics with
decreasing force values i.e. 5/16” 6-OZ in first
week, similar size 4-OZ in 2and and similar size
2-OZ in third and subsequent weeks of
treatment.
► Appliance is activated by placing loop
forming plier 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.
 COMPRESSED SPRINGS
► Gianelly and co-workers.
► Springs made from compressed stainless steel or
NiTi used in conjunction with non-cooperation
based appliances.
► NiTi coils are placed on a sectional wire made from
0.016 x 0.022 stainless steel that extends from
premolar to first molar (second premolar remains
unbracketed). 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.
DEFLECTION OF STRIGHT WIRE
► Gianely and associates.
► Author demonstrated distalization of maxillary
molar with 100 gm NiTi wire (0.018 x 0.025 Neo
sentalloy) compressed between maxillary first
premolar and first molar with rimpable stops A
nance holding arch cemented to first premolar is
used as anchorage.
► Kalra has developed a TMA arch wire compressed
between maxillary first premolar and first molar.
► Gianelly recommends that distance between stops
should be 5-6 mm longer than space between
bracket and molar tube.
 REPELLING MAGNETIC APPLIANCE
► Firstand second premolar are banded and an
impression is made. A palatal stabilizing plate is
fabricated and cemented in place. First molar are
also banded. 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.
► Activation every two or four weeks.
► Not gained wide acceptance because the magnets
tend to be expensive and bulky.
 K-LOOP
► Varun Kalra in 1995
► Consists of K-loop to provide forces and
movements and Nance button to provide
anchorage.
► 0.017 x 0.025 TMA wire.
► Each loop of K is 8 mm large and 1.5 mm wide.
The leg of K are bent down to 20o and inserted
into molar tube and premolar bracket. Wire is
marked on mesial end molar tube and distal of
premolar bracket. Stops are bent in wire 1 mm
distal to distal mark and 1 mm mesial to mesial
mark. Each stop is well defined to about 1.5 mm
long allowing 2 mm activation of K-loop.
► 20o bends produce moments that counteract
tipping moments created by force of appliance.
► Reactivated to 2 mm after six to eight weeks are
reactivation produces a total of 4 mm of distal
molar movement.
► Anchorage by nance arch to first premolar.
 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 should be made of 0.022 inch
round wire and can also be made of rectangular
wire.
► 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.
 MODIFIED NANCE APPLIANCE
► Tracy J.Reiner
► For unilateral distalization.
► Made of 0.036” stainless steel
► On Class I side it projects anteriorly like the arm of
Quad helix. This is to resists horizontal movement
that would rotate molar distally.
► On Class II side also had an arch bent similar to
Quadhelix with anterior terminous soldered to first
bicuspid band. An 0.020 Omega loop soldered to
anterior end of frame work and distal end of loop
to slide distally as it was opened for activation.
►A 10 mm 0.09” x 0.036” open coil spring I added
to frame work between Omega loop and first
molar band.
► First molar band was soldered to 6 mm 0.045”
tube with frame work running through the tube.
So that band assembly could slide.
► Activated by opening Omega loop to compare coil
spring to a length of 7 mm that delivers 150 gm
force.
► Distalization is 0.019 mm per week.
 MODIFIED NANCE APPLIANCE
► Joseph Ghafari.
► Consists of palatal arch attached to first
molar band on normal side and to first
premolar band on Class II side.
► Both premolars and molars coil fitted with
molar tubes so that sectional arch wire with
compressed open coil spring can be used
between them.
 JONES JIG
► Makes use of open coil NiTi spring to delivery 70-
75 g of force. Over the compression range of
around 5 mm.
► Modified Nance from one side anchor premolar to
other side premolar is used.
► Band first molar and second premolar, attach
double tube on molar and bracket on premolar.
► Insert jones jig into molar tube and activate the
open coil spring by tying a liguature from anterior
hook of premolar bracket.
 MOLAR DISTALIZING BOW :
► Consists of 0.8 to 1.5 mm thick
thermoplastic splint extending into buccal
sulcus. The distalizing bow fits into anterior
slot. Ends of bow fits into molar tubes
(Head gear tube).
► To activate the appliance, central section of
bow must be pressed and fitted into
anterior slot. This compresses the coils and
force is transmitted to molar.
 SPACE REGAINERS :
► Howley’s appliance with active helical
spring.
► Sling shot appliance
► King’s appliance.
► Clasp ring
► To obtain distal movement of mesially
inclined first molar.
 TRANSPALTAL ARCH :
► Robert A.Goshgarian of Illinois in 1972.
► Lemons and Holmer (1961) have indicated
that in majority of Class II cases, first
molars are rotated mesially A gain of 1-2
mm of arch length per side achieved
following corrections of rotations. Partial
class II correction can also be noted.
► Cetlin (1992) stated that distalization of
upper first molar can be achieved by
unilaterally activating the appliance.
► Rotation is placed in only one arm of TPA
and then the other arm is rotated into
position, producing distalizing force.
► Same adjustment can be made opposite
side 6 to 8 weeks later.
 REMOVABLE MOLAR
DISTALIZATION SPLINT :
► Major draw back of removable appliance in that it
requires patient co-operation.
► Made of 1.5 mm biocryl in a biostar machine.
► If both upper molars are to be moved distally,
splint extends from the area of upper right first or
second premolar to left first or second premolar.
If only one molar is to be moved, splint extends to
the terminal molar on opposite side.
► Two internal clasps are used of retention, and NiTi
open coil springs produces about 220 gm of distal
force molar are fitted with bonded button or band.
 ACRYLIC CERVICAL OCCIPITAL
APPLIANCE :
► H.Margolis.
► Consists of acrylic palatal section, Adams
clasp on premolars, labial bow that overlie
incisors for retention and finger spring
against mesial aspect of first molar.
► Finger springs which are activated in posterior
direction approximately one half of cusp width,
can be made of round or rectangular wire and
when activated excerts no more than 100-125 gm
of force.
► Molars tip distally. A 1 mm bite plate is added to
palatal acrylic to disocclude posteriorly.
► Appliance is intended to be worn 24 hours a day,
except during needs.
► Disadvantage in molar tips distally. However
tipping is less when springs are closer to center of
resistance of molars.
 CRICKETT APPLIANCE :
► Victor C.Welt.
► Rickett developed and successfully used
modification of Crozat appliance (Crozat/Rickett).
► Embraces essential features of quadhelix but
replacing palatal and lingual bars of upper and
lower appliances with Quad and bi-helix
respectively.
► Upper palatal and lower lingual bars are
constructed with 0.032” yellow and 0.038” blue
elgiloy respectively. Cribs, clasps and occlusal
rests from 0.028” blue elgiloy lingual arm from
0.030” yellow and buccal arm from 0.045” blue
elgiloy.
 C-SPACE REGAINER :
► Move molar bodily without significant incisor
flaring.
► Can be used to intrude teeth as well as to
move them distally or sagittally (in open bite
cases).
► Labial framework of 0.036” stainless steel and an
acrylic splint. A closed helix as wide in diameter
as comfort permits bent in the region of canines,
labial framework extends distally to lie as close to
buccal molar tubes as pallible. An 0.10 x 0.040”
open coil spring soldered immediately distal to
helix and 0.028” ball clasps to retain the appliance.
Splint covers the crown of anterior along with
labial frame and ball clasps. Open coil spring of
13 mm of length between solder point and mesial
end of molar tube when compressed excerpts 200
gm of force.
► Vertical control is maintained by adjusting the
frame work occlusally or gingivally.
 FIXED PISTON APPLIANCE :
► Unless a supplemental force is used to provide a
moment that torques the roots distally, a
significant amount of anchor may be lost as molar
relapses to an upright position.
► Maxillary first molar and first premolar bands,
0.036” stainless steel tubing to bicuspids, 0.030”
stainless steel wire soldered to first molar,
enlarged nance with 0.040”: stainless steel ire
reinforced, 0.055” internal diameter NiTi open coil
spring.
► Solder 0036” tubing to buccal and lingual occlusal
thirds of premolar so that they extend parallel to
first molar.
► Solder 0.030” stainless steel wires to buccal and
lingual surface of first molar band.
 TENDEM YOKE :
► Consists of 0.04” end sections, which provide
rigidity and support intermaxillary hooks and
anterior arch bar of 0.22” true-chronic for
flexibility.
► Produce rapid, friction free, 24 hours distal
movement of molars.
► Molar tube is 0.018 x 0.025” or 0.022” x 0.028”
with 0.045” round tube gingival.
► Intermaxillary elastics are worn for 12 hours a day
for distalizing following which they are removed
and head gear is applied at night.
 MOLAR
DISTALIZATION IN
LOWER ARCH :
 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. 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 portion
MODIFIED LINGUAL APPLIANCE
:
► Unilateral distalization.
► Lingual arch from molar on normal side to
premolar on Class II side.
► Both premolar and molar are fitted with
tubes so that sectional wire with
compressed open coil spring can be used to
distalize the molar.
 DISTAL JET FOR LOWER
MOLAR :
► Used to upring lower molars prior to prosthesis.
► Solder a 0.036” tube to premolar band. Parallel to
occlusal plane but below the edentulous ridge
orient tube so that wire with bayonet bend can
slide into tube from distal aspect. Bend a circle in
distal end of this wire and attach it to molar tube
with a screw so that wire and band are held
together but are free to rotate around common
axis.
► Used adjustable screw clamp and open coil NiTi.
EXTRA-ORAL –
BILATERAL :
 CERVICAL PULL (Low Pull or
Kloehn)
► In patients with decreased vertical skeletal
dimension.
► Restrict forward growth of maxilla and/or to
prevent the forward growth of maxillary
posteriors.
► Force is below the occlusal plane producing both
extrusive and distalizing force.
► Used in deep bite, hypodivergent bases.
► Outer bow longer than inner and bent upwards so
that both point of force application and line of
force lie above the centre of resistance of molar.
OCCIPITAL PULL (High Pull) :
► Force above the occlusal plane and is
distalizing and intrusive.
► Skeletal or dento-alveolar open bite and/or
steep mandibular plane angle
(hyperdivergent).
► Outer bow same length as inner and bent
upwards so that line of force is above centre
of resistance of molar.
UNILATERAL
 Power Arm :
► Outer bow is longer and/or wider than other
with wider and longer bow located on the
side and anticipated to receive greater distal
force.
► Disadvantage is it also generates lateral
forces which tend to move the favoured
molar into lingual corssbite and other molar
into buccal crossbite.
 Soldered – Offset Face Bow :
► Outer bow is attached to inner bow by a
fixed soldered joint placed on the side
favoured to receive the greater distal force.
 Swivel-Offset face bow :
► Outer bow is attached to inner bow through
a swivel joint located in an offset partition
on the side favoured to receive the greater
force.
 Spring – Attachment face bow :
► An open coil spring is warped around one of
the inner bow terminal and conventional
bilateral face bow. On the side favoured to
receive greater force.
 CONCLUSION :
► There are many advantages and disadvantages of both the
intra-oral and extra-oral methods. Main drawback of
extra-oral approach is patient compliance. This pit fall has
been overcome by the intra-oral appliances but are not
effective as extra-oral appliances.
► The need of the hour is an appliance which includes
advantages of both and eliminates disadvantages of both.
► It is imperative on our part to know indication,
contraindication and modifications that are possible with
distalization methods.
► Patient selection is of atmost importance and should
not be overlooked. Right appliance for the right patient at
right time. Appliance should be selected for patient not
patient for appliance.
► To fight a borderline case distalization is a important
weapon in orthodontists armamentarium.
 REFERENCES :
► McNamara and Brudon, New Edition, Page. 343 to 375
and 199 to 211.
► Graber and Vandarsadall, 3rd Eidtion, Page. 760 & 761.
► Seminars in Orthodontics, 2000.
► AJO : 79 : 1981 : 229-249, 1959 : 125-130, 1972 : 61 :
578-602.
► Ravindra Nanda : Bio-Mechanics in Orthodontics. Page.
265-281.
► JCO : 1991 : 24, 1992 : 25 : 402-404, 1985 : 19 : 30-33,
1992 : 25, 1994 : 28 : 43-49, 1993 : 27 : 74-81, 1995 :
29 : 298-301, 1995 : 29 : 396-397, 2000 : 34 : 32-35.
► EJO : 1991 : 13 : 43-46.
Thank you