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Molar Distalization

Jun 01, 2018

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DrArpitaKashyap
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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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    Inications "or Molar istalization

    $. %on-growing patient

    -&o regain lost arch length

    -'loc(ing out of canines

    ). #pper second molar extraction

    -Lower arch normal

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    Inications "or Molar istalization

    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

    Inications "or Molar istalization

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    Inications "or Molar istalization

    ood soft tissue profile

    'orderline cases

    Mild to moderate space

    discrepanc* with missing $rd

    molars+2ndmolars not *et erupted

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    Inications "or Molar istalization

    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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    Nonextraction treatment

    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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    Nonextraction treatment

    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 #