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Molar Distalization-A Review

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Molar Distalization-A Review Molar Distalization - A Review Dr. Sumnima Sharma1 , Dr. Vijayta Yadav2, Dr. Neha Choudhary3 P G Student1,3, Reader2, Department of Orthodontics & Dentofacial Orthopedics, Career Post Graduate Institute of Dental Sciences & Hospital , Lucknow Abstract The most important step of gaining space in the dental arch in treatment planning can be achieved by different methods one of which is molar distalization. Various appliances have been introduced to distalize molars by using non extraction treatment. Headgear was the first appliance which was used for this purpose but this appliance need patient cooperation and was esthetically unpleasant. Thus there were various intra oral appliance which have been introduced. How to cite this Article: Sharma S, Yadav V, Choudhary N.Molar Distalization - A Review. HTAJOCD.2019 Introduction distally inclined. * “New Distalizer” appliance reatment options in orthodontics may * Posteriorly and superiorly displaced * Crozat treatment differ depending on the type of condyles. * Crickett appliance Tmalocclusion whenever there is Various Modalities to Distalize Molars * Distalization using Microimplant space deficiency, the methods of gaining space A. Extraoral Appliances: * Distalization with Lever arm and Mini that strikes to our mind first are, extraction, I) To Cause Bilateral Molar Distalization Implant system expansion and stripping .In the past, 1. High pull headgear, 2. Straight pull * Palatal Implant Supported Distalization. orthodontists had two main options to create the headgear, 3. Cervical or low pull headgear * ZAS (Zygomatic Anchorage System) space in the arch .One was to expand the arch II) To Cause Unilateral Molar Distalization * SAS (Skeletal Anchorage System) and the other was to extract. Angle, proposed 1. Power arm face-bow, 2. Swivel offset face B. Mandibular Arch expansion of dental arches for nearly every bow, 3. soldered offset face bow, 4. Spring * Lip bumper patient and extraction for orthodontic purpose attached face bow * Franzulum appliance. was not necessary for stability of results or for B. Intra Oral: * Modification of Distal Jet appliance. aesthetics1. These appliances can be removable or of * Unilateral Frozat Appliance In 1930's, Charles Tweed observed relapse fixed type and can be categorized into two * Implant Supported Distalization. after non-extraction expansion treatment and groups. * SAS (Skeletal Anchorage System) decided to retreat with extraction. However, we 1. Interarch: Diagnostic Criteria For Distalizing Maxillary the orthodontists of today are fortunate enough ?Atkinson Buccal Bar Molar to have more techniques and appliances in our ?Tandem Yoke The criteria for distalization varied widely hands to gain space i.e. by distalizing molar2. ? Dimensional Bimetric Distalization Arch among the clinician but some of the most Molar distalization is a process in the field of ?Modified Herbst Appliance common criteria are; orthodontics which is used to move molar teeth, ?Saif Springs ?Class-II or end-to-end molar relationship especially permanent first molars, distally in an ?Klapper Super Springs ?Maxillary molar protrusion arch. This procedure is often used in treatment of ?Eureka Springs ?Mild or moderate crowding patients who have Class 2 malocclusion.3 ?Jasper Jumper ?Good maxillary second molar positions Distalization in the maxillary arch is easier than ?Churro Jumper ?Class I skeletal pattern the mandibular arch because maxilla has more ?Sliding Jig ?Straight profile and straight divergence trabecular bone than the mandible, which has ?Forsus Fatigue Resistance Device ?Normal skeletal vertical development higher percentage of cortical bone. The ?Forsus Nitinol Flat Spring (facial proportion should be with in normal distalization of maxillary molar is of significant ?Twin Force limits). value for treatment of cases with minimal arch 2. Intraarch: ?Normal transverse development (no cross discrepancy and mild Class-II molar A. Maxillary Arch: bites etc). relationship associated with normal i) Removable Appliance: ?Good soft tissue drape. mandible.Current molar distalizing appliances ?Cetlin appliance ?Low to moderate mandibular plane angle allow effective control and manipulation of the ?ACCO (acrylic cervical occipital appliance) (hypodivergent). moment to force ratio. ?Modified ACCO appliance ?Good expectation for patient cooperation. This article is a review of the molar ?Removable molar distalization splint Classification distalization appliances and techniques used, as ?Molar Distalizing Bow A. Extraoral Methods of Molar Distalization space gaining methods have gained immense ?Segmented Removable appliance for 1. Headgear Headgear obtain support from importance in recent years. Distalization (RMD) back of neck, cranial bones and can provide Indications of Molar Distalization ?C-space regainer three dimensional anchorage control depending * Class-II molar relationship due to maxillary ii) Fixed Appliance upon the type of headgear and type of force. dentoalveolar protrusion, impacted / high * K loop Force is transmitted from headgear strap to teeth labially placed cuspids, ectopic eruption of * Pendulum appliance and its modifications. via facebow or J hook. either 1st/2nd bicuspid * Jones jig B. Intraoral Methods of Molar Distalization * Class-II molar relationship due Class-II * Distal jet and its modifications Various intraoral molar distalization Subdivision cases requiring unilateral distal * Molar distalization bow (MDB) techniques which have recently assumed an molar movement. * Intraoral Bodily Molar Distalizing important role in clinical orthodontics; * Regaining the space loss due to mesial drift Appliance (IBDA) Modified Herbst Appliance of 1st molars following premature loss of * Super elastic NiTi wire The Herbst Appliance as originally designed * NiTi Coil Springs by Emil Herbst in 1905 and was reintroduced by deciduous teeth. 4 * Minimal crowding or spacing anteriorly . * Magnets Pancharz, Herbst appliance is a passive tube * Mesially inclined upper first molars, * First class appliance for molar distalization and plunger system with the exact length of the anchorage loss during active orthodontic * Transpalatal arch tube determining the amount of anterior treatment. * Denholz appliance (Lip Bumper) mandibular displacement .(fig:1) Research to Contraindications of Molar Distalization * Nance palatal appliance date has shown that the Herbst appliance has the * An end on or full Class-II molar relationship * Modified Nance appliance for molar ability to inhibit maxillary anteroposterior due to mandibular retrognathism, distalization growth and to produce an increase in mandibular retrognathic profile * Lokar Molar Distalizer length and lower facial height. Recently it has * Skeletal and dental openbite * Distalix Appliance been reported that in many cases, Herbst * Excessive lower anterior facial height * Fixed piston appliances appliance therapy results in approximately (Dolicofacial form) * Greenfield Lingual distalizer equal amounts of dental and skeletal changes.A * Constricted maxilla, maxillary first molar * Lingual Distalizer System new design of the Herbst appliance was Sharma, et al.: Molar Distalization - A Review introduced. It was developed by Larry White, continuous force to the upper 1st molars . Thus, mandibular movement than is possible with and used stainless steel crown on the maxillary the appliance produces a broad, swing or original bite jumping mechanism of Herbst . first molars and a removable mandibular pendulum of force from midline of the palate to K-Loop: occlusal coverage acrylic splint. the upper molars. The spring can also be The appliance was designed byDr. Varun Bimetric ( Wilson Arch) adjusted to expand and rotate the max 1st molars. Kalra (1995)13to achieve bodily movement or Introduced in 1955 by Wilson the bimetric The 0.032” recurved molar insertion wire fits controlled or uncontrolled tipping of molars . arch consist of a labial arch made of a 0.040'' into the 0.036” lingual sheath on the max 1st The K Loop is made of 0.017 x 0.025 inch TMA posterior section and a 0.020” anterior section . molar band.(fig:6) Due to the nature of the wire, which can be activated twice as much as Hooks for class II elastics are soldered on to the pendulum springs maxillary molars have a stainless steel before it undergoes permanent anterior end of the 0.040” section, and an tendency to go lingually when distalized. To deformation, and the loop made of TMA adjustable omega loop is placed in the premolar compensate for this shortcoming it is prudent to produces less than half the force of one made region of the 0.0040 section.The appliance is open the horizontal adjustment loop utilizing a with stainless steel. Each loop should be 8 mm activated by placement of an open coil spring bird beak plier, which lengthens the pendulum long 1.5 mm wide (fig:11). between the omega loop and the maxillary first springs and helps prevent the unwanted lingual Lokar appliance: molar .(fig:2) A class I molar relationship can be movement.The appliance is activated by using a Lokar in 199614 had introduced new molar achieved in as little as 6-12 week. bird beak plier. During activation care should be distalizing appliance called “Lokar molar Cetlin Appliance taken to prevent opening or widening of the coil. distalizer”.This appliance utilizes the It was introduced by N.M Cetlin & Ten Modified Pendulum Appliance /M- continuous ideal force nickel titanium spring to Hove in 1983.The removable distalizing plate is Pendulum: generate rapid
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