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Review Paper INTRAORAL APPROACH to MOLAR Received : 08‑09‑15 Review completed : 17‑11‑15 Review Paper Accepted : 01‑12‑15 INTRAORAL APPROACH TO MOLAR DISTALIZATION: A REVIEW Piyush Bolya, * Bhoopendra Singh Rajput, ** Gunjan Tiwari, *** Hitender Singh Yadav, † Ashish Choubey, †† Sandeep Kumar Swarnkar ††† * Assistant Professor, Department of Orthodontics & Dentofacial Orthopaedics, Darshan Dental College & Hospital, Udaipur, Rajasthan, India ** Assistant Professor, Department of Oral and Maxillofacial Surgery, RR Dental College, Udaipur, Rajasthan, India *** Consultant Orthodontist, Smile Experts, Bhopal, Madhya Pradesh, India † Post Graduate Student, Department of Pediatric and Preventive Dentistry, Maharana Pratap College of Dentistry and Rc, Gwalior, Madhya Pardesh, India †† Post Graduate Student, Department of Conservative Dentistry and Endodontics, Maharana Pratap College of Dentistry and Rc, Gwalior, Madhya Pardesh, India ††† Post Graduate Student, Department of Pediatric and Preventive Dentistry, Maharana Pratap College of Dentistry and Rc, Gwalior, Madhya Pardesh, India _________________________________________________________________________ ABSTRACT inappropriate and unacceptable. According to To extract or not to extract has been a ley Moyers (1988)[2] the nonextraction treatment question in past for decades. Traditional upper modalities for Class II cases resulted where the molar distalization techniques require patient malocclusion is due to aggravation of dental co-operation with the headgear or elastics. symptoms and has anterior posterior and vertical Recently, several different intraoral skeletal imbalance requires maxillary molar procedures have been introduced to minimize distalizaiton to achieve class I molar and canine the need for patient co-operation. The relationship. The emergence of various modalities correction of Class II malocclusions has been of molar distalization has given new meaning to hampered by the use of appliances which the non-extraction treatment. These appliances require the patient to co-operate with have improved our treatment options considerably headgear, elastics, or the wearing of a over the past few years. removable appliance. ‘Non-compliance CLASSIFICATION (Table 1) therapy’ involves the use of appliances which 1. Location of appliance minimize the need for such co-operation and Extra-oral attempt to maximize the predictability of Intra-oral results. This article reviews and describes the 2. Position of appliance in mouth types of appliances used, and their mode of Buccal Palatal action-based on the current available research. 3. Type of tooth movement KEYWORDS: Distalization; intraoral; Bodily movement malocclusion Tipping movement 4. Compliance needed from patient INTRODUCTION Maximum compliance The omnipresent question faced practically every Minimum or No compliance time the orthodontists do a treatment plan for the 5. Type of appliance patient, “Do we need to extract teeth or can the Removable necessary space be created without extractions.” Fixed In the adult patients there is no clinically 6. Arches involved significant growth in the bone structure; therefore, Intra-arch alternative solutions must be found to obtain Inter-arch space in which the teeth can be moved, to correct 7. Appliances used the malocclusion. Edward Angle,[1] the "father of Maxillary modern orthodontics," set a non extraction tone to Mandibular treatment. He believed that when teeth could be Various non-compliance modalities to distalize corrected by other modalities, extraction of teeth molars for orthodontic purpose seemed particularly IJOCR Apr - Jun 2015; Volume 3 Issue 1 75 Molar distalization Bolya P, Rajput BS, Tiwari G, Yadav HS, Choubey A, Swarnkar SK Each orthodontist can adhere strictly to a system breakage frequency comparable to that of the Saif of orthodontic mechanics and achieve satisfactory Spring. results in cases to which system is adapted. Jasper Jumper However the diversity and complexity of Jasper JJ and Mc Namara James[11] in 1995 orthodontic problems demand a whole spectrum described a modification of Herbst bite jumping of appliance function not to be found in any of the mechanism known as Jasper Jumper,[3,11-14] that single appliance. The concept of the so-called can be attached to fixed appliances. This interarch "pure" appliance historically has proven to be an flexible force module allows the patient greater illusion and enforces restrictive treatment freedom of mandibular movement than is possible concepts. Appliance systems which are designed with original bite jumping mechanism of Herbst. to produce distal movement of first molars have Churro Jumper been available for over a century. Several The Churro Jumper, developed by Dr. Castanon methods are known to cause molar distalization, et al., (1998)[15] furnishes orthodontists with an none of which work for all patients in all effective and inexpensive alternative force system situations. for the antero-posterior correction of Class II and Herbst Appliance Class III malocclusions. The appliance functions The Herbst Appliance as originally designed by more like Jasper Jumper.[15,3,10] Emil Herbst in 1905[5] based on the idea of Klapper super Spring jumping the bite and popularised by Pancharz,[4] In 1998 Lewis Klapper[3,10] introduced the attempts to address these problems of patient Klapper superspring for the correction of class II cooperation and control of the direction of malocclusions. On first glance the device mandibular growth stimulation. Research to date resembles a Jasper Jumper with the substitution. has shown that the Herbst appliance has the Forsus Nitinol flat Spring ability to inhibit maxillary Anteroposterior In 2003 William Vogt[16,17] introduced two new growth and to produce an increase in mandibular fixed intraarch spring devices for class II length and lower facial height.[5-7] It has been correction, the Forsus Nitinol Flat Spring and the reported that in many cases, Herbst appliance Forsus Fatigue Resistant Device. therapy results in approximately equal amounts of Forsus Fatigue Resistant Device dental and skeletal changes. The dental changes Device is an interarch push spring that produces reported have included distalization of the about of force when fully compressed. Unlike maxillary molars and mesial movement of the other push spring appliance, FRD can intrude mandibular molars and incisors. In 1989, John R maxillary first molars and thus correct a Valant[8,9] used same design and extracted upper malocclusion without opening the bite. The distal second molars for distalizing of the molars and he end of the FRD’s push road insert into the found that 10mm of increase in arch length. On telescoping cylinder. And a hook of the mesial cephalometric analysis he found that bodily molar end is crimped directly to the arch near the canine distal movement of the molars had taken place. or premolar brackets. The scoping cylinder Saif Spring consists of inner and outer slide tubes surrounded The first clinically useful interarch force system by an open coil spring. An eyelet at the distal end was the developed by Armstrong. In the late 1960 of the cylinder is connected the maxillary molar or early 1970s, Armstrong introduced the pace headgear tube with an L pin. The push rod has a spring, later termed Multicoil spring, and finally built in stop that compress the spring when the called Saif Spring (Several adjustable patient’s mouth closes. The spring force is then intermaxillary force).[10, 3] transferred to the maxillary molars, using the NiTi Interarch Spring mandibular arch as the anchorage unit. Niti interarch spring[3] was introduced by GAC Eureka Spring International in the early 1990s, with the In 1997 Devincenzo[18] described the Eureka expectation that the low force and high flexibility Spring, which is a fixed inter maxillary force of the nickel titanium alloy could overcome the delivery system.[18,3] it’s a compression type of breakage problems of the Saif Spring. But the spring. And compression spring have inherent low fatigue resistance of these alloy resulted in a advantages over extension and curvilinear IJOCR Apr - Jun 2015; Volume 3 Issue 1 76 Molar distalization Bolya P, Rajput BS, Tiwari G, Yadav HS, Choubey A, Swarnkar SK counterparts, including reduced spring fatigue, distally and then an extraoral force to upright the resulting in less breakage, increased extension, roots. resulting in force application over a wide range of ACCO Appliance mouth positions. On full compression, all these The ACCO[20] (Acrylic Cervical Occipital springs exert 225 ± 25 gm / cm2 of force, but anchorage) appliance is a removable acrylic Eureka spring force is 160 ± 20 gm / cm2. Eureka appliance which is used in conjunction with a spring in a complete Class II patient, Northwest Headgear to effect distal mass nonextraction application with the mouth closed movement of buccal segments. The buccal and opened to 60 mm. the internal spring segments involved are usually maxillary, but the transmits a distalizing force to the maxillary appliance can be used as well on mandibular dentition and an equal and opposite mesializing buccal segments. The appliance is originally force to the mandibular teeth. The mechanics of devised by Dr. Herbert Margolis20 to be used to the appliance has the opposite effect to that of “harness Growth”, i.e. the entire maxilla was to class II elastics in that it acts to intrude both the be restrained while mandible was to be allowed to lower incisors and the upper molars. The effects express its growth potential. of this
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