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Molar Distalization by Temporary Anchorage Devices (TAD S) – a Review Article

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Molar Distalization by Temporary Anchorage Devices (TAD S) – a Review Article Volume 29 Issue 1 Article 2 2017 Molar Distalization by Temporary Anchorage Devices (TAD s) – A Review Article Jun Ming Tan Postgraduate Student, Division of Orthodontic and Dentofacial Orthopedic, Department of Dentistry, National Taiwan University Hospital; Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, [email protected] Yi-Min Liu Adjunct Attending Physician, Division of Orthodontic and Dentofacial Orthopedic, Department of Dentistry, National Taiwan University Hospital Hung-Cheng Chiu Adjunct Attending Physician, Division of Orthodontic and Dentofacial Orthopedic, Department of Dentistry, National Taiwan University Hospital Yi-Jane Chen Attending Physician, Division of Orthodontic and Dentofacial Orthopedic, Department of Dentistry, National Taiwan University Hospital; Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University Follow this and additional works at: https://www.tjo.org.tw/tjo Part of the Orthodontics and Orthodontology Commons Recommended Citation Tan, Jun Ming; Liu, Yi-Min; Chiu, Hung-Cheng; and Chen, Yi-Jane (2017) "Molar Distalization by Temporary Anchorage Devices (TAD s) – A Review Article," Taiwanese Journal of Orthodontics: Vol. 29 : Iss. 1 , Article 2. DOI: 10.30036/TJO.201703_29(1).0002 Available at: https://www.tjo.org.tw/tjo/vol29/iss1/2 This Review Article is brought to you for free and open access by Taiwanese Journal of Orthodontics. It has been accepted for inclusion in Taiwanese Journal of Orthodontics by an authorized editor of Taiwanese Journal of Orthodontics. Review Article MOLAR DISTALIZATION BY TEMPORARY ANCHORAGE DEVICES (TADS) – A REVIEW ARTICLE 1,4 2 2 3,4 Jun Ming Tan, Yi-Min Liu, Hung-Cheng Chiu, Yi-Jane Chen, 1 Postgraduate Student, Division of Orthodontic and Dentofacial Orthopedic, Department of Dentistry, National Taiwan University Hospital 2 Adjunct Attending Physician, Division of Orthodontic and Dentofacial Orthopedic, Department of Dentistry, National Taiwan University Hospital 3 Attending Physician, Division of Orthodontic and Dentofacial Orthopedic, Department of Dentistry, National Taiwan University Hospital 4 Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University Clinically, there are many ways to achieve molar distalization, such as skeletal anchorage, extraoral anchorage, sliding jig, lip bumper, and pendulum, etc. Although several methods have been described to distalize molars or total dentition, there is no strong scientific evidence of the effectiveness of various methods. To date, temporary anchorage devices (TADs) are increasingly used as orthodontic anchorage sources because of its strong anchorage, including endoosseous implants, miniplates, miniscrews and microscrews. Application of bony anchorage makes teeth move more efficiently, without depending on patient compliance in wearing appliance. However, only case reports and small case series have been published on the benefits of TADs in molar distalization. Thus, the purpose of this study was to review the papers on methods of molar distalization with use of TADs, potential side effects, and possible range of distalization. (Taiwanese Journal of Orthodontics. 29(1): 8-15, 2017) Keywords: Molar Distalization; Temporary Anchorage Devices (TADs); Review Article complaint of protrusive maxillary dentition with lip INTRODUCTION protrusion, crowding of teeth, etc. In such circumstances, Nowadays, facial esthetics has become a major the major orthodontic goal is to reduce the proclination concern of many orthodontic patients. Especially the of the maxillary incisors and to gain space for crowding alignment and angulation of maxillary anterior teeth teeth. Thus, the treatment plan often includes extraction plays an important role in defining beauty and facial of bilateral premolars, followed by retraction of anterior 1 harmony. Excessive labioversion of maxillary teeth teeth with maximum anchorage. In some circumstances, and crowding of teeth can ruin a pleasing smile. Many non-extraction treatment is planned in combination with patients seek for orthodontic treatment with the chief total arch distalization or molar distalization. Received: Stepmber 22, 2016 Revised: March 10, 2017 Accepted: March 13, 2017 Reprints and correspondence to: Dr. Jun Ming Tan, No.1, Chang Te St., Zhongzheng Dist., Taipei City 100, Taiwan Tel: 02-23562347 E-mail: [email protected] 8 Taiwanese Journal of Orthodontics. 2017, Vol. 29. No. 1 Molar Distalization by TADs When non-extraction treatment plan is chosen, there 1. Miniscrew Implant Supported Distalization Device are several approaches to achieve distalization of arch Papadopoulos introduced the Miniscrew or molars, including pendulum, lip bumper, sliding jig, Implant Supported Distalization System (MISDS) 3 extraoral anchorage, skeletal anchorage, etc. To date, in 2008 (Figure 1, A). This appliance comprised Temporary Anchorage Devices (TADs) are increasingly two miniscrew implants in the paramedian region used as orthodontic anchorage sources because of its of the palate. The distalization force was applied by strong anchorage, which can avoid anchorage loss the palatally positioned open nickel-titanium coil of premolars and flaring of incisors during molar 2 springs, which passed through the center of resistance distalization. Many types of TADs, include endo-osseous of the maxillary molars. Squeezing the coil springs implants, miniplates, miniscrews and microscrews can and screwing the anteriorly positioned stop screws provide reliable and stable anchorage to distalize arch following cementation activated the appliance. or molars. In this review article, effectiveness of bony Sar et al. compared the effects of the MISDS anchorage during distalization will be explored. and the Bone-Anchored Pendulum Appliance (BAPA) (Figure 1, B)—for maxillary molar distalization and RESULTS evaluated the efficacy of two distalizing forces (Table 4 A Methods of molar distalization and related side 1). Some unwanted side effects were found with effects implant-supported molar distalization appliances, There are several methods to distalize molars by such as distal crown tipping accompanying molar using mini-implants, as follows, distalization. The point of force application passed Figure 1. A Miniscrew Implant Supported Distalization System(MISDS); B Bone-Anchored Pendulum Appliance (BAPA). From Sar et al., Angle Orthod. 2013 May;83(3):460-7. Table I. Comparison between MISDS and BAPA in Sar et al.’ study MISDS BAPA Sample Sizes 14 14 Force applied Apex level Crown level Molar Distalization (mm) 2.81 2.93 Average distalization duration (months) 8.2 10.2 Distalization rate (mm / month) 0.2 0.3 Type of distalization Nearly bodily movement Crown tipping Taiwanese Journal of Orthodontics. 2017, Vol. 29. No. 1 9 Tan JM, Liu YM, Chiu HC, Chen YJ below the center of resistance of the maxillary molars 2. Direct use of mini-implants in BAPA, whereas it passed through the center of Sugawara et al. demonstrated two fundamental resistance in MISDS. This might cause clinically more methods of applying distalizing forces to the subjects in 6 distal crown tipping in BAPA. his study. One is for single molar distalization (Figure 3. 5 In Kyung et al.’s study, two midpalatal miniscrews A), the other is for en masse distalization (Figure 3. B). were placed. A screw-supported customized S-sheath Single Molar Distalization was fabricated and cemented on the top of 2 miniscrews Enough space for the molar distalization will with flowable composite resin, then a removable be needed. A retractive force is applied to the second hook was placed into the sheath. A mesially extended molars with an open coil spring. The first premolars/ transpalatal arch (ME-TPA) was placed in the lingual first molars must be ligated firmly with TADs to avoid sheath of the maxillary first molar. Elastics were placed the side effects of the reciprocal coil spring. After the from anterior hooks of the ME-TPA to distal hooks distalization of the second molars, distalization of the extending from the S-sheath to the TPA (Figure 2. A). first molars is done with the same procedure. After target was hit, the ME-TPA was replaced with a modified TPA to maintain the position of the maxillary En masse Distalization first molars (Figure 2. B). When the force was applied Direct retractive force is applied from the TADs to 7 on the palatal side, the molar segment rotated mesially, the first premolars to perform en masse distalization. and the intermolar width increased. Thus, the ME-TPA Elastic modules or Ni-Ti closing-coil springs usually should be activated to counteract these complications provide the retractive orthodontic force. During (Figure 2. C). en-masse retraction, the 6 anterior teeth were tied Figure 2. A A screw-supported S-sheath was fabricated on the palate. Elastics were placed from anterior hooks of the ME-TPA to distal hooks extending from the S-sheath to the TPA; B 7 months after start of treatment; C Complications in distal movements. From Kyung et. al., AJODO. 2009 Apr;135:S123-32. 10 Taiwanese Journal of Orthodontics. 2017, Vol. 29. No. 1 Molar Distalization by TADs together, and the distalizing force was applied to Poletti et al.’s study, TADs were placed in the retromolar the canines/ premolars or to the short anterior hooks area which is relatively thick cortical bone layer, far from attached between the lateral incisors and the canines. dental roots, and do not interfere with dental movements 8 The directions of
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