MOLAR

DISTALIZATion
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
 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
 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. (1969) extracted the
maxillary 2nd molar and distalized the first
molar to correct class II div.I.
Indications for Molar
distalization
1. 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 –utilized for relief of
anterior crowding,
- Upper molars distalized to get a class I
relation
Indications for Molar
distalization
3. Non-growing patient

- To regain lost arch length

- Blocking out of canines

4. Upper second molar extraction

- Lower arch normal

 Class II Malocclusion

 Non-Extraction treatment

 Non-Compliance therapies

 Treatment - Molar Distalization

 Space regaining procedure

-Mesial migration of first permanent molars

Indications for Molar
distalization
Class I malocclusion- with highly placed canine/impacted
canine

 Lack of space for eruption of premolars due to mesial migration

of permanent first molars
Indications for Molar
distalization
 End on molar relationship with
mild to moderate space
requirement
 Cases with less than a full
cusp class II molar
relationship
Indications for Molar
distalization

 Good soft tissue profile

 Borderline cases

 Mild to moderate space

discrepancy with missing 3rd

molars/2nd molars not yet erupted

Indications for Molar
distalization
 Axial inclination : Mesially
angulated upper molars
 Normal or Hypodivergant
growth pattern
 Late mixed dentition with mild
crowding of anteriors
 CONTRAINDICATIONS
 Profile :
Retrognathic profile
 Functional :
Numerous signs and symptoms of
temperomandibular joint.
Posteriorly and superiorly displaced condyles.
 Skeletal :
Class II skeletal
Skeletal open bite
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
 Extraction of 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 in
moderate to severe anterior crowding.
Possible impaction of third molar even with
second molar extraction.
UPPER MOLAR POSITION
 It is 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.
Case selection
1. Normal or near normal mandibular arch
2. Late mixed dentition-ideal
- Early permanent dentition-growth still left in maxillary
tuberosity area.- 16-17 yrs-males
14-15 yrs-females

3. Molars placed normally- buccolingually

4. 3rd molars-absent –stacking of upper molars – unsuitable
5. Profile considerations- well developed nose & chin
6. High MPA- contraindicated-wedging effect
7. Space discrepancy- not very severe
Molar distalization techniques

Extra- Intra-
Oral Oral
Intra Oral Tech.

Conventional
Skeletal
Classification
1. Location of appliance
 Extra-oral
 Intra-oral
2. Position of appliance in mouth
 Buccal
 Palatal
3. Type of tooth movement
 Bodily movement
 Tipping movement
Classification
4. Compliance needed from patient
 Maximum compliance
 Minimum or No compliance

5. Type of appliance
 Removable
 Fixed

6. Arches involved
Intra-arch

Inter-arch
Various appliances used for
Molar Distalization :
 Headgears
 Wilson Bimetric arch design
 ACCO
 Crozat appliance
 Crickett appliance
 Modified Nance Lingual appliance
 Non-extraction treatment
 Schmuth and muller double plates
 Molar distalization with magnets
Various appliances used for
Molar Distalization
 Use of Super elastic NiTi
 Jones Jig
 The Pendulum appliance
 Claspring
 Removable molar distalization splint
 Fixed piston appliance
 The K-loop appliance
 The distal jet
 Using Implants
 Fixed functional appliances
Distalization using Headgears
 Very efficient
 Reciprocal forces are not transmitted to other teeth
 Molar movements depends on direction of force in relation to
the C Res of the molar & magnitude of force
Biomechanics of Headgears:
 C Res
 Moments
Straight pull headgear
 Class II Malocclusion with no
vertical problems
 Prevent anterior migration
of maxillary teeth, translate
them posteriorly
 Buccal force to molar -
Expansion of inner bow
Cervical Headgear
 Short face Class II
maxillary protrusive
cases with low MPA
& Deepbites
 Extrusive &
distalizing effect
High pull Headgear
 Produces intrusive &
Posterior direction of
pull
 Long face class II
patients with high MPA
 Force through c res –
Intrusion & distal
movement of molar
 6-8 months – class II-
classI
Adv-effective, no reciprocal forces
Disadv- Patient compliance
Bimetric system for Molar
Distalization
 Dr.Wilson-Tandem yoke
with bimetric arches for
molar distalization
 Tandem yoke-.045”
round tube – slides on .
040” end section of the
bimetric loop.
 .018 retractor
 .045” coil spring for
distalizing
 Intermaxillary traction
 Coil spring- between molar
tube & the yoke
 Elastics- 12 hours a day
 Headgear – at night

 The Omega adjustable stop

–to modify & control arch
length
 Crimpable .040”tube
 .061 Omega loop
 Coil springs &
intermaxillary hooks.
Bimetric arch modified by Dr. Jayade

 Class II correction- Distalization + expands canine-

premolar area- unlocks the occlusion

 A mild-moderate class II div 2 with normal

mandibular arch-easily corrected

Bimetric arch modified by Dr. Jayade

Archwire design:
 .016”premium wire
 Premolars bonded if
expansion is required
 Teardrop shaped loop
 Bite opening bend
 Mild toe-in
 2mm activation
Elastic load reduction principle:
 Class II elastics – used sequentially
T.P Green – 1st week
Pink - 2nd week
Yellow – next 2-3 weeks
 Initial heavy force- to resist forward
pushing force of new wire- force
transferred distally
 Later Molar uprights-mesially directed
archwire force decreases- support with
light forces.
 Extrusive component of class II- kept to a
minimum

Borderline cases –Non extraction

ACCO Appliance ACRYLIC CERVICAL OCCIPITAL
APPLIANCE ACCO:- Developed by H.margolis.

 JCO1969
Removable appliance with headgear
 Distal mass movement of buccal segments
 Dr.Leonard Margolis – harness growth-
later springs added for distal tooth
movement
IT consists of acrylic palatal palatal section
,modified adams clasp on the Ist PM ,labial bow
across incisors for retention and finger spring
against mesial aspect of first molars .
The finger springs are activated approximately
one half a cusp width in posterior direction,it can
be made of round or rectangular wire ,force
applied of 100 – 125 gm .1 mm bite plate to
disocclude the posteriors. 24 hour wear is
required.
ADVANTAGES: 1) Constant acting force
enhancing rate of molar movement
2) Relative comfort easy to wear
3) Effective for asymmetric distal movement
DISADVANTAGES:-
Tips crown distally ( less when close to Cres of
molar)
High pull headgear in conjunction to ACCO
(Cetlin,Tenhoeve)
Anchorage loss.
To control elastic reaction force lower arch
anchorage controlled by lip bumper
 Northwest Headgear-
12hrs/day, counteracts
anterior component of
force

Appliance design:
 Labial bow: .022 x .028 wire
 Loops to receive NWHG
between the central and lateral
on each side
 Wire covered with acrylic for
good retention
INTRAMAXILLRY APPLIANCES
WILSON’S RAPID MOLAR DISTALIZATION

 Advocated by William L. Wilson & Robert

C.Wilson (1984 JCO) under modular
orthodontics.
 The Wilson treatment achieves molar

distalization without extra oral forces.

 THE CONCEPT:- Newton’s' 3rd law of

motion states that 'for every force, there is

an equal and opposite force', (i.e.) for every
moment, there is a counter moment.
 Nonextraction treatment
Cetlin & Ten Hoeve, JCO 1983

Space Gaining in the Mandibular Arch With the Lip Bumper

 .045 SS wire covered with tubing

 U-shaped loops – adjustment areas
And stops mesial to the molar tubes.
 Placed on most distal molar
 Recent studies- Ram Nanda etal
- AJO 1991 Jun
Posterior movement of mandibular incisors are very minimal
 Nonextraction treatment
Cetlin & Ten Hoeve, JCO 1983
Space gaining in the maxillary arch
 Combination of extraoral force and an
intraoral force
Inraoral
 Anchorage – adaptation to palate &
acrylic shield around incisors
 Bite plane
 Adams clasp on premolars
 Springs on molars activated by 1-1.5
mm – force -30 gms
Exraoral
 Cervical or high pull headgear
150 gms / side ; 12 -14 hrs/day
Nonextraction treatment
Cetlin & Ten Hoeve, JCO 1983
Palatal bar as an adjunct in space
gaining in the maxillary arch
 Unilateral distalization
Modified Nance and Lingual appliances
for unilateral tooth movement Ghafari JCO 1985
Nance holding arch :
 Palatal arch attached to first

molar bands , embedded in an

acrylic "button"
 space maintainer in the maxillary

arch,
 support maxillary posterior

anchorage during tooth

movement
Modified Nance holding arch and
modified lingual arch:
 Anchorage for unilateral
distalization of posterior teeth
 No patient compliance required
Modified Nance and Lingual appliances
for unilateral tooth movement
Modified Nance holding arch

 12 yrs/M
 Skeletal & Dental class I
 Right side- distoocclusion
 2nd premolar- 3.5 mm space
 R – 1st PM & molars banded
 Segmental .019 x .025 NiTi
 Open coil spring
 4 months
 No labial movement of incisors
Modified Nance and Lingual appliances
for unilateral tooth movement
Modified Lingual arch
 13 yr /F

 Skeletal class I

 Lingually positioned R 5

 3.2 mm space

 Lingual arch from L6 to R4

 Coil spring from R 4-6 on a

segmental .019 x .025 NiTi

K-Loop Molar Distalizing Appliance
Valrun Kalra – JCO 1995

 K-loop – forces - .017 x .025 TMA

 Nance button – anchorage
 8mm long , 1.5 mm wide
 Legs- 20 degree bend
 Inserted into molar and first
premolar tube, marked
 Stops bent 1mm distal , 1mm
mesial
 Stops- 1.5mm long
K-Loop Molar Distalizing Appliance
Valrun Kalra – JCO 1995
 Reactivated 2mm 6-8
weeks later
 Molars move by 4mm,
premolars by 1mm
 Anchorage can be
reinforced by headgear
K- loop Appliance
 Advantages:
 Simple & efficient
 Controls moment to force ratio to produce

bodily movement
 Easy fabrication and placement
 Hygienic and comfortable to the patient
 Low cost.
Removable molar distalization splint
Dr. Karrodi Ritto JCO 1995

 Splint – 1.5mm Biocryl-Biostar machine

 More esthetic & comfortable
 Bilateral- 1st premolar- 1st premolar
 Unilateral – Premolar – Opposite Molar
 Two internal clasps – retention
 NiTi open coil spring- 220 gm force
 1.5mm-2mm/month
 Distalization of Molars with
Repelling Magnets Gianelley etal JCO 1988

 Anchorage – Modified Nance

appliance
 Wire extending from 1st
premolars
 Acrylic button anteriorly
contacting the incisors
 Auxillary wire with a loop at its
end soldered - premolars bands
Distalization of Molars with
Repelling Magnets
 Incisor brackets – passive
sectional wire- maintain incisor
alignment
 Repelling surfaces of magnets
brought into contact by passing an
.014 ligature through the loop,
then tying back a washer anterior
to the magnets
 Force- 200-225 gms , dropped as
space opened
 3mm in 7 weeks
 Anchor loss – 1mm
Japanese NiTi coils used to move
molars distally -Gianelly AJO 1991
 100 gm superelastic coils
 Nance appliance with bite plate
in anterior region
 .016 x .022 wire with stops
abutting distal wings of premolar
and molars
 Coil – between 1st premolar and
the molars
 .018 “ uprighting spring placed in
vertical slot of
premolars,directing crowns
distally
Japanese NiTi coils used to move
molars distally
 2nd molars erupted- Class II elastics
 Rectangular wire – 10 degree lingual root torque
 Once distalized, Coils &Nance appliance are removed, insert .

016 x .022 “ wire with stops + High pull headgear to upright

roots of molars
Molar distalization with
Superelastic NiTi wire Gianelly JCO 1992

 100gm Neosentalloy upper

archwire
 3 markings
 Stops crimped, hook added
 Insert wire such that posterior
stop abuts mesial end of molar
tube, anterior stop abuts distal of
premolar
 Anchorage reinforced by class II,
or Nance appliance
Molar distalization with
Superelastic NiTi wire
Case report :
 12 yr / F
 Unilateral class II
 Class II against upper 1st
premolar
 Overcorrected- 4 months
NiTi Double Loop system for simultaneous
distalization of first and second molars
Giancotti JCO 1998

 Mandibular molars and 2nd premolars

banded, other teeth bonded
 Lip bumper- prevent extrusion
 Maxillary molars and bicuspids –
banded, aligned
 80 gm Neosentalloy – maxillary
archwire placed – marked
1. Distal to 1st premolar
2. 5mm distal to 1st molar tube
 Stops crimped on markings
NiTi Double Loop system for simultaneous
distalization of first and second molars
Giancotti JCO 1998

 Mandibular molars and 2nd premolars

banded, other teeth bonded
 Lip bumper- prevent extrusion
 Maxillary molars and bicuspids –
banded, aligned
 80 gm Neosentalloy – maxillary
archwire placed – marked
1. Distal to 1st premolar
2. 5mm distal to 1st molar tube
 Stops crimped on markings
NiTi Double Loop system for simultaneous
distalization of first and second molars
 Sectional NiTi archwires –
crimp stops
1. Mesial and distal to 2nd
premolar
2. 5mm distal to 2nd molar tube
 Uprighting springs on 1st
bicuspids
 Class II elastics
24yr/f, class II div I
 Simultaneous, bodily
movement 5months- overcorrected
 NiTi Double Loop system for simultaneous
distalization of first and second molars

 Minimal patient co-operation

 Ideal for simultaneous distalization

 Anchorage easily controlled , without need for TPA/Nance

 Due to streching of transeptal fibres, 1st molars can be

distalized using lighter 80 gm force

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.
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.
Pendulum Appliance for class II non-
compliance therapy
JAMES J. HILGERS,JCO 1992

 Nance button

 .032 TMA springs

 Broad swinging arc (Pendulum)

of force from midline of palate
to upper molars
Pendulum Appliance
Fabrication :
Pendulum springs consist of
1. Recurved molar insertion wire
2. Horizontal adjustment loop
3. Closed helix
4. Loop for retention in acrylic
button
 Springs- close to center of
Nance button
 Anterior portion- retention-
occlusally bonded rests
- Band upper 1st
premolars, solder retaining
wire to the bands
Pendulum Appliance
 Nance button- extend to about 5mm
from teeth
 Anterior retention loops fixed on
model, later soldered to bicuspid
bands
 Acrylic pressed against the palatal
vault
 Pendulum springs inserted
Pendulum Appliance
Pend-X

Pendulum appliance with

Jack-screw-
One-quarter turn every 3 days
 Pendulum Appliance
Preactivation and placement:
 Springs bent parallel to midline of the
palate
 Molar bands cemented
 Anterior portion of appliance later
cemented
 Pendulum spring brought forward &
engaged in lingual sheath
 As molar distalizes, moves on an arc
towards midline- counteracted – opening
horizontal loop
Pendulum Appliance
 Reactivate if required
 Reavtivated by pushing it distally towards the midline
 Stabilize after correction
 Nance appliance
 Full arch bonding – continous wire with omega loop
 Headgear for few months
Pendulum Appliance
 Unilateral correction
Pendulum Appliance
Conclusion :
 Excellent patient tolerance
 Upto 5mm distalization in 4 months
 Distalization + Expansion
 Patient compliance not needed
 Modified Pendulum Appliance- Scuzzo- 2000 April
Removable arms
Removable pendulum
 Franzulum appliance
Friedrich Byloff et al JCO2000 sep

 Anterior anchorage :
acrylic button-5mm wide
 Rests on canine and
premolars - .032 wire
 Tube from acrylic button
to receive active
component
 NiTi coil springs-100-
200g/side
 J-shaped wireinserted into
tube
Franzulum appliance
 Anchor unit bonded with composite
 J-shaped distalizing unit ligated to
lingual sheath
 Active component close to C Res

Case report
 11yrs 10mts / M
 end on molar relationship
 Space deficiency in both the arches
 Premolars blocked out
 Upper pendulum and lower Franzulum
 Nance holding arch
 Fixed appliance with cervical headgear
and Cl II elastics
 End of treatment; Class I molar relation,
no signficant. Change in facial profile
Open Coil Jig
Jones, White –JCO 1992 Oct

 Richard D. Jones
 American Orthodontics
 Open coil NiTi spring
 Nance appliance
Open Coil Jig
6
3 4 5

1. Heavy round wire 1

2. Light wire
3. Fixed Sheath
4. Hook
5. Sliding Sheath
6. Open coil spring

2
 The advantages
 : light forces,
 ease of activation,
 it can be used without bonding the

anterior teeth.
 4-5 mm distalization in 3-4 months

 Disadvantages are: 1) distal tipping of

the molars, 2) mesial tipping of the
premolars
  
Lokar Molar Distalizing
Appliance
A- Inserts into molar attachment with a rectangular wire
B- Compression spring
C- Sliding sleeve
D- Groove
E- Flat guiding bar
F- Round posterior guiding bar
G- Immovable posterior sleeve
Lokar Molar Distalizing
Appliance
 With this arrangement it can be visualized that on
activation the coils spring is compressed by the
sliding sleeve and an increase in the guiding rod
occurs
 This appliance can be best used with Nance palatal
button. Advantages of this appliance are ease of
insertion, ease of activation minimal breakage.
Distal jet Appliance
Aldo Carano, Mauro Testa JCO 1996

 Fixed lingual appliance

Appliance design :
 Wire extending from acrylic
through tube ends in a bayonet
bend-inserted into lingual sheath
 Coil spring
 Clamp
 Anchor wire to 2nd premolar
Distal jet Applaiance
Aldo Carano, Mauro Testa JCO 1996

 Reactivation- sliding clamp

closer to first molar
 After distalization –

- clamp-spring assembly-
acrylic,

- premolar arms cut off.

Distal jet Appliance
Case report
 18/F, Class II divI

 No skeletal abnormalities

 Non-extraction therapy (3rd molars

removed)
 Distal jet

 4 months- Class I ,2mm-L, 3mm-R

Distal jet Appliance
Advantages :
 Bodily movement

 Easy insertion

 Well tolerated

 Esthetic

 Unilateral, Bilateral

 Permits simultaneous use of full bonded appliances

Modifications of Distal jet Appliance
Andrew Quick, Angela Harris JCO 2000

Earlier :
 Sliding collar-tightened- small set
screw- Allen wrench
Modification :
 Rear entry of sliding section into the
molar sheath
 Sliding wire- .032 “
 Stop collar soldered to wire
 Activation
 Retention- solid tubing
Fixed piston appliance -
Greenfield

 .036 “ tubing- soldered to

biccuspids
 .030 “ ss wires- first molars
 Nance button
 NiTi coil
 Unilateral Distal Molar Distalization movement
with an Implant supported Distal jet appliance
Karaman et al- Angle Orthodontics-2002

Case :
 11yr/M
 Well balanced face
 Straight profile
 Class II molar relation on left side
 Super class I on right side
 Mandibular teeth- favorable alignment
 Upper left 2nd premolar impacted
 ANB- 0 degrees
Unilateral Distal Molar Distalization
movement with an Implant supported Distal
jet appliance

Treatment objectives :
 Class I molar relation
 Eruption of impacted molar
 Controlled eruption of erupting teeth
Treatment alternatives
 Extraction of L 1st premolar
 Extraction of L 1st premolar
 Distalization of upper left molar
Unilateral Distal Molar Distalization
movement with an Implant supported Distal
jet appliance
Appliance fabrication :
Molar bands with palatal tubes
Anchorage screw- 3mm dia, 14
mm long
Anterior palatal suture, 2-3 mm
posterior to incisive papilla
Impressions for appliance
construction
1mm tube adjusted to implant
Unilateral Distal Molar Distalization
movement with an Implant supported Distal
jet appliance
 Anchor wires .8mm-soldered to tubes
for occlusal rests on premolars
 .9mm wire extended through each
tube ending in a bayonet bend-palatal
tube of molar
 NiTi open coil spring – active on left
side only
 Appliance attached to premolars –
composite
 Joint between implant & tube-secured
with composite
 2 months- 4.5mm distalization
 Space for canine-maintained
ARTICLES AND
REFERENCES
 Pendulum appliance produces force of  Although pendulum appliance
200 to 250 grams in a swinging arc like
pendulum from midline, so it is named
has these benefits but still
pendulum appliance. According to Hilger using pendulum appliance,
the preactivation of appliance is done by there is distal tipping of molars
bending springs to 90 degree and and anterior anchorage loss
approximately 30 degree is lost during
insertion of appliance resulting in 60 ocuur. Joseph and Butchart
degree activation for distalization of observed 5.1 mm distal
molars. Usually activation of appliance movement of molars with 15.7
again is not needed and molars are
degree distal tipping of first
moved distally by 5mm in 3 to 4 months.
Anchorage loss is minimum that is 1.5 molar and 4.9 degree
mm in premolar area and 1-2 degree proclination of maxillary
proclination of maxillary anterios.This incisors.
appliance meets most of ideal
requirements of an intraoral appliance
  Modified pendulum with removable
PENDEX appliance It was also introduced arms Pendulum appliance is fixed
by Dr. Hilgers. Its design is same as compromising maintenance of oral
original pendulum appliance except for hygiene. Precise activation of appliance
presence of a palatal expansion screw in cannot be done intraorally. Scuzzo gave
solution to these problems by
the midline. (fig.2) It is used in class II introducing modified version of
malocclusion cases where transverse pendulum in which springs of appliance
expansion is needed to correct constricted can be removed for extra oral
activation. (fig.3) Rest part of appliance
maxillary arch. remains fixed. The active components
of pendulum appliance are inserted into
acrylic sheaths of Nance palatal button
and these can be easily removed from
sheaths for activation. This modified
pendulum produces molar distalization
at a rate of 1.5mm per month and
distalization of maxillary molars can be
controlled more accurately as compared
to opening of loops intraoral
Dental Press journal of orthodontics -
2015
Patient compliance ??
• Headgear will
need to be worn
for 12 to 14 hr. a
Patient compliance ??
day with a
bilateral force to
achieve molar
distalization
 Click icon to add picture
ACRYLIC CERVICAL
OCCIPITAL APPLIANCE-
H.MARGOLIS

Incorporation of anterior bite plane and

palatal spring to deliver the force along
the 24 hr. Disadvantage in molar tips
distally. However tipping is less when
springs are closer to center of
resistance of molars
 PATIENT NON-
COMPLIANCE TECHNIQUES
 Conventional
intra oral tech.

o Pendulum appliance.
o Modified pendulum
appliance.
o Jones jig appliance.
o Keles slider.
o NiTi coil spring with
Nance button.
o Repelling magnets
with Nance button.
o Distal jet.
 Conventional
intra oral tech.

o Pendulum appliance.
o Modified pendulum
appliance.
o Jones jig appliance.
o Keles slider.
o NiTi coil spring with
Nance button.
o Repelling magnets
with Nance button.
o Distal jet.
Conventional intra oral tech.
Conventional intra oral tech.

Forces ranged
(70-250 g)
Intra Oral Tech.

Conventional
Skeletal
Conventional vs Skeletal
Conventional vs Skeletal
Different techniques
 Patient
Complian
ce
With this new device molar distalization is
achieved,with no patient compliance and
didn’t require head gear for molar to upright
Conclusion

 Borderline cases
 Space gaining procedures
 Simplicity
 Clinical effectiveness
 Patient compliance factor
modified C palatal plate
MCPP

Kook et al. introduced a modified C-palatal plate

(MCPP) that did not require additional surgery.
MCPPs showed distalization and intrusion of the
maxillary molars in adolescents and adults, and
similar or more distal movement of maxillary first
molars compared with cervical headgear and buccal
miniscrews.
 Conclusions:
 The maxillary first molar was distalized by

3.3 mm at the crown and 2.2 mm at root

levels, with distal tipping of 3.4. It is
recommended that clinicians should consider
using the modified palatal anchorage plate
appliance in treatment planning for patients
who require maxillary total arch distalization.
(Am J Orthod Dentofacial Orthop 2014
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.as e. ► 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 notright time. Appliance
should be selected for patient
 . ► To fight a borderline case distalization is a important weapon in
orthodontists armamentarium weapon in orthodontists
armamentarium
THANK YOU