Molar distalization (2)

INTRODUCTION
• In the early 90’s, non compliance therapies in various
forms have become more prominent than ever before.
• One of the non compliance therapies and fairly recent
concept is the MOLAR DISTALIZATION which has
been effectively used in the correction of malocclusion.
• Advances in mechanotherapy and changes in
treatment concepts have reduced or minimized the
need for extraction in severe discrepancies. Various
techniques are currently employed in non extraction
therapy in the treatment of a malocclusion.
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• Early cephalometric studies have showed that little or
no distal movement of upper molars was produced by
class II elastic treatment of that era
• The head gear was reintroduced as a means of
moving the upper molars back.
• patient compliance plays a major role in success of
head gear therapy
• An appliance system independent of the patient
cooperation was the need of the hour and then
evolved the molar distalizers.

HISTORY
• The extraction/non extraction debate from the Angle
era to the present day orthodontics does not define
an absolute indication for a specific treatment plan.
• Angle strongly believed in retaining teeth provided by
nature and molding the facial form through occlusion.
• Angle’s unweilding allegiance to non extraction
therapy was based on his own specific knowledge
dentofacial growth and development and to the
concepts of facial beauty harmony.

• Case argued for therapeutic extractions in
orthodontia based on the fact that inherited
inharmonious in contiguous structure over
which we have no control makes it impossible
for us to place all the teeth in the arch without
fulfilling the designs of an inherited deformity.
• Angle’s disciples like CHARLES TWEEDand
RAYMONDBEGG, supported the need for
extractions in orthodontics.

• The dogma was “if in doubt extract” which led
to blind extractions of the premolars resulting
in ‘dished in faces’.
• Gradually the awareness of soft tissue profile
and function occlusal concepts were
introduced into orthodontics which put the
mind of the orthodontist into thinking twice
before an extraction.

• Now we are at a soft spot to decide, to extract or not
to extract and the dogma is “when in doubt do not
extract”.
• Presently the swing of pendulum towards the non
extraction protocol
• A boon in the hands of the orthodontist. It is important
to understand the indications, the biomechanical
concepts and the contra indications of the Molar
distalization appliance system.

• Magnitude of forces and moments
• Moment to force ratio
• Constancy of forces and moments
• Bracket friction
• Ease of fabrication
• Cost
– Burstone

INDICATIONS
• In the non extraction treatment of class II malocclusion.
• In low angle cases.
• In class I skeletal pattern cases.
• In patients with mild arch length discrepancy.
• In cases where upper permanent first molars have moved
mesially due to early loss of deciduous molars.
• In patients where second molar extractions are planned or has
not yet erupted.

CONTRAINDICATIONS
• In high angle cases.
• In class II and class III skeletal pattern
• Skeletal and dental open bite.
• Severe arch length discrepancy cases.

CLASSIFICATION
• EXTRA ORAL
– Head gears
• Cervical pull
• Combination pull
• Kloehn.
• INTRA ORAL
– Removable appliances
– Fixed appliances
• Buccaly acting
• Palatally acting

DISTALIZINGAPPLIANCES

TUBE PLATES
• This appliance was developed by Alain Benauwt in the year 1972.
• This appliance has a
stationary part and a movable
part. They are held together by
a long horse shoe shaped wire,
which moves the movable part
by virtue of the elasticity of the
wire. Each end is inserted into
the tube, one with fixed part of
the appliance.

ADVANTAGES
• The appliance is said to have a good retention as the
movable part also contributes to the retention.
• Unwanted displacement of teeth is minimized due to
the clasp as it avoids molar rotation.
• Possible to add an extra oral appliance to support
and reinforce stationary part. Progressive expansion
of the arch is also possible by changing the
angulation of the tube in relation to saggital plane.
• Repair is easy.

DISADVANTAGE
• Construction is very delicate, since the two
wires holding the movable part should do so
without binding.

THE CETLIN APPLIANCE
• developed by Cetlin in 1982
• extra oral force in the form of headgear and an intra
oral force in the form of a removable appliance.
• To overcome the disadvantages caused due to the
tipping of molars, the Cetlin appliance utilizes a
removable appliance intra orally to tip the crowns
distally and then an extra oral force to upright the
roots. So the intra oral remarkable appliance can be
called the crown mover while extra oral force, the root
mover.

ANCHORAGE
• The anchorage for removable appliance is by proper adaptation
to the palate an acrylic shield around the four maxillary incisors
and a modified Adams clasp on the first premolars.
THE EXTRA ORAL FORCE
• The extra oral appliance is a headgear which is inserted into the
molar tube. The headgear is usually cervical or a high pull,
depending on the usual consideration of skeletal pattern.

• The removable appliance is worn 24 hours a day. The appliance
also contains a bite plane to disengage the molars (to aid rapid
Molar Movements).

THE CRICKETT APPLIANCE
• WEST in 1984
• The Crickett’s appliance embraces the
essential features of the quad Helix. But
replaces the palatal and lingual bars of upper
and lower appliances with a quad and bi-helix
respectively

• The Crickett’s lingual arms are
embedded to provide an adjustable
spring action directed to lingual
surfaces of all teeth, without the
need for further soldering.
• The buccal arms are retained for
attachment of elastics and for ease
of insertion and removal of the
appliance.
• Upper palatal and lower lingual
main frames are constructed from
0.032” yellow and 0.038” blue
elgiloy respectively.
• The cribs, clasps and occlusal rests
from 0.028” blue elgiloy. The lingual
arms from 0.030” yellow elgiloy and
buccal arms from 0.045” blue
elgiloy.
Crickett appliance
Activated appliance

ADVANTAGE
• The crickett is an effective appliance for variety of
tooth movements including distalization of molars.
DISADVANTAGE
• The major limitation of this appliance is when
intrusion of anterior teeth has to be performed.

REPELLING MAGNETS
• Gianelly in the year 1989.
• method of distalizing the molar is by the use
of modified nance appliance with the use of
repelling magnets.

The modified nance appliance serves 2 functions:
• Activation of the Magnets
• This is by tying a 0.4” ligature wire through the
loop and extended anteriorly to encircle a tie back
hook mesial to the magnets. When tightened, the
magnets are held in contact.
• To Contain the Reaction Force Arising From the
Magnets

DISADVANTAGE
• Forces exerted by magnets drops significantly
as spaces are opened.
• Discomfort to the patient.

MODIFICATION
• In 1991, Takami introduced a system using
two opposing magnets for each maxillary
quadrant.

DISADVANTAGE
• Labial movement of the anterior teeth was observed
despite the use of a nance holding arch.
• Initial discomfort to the patient because of the size of
magnets.
• Using repelling force, orthodontic force decreased by
50% to 70% with every 0.5mm - 1.0mm of movement
hence frequent reactivation was required every two
weeks.

MOLAR DISTALIZATION USING
SUPER ELASTIC NITI WIRE
• introduced by Locatelli and Bednar in 1992.
• Maxillary molars are moved distally using a
super elastic nickel titanium wire with shape
memory (Neosentalloy).

• As the wire returns to its original shape, it
exerts a 100 gm distal force against the
molars and a mesial reaction force on
premolars. There is also tendency for the
premolars to move buccaly.
• Anchorage can be controlled by placing 100-
150 gm class II elastics at the hook between
canine and lateral.

ADVANTAGES
• This method moves the molars distally by 1-2 mm per month
with little loss of anchorage.
• Neosentalloy is easy to insert even after all the teeth have been
bracketed or banded.
DISADVANTAGES
• Once the second molars are erupted, distal movement of first
molars usually take more time.
• If the first molars do not move by atleast 1mm / month, a 200
gm 0.018 X 0.025 Neosentalloy wire can be placed with
increase in force, therby increasing the chances of loss of
anchorage.

MODIFICATION
• To overcome the disadvantages of the conventional
design, Giancotti and Cozza in the year 1998
introduced a new system using the Neosentalloy.
NITI DOUBLE LOOP SYSTEM
• This new system was employed in simultaneous
distalization of the 1st and 2nd molars

Nickel Titanium double loop system

• Two sectional Niti arch wires (on either side)
are prepared by crimping stops distal and
mesial of the IInd premolar bracket and 5 mm
distal to each second molar tube.
• Uprighting springs are inserted into vertical
slot of the 1st premolar and class II elastics
are placed between mandibular 1st molar and
maxillary canine bracket.

ADVANTAGES
• Minimal patient cooperation
• Ideal for simultaneous first and second molar
distalization
• Second Molars move easier distally compared to first
molar because of their different anatomical shape of
the roots and lack of posterior obstacles.
• Because of the stretching of transeptal fibers, an 80
gm Niti wire is used instead of 100 gm or 200 gm.

PENDULUM APPLIANCE
• developed by James Hilger in the year 1992.
• a hybrid that uses a large nance acrylic button in the
palate for anchorage, along with .032 TMA spring
that deliver continuous force to the inner first molar
without affecting the palatal button.
• a broad swinging or pendulum of force from the
midline of palate to the upper molars.

• The right and left pendulum
springs formed from 0.032”
TMA wire, consist of a recurved
molar insertion wire, a small
horizontal adjustment loop, a
closed helix and a loop for
retention in the acrylic button.
• Springs are extended as close
to the centre of the palatal
button as possible to maximize
their range of motion, to allow
for easier insertion into the
lingual sheaths and to reduce
forces to an acceptable range.
Pendulum appliance
• Springs are mounted as close as possible to the distal aspect of nance button
which permits access to acrylic for polishing.
• Lingual sheath should be 0.36” so that 0.32” wire fits looselywww.indiandentalacademy.com

PREACTIVATION AND PLACEMENT

ADVANTAGE
• Use of 0.032 TMA springs delivers continuous force
to the upper first Molar without affecting the palatal
button.
• Activation can be done before appliance placement.
DISADVANTAGE
• Pure bodily movement of the molar is not seen,
tendency towards cross bite.

M-PENDULUM
• In 1999, Schuzzo, Pisani and Takemoto,
introduced a modification to this appliance
called the M-PENDULUM appliance.
• This modification ensured a bodily movement
of molar crowns and roots.

• Horizontal loop is inverted
MESIALLY. This allows bodily
movement of both roots and crown
of the Molars.
• Once distal movement is occurred,
loop is opened an activated which
produces a buccal and distal
uprighting of root.
• The inverted loop should not be
activated until spring has
deactivated following each phase of
distalization.
• A passive fit of the distal end of
spring with no distal force applied to
the Molar Crowns will allow
backward tipping of Molar roots.
M-PENDULUM

ADVANTAGES
• True bodily molar movement
• Minimal dependence on patient compliance.
• Less need for reactivation.
• Ease of fabrication.

MODIFIEDPENDULUMAPPLIANCEWITHREMOVABLE
ARMS
• Pisani and Takemoto along with Vecchia in the year
2000 introduced this particular modification

• Double over 7mm – 9mm length of 0.032
TMA wire to form bayonets. Attach each
bayonet to an M-PENDULUM arm either
by using Laser welder or by wrapping
0.10 ligature around arm and soldering
the unit.
• Embed each bayonet in the soft acrylic
that will be used to form nance button
producing sheaths in which to insert the
removable arm.
• Activate the arms in the working cast as
desired.
• Appliance is placed in the mouth and
terminal ends of arms into lingual molar
band sheath.
• Removable arms can be reactivated with
debonding the occlusal rest of nance
button.
Removable 0.032” TMA arm

MODIFIED PENDULUM
APPLAINCE FOR ANTERIOR
ANCHORAGE CONTROL
• This latest modification was introduced by
PABLO ECHARRI and SCHUZZO in the year
2003.

• This design consists of four
removable arms for both first and
second molars.
• The second molars are distalized
after which their arms are left
passively in place for anchorage
and first molar arms are activated
for distalization.
• Pendulum is replaced with a nance
button after first molar distalization.
A 0.016 SS passive arch wire is
placed to avoid any incisor
protrusion.
• E-Chain is used to distalize second
and first bicuspids.
• If anterior anchorage is critical,
palatal acrylic should be kept out of
contact with the incisors.
• Second bicuspid arm should not be
cut for spontaneous distalization to
prevent incisor protrusion.

Intra osseus screw
BONE ANCHORED PENDULUM APPLIANCE

Procedure
• Screw inserted in the anterior
paramedian region of the
median palatal suture, 7-8 mm
posterior to the incisor foramen
and 3-4 mm lateral to the
median line.
• A 1.3 mm diameter drill is used
to maintain primary stability of
the screw.

INTRA ORAL APPLICATION OF THE
BONE ANCHORED PENDULUM APPLIANCE.

THELOKARAPPLAINCE
• Dr. Lokarin the year 1994
• 2 basic components-A Mesial sliding component, A component which
inserts into the arch wire tube of the molar
• The distalizer is inserted into the arch wire tube of the first molar and the
application is adapted such that it is parallel to the plane of occlusion
and as close to the teeth as possible for comfort.
• An 0.12” stainless steel ligature wire is hand twisted around the
premolar bracket before the Lokar is fixed to the molar tube. This
ligature wire is engaged around the mesial sliding component of the
distalizer and tightened to activate the appliance.
• The force is developed by NiTi-Coil springs which get compressed
during activation. The anchorage is by a Nance appliance, soldered to

FIXED PISTON APPLIANCE
• The Fixed Piston Appliance introduced by Greenfield
• Can produce bodily movement of Maxillary first
molars without the use of extra oral appliances and
with no loss of fast anchorage.

• Maxillary 1st molar and 1st
premolar bands.
• 0.036” stainless steel tubing
(soldered to Bicuspids)
• 0.030” stainless steel wire
(soldered to first molars)
• Enlarged nance button,
reinforced with an 0.040” SS
wire.
• 0.55” (interior diameter) super
elastic open coil spring.

Advantages
• Produces bodily movement of maximum first molars with no loss of
anchorage.
• Does not require the need of patient compliance but allows the use
of head gear if required.
• Uses a light controlled force of only 1.5-2 Oz/tooth
• Does not interfere with occlusal plane thus maintaining control of
vertical dimension.

• Unilateral GMD

• First premolar and second deciduous molar
as anchor teeth
WHEN DECIDUOUS TEETH ARE USED AS ANCHOR UNITS,HALF THE
LENGTH OF ROOT SHOULD BE PRESENT

• Canine used as anchor teeth

• Second premolars and first molars used as
anchor for second molar distalization

• Second premolars used as anchorage

• GMD replaced by a expander

• Lingual distalizer
applies force only from the lingual side of
maxillary molars with twin piston module

JONES JIG
• Developed by Jones and White in the year
1992
• Jones Jig uses an open coil spring NiTi to
decliner 70-75 gm of force over a
compression range of 1-5mm to the Molars.

• A modified nance appliance is used with the Jones Jig because this can be
attached to first premolar, second premolar, or deciduous second molar.
• A 0.036” SS wire is bent to the palate on the cast extending it as far a the canines
and it is soldered to the anchor bands.
• Acrylic button is fabricated about half inch in diameter.
• The nance appliance is cemented and the Jones Jig is laid in place on both sides.
• Reactivation is done after every 4 -5 week’s intervals.

ADVANTAGES.
• The extent of forward movement of the anterior teeth
while using the Jones Jig is very minimal.
• Can be used without the need of a full banded upper
arch.
• The coils of Jig can be changed with minimal time
and the use of arch wires and class II elastics can be
avoided.

REMOVABLE MOLAR
DISTALIZATION SPLINT
• Developed by Korrodi Ritto in the year 1995.
• The Removable Molar Distalization Splint can
achieve better patient cooperation than some
other removable devices.

• Clear splint is made from 1.5mm
Biocryl in a Biostar machine.
• If both upper first molar are to be
moved distally at the same time,
the splint extends from the area of
upper first or second premolar to
the area of upper left premolar
• If only one molar is distalized, the
splint extends to the terminal
molar on the other side.
• Two internal clasps are used for
retention and a Ni-Ti coil spring
produces 220gm of distal force.
The coils are reactivated.
Molar distalization splint

ADVANTAGES
• It is smaller than conventional removable plates.
• It is comfortable.
• Esthetics
• Better co operation of the patient.
• Molar distalization even in cases of deep over bite.
DISADVANTAGES
• There is more amount of molar tipping than bodily molar
distalization. (So it is ideally used only in cases where the
molars are mesially tipped prior to treatment).

DISTAL JET APPLIANCE
• Introduced in the year 1996 by Carano and
Testa.

• Bilateral tubes of 0.036” internal
diameter are attached to an
acrylic nance button.
• A coil spring and screw clasp are
slid over each tube.(NiTi coil
spring of 150gms for children and
250gm for adults.)
• The wire extending from the
acrylic through each tube ends in
a bayonet bend that is inserted
into the lingual sheath of the first
molar band, this results in force
acting through the centre of
resistance of molar thereby giving
a translatory movement.
• An anchor wire from nance button
is soldered to bands on second
premolar.
Distal Jet Appliance

MODIFICATIONS OF THE
DISTAL JET APPLIANCE

DOUBLE SET SCREW DISTAL JET
• Introduced in the year 1998 by Jay Bowman.
• This modified distal jet incorporates two set
screws into activation order which permits an
easier, cleaner and more reliable conversion
to a molar nance holding arch.

• The mesial set screw is used during
active distalization.
• Upon distalization activation caller is
slid mesially to gain access to the
coil spring.
• The double set screw collar is slid
back to this junction. The mesial
screw is set on the tube and the
distal screw is set on the bayonet
wire locking the two pieces together
to prevent molar movement.
• Lingual sheath on molar maybe
crimped to reduce any play of
double back wire inserted into it and
also rotation over the nance acrylic
button.
DOUBLE SET SCREW DISTAL JET

MODIFIED DISTAL JET APPLIANCE
• This modification was introduced in the year
2000 by Quick and Harris.
• The basis of this modification is the rear entry
of the sliding section into the lingual molar
sheath so that the appliance pulls rather than
pushes the molars distally.

• The double back wire (or “foot”) is
inserted into the lingual sheath from
the distal.
• The foot should be longer than the
lingual sheath so that it can be tied
back to the sliding section with an
elastomeric or metal ligature.
• Sliding section is made of either
0.030” or 0.032” wire.
• Support tubes of corresponding
internal diameter are embedded to
acrylic nance button.
• Care is taken while bending the
distal portion of the sliding wire to
allow enough clearance from the
tuberosity of the palate when the
wire is removed
Distal jet with Rearentry

DISTAL JET SIMPLIFIED AND
UPDATED
• Due to the problems frequently encountered
with the use of the previous distal jet
appliances, Carano and Testa, again along
with Bowman introduced the latest of the
modification in the year 2002

• The locking mechanism of the distal jet consist of three interacting
components – lock, screw and activation wrench.
• This screw and wrench was too small for precise, positive control of the
appliance and too small for failure in certain situations.
• The screw and the activation wrench are much larger and more
durable.
• The screw is placed more mesially and the horizontal barrel of the lock
has been extended by 7 mm extending the working range of the
appliance and simplifying activation and conversion.
• The new barrel is also much narrower to improve patient comfort to
allow more precise positioning of the tube and the piston.

THE KLOOPMOLARDISTALIZER.
• Introduced by Kalra in the year 1998

• The appliance consists of a K loop to provide the
forces and moments and a Nance button to resist
anchorage.
• The K loop is made up of 0.017 X 0.025 “ TMA which
can be activated twice as much as stainless steel
before it undergoes permanent deformation.
• Force produced by the TMA will also be half.

• The loop of the K should be bent 8 mm in length and 1.5 mm wide.
• The legs of the loop are bent down 20° and inserted into molar tube and
Premolar bracket.
• Wire is marked at the mesial of the molar tube distal of the premolar bracket.
• Stops are bent into the wire 1mm distal to distal mark and 1mm mesial to mesial
mark.
• Each stop should be well defined and about 1.5 mm long. These bends help
keep the appliance away from muccobuccal fold, allowing a 2mm activation of
the loop

• The 20° bends will produce moments that counteract the tipping moments
created by the force of the appliance and these moments are reinforced by the
moment of activation as the loop is squeezed into place.
• K loop is placed at the centre between 1st premolar and molar to prevent any
extrusive r intrusive force.
• For additional molar movement, the appliance is reactivated by 2mm after 6-8
weeks.

ADVANTAGES
• The advantages of the K loop are:
• Simple and efficient.
• Controls M: F ratio to produce bodily movement.
• Easy to fabricate and place.
• Hygienic and comfortable.
• Minimal patient cooperation.
• Low cost.
DISADVANTAGES
• Improper placement of the loop cold result in undesirable tooth
movements (extrusive or intrusive force).

NANCE APPLIANCE AND COIL
SPRING
• Developed by Peringer, Parmann and
Droschl in the year 1997.

• The appliance consists of 2 premolar bands, connected by a
soldered palatal framework and an anterior acrylic shield for
palatal support.
• Distalization is produced by the sentalloy coil springs (150-
200gm) on sectional arch wires.
Nance coil appliance with open coil springs

MODIFIED NANCE APPLIANCE FOR
UNILATERAL MOLAR DISTALIZATION.
• The class I side of 0.036” SS
wire framework was finished
with an anteriorly projecting
0.036” arm like that of quad
heix.
• The active class II side has an
arm which is soldered to the first
bicuspid band.
• An 0.020” omega loop is
soldered to the anterior end of
framework which allows the
distal end of the loop to slide
distally as it is opened by
activation.
This was introduced the
year1992 by REINER

THE FIRST CLASS APPLIANCE
• Developed by Forini, Lupoli, Parri in the year
1999.
• The FCA is a new type of appliance
fabricated for Molar Distalization.

VESTIBULARCOMPONENTS
• Formative screws are
soldered on the buccal sides
of first molar bands occlusal
to the 0.022”x0.028” single
tubes
• Split rings welded to the
second premolar control the
vestibular screws.
• Stop screws are used to
maintain the distal positions
of molar after active
movement has completed.

PALATALCOMPONENTS

ADVANTAGES
• Rapid distalization of first and second molars.
• Reduces time in class II cases
• Can be used in deciduous and permanent dentition
• Distalizes Molars bodily
• After distalization it can be left in place as an
anchorage unit to maintain space.

THE SUPERSPRING II
• The Super Spring II was developed by
Klapper in the year 1999

• The Super Spring II new
maxillary oval tube prevents
any lateral movement of the
spring in the vestibule.
Therefore only minor
adjustments for individual
variations need to be made.
• With Super Spring II the
initial dental discomfort
disappears within about 3
days.

CLINICAL APPLICATIONS
• The Super Spring II can be used with fully bracketed appliances
and it makes an ideal auxiliary for various uses.
• In the late mixed dentition, while the mandibular arch is fully
bonded for anchorage, the maxillary molars can be distalized
without bonding the adjacent teeth.
• The Super Spring II moves both the crown and roots with a
moderate, continuous force and the adjacent teeth then follow
the molar distally

C- SPACE REGAINER
• Developed by Chung and Park in the year 2000.
• Significant drawback of most distalizing appliances is
the equal and opposite mesial force that tends to
flare the incisors labially.
• The C-SPACED RETAINER was developed to
produce bodily molar movement without significant
incisor flaring.

INDICATIONS
• Mesial drift of first molar following premature
loss of deciduous molar in mixed dentition.
• Mild arch length discrepancy.
• Open bite.
• Class II Malocclusion.
• Class III Malocclusion.

• A labial wire framework made
of 0.036” SS and an acrylic
splint.
• A closed helix wide in
diameter as comfort will allow
is bent into the framework in
each canine region.
• The labial framework is
extended distally to lie as
close to the buccal tubes as
possible allowing easy
insertion into headgear tubes.
• The Distal ends of the wire
are polished for a loose fit in
molar tubes.

INTRA ORAL BODILY MOLAR
DISTALIZER
• Developed by Ahmet Keles in the year 2000.

• An Anchorage part – Nance button .
• Distalization part - The springs
have two components, the distalizer
section of the spring applied a
crown tipping force while the
uprighting section applied a root
tipping
• On the palatal side of the first molar
bands 0.032x0.032 inch slot size
hinge cap palatal attachements are
welded.
• A wide acrylic button was
constructed and attached to first
premolar band with 0.045” SS wire.
The acrylic portion covered the
palatal aspect of the incisors and
hence caused an opening of the bite
thereby enhancing molar
distalization.
• 0.032x0.032” TMA springs are bentwww.indiandentalacademy.com

• Activation is done by pulling
from distal to mesial with
wingart pliers and then seating
into the slot of the hinge cap.
• A total 230gm of distal force
was applied.
• After distal movement was
achieved, the class I Molar was
stabilized by a conventional
nance appliance.
• This was attached to the hinge
cap on the molars for 2 months
before second phase of
treatment

ASSYMETRIC DISTALIZATION
– TMA TRANSPALATAL ARCH
• Asymmetric distalization using a TMA
transpalatal arch was introduced by
Maldurino and Balducci in the year 2001.
• Maxillary molars can be distalized unilaterally
by using a standard transpalatal arch in
conjugation with extra oral traction according
to Cetlin method.

• The TPA is constructed
using an 0.032 inch TMA
bars ( TMA is more resilient
than stainless steel).
• The direction of insertion of
the TPA into the occlusal
molar tubes is different.
• The arch is inserted from
distal into anchor molar and
mesially into the molar which
has to be distalized.

• When activated, the arch applies a mesio buccal rotation to the anchor
molar and distally directed force on the opposite molar. The central
omega loop is not needed as TMA is not used for palatal expansion.
• TMA is activated monthly by bending the end inserted from the distal by
about 30°.

ADVANTAGES
• TMA has better shape memory and resilience than stainless
steel.
• The arch is simple to construct.
• System is hygienic and economic.
• No anterior anchorage loss.
DISADVANTAGE
• One possible disadvantage of this method is that only one molar
can be distalized at a time.

A MIDPALATAL SCREW
FOR DISTALIZATION
• First introduced by Kyung and Park in the year 2003.
• Byloff and colleagues have successfully moved
molars distally using a Graz implant – supported
Pendulum appliance but the implant must be
surgically removed after orthodontic treatment.
• Karaman and colleagues have a distalized Molars by
implanting a screw 3mm in diameter and 14mm long,
2-3mm behind incisal canal, but this screws runs the
risk of damaging surrounding structures

PROCEDURE
• Inserting a mini screw is difficult with
a conventional straight screwdriver
which forms an oblique angle with
the bone surfaces,
• A contra angled handpiece is used
and it must be longer than the depth
of palate to avoid contact with
Maxillary anterior teeth.
• Because cortical bone can be
damaged easily by frictional heat,
the screw should be inserted with
irrigation at rate of no more than 30
turns/min.
• Care should be taken not to let the
power chain directly contact the soft
tissue.www.indiandentalacademy.com

THE UNILATERAL FROZAT
APPLIANCE
• Developed by Kinzinger in the year 2004.
• 2 molar bands soldered to an 0.38” blue
elgiloy or .040” stainless steel wire.
• The wire is fabricated on the cast with lingual
steps bent mesial to the molars and the
distance from the alveolar process kept as
constant as possible in the anterior segment.

• On the anchorage side, the lingual arch is bent into
an occlusal parallel loop, distal to the solder point on
the Molar band, then curved around to form the
lingual arm of the appliance.
• Arms should be in contact with the lingual surfaces of
all anchor teeth and that the wire segment inserted
buccally on these teeth is as rigid and passive as
possible. The lingual arm and the segmental arch
wire to form one large, multi root anchor unit.

• generates a distalizing force against the target molar but also a mesial
force, combined with mesiobuccal movement on the anchorage unit.
• The activation bends in the lingual arch should be placed at the level of
the molars to ensure that the centre rotation is as close as possible to
the centre of resistance, making the tooth movement mostly translatory.
• The mesially directed forces and the mesiobuccal movement acting on
anchor molar is undesirable.
• The Unilateral Frozat appliance allows a controlled uprighting and
distalization of the lower molars. Intermaxillary anchorage is achieved
by simultaneously inserting a rigid and passive buccal wire segment

WILSON’S RAPID MOLAR
DISTALIZATION
• Advocated by William L. Wilson and Robert C. Wilson
• to distalize the maxillary molars, while the mandibular
molars maintain the pre-treatment antero-posterior
positions.
• The Wilson treatment achieves molar distalization
without extra oral forces

ADVANTAGES
• No extra oral force.
• Class II correction starts immediately (even in mixed dentition).
• No reactionary maxillary incisor proclination.
• Can be used in mixed dentition.
DISADVANTAGES
• Longer treatment time (than originally propose) Wilson said that the
treatment time was 6-10 weeks actually it takes 16 weeks.
• Distal tipping occurs frequently. The tipped molars have questionable
stability.
• A significant portion of the class II correction was found to be due to
mesial movement of Mandibular Molars.

THE CARRIERE DISTALIZER
• Developed by Carriere in the year 2004.
• Produce a distal rotational movement of maxillary first molars around their
palatal roots when necessary.
• Simultaneously produce a uniform force for distal molar movement.
• Independently move each post segment from canine to molar as a unit.
• Eliminate wire changes.
• Minimize periodontal reactions.
• The clinical evidence of achievement of these objectives will be the
appearance of interincisal diastemas and wide spaces mesial to canine

• The distalizer is made of mold injected Nickel free stainless steel.
• The ‘Canine Pad’ which allows distal movement of canine along
alveolar ridge without tipping provides a hook for attachment of class II
elastics.
• This pad is mesial end of the arm that runs posteriorly over the 2 upper
premolars in a slight curve.
• The posterior end of the arm is permanently attached ball that
articulates in a socket on the molar pad.

• Several anchorage procedures can be given:
• Passive lingual arch
• Hamula lingual arch
• Full mandibular fixed appliance.
• Lower Essix appliance
• Miniscrews
Carriere distalizerwith class II elastic attached

THE FRANZULUM APPLIANCE
• Invented by Byloff and Darendeliler in the
year 2000.
• Gaining space in the mandible is more
difficult than in the maxilla. Extra oral
appliances are seldom attached to the
mandibular molar because of the pressure
they place on the condyles.

• The Franzulum appliance’s
anterior anchorage unit is an
acrylic button, positioned
lingually and inferiorly to the
mandibular anterior teeth and
extending from mandibular left
canine to the right canine.
• Rests on the canines and first
premolars are made from 0.32”
stainless steel wire. Tubes
between the second premolars
and the first molars receive the
active components.

Interesting studies comparing the Jones jig,
pendulum appliance and the Distal jet appliance
conclude that the maximum distalization was
achieved with the pendulum however it showed a
greater percentage of anchor loss and also the
chances of stability was questionable.
 The distal jet appliance displayed more of
bodily movement with minimal anchor loss.

Karlsoon and Bondemark in 2005 compared the
efficiency of extra oral appliance with an intra oral
appliance for distal molar movement of maxillary first
molar and concluded that the amount of distal molar
movement of the maxillary first molars was significantly
higher and more rapid with the intra oral appliance than
the extra oral appliance.
 Moderate and acceptable anchorage loss was
produced with the intra oral appliance implying
increased over jet whereas the extra oral appliance
created a decreased over jet.
Efficacy of the magnets in distalizing the molar though
less than that of the coil springs, the anchor loss and
distal tipping of the molars was minimal in comparison.www.indiandentalacademy.com

CONCLUSION
Though a number of appliance systems are available,
every clinician should cautiously begin with a precise
diagnosis, sound treatment plan and appliance
selection taking into consideration various factors
pertaining to the case selection like the age of the
patient, growth pattern and also the factors relating to
a particular appliance system ( Molar Distalizers ).
Therefore any one molar distalizer cannot be
concluded to be ideal for any clinical situations.

CONCLUSION
It is in the hands of the clinician to thoroughly
analyze the clinical picture and select the
appropriate molar distalizing appliance. Thus
it’s not just the superiority of the mechanics
but the superior thinking and application of
the clinician that can produce a good and
stable result.

Molar distalization (2)

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