MOLAR DISTALIZATION , headgear, fixed functional

molar distalisation ,

1. MOLAR DISTALIZATION

CONTENTS

 INTRODUCTION
 HISTORY
 INDICATIONS AND CONTRAINDICATIONS
 DIAGNOSIS
 TIMING
 SUCCESS RATE
 BIOMECHANICS
 CLASSIFICATION
 APPLIANCES IN DETAIL WITH RECENT ADVANCES
 CONCLUSION
 REFERENCES

2. DEFINITION
• Molar distalization is a term that is commonly used now for referring to the procedure
of increasing the length of the dental arch by the rearward movement of the buccal
segment teeth
HISTORY
• William Kingsley(1892) – headgear
• Oppenheim (1944) advocated that position of mandibular teeth is the most correct &
correction of class I done by molar distalization without disturbing the mandibular teeth
position
• Kloehn (1947) started a long and beneficial series of investigations and clinical
applications of cervical anchorage to the maxillary dentition.
• Gould (1957) was first person to discuss about unilateral distalization of molars with
extra-oral force.
• Graber T.M. (1969) extracted the maxillary Il molar and distalized the first molar to
correct class II div.I.
• Late 1970s and 1980-Repelling magnets open coil springs, and superelastic wires were
tested
• Hilgers in 1992 introduced pendulum appliance
• Jones and White introduced a buccal sectional assembly, which is popularly called
Jones Jig (1992)

3. INDICATIONS
 To distalise (normalise) the mesially migrated maxillary molars due to their premature
mesial drift.
 To correct class II dental relationship of no more than half-cusp severity and mild
maxillary dentoalveolar protrusion. The mandibular arch either requires no or need
minimal orthodontics.
 In class I occlusion patients, molar distalisation may be indicated to gain space to
resolve minor crowding in the anterior segment
 To obtain space for erupting canines more so by utilising the Leeway space and minor
distal movement of the molars.
 To recover anchorage loss during active orthodontic treatment
 In low mandibular plane angle cases
 Midline discrepancy cases.
 Second molar extraction cases where the third molars are well formed and erupting
properly.
 Straight profile
 Normal, healthy tempero mandibular joint
 Correct maxillomandibular relationship
 Normal, short lower face height
CONTRAINDICATIONS
 Patients with severe arch length tooth size discrepancy.
 Patients having high mandibular angle are contraindicated for distalization of molars.
 Treatment by distalisation is also difficult in fully grown patients. Anterior anchorage
loss can occur due to the forces required for distalisation of third molar.
 Open bite.
 Patients with class I or class III molar relation
 According to William Wilson in 1978, molar distalisation should not be done before 11
years of age as the maxillary tuberosity enters its rapid growth phase which may lead
to second and third molar impaction

4. Op Kharbanda,diagnosis and management of malocclusion
Diagnostic criteria
• First step in diagnosis is to confirm forward positioning of maxillary molar position
during centric relation through cephalometric records.
• Kotm cautioned against using extraoral force in patients with undiagnosed meniscus
disorders who are borderline clickers with an “end on click”. It may pushback maxillary
molar; causing more posterior tooth contact backward (for true click), the mandible
assumes its normal position but meniscus remains too far forward.
• Second step is to check the sagittal relationship by Pterygoid Vertical Plane
(PTV)/Maxillary molar relationship and also by convexity prognosis
• Sassounis analysis
RICKETTS CRITERION
• The clinical norm is age+3 and clinical deviation is +/-3 mm.
(growing patients).
• In non-growing patients mean value is 18 mm.
• If the distance M1/PTV -shorter -the possibility for distalization is low

5. Treatment timing
• The mysteries of dentofacial growth and development have to be realized first before
the start of treatment.
• Although there may be little consensus as to the best time to start molar distalization,
there appears to be some agreement as to when it may be too late to start correction i.e.
after eruption of the second permanent molar teeth. Best time to start/initiate molar
distalization would be in late mixed dentition.
• There appears to be some potential for synergistic effect as the dentition transitions
from primary to permanent,
• Because clinically, erupting premolars and canines often appear to follow the molars
as they are moved distally.
Biomechanics of molar distalisation

 Molar distalisation cause distal crown tipping, extrusion and distal rotation of the
maxillary molars.
 The molars tend to rotate either buccal or palatal depending upon the point of
application of force.
 The reciprocal forces of molar distalisation are counteracted by anchorage derived from
modified Nance button.
 The CRes of anchorage dental units - located between the root apices of the premolars
 The premolars and the canines move mesially leading to incisors proclination which is,
termed as anterior anchorage loss.
 The maxillary molar- centre of resistance- trifurcation of roots, the point of force
application is limited by the biological limitations and hence some amount of distal
tipping is unavoidable.
 Most molar distalisation appliance cause some distal palatal rotation and narrowing of
the intermolar width, which is greater with pendulum appliance.
 Pendulum appliance or its variations cause distopalatal rotation of the maxillary first
molar as the tooth is distalised along the arc of the activation of the spring

6. Maxillary molar is distalised at the rate of 0.75–1 mm/month on an average.
The distal molar tip was found to be 8.38 ± 1.8 degrees for pendulum appliance and 7.67 ± 3.4
degrees for Jones Jig

7. CLASSIFICATION
1 Extraoral appliances
(a) Headgear
2. Intra oral appliances
(a) Intra arch:
i. Removable appliances:
A. ACCO (acrylic cervical occipital appliance]
B. Removable molar distalization splint
C. Segmental removable appliance in molar distalization
B ] Interarch
(a) Rigid intermaxillary appliances
i. Herbst Appliance
(b) Flexible intermaxillary appliances
i. Jasper Jumper
ii. Churro Jumper
(c) Hybrid appliances
i. Eureka Springs
33 Maxillary arch
a Flexible palatally positioned distalization force system
• i. Pendulum appliance and its modifications
• ii. Distal jet and its modifications
• iii. Intraoral Bodily Molar Distalizing Appliance(IBDA
• iv. Simplified molar distalizer
(b) Flexible buccally positioned distalization force system

8. i. Repelling magnets
ii. NiTi wire
iii. Jones jig
iv. Sectional jig assembly
v. K loop
(c) Flexible bucally and palatally positioned distalization force system
i Fixed piston appliances
d) Hybrid appliances (rigid bucally and flexible palatally positioned distalization force system
• i. First class appliance for molar distalization
(e) Transpalatal arches for molar rotation and/or distalization
• i. Stainless steel transpalatal arch
• ii. TMA transpalatal arch
(f) Implant supported appliances
• i. Graz Implant Supported Pendulum Appliance
• ii. Skeletal anchorage system
• iii. Midpalatal Miniscrew
4. Mandibular Arch
i Lip bumper
ii. Franzulum appliance
iii. Unilateral Crozat Appliance

9. CLASSIFICATION
 Dental/conventional anchorage derived appliances
 Skeletal anchorage using minis crews/skeletal anchorage system
 Combination of buccal and palatal application of force
Dental/conventional anchorage derived appliances
Buccal appliance
Jigs with class II elastics
Repelling magnets
NiTi springs and wires
Jones Jig
K loop
Palatal appliance
• Pendulum appliance
• Modifications of pendulum appliance
• Fixed piston appliance
• Distal Jet spring loaded palatal appliance
Buccal and palatal appliance
First class appliance
Skeletal anchorage using miniscrews/skeletal anchorage system
Palatal anchorage
 Bone anchored pendulum appliance (BAPA)
 Miniscrew supported pendulum appliance

10.  Palatal supported all wire framework
 Beneslider TAD supported buccal Jig
 TAD supported long arm buccal jig
 TAD supported jig on fixed appliance
 AIIMS Universal Connector supported Jones Jig
Combination of buccal and palatal
• Dual force distaliser supported with Nance button anchored with TAD
HEAD GEAR
 In 1822, Gunnel first described Extra-oral anchorage.
 In 1866, Guilford used the headgear for correcting protruding maxillary teeth.
 1892 Norman William Kingsley reported remodeling of class II molar relationship to
class I using headgear.
 Klein Phillip in 1957 assessed the outcome of cervical traction for correcting class II
malocclusion
 Force Delivering Unit: “J” hook or face bow that delivers force to the intra oral
location.
 Force Generation Unit: This is the active unit. These are usually bands, springs or
elastics.
 The Anchor Unit: The location depends on the direction of force (neck pad or head
cap).

11. Face bow

• Inner bow
• Outer bow
• junction
Point of anchorage:
 cervical
occipital
parietal
combination

High pull Headgear

Cervical Headgear

12. Combination headgear:

The effect of the headgear depends on the direction of application of force.
The following effects are observed.

SOLDERED OFFSET FACEBOW
In this design the outer bow is attached to the inner bow by a fixed soldered joint placed on the side
anticipated to receive the greater distal force

13. INTERNAL HINGE
• It has hinge added mesial to the molar on the side not to be distalized and the external
arm is also shortened on the same side .
• It is more effective in achieving asymmetric distalization of molar .
• The internal hinge facebow provides more satisfactory unilateral force delivery by
preventing the influence of asymmetric molar rotation

Swivel offset face-bow
 Here the outer bow is connected with the
inner bow through a swivel joint located in an offset position on the side where the
greater distal forceis desired.
 Theoretically, the effect of a swivel offset face
bow can be determined by the location of the swivel joint
 But experimentally, the results obtained were different from the expected ones.
 When swivel offset face bow is fabricated so as to produce same asymmetric effect as
the powerarm face-bow, the asymmetric effect and the lateral effect observed with the
swivel offset face-bow were substantially larger than those of the power arm face-bow
type

14. Limiting lateral force
• According to Yoshida et though the net lateral force on both molars cannot be changed,
the distribution of the net distal and lateral force into individual molars can be changed
by alterations in the configuration of the outer and inner bows.
• When the power arm face-bow is reversed, with longer or wider outer bow on the Class
I side and shorter outer bow on Class II side, it produces a buccal force on the molar
that should be more distalized and thus, preventing crossbite.
• Some author have even suggested using transpalatal bar in association with headgear
for avoiding excessive lateral forces.
• Distal toe-in bend can be added on the side of the palatal arch where molar distalization
is not desired so that mesial force produced by palatal arch can counteract distal force
generated by reversed power arm face-bow. Then equal and opposite distal forces are
developed on the other end of the palatal arch with desired buccal force
Acrylic Cervical Occipital Appliance (ACCO)
 Herbert Margolis
 It is a removable acrylic plate with springs for distalization along with extraoral traction
Design:
 Acrylic plate covering the palatal area with an anterior bite plate disoccluding posterior
teeth
 Modified Adams clasps on the first premolars,
 A labial bow over the incisors for retention purpose
 For moving molars distally there are finger springs facing the mesial aspects of first
molars in alliance with an extraoral traction.

15. Advantages
• First, it applies a constantly acting force that, in the authors' experience, enhances the
rate of molar movement.
• This view is corroborated by the observation that continuous forces move teeth faster
than intermittent forces.
• Second, patients readily accept the appliance because it is intraoral and relatively
comfortable to wear. Patient cooperation is good, provided the appliance fits properly.
• Another significant advantage is that it provides an effective method to distalize molars
asymmetrically.
• If unilateral distal molar movement is required, springs are only placed on that side. If
bilateral, but asymmetric, distal movement is necessary, springs can be activated and
deactivated appropriately
Disadvantages
There are a few disadvantages to the use of the ACCO.
• First, as indicated, the finger springs of the appliance tip the crowns of the molars
distally, as opposed to moving them bodily.
• However, the tipping is less when the finger springs are closer to the center of resistance
of the molars.
• A second disadvantage of the ACCO appliance is that, unlike the headgear, the
anchorage is intraoral. Anchorage loss will become evident as an increase in overjet
because the acrylic encompasses the incisors.
REMOVABLE MOLAR DISTALIZATION SPLINT
 Korrodi Ritto in 1995
 Clear splint is made from 1.5mm Biocyrl in a Biostar machine.
 Two internal clasps are used for retention and a NiTi coil spring produces 220 gm of
distal force.
 The coils are reactivated.

16.  ADVANTAGES
 It is smaller than conventional removable plates.
 It is comfortable.
 Esthetics
 Better to co operation of the patient.
 Molar distalization even in cases of deep over bite.
DISADVANTAGES
 More amount of molar tipping than bodily molar distalization.
WILSONS' RAPID MOLAR DISTALIZATION
William L. Wilson and Robert C. Wilson in 1984
Distalizes maxillary molars, while the mandibular molars maintain the pre-treatment AP
positions.
Bimetric distalizing arches (BDA) and a mandibular 3D lingual arch.
The biometric arch produces a coil spring action against the molars and produces an anterior
counter movement against the incisors, which is controlled by wearing class II elastics.
These in turn, react with the lower mesial force vector which is controlled by the 3D lingual
arch with a design for anchorage resistance.
This is supplemented by molar buccal root torque and cortical resistance to satisfy anchorage
needs.

17. • The vertical component of elastic force is controlled by using the elastic load reduction
principle, in which the elastic force is reduced to physiologically acceptable levels.
• Mandibular anchorage and elastic load reduction control the reactive counter
movements and produce a relatively friction free, rapid distalization of molars, without
head gear and with preservation of mandibular arch integrity.
• The delayed bracketing of the premolar and second molars permit the use of bypass
mechanics of the 3D biometric distalizing arch in modular first phase treatment.
• This produces rapid friction free distalization without head gear.
• WILSON’S SCHEDULE FOR MAXIMUM MANDIBULAR ANCHORAGE
• · 6 Ounce elastics for 5 days
• · 5 Ounce elastics for 5 days
• · 2 ounce elastics for 11 days
• FOR MINIMAL MANDIBULAR ANCHORAGE
• · 6 OUNCE FOR 10 DAYS
• · 3 OUNCE FOR 11 DAYS
CETLIN APPLIANCE
Cetlin and Tenhoe in 1983.
• Combination of extra oral force(HG) and an intra oral force in the form of removable
appliance
• To overcome the disadvantages caused due to the tipping of molars
• Removable appliance - tip the crowns distally
• Extra oral force - upright the roots.
• THE APPLIANCE
• Removable appliance - 24 hours
• HG - 12-14 hours/day.

18. • ABP - to disengage the molars
THE FORCE APPLIED
• Spring activated -1 to 1.5 mm, - 30 gms.
• HG exerts 150 gm force per tooth and is used to control root position.
•

INTERARCH
Appliances producing pushing forces
• These include appliances that deliver a ‘pushing’ force vector, forcing the attachment
points of the appliance away from one
• Class II bite correctors include:
1. The Herbst appliance :
• A fixed functional appliance popularized by Pancherz.
• It consists of a bilateral telescopic mechanism that protrudes the mandible with
compensatory maxillary molar distalization.
• The sagittal correction of the molar relationship results from a combination of skeletal
changes (43%) and dento-alveolar changes (57%).

19. Its action is similar to that of the Forsus springs (3M, Monrovia, California, USA) and
AdvanSync bite correctors (Ormco, California, USA) that are used in conjunction with a
transpalatal arc
2. The Jasper Jumper
• It consists of two vinyl coated auxiliary springs attached to the maxillary first
permanent molars and to the mandibular archwire anteriorly, with the springs resting in
the buccal sulcus.
• The springs hold the mandible in a protruded position.
• The majority of the action is reported to be dental, rather than skeletal, change.
3 The adjustable bite corrector
• It is similar to the Herbst appliance and to the Jasper Jumper.
• The advantages are the adjustable length, stretchable springs, and easy adjustment of
the attachment parts.
• No long-term studies have been published on this appliance to date

MAXILLARY ARCH

PENDULUM APPLIANCE
JAMES J. HILGERS, 1992
The appliance used modified Nance button for anchorage and TMA wire springs to apply force
from the palatal side for molar distalisation.
It produces broad swinging arc (pendulum) of force from midline of palate to upper molars
Appliance Design
• The pendulum appliance consists of anchorage derived from premolars.
• Bands on first premolars and soldered palatal extensions of 0.036-in. SS wire are
embedded in an acrylic button in the rugae area and contour of the anterior palate.

20. • The maxillary first molars with a welded lingual tube on each of the molar band.
• Two palatal springs made of 0.032 in. TMA wire, embedded in the Nance button on
either side of the midline.
• The activated springs deliver 150 g of force sufficient to distalise the molar partly by
bodily and partly by tipping movement.
• Distalization generated by the PA is rapid and a 1–2 mm space mesial to the first molar
can be expected within 6 weeks of insertion. The PA can provide 4–5 mm of arch length
on each side
Variations with Emphasis on Molar Control
• Because the spring force is applied occlusally relative to the center of resistance of the
molar, the molars are not distalized in a bodily fashion; instead, a crown distal tipping
is expected.
• Furthermore, due to the swinging arc of the force, the molar distalization is not a linear
movement; rather, a mesial-buccal rotation is inevitable.
• Also, because the depth of the maxillary vault and the position of Nance button,
together with the helix mechanism attached to it, is higher than that of the molar and
the lingual sheath, the helix springs therefore exert intrusive forces against the molars,
causing them to intrude when they are moving distally. Byloff et al describe the
working mechanism of their modified appliance with a two-phase theory.
• Distal Molar Crown Movement (Phase 1)
• During this first phase, the springs are activated 45° in the center of the helices on the
sagittal plane until an overcorrected Class I relationship is obtained. One or two
intraoral reactivations are generally necessary.
• To facilitate intraoral reinsertion of the spring, the lingual sheath should have an inset
of 8°

21. •
• Molar Root Uprighting (Phase 2)
• When the necessary sagittal correction and amount of space are obtained, the appliance
is modified by adding a bend to the spring design to upright the molars by moving the
roots distally.
• In order to make the uprighting bends, the angle between the recurved end of the spring,
which is engaged into the palatal molar sheaths, and the long arm of the spring is
increased intraorally in the sagittal plane 10–15°.
• The moment created is expected to upright the molars. The springs are still slightly
active in the sagittal plane to maintain the position of the molar crowns. The appliance
is left in place until the molar crown seems to be sufficiently uprighted.
• As an alternative, uprighting bends can also be incorporated at the beginning of the
distalization. In this situation, the restriction of crown tipping is implemented through
the whole process of molar distalization
• rAdvantages of Pendulum appliance over other distalizing appliances:
• 1. The need for minimal patient cooperation is one of the most desirable qualities of the
Pendulum appliance when compared with other appliances such as the headgear, the
ACCO, and the Wilson distalizing arch.
• 2. Only one activation period is mostly necessary to achieve results. Most distalizing
appliances , including headgears, the ACCO, and Wilson mechanics, require some sort
of reactivation or titration of forces to effect a change.

22. • 3. Pendulum does not require intermaxillary elastics for anchorage support, as required
in the Wilson distalizing system. So loss of anchorage in the mandibular arch is not a
concern.
ACTIVATION
Stepwise Activation
• Some authors suggest that, in contrast to the recommendation of Hilgers, the PA springs
are activated 45° (instead of 60°) in the center of the helices on the sagittal plane with
an initial force of 200–250 g.
• Depending on the molar movement required, activation is repeated intraorally once or
twice during treatment.
• With the expansion mechanism, patients are instructed to turn the expansion screw
once every 3 days for a period of 4 weeks.
• As a general principle, patients with molar crossbite tendencies or complete crossbites
are asked to continue the activation for up to 12 weeks, depending on how much
expansion is needed. The PA is worn until a super Class I relation is obtained.
Single Activation
• Joseph & Butchart recommend that the PA should be activated only once by bending
the springs 90° to the base of the appliance, and should be maintained in the mouth until
all the molars are overcorrected to a super Class I relationship
• Advantages
• Excellent patient tolerance
• Up to 5 mm distalization in 4 months
• Distalization + expansion can be achieved
• Only one activation period is mostly necessary to achieve results. Most distalizing
appliances,including headgears, the ACCO, and Wilson mechanics, require some sort
of reactivation or titration of forces to effect a change

23. Disadvantages
• The pendulum appliance not only drives the molars distally, there is also a slight lingual
tipping.
• The Nance button causes proclination of front teeth.
• Not very easy to fabricate.
Pure bodily movement of the molar is not seen
Modifications of pendulum appliance
• PENDEX appliance
• § Modified pendulum appliance/M pendulum
• § Modified pendulum with removable arms
• § Modified pendulum for anterior anchorage control
• § T- REX appliance
• § Franzulum appliance
• § Hilger PhD appliance
• § Mini distalizing appliance (MDA)
• § Pendulum K appliance
• § Bone anchored pendulum appliance (BAPA)
§ Pendulum appliance with maxillary molar root uprighting bend

K pendulum
 Kinzinger et al presented a modified design named the K-Pendulum.
 The appliance includes a distal screw dividing the Nance button into two sections.
 The anterior section provides anchorage and the posterior section accommodates the
pendulum springs. The pendulum springs are additionally incorporated with a built-in

24. straightening activation and toe-in bending, to allow for an elimination of molar
rotation.
 There is no need for the pendulum springs to be disengaged from the lingual sheaths
 By designating the two functions (anchorage and distalization) to be implemented by
two separate components, the reciprocal force acting against the labial segment might
be reduced
 Contrary to this distal screw design, a transverse expansion mechanism is also
incorporated into the Nance button, not only to correct the constricted upper dental arch
but, more importantly, to reduce the anchorage burden in the labial segment by
transforming part of the reciprocal force into the buccal segment
The Modified Pendulum Appliance/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
APPLIANCE DESIGN
• The horizontal Pendulum omega loop is inverted, which will allow bodily movement
of both the roots and crowns of the maxillary molars.
• Once distal molar movement has occurred, the loop can be activated simply by opening
it.
• The activation produces buccal and/or distal uprighting of the molar roots and thus a
true bodily movement rather than a simple tipping or rotation.
ADVANTAGES
• 1. True bodily molar movement
• 2. Minimal dependence on patient compliance.
• 3. Less need for reactivation.
• 4. Ease of fabrication
•

25. PENDEX appliance
• Pendex appliance was given by Hilgers.
• The design of the Pendex appliance is essentially the same as the Pendulum, except
for the addition of a palatal expansion screw in the midline.
• It is used in instances where there is tendency towards transverse maxillary
constriction as in patients with class II malocclusion
T-REX appliance:
• This design features two wires that extend from the palatal acrylic and are
soldered to the lingual aspect of the maxillary first molars.
• These wires provide additional stability to the appliance during the expansion
phase; they are severed or removed when the molar distalization phase is initiated
• After the desired molar distalization has been realized , the next step is to remove
the occlusal rests on the maxillary second premolars , much in the same manner
the locking wires were removed.
The maxillary second premolars will drift posteriorly, due to the pull of the transseptal
fibers . This spontaneous movement improves the Class II correction with minimal
anchorage loss

• Two or three appointments later, the Pendex appliance is removed, and a so-called
"Quick Nance" is inserted . A preformed Nance crib, made from .032" stainless steel
and available in various sizes, (Onnco Corp., Orange CA), the ends of which have been
doubled over to fit into the .036" lingual sheaths on the maxillary first molar bands, is
used to make the Quick-Nance.

26. • Hilgers and Bennette recommend taking a maxillary impression during the
appointment before the Pendulum appliance is to be removed to allow for preselection
of the proper sized Nance button

Hilgers Phd appliance
• Another appliance in the PENDULUM family is the Phd appliance.
• This version features an all-metal design with no acrylic plate. The primary
advantage being comfort and improved hygiene for the patient.
• Anchorage consists of banded first premolars with stabilizing wires from the
premolars to the molar bands.
• This appliance allows for phasing treatment if desired, with palatal expansion
first, followed by sectioning of the holding wires and distalizing of the molars.
• The pendulum springs in the Phd appliance insert into sheaths welded or soldered
to the palatal side of the expansion screw housing.
• This configuration allows the clinician to remove the springs, either before palatal
expansion is started or for adjustments/reactivation of the springs during the
molar distalizing phase
• FLEXIBLE BUCCALLY AND PALATALLY POSI TIONED DISTALIZATION
FORCE SYSTEM

27. 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
APPLIANCE DESIGN
The appliance components are
• 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 a 0.040” SS wire.
• 0.55” (interior diameter) super elastic open coil spring.

28. MANDIBULAR ARCH
FRANZULUM MANDIBLE
• In the mandible gaining space is difficult than in the upper arch.
• Extraoral appliances are attached to the mandibular molars
because they place the pressure on condyle.
• The Franzulum appliance was presented by Friedrich Byloff in
2000.
APPLIANCE DESIGN
• The Franzulum Appliance’s anterior anchorage unit is an acrylic button, positioned
lingually and inferiorly to the mandibular anterior teeth, and extending from the
mandibular left canine to the mandibular right canine .
• The acrylic should be at least 5mm wide to avoid mucosal trauma and to dissipate the
reactive force produced by the distalizing components. Rests on the canines and first
premolars are made from .032" stainless steel wire. Tubes between the second
premolars and first molars receive the active components.
• The posterior distalizing unit uses nickel titanium coil springs, about 18mm in length,
which apply an initial force of 100-120g per side.
A J-shaped wire passing through each coil is inserted into the corresponding tube of the
anchorage unit
Tahe recurved posterior portion of the wire is engaged in the lingual sheath of the mandibular
first molar band .
The anchorage unit is bonded with composite resin to the canines and first premolars.
The J-shaped distalizing unit is then ligated to the lingual sheaths of the molar bands,
compressing the coil springs.
Thus, the active part of the appliance runs lingually at a level close to the center of resistance
of the molar, to produce an almost pure bodily movement.

29. K LOOP
• Varun Kalra introduced the K-Loop molar distalizer in 1995.
• The appliance comprises of a K-loop to give the forces and moments.
• The K-loop is made of.017" X.025" TMA wire. It can be activated twice as much as SS
before it undergoes to deformation.
LOOP DESIGN
• The loop of the 'K' should be 8 mm long and 1.5 mm wide.
• The legs of the 'K' are to be bent down 20° and inserted into the molar tube and the
premolar bracket.
• The wires are marked at the mesial of the molar tube and the distal of the premolar
bracket.
• Stops are bent into the wire 1 mm distal to the distal mark and 1 mm mesial to the
mesial mark

30. ACTIVATION
 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.
 Translatory movement of the molar is obtained.
 K loop is placed at the centre between 1 st premolar and molar to prevent any extrusive
or intrusive force.
 For additional molar movement, the appliance is reactivated by 2mm after 6-8 weeks
 Thus, the molar undergoes a translatory movement instead of tipping.
 If an extrusive or intrusive force against the molar is not desired, it is important to center
the K-loop between the first molar and the premolar

 ADVANTAGES
 1. Simple and efficient.
 2. Controls M: F ratio to produce bodily movement.
 3. Easy to fabricate and place.
 4. Hygienic and comfortable.

31.  5. Minimal patient cooperation.
 6. Low cost.
 DISADVANTAGES
 Improper placement of the loop cold result in undesirable tooth movements (extrusive
or intrusive force)
Distal jet for upper molar
• It was developed Carano and Testa in 1996.
APPLIANCE DESIGN
Bilateral tubes of 0.036” internal diameter are attached to an acrylic nance button.
• A coil spring and screw clasp are slide 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 result 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.
Components:
• 1. TP connector
• 2. The bayonet director unit –
• 3. The molar bayonet –
• 4. The Distal stop –
• 5. Nickel titanium springs –
• 6. Activation locks -
• 7. Lock wrench -
APPLIANCE ACTIVATION
• 1 After the Distal Jet has been tried in and cemented, squeeze the lingual sheath around
the doubled-back wire.

32. • This tightens the connection of the molar to the bayonet wire for more precise control
during distalization.
• Alternatively, either a stainless steel ligature wire or a separating elastic may be used to
tie the sheath and wire together.
• Separating elastics have the advantage of providing a cushion effect for patient
comfort, but must be checked at each appointment and replaced when necessary.
• 2. Insert the activation wrench into the recess in the .050" hex-screw head . Using the
wrench as a guide, slide the lock back to compress the spring completely, and tighten
the screw
MODIFICATIONS OF DISTAL JET
• Conversion to Nance Holding Arch:
Upon completion of molar distalization, the Distal Jet is converted to a Nance holding
arch to prevent further distal movement and consequent anchorage loss. It can be done by these
two methods:
1 placing light-cured acrylic around the coil spring, over the distal bayonet bend, and over the
activation collar to produce a solid extension from the molar bands to the acrylic button.
2. recurved wire is tied to tube mesial to the activation collar with steel ligature wire .The coil
spring should be compressed completely and the set screw tightened to prevent mesial
movement of the molars.
Molar Rotation Correction
• A unique feature of the Distal Jet is its ability to be used as a transpalatal bar to correct
and control molar rotations .
• The terminal ends of the Distal Jet bayonet wires are similar to transpalatal bars in
shape and function.
• Therefore, rotational bends can easily be placed in the doubled-back wire sections of
the Distal Jet, just as they would be with a transpalatal bar.
• The longer barrel of the new lock greatly facilitates such adjustments.

33. • Any corrective bends should be made before the appliance is cemented in the mouth
either during appliance construction in the lab, or at chairside when the appliance is
delivered.
• Rotations should be corrected before activating the appliance to distalize the molars.
ADVANTAGES
• 1. The distal jet can be converted into a passive nance appliance so that the molar can
be held in place as anterior teeth are distalized.
• 2. Relatively easy to insert and well tolerated by the patient.
• 3. Esthetic.
• 4. Requires no patient cooperation
DISADVANTAGES
• 1. Inability to obtain positive engagement of the lock on the tube to fully compress the
spring.
2. Looseness of the appliance during retention phase
• One of the challenges that arises in any treatment that involves intentional molar
distalization is the consolidation of the arches after posterior molar movement has been
completed.
• In some instances, in addition to the Nance button, Bowman-? has suggested the use of
fixed appliances combined with the simultaneous use of a Jasper Jumper appliance.
• This fixed force module is added to maintain the distalization of the maxillary molars,
to provide anchorage during anterior retraction with closing-loop or sliding mechanics,
and to encourage a more favorable pattern of craniofacial growth.
• Carano, however, states that the Jumpers should be used only in non-compliant
patients, raising concerns about lower arch stability.
• Another difference between the approaches of Carano and Bowman is with regard to
the use of fixed appliances in conjunction with Distal Jet treatment.
• Carano states that he never uses maxillary brackets, maintaining that the best dental
anchorage are teeth that have not been moved orthodontically. For patients in the mixed

34. dentition, Carano’s sequence includes conversion of the Distal Jet into a retainer after
molar distalization is complete. He then uses utility archwires in both arches combined
with Class II elastics to "gently retract" the maxillary incisors. A final phase of fixed
appliance therapy is needed to detail the occlusion after the transition to the permanent
dentition is complete. After stabilization of the Distal Jet and placement of fixed
appliances in permanent dentition patients, omega stops are placed mesial to the
distalized molars.
• FLEXIBLE BUCCALLY POSITIONED DISTALIZATION FORCE SYSTEM
JONES JIG
• Jones and White introduced the jones jig in 1992.
• The appliance design
• The Jones Jig™ (American Orthodontics, Sheboygan, WI) was introduced by Jones &
White and includes an active unit positioned buccally, consisting of active arms or jig
assemblies incorporating nickel-titanium open coil springs and an anchorage unit
consisting of a modified Nance Appliance.
• The modified Nance Appliance includes an acrylic palatal button of at least 15 mm in
diameter, which is stabilized with 0.036′′ stainless steel wires that extend bilaterally and
are soldered to bands on maxillary first or second premolars or to deciduous second
molars .
• Gulati et al stabilized the Nance holding arch to both maxillary first and second
premolars with 0.040′′ stainless steel wire.
• The Nance button should not be in contact with the anterior teeth and the incisal papilla,
while it should resemble a modified
ACTIVATION
• The appliance is activated by tying back the sliding hook to the anchor teeth (first or
second premolars), with a 0.012′′ or 0.010′′ stainless steel ligature, thus compressing
the open coil spring 1–5 mm.
• The activated open coil spring can produce approximately 70–75 g of continuous
distalizing force to the maxillary first molars for a period of 2.5–9 months.

35. • Gulati et al used Sentalloy Open Coil Springs instead of nickel-titanium springs, which
according to them can exert a distalizing force of 150 g.
• The patients are monitored every 4–5 weeks for further adjustments.
• When the anchoring teeth are the first premolars, the second premolars seem to follow
the molar distal movement during distalization due to the pull of the transseptal fibers
• butterfly” extending from the mesial of the maxillary second premolars to the middle
of the canines and laterally within 3.5 mm of the canine and the first premolar.
• The jig assembly consists of a 0.036′′ wire, which holds the nickel-titanium open coil
spring or the superelastic Japanese nickel titanium spring, and a sliding eyelet tube.
• An additional stabilizing wire is attached along with a hook to the distal portion of the
main wire.
• Thus the jig assembly comprises in its distal end two arms, which are used to stabilize
the appliance,
ADVANTAGES
• The main advantages of the Jones Jig include minimal reliance on patient compliance,
the lack of pain, the rapid distalization, better control of molar distal tipping and
rotation, and the continuous force application.
DISADVANTAGE
the Jones Jig is quite comfortable for the patient. However, the anchorage loss due to the mesial
movement of the anterior teeth and the distal tipping of the molars

36. Modifications of the Jones Jig
 In 1996 Scott proposed the Lokar Appliance
 The Lokar Appliance consists of a nickel titanium coil spring activated by a mesial
sliding sleeve (mesial component) and an appropriately sized rectangular wire (distal
component) which is inserted into the archwire tube of the first molar.
 For anchorage, a Nance acrylic button 2–3 mm thick can be used which is stabilized to
the maxillary second premolars with a 0.040′′ stainless steel wire.
 Alternatively, fixed appliances can be used. In addition, extraoral and lip bumper forces
may be applied at the same time because the molar tubes are not used.

• After cementation of the molar bands and Nance button, the Lokar Appliance is inserted
into the archwire tube of the first molar and adapted so that it is parallel to the occlusal
plane and close to the teeth for maximum patient comfort.
• It is important to have both mesial and distal ends of the appliance adapted as close as
possible to the teeth, so they will not irritate the cheek or the lip. In addition, bends
should not be placed in the sliding components of the appliance because they could
inhibit efficient molar distalization.
ACTIVATION
• For activation of the Lokar Appliance, the mesial component is tied back by a ligature
wire to the second premolars, thus compressing the spring. The optimal compression of
the spring is about 1–2 mm.
• The patient is monitored every 5 weeks, at which points the appliance can be
reactivated: the ligature is untied, the spring is compressed, and the ligature is tied
again.
• Each reactivation can produce 1–3 mm of molar distal movement.
• The first molars are distalized until a Class III molar relationship has been achieved,
which is needed to counteract the mesial movement of the maxillary premolars and the
anchorage loss during retraction of the anterior teeth.

37. • The appliance can be used alone or in combination with fixed appliances. After
distalization of the molars is complete, the Nance holding arch and Lokar Appliance
are removed and a new Nance is placed to maintain the molar position.
• Then, full-fixed appliances or 2 × 4 fixed appliances can be used as a second phase of
the overall orthodontic treatment
NDICATIONS AND CONTRAINDICATI ONS
 The Lokar Appliance is indicated in patients with Class II malocclusion due to
maxillary protrusion, canine impaction or ectopic eruption of the maxillary premolars
and in any other situation in which first molar distalization is indicated.
 However, the appliance is contraindicated in Class II patients with mandibular
retrognathism.
ADVANTAGE
• Production of persistent and predictable results, increased efficiency, easy insertion,
ligation and use, as well as the short chair time required to initiate treatment and for
reactivation
REPELLING MAGNETS
• This was developed by Gianelly in the year 1989.
APPLIANCE DESIGN
• One method of distalizing the molar is by the use of modified nance appliance with the
use of repelling magnets.
• The modified nance appliance is cemented on the first premolar, this is to encourage
the distal drift of the second premolar that occurs normally as first molars are moved
posteriorly
• The acrylic palatal button extends anteriorly to the incisor segment by means of a
0.045” wire soldered to the lingual aspect of the premolars.
• The acrylic component is placed both against the palatal vault and the incisors.
• Bilateral distal extensions (0.045” wire) with loops at the end are soldered to the labial
aspect of premolar bands so that the loops approximate the molar tubes.

38. Distal Movement of Maxillary Molars with Magnets
• Design of the Intraarch Appliance
• Usually, prefabricated repelling samarium-cobalt (SmCo) magnets are used in each
quadrant of the maxilla and a Nance acrylic button provides anchorage .
• The magnets (single size 4 × 5 × 2 mm) are encased in stainless steel without covering
the pole faces and mounted so the mesial magnet is free to move along a sectional bar
(1.5 × 0.5 × 22.0 mm) (Fig. 21.2).
• The buccally placed magnets are attached to the first maxillary molar band by a three-
prong fork. The middle prong is sized for insertion into the headgear tube and ligation
around the two outer prongs secures the bar with magnets to the molar tube. The system
is activated by a 0.25 mm ligature wire, ligated from a distobuccal vertical tube or an
eyelet on the second premolar band to a sliding yoke mesial to the magnetsWhen the
repelling magnets are ligated together, two forces are produced, one distally directed to
move the molars distally and one reciprocal mesially directed force.
• To provide anchorage against the reciprocal force, a Nance button is attached to a 0.9
mm lingual archwire which is usually soldered lingually to the second premolar band
or, in the mixed dentition, to the second deciduous molar band .
• In patients with deep bite, the Nance button can be changed to a frontal acrylic bite
plane extended to the palatal vault in order to produce bite opening and anchorage
simultaneously
• ADVANTAGE
• The repelling magnets give a rapid result in terms of distal molar movement.
• The magnet system affords a precise control over the forces by means of the specific
force– distance diagrams and the force level can easily be calculated at any time by
measuring the distance between the magnets.
• The properties of the magnets are such that they have constant power over time, which
means that, in contrast to other force systems, e.g. elastics or elastomeric elements,
there will be no risk of fatigue of forces over relevant clinical time.

39. • •The magnetic forces and magnetic field can be exerted through mucosa and bone,
which means that it is possible that orthodontic tooth movements may be increased by
accelerated cellular reactions in the periodontal ligament and/or enhanced bone
remodeling..
• DISADVANTAGE
• • The magnet system requires frequent activation appointments, at least every third
week, since the force drops dramatically with increased distance between the magnets.
• • It is also well known that the magnets easily corrode which leads to substance loss
and disturbed physical properties. To retain good physical properties, the magnets have
to be encased in a robust biocompatible material to protect them clinically from
corrosive assault.
• • The magnets are expensive due to complicated fabrication processes. First, the
material is reduced to a powder of suitable particle size and then it must be aligned by
a strong magnetic field so that the easy axes of all the particles are made parallel. When
magnetized, it must be compacted into dense form, which can be accomplished either
by mechanical pressure or by a sintering process.
• • The magnets are brittle, particularly the samarium-cobalt magnets, and suffer
irreversible magnetic loss if heated. If the magnets are heated to even modest
temperatures, above 60–70°, there is a significant and irreversible loss in flux or force.
• • Evidence exists to suggest that magnets for distal molar movement offer no
advantages over other approaches such as, for example, intraarch appliances that use
superelastic coils as a force system
SUPER ELASTIC NiTi WIRE
• This was introduced by Locatelli and Bednar in the year 1992.
• Maxillary molars are moved distally using a super elastic nickel titanium wire with
shape memory (Neosentalloy)
APPLIANCE DESIGN

40. • 1. On a 100 gm Neosentalloy wire with regular arch form 3 marks are marked on each
side at the distal wing of the 1st premolar bracket, 5- 7 mm distal to opening of the
molar tube and between the lateral incisors and canines.
• 2. Crimp a stop at each of the posterior marks and add hooks for inter maxillary elastics
between lateral incisors and canine.
• 3. Insert the wire into the molar tube till the posterior tube abuts the tube. To place the
wire through the first pre molar grab the anterior stop and gently force the wire distally
so that the stop abuts the distal wing of the premolar bracket. Since the wire is 5-7 mm
longer than the available space, the excess will be deflected gingivally into
muccobuccal fold.
• 4. 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 buccally.
• 5. Anchorage can be controlled by placing 100 -150 gm class II elastics at the hook
between canine and lateral.
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 2n d molars.
APPLIANCE DESIGN
• The mandibular first and second molars and second bicuspids are banded and
remaining teeth are bonded. Lip bumper is given to prevent any extrusion from the use
of class II elastics.
• Maxillary molars and bicuspids are banded and anterior teeth bonded.
• An 80 gm Neosentalloy arch wire is placed on the maxillary arch and marked distal to
the first premolar bracket and 5mm distal to the first molar tube. Stops are then crimped
in the arch wire.

41. • 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
• 1. Minimal patient cooperation
• 2. Ideal for simultaneous first and second molar distalization
• 3. Second Molars move easier distally compared to first molar because of their different
anatomical shape of the roots and lack of posterior obstacles.
• 4. Because of the stretching of transeptal fibers, an 80 gm Niti wire is used instead of
100 gm or 200 gm.
HYBRID APPLIANCE
First class appliance (FCA)
• Knapp in 1899, which incorporated two screws for molar distalization
• It tends to be utilized for distalization with minimal anchorage
APPLIANCE DESIGN
• Bands are placed on the maxillary first molars and on the second premolars /
deciduous second molars.
• The appliance mainly consists of 2 components
• (i) Vestibular Components
(ii) Palatal Components
VESTIBULAR COMPONENTS
• On the buccal side of the first molar bands, vestibular screws (the active unit of
the appliance) are soldered occlusally to the 0.022 × 0.028′′ single tubes.
• The screws are 10 mm long with four holes for activation. The vestibular screws
are seated into closed rings that are welded to the bands of the second deciduous
molars or the second premolars

42. PALATAL COMPONENTS
• a Nance button with 0.045′′ wires embedded in the acrylic.
• The acrylic button is large to enhance anchorage control during both the active phase
of treatment and the retention phase.
• The 0.045′′ wires are shaped in a single piece, in order to avoid any breakage because
of the presence of welded joints. These wires are soldered lingual of the second
deciduous molar/premolar bands, while posteriorly they are inserted into 0.045′′ tube
sections welded to the palatal sides of the first molar bands.
• The tubes act as a guide during molar distalization to promote a bodily tooth movement.
Ten millimeter long open nickel-titanium 0.010 × 0.045′′ coil springs are fully
compressed between the solder joint on the second deciduous molar/premolar band and
the tube on the molar band. The continuous force delivered by the springs is able to
counterbalance the action of the vestibular screws.
• The distal molar movement takes place in a “double-track” system that prevents
rotations or contractions of the molars.
Effects of Second Molar Eruption
 No significant differences between subjects with unerupted second molars and subjects
with partially or totally erupted second molars were found in the amount of first molar
distalization (3.9 mm vs 4.0 mm) and distal inclination (−4.1° vs −4.8°) and in the
amount of anchorage loss
 These results confirmed those reported for the Pendulum in previous studies that the
amount of distal movement and inclination of the upper first molars as well as the
amount of anchorage loss were not influenced by the presence of the upper second
molars.
 Interestingly, Bolla and coworkers noted more favorable changes (less distal tipping of
the first molar and less anchorage loss and extrusion) in those subjects treated with the
Distal Jet after the eruption of the second molars.
With the FCA no significant differences in the inclination of the mandibular plane in
relation to both the cranial base and the palatal plane were found between patients who had
second molars erupted and those who did not

43. 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.
Distalization Rate
• The FCA induced an average 4.0 mm/side distal movement of the crowns of the
maxillary first molars during a period of 2.4 months .
• It was able to produce a true “rapid” molar distalization (1.7 mm/month on average)
when compared with the rate of distalization of other devices .
• Molar distalization accounted for 70% of the change in sagittal position between the
first molar and the second premolar
Transformation of the First Class Appliance into a Retention Device
• It is mandatory to stabilize the maxillary molars once they have been moved distally as
it has been clearly demonstrated that they have a strong tendency to relapse mesially
towards their original position.
• Once the first molars have achieved a Class I occlusion, the appliance is transformed
into a modified Nance holding arch by removing the bands on the second premolars
together with the male screws and the palatal coil springs .
• The tubes on the palatal sides of the first molar bands are crimped with a hard wire
cutter to stabilize the molar in the distal position.
LIP BUMPER :
• Used for prevention of poor lip habits and creation of increased space for mandibular
arch.
• Force from mentalis muscle is transmitted to molar, enabling them to move to an upright
and distal portion

44. UNILATERAL FROZAT AP PLIANCE
• Kinzinger in 2004
• 0.38” blue elgiloy or .040” stainless steel wire.
• Lingual steps bent mesial to the molars
• 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.
NANCE APPLIANCE AND COIL SPRING

APPLIANCE DESIGN
• 2 premolar bands - soldered palatal framework - anterior acrylic shield for palatal
support.
• Sentalloy coil springs (150-200gm) on sectional arch wires.
ADVANTAGES
• Effective method for moving maxillary posterior teeth.
DISADVANTAGE
• Tooth distalized showed great amount of tipping. More the distalization greater the
tipping
TPA ARCHES FOR MOLAR ROTATION / DISTALIZATION
• Introduced by Maldurino and Balducci in the year 2001
APPLIANCE DESIGN
• 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.

45. ACTIVATION
• 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°.
TMA produces distally directed forces anchor end bend at 30º
• TMA may fracture in mouth as it is more fragile.
• It causes mesio buccal rotation of the anchor molar, it should be combined with fixed
orthodontic wire between canine and IInd molar of the anchor side.
• This system can distalize only one molar at a time.
• An extra oral force is worn at night to reinforce anchorage
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.
DISADVANTAGES
• One possible disadvantage of this method is that only one molar can be distalized at a
time.
IMPLANT SUPPORTED APPLIANCE
Bone anchored pendulum appliance(BAPA]
• Kircelli et al
• Beyza et al has designed BAPA which uses a titanium intraosseous screw (2.0 mm
diameter 38mm length) (IMF intermaxillary fixation screw, Stryker, Leibinger,
Germany) as a rigid bone anchor.
• The screw was inserted in the anterior paramedian region of the median palatal suture,
7-8 mm posterior to the incisive foramen and 3-4 mm lateral to the median line.

46. • It was found that molar distalization, as well as premolar distalization, was achieved
with BAPA without any anchorage loss
• The BAPA presented an effective and minimally invasive, compliance-free alternative
for intraoral molar distalization in non extraction Class II treatment.
MIDPALATAL MINISCREW DISTALIZER
• Traditional methods of molar distalization tend to cause unwanted movement of the
teeth.


Intraosseous screw - supported appliance/ the distalization appliance
APPLIANCE DESIGN
• The intraosseous screw - pure Ti
• The endosseous screw body - self-tapping thread with a sandblasted
surface.

47. • The diameter is 1.8 mm, lengths 14 mm.
• TPA was prepared with a ‘‘U’’ bend touching the screw.
• Sectional 0.016 x 0.022” SS
• Nickel-titanium open-coil springs
• A continuous force of approximately 250 g per side

48. GRAZ IMPLANT SUPPORTED PENDULUM
Byloff et al (Int J Adult Orthod. Orthognathic Surg 2000)
• Site - Median palatal region
• The system can be loaded 2 weeks after surgical placement, actively
distalizes maxillary molars consecutively, serves as an active anchor unit,
and provides stability against rotational movements.
• When the desired molar distalization has been achieved, the GISP can be
used to maintain the molar position, not only passively but actively by
exerting counteracting forces to the mesial forces exerted on the molars
during retraction of the anterior teeth, thus providing active anchorage
The anchorage part of the GISP consists of
• A surgical plate with 4 screw holes.
• Two cylinders (10 mm long and 3.5 mm in diameter)
• The entire anchorage device is made of 100% Titanium and the removable
part, which is a Pendulum-type appliance.

49. Karaman implant-supported modified distal jet appliance
• Molar bands with palatal tubes
• An anchorage screw
• Anchor wires on 1
st
premolars.
• Niti open-coil springs

• Maxillary molar moved distally 5mm after 4 months of treatment and intruded by 2mm
without movement of premolars.
• Upper incisor position, MPA, and LAFH remained the same.
• No anchor loss

The Straumann Orthosystem
• Giancotti et al described the use of the Straumann Orthosystem (Straumann,
Waldenburg, Switzerland) with a different stainless steel cap for orthodontic appliance
placement, from that used by Wehrbein et al.
• pure titanium
• Length of either 4 or 6 mm,
• Diameter of 3.3 mm, and an SLA surface.
• Its 2.5-mm transmucosal collar has a highly polished surface.

50. •
Beneslider
• Two benefit mini-implants are placed in the anterior palate about 5–10 mm apart along
the line of force.
• The mini-implants are inserted in the area of the mid-palatal suture
• Two mini screw implants are coupled with a Beneplate.
• The molar distalising force is delivered through a skeleton of the system which is
attached and takes anchorage from the implants.
• The two open-coil springs (240 g for children and 500 g for adults), activated

51. Advanced Molar Distalization Appliance” (AMDA

Active unit
• Wire-tubing system
• Compressed nickel-titanium open coil springs
Anchorage unit
• Two self-drilling and self-tapping miniscrew implants of a diameter of 2 mm and 8-10
mm in length

52. REFERENCES

1 Rio de Janeiro ,Asymmetric headgear for differential molar movement: a study using finite
element analysis, JO SEPTEMBER 2009 ,
2 Moschos A .Papadopoulos DDS , Orthodontic Treatment of the Class II Noncompliant
Patient , 2006
3 James A Mc Nammara JR DDS , PhD, ORTHODONTICS AND DENTOFACIAL
ORTHOPEDICS James A McNamaORTHODONTICS AND DENTOFACIAL ,, 2001
4 Ali, F., Soni, S., & Kaur, R. Molar distalization: A review. International Journal of Health
sciences,2021 , 5(S2), 6–22
5 Moschos A Papadopoulos , The “Advanced Molar Distalization Appliance”: A Novel
Approach to Correct Class II Malocclusion .2009
6 RAPHAEL L. GREENFIELD. Fixed Piston Appliance for Rapid Class II Correction
JCO 1995
7 Kashyap and Rawat , IP Indian Journal of Orthodontics and Dentofacial Research
2022;8(2):75–78
8 FRIEDRICH BYLOFF , DDS, MS , The Franzulum Appliance , JCO/SEPTEMBER 2000