ASAR-INTERNATIONAL CONFERENCE ON DENTISTRY,

SAMBALPUR

Presented By: Asmita Ray 1

3rd Year Post Graduate Student
Department of Orthodontics &
Dentofacial Orthopaedics
TIDSHRC, Bilaspur, C.G
 INTRODUCTION
 AIM
 OBJECTIVE
 PRE-TREATMENT RECORDS
 CURRENT TREATMENT PHOTOGRAPHS
 TECHNIQUE
 DISCUSSION
 CONCLUSION
 REFERENCES

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 Treatment of class II malocclusion often require maxillary molar distalization.

 Some of the cases can be treated by non extraction treatment modalities such

as headgear, removable appliances, and intraoral distalizers such as the

Pendulum appliance, Distal Jet, and Jones Jig.

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 Anchorage loss from proclination of

anterior teeth, distal tipping and

increased overjet are major concerns
with most of these appliances; some
also require active patient
compliance.

 These are the unwanted side effects

which diminish clinical effectiveness

of distalization.
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 Skeletally anchored distalization appliances now provide excellent

alternatives for Class II treatment.

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“To achieve maximum molar distalization using a minimally invasive
procedure with minimal patient compliance”.

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 The primary treatment objective is to distalize the upper molars enough to

create space for achieving ideal overjet and overbite & alignment of teeth in
arch without worsening the profile

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 The present paper describes a reverse

L-shaped distalization appliance with

a helix that derives anchorage
support from a mini-implant in the
buccal alveolar bone.

 This device requires minimal patient

compliance, minimally invasive

procedure and no laboratory work.

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 EXTRAORAL
PHOTOGRAPHS:

Age-23 YRS 1 MO
SEX-FEMALE

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 End on
INTRA-ORAL
molar
PHOTOGRAPHS:
relaionship

End on canine
relationsHip:

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 L
A
O T
P -
G C
E
P
H

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P
R
E
M
T
O
R
D
E
E
A
L
T
S
M
E
N
T
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 INTRA-ORAL KELES TPA
FOR MOLAR
PHOTOGRAPHS:
DEROTATION

TAD PLACED IN
APPLIANCE
BUCCAL
PLACED ALVEOLAR
BONE 15
 First, the upper arch is aligned on

continuous archwires, for .022" × .028"

brackets.

 A mini-implant is inserted between the

upper second premolar & first molar on

both sides

 A passive .017" × .025" TMA wire segment is

bent into a smooth L-shape and threaded

through a nickel titanium open-coil spring.
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 When this assembly is attached between the
mini-implant and the first-molar & second
molar auxiliary tube, it compresses the spring
to generate force.

 The spring can be reactivated monthly by

adding crimpable segments to the wire until
the first molar is overcorrected to a super-Class
I relationship.

 The premolars will be then retracted with

anchorage from the molar—still supported by
the mini-implant—followed by finishing and
detailing. 17
 The L-spring appliance is specifically tailored for fulfilling the biomechanical

demands of molar distalization.

 Equal and opposite forces (F) are created by the compressed push-coil spring

between the mini-implant and first molar.

 In our technique, distal tipping of the molar can be minimized by the keles TPA

 The overall force system ensures that the molar will be uprighted as it is

pushed back, which will help to prevent relapse of the distal movement.

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 Current approaches for correcting class II malocclusions are based primarily on

elastics, which depend on patient compliance.

 Our method requires no compliance and is much simpler than technique-sensitive,

laboratory- constructed palatal devices.

 There is no anterior anchorage loss, and only one mini-implant is needed.

 This approach will also provide better root control, because the molar slides on rigid

rectangular archwires.

 Considering these advantages, the mini-implant-supported reverse L-spring will be

particularly effective in correcting a Class II subdivision malocclusion to a Class I

relationship. 19
 Upadhyay M et al: A Mini-Implant-Supported S-Spring for Unilateral Molar Distalization, JCO, july
2020,vol 7: 410-418
 Hilgers, J.J.: The Pendulum appliance for Class II non-compliance therapy, J. Clin. Orthod. 26:706-
714, 1992.
 Polat-Ozsoy, O.: The use of intraosseous screw for upper molar distalization: A case report, Eur. J.
Dent. 2:115-121, 2008.
 Maino, B.G.; Alessandrini, P.; and Mura, P.: A modified ACCO for Class II nonextraction treatment, J.
Clin. Orthod. 40:605612, 2006.
 Gumus, A. and Arat, Z.: A removable Class II appliance for simultaneous distalization and
expansion, J. Clin. Orthod. 39:613-617, 2005.
 Patel, M.P.; Janson, G.; Henriques, J.F.; Almeida, R.R.; Freitas, M.R.; Pinzan, A.; and Freitas, K.M.:
Comparative distalization effects of Jones Jig and Pendulum appliances, Am. J. Orthod. 135:336-
342, 2009.
 Karaman, A.I.; Basciftci, F.A.; and Polat, O.: Unilateral distal molar movement with an implant-
supported Distal Jet appliance, Angle Orthod. 72:167-174, 2002.
 Bowman, S.J.: Upper-molar distalization and the Distal Jet, J. Clin. Orthod. 50:159-169, 2016.
 Brickman, C.D.; Sinha, P.K.; and Nanda, R.S.: Evaluation of the Jones Jig appliance for distal molar
movement, Am. J. Orthod. 118:49-53, 2000.
 Haydar, S. and Uner, O.: Comparison of Jones Jig molar distalization appliance with extraoral
traction, Am. J. Orthod. 117:4953, 2000. 20