Distalization with the Miniscrew-

Supported EZ Slider Auxiliary

2014 JCO, ENIS GÜRAY,
FARUK

Presented by Dr Anushriya Dutta

Guided by Dr Anshul Singla (Prof.)
Intraoral molar-distalization appliances that require little

or no patient compliance—including the Pendulum,

Distal Jet, and sliding jigs have been developed as
alternatives to headgear.

To avoid the anchorage loss that often occurs with these

devices, skeletal anchorage has increasingly been

employed, leading to the introduction of new systems.
This article introduces the EZ Slider sliding auxiliary for
use with mini-implants in the distalization of posterior
segments.
Appliance Design:-

EZ Sliders, made of medical-grade 304 stainless

steel, are interchangeable auxiliaries for the delivery
of distal or mesial forces in conjunction with
buccally placed temporary anchorage devices
(TADs) and closed-coil springs
 Power Arm

Body

Self -Locking
Arms

3
 Click-in Click-out Self-Locking Arm

• Easy insertion
to the archwire
• Easy force
application
• Less chairtime
 The EZ Slider Creates Parallel Forces that
Prevent Unwanted Tipping and Rotations While
Allowing the Movement of Multiple Teeth
Presented in
a box of
12 sliders.

• 4 long
• 4 medium
• 4 small
In normal posterior-distalization treatment, the long

(30mm) Slider is used initially to apply force to the

second molars, followed by the medium (20mm)
Slider for the first molars and the short (12.5mm)

Any Slider can be shortened or lengthened by simple

bending.
After the distalization of any tooth, a crimpable hook can

be used as a stop if needed.

HR

HR
8
HL

HL
9
By using the EZ Slider the application point of the force
is brought to the force level to provide more horizontal
vector and to prevent side effects.

Important note:TAD should be placed at the level of the

power arm to avoid the vertical vector.
10
Activation Space

Point of Force
Application

The arms could be bent to create more activation space

11
 Molar Distalization System

Consecutive Use of the Long-Medium-Small EZ Sliders

Long (30mm) is used for the Second Molars

 Molar System

Consecutive Use of the Long-Medium-Small EZ Sliders

Distalization
Case 1

A 14-year-old female presented with the chief

complaint of her dental appearance.

Examination indicated a mild skeletal Class I

malocclusion with Class II canine and molar
relationships and congenitally missing upper lateral
incisors.
Congenitally Missing Upper Laterals
Treatment Plan
Distalization of the posterior segments for placing
implants for the missed lateral incisors

TADs were inserted bilaterally between the upper second

premolars and first molars.

 After .018" edgewise brackets were bonded and an .016“

nickel titanium archwire was placed, a 250g distalizing
force was applied on each side with a nickel titanium
closed-coil spring from the mini-implant to the power
arm of a 30mm EZ Slider.
 6 weeks later the first molars are pushed distally and the sliders are applied to
upper premolars and canines
After five months of EZ Slider application,Class I
molar and canine relationships had been established,
and 7mm spaces had been created to accommodate
dental implants distal to the central incisors.

Up-and-down elastics were prescribed to stabilize the

occlusal relationship, and the case was finished in
another month
 Discussion

When intraoral appliances are used for posterior

distalization, anchorage loss prolongs treatment due to

round-tripping and can lead to labial bone loss and
gingival-height deficiencies in patients with proclined
maxillary incisors.
Distal tipping of the molars may require attachments such

as uprighting springs to prevent early relapse.

By comparison, though leveling of the anterior teeth

will inevitably require some round-tripping of the

incisors, the combination of a skeletally anchored EZ
Slider with an .016" × .022" stainless steel archwire
will allow the posterior teeth to upright spontaneously
during distalization
With headgear and some intraoral-distalization
appliances or even skeletally anchored mechanics, the
second molars can limit distal movement of the first
molars.

The EZ Slider avoids this problem because only one

tooth is distalized at a time. The third molars should
always be considered, but were not an issue in our
young patients because they had not yet erupted
To prevent root contact with the second premolar, a mini-

implant between the second premolar and first molar

should be replaced at the appropriate time with one
between the first and second molars.

Since EZ Slider mechanics can cause molar extrusion and

premolar or canine intrusion, the appliance should not be

used in high-angle cases.
When a retraction force from the mini-implant to the canine

is supported by indirect anchorage, the occlusal plane will

be canted due to the vertical force vector.
To avoid this adverse effect, the vertical component of the

distalization force must be minimized while the horizontal

vector is maximized.
Therefore, the point of application of the retraction force

(the power arm) should be at the same horizontal level as

the mini-implants
Coil springs are preferred over elastics because of their
ability to exert continuous forces with stable skeletal
anchorage
 Conclusion
The EZ Slider can be easily applied to any archwire
with its “Click-in Click-out” self-locking arms
—This provides less chairtime
 EZ Slider is effective on the distalization and also on
the mesialization of the posterior segments
— They can be used with any kind and any brand of
TAD
 Maxillary molar distalization with Miniscrew-
supported appliances in Class II malocclusion: A
systematic review
Maxillary molar distalization is the most frequently used
nonextraction treatment in the correction of Class II
malocclusion to establish a Class I molar and canine
relationships

The common and unwanted side effect of coventional

intraoral methods is the mesial shift of premolars and
incisors leading to anchorage loss.
To overcome these limitations, miniscrews were
developed, which are less invasive, cheaper, require less
total treatment time, and need minimal patient
compliance compared to implants and miniplates
Effects on Molar Distalization, Tipping, and Vertical
Movement:-
The molars were distalized with a mean value varying from
1.87 mm to 6.4 mm, with the highest (6.4 mm) distalization
observed by Kircelli et al.
Distal tipping of the molar was minimal when the
distalizing force was applied palatally as the reactive
forces were located gingivally, close to the center of
resistance of the molar

Single Screw vs Dual Miniscrew Effect on Molar

Distalization
In the present review studies which compared single vs dual
miniscrews for molar distalization showed greater molar
distalization in the dual screw group compared to the single
screw group
Miniscrew in Interradicular Area vs Midpalatine:-

Appliances with miniscrews placed in the paramedian palate

caused distal movement of the molars by more than 5 mm
without undesirable side effects on the premolars and
incisors.

The main limitation with the placement of miniscrews in the

anterior part of the palate is that this procedure is complex to
place and remove the screws.
Extensive molar distal movement is difficult to achieve
with interradicular miniscrews because the screws would
come in contact with the surrounding root during tooth
movement.

Effects on the Premolars and Incisor/Anchorage Unit

In the present systematic review, eight out of 14 studies

showed distalization of premolars and incisors and the mean
distal movement of premolars and incisors varied from 1.75
mm to 5.4 mm and 0.1 mm to 2.7 mm, respectively
CONCLUSIONS
Despite the limitations related to the heterogeneity of
the studies included in the review, it can be concluded
that miniscrew-supported appliances are effective in
molar distalization with minimal distal tipping.

Along with molar distalization, miniscrew-supported

appliances lead to premolar distalization without
anchorage loss