intraoral distalizing devices

Intraoral Distalizing Devices

Nalaka Jayaratne BDS, PhDResident in Orthodontics,University of Connecticut School of Dental MedicineUSA

Why do we use distalizing devices? • To move molars in a distal direction

Gain spaceAvoid extractions

• Useful in treating patients with a normal mandible and a mild to moderate Class II relationship

• Ideal time – Mixed dentition prior to 2nd molar eruption

Distalizing devices

Extraoral

Intraoral

Distalizing devices

Extraoral• Headgear

Intraoral

Distalizing devices

Extraoral• HeadgearMost widely usedEsthetically unacceptableDepends on patient compliance

Intraoral

Distalizing devices

Extraoral• HeadgearMost widely usedEsthetically unacceptableDepends on patient compliance

Intraoral• Pendulum and pendex

appliances• Distal jet• Jones jig • Nickel-titanium coil springs• Wilson bimetric distalizing

arch system

Intraoral appliances • Effective distalization without patient compliance

• Normally use a Nance button as anchorage

Intraoral appliances • Effective distalization without patient compliance

• Normally use a Nance button as anchorage Insufficient to neutralize the side effects of anchorage loss

Intraoral appliances • Effective distalization without patient compliance

• Normally use a Nance button as anchorage Insufficient to neutralize the side effects of anchorage loss Maxillary anterior crowding, overjet↑, tipping of premolars and canines

Pendulum

Pendulum

Large Nance button

Pendulum

Large Nance button

TMA Springs (0.032”)

Pendulum

Large Nance button

TMA Springs (0.032”)

Distalization = 3.81 mm

Pendulum

Pendulum• Continuous force ~ 100-200g

Pendulum• Continuous force ~ 100-200g

• Distalization2.55 – 18.5mm (SR)4-5mm (text book)

Pendex

www.northstardental.com

Pendex

www.northstardental.com

Jackscrew

Distal Jet

Distal Jet

Large Nance button

Distal Jet

Large Nance button

Spring (NiTi or SS)

Distal Jet

Large Nance button

Spring (NiTi or SS)

Parallel to occlusal plane4-5mm apical to molar centroid

Distal Jet

Distal JetTelescopic UnitSpring sliding on a 0.036” tube

Distal JetTelescopic UnitSpring sliding on a 0.036” tube

Activation Screw

Distal Jet Activation

http://www.perfectfinishortho.com/

Distal Jet Activation

Distalization = 1.9 – 5mm

http://www.perfectfinishortho.com/

Keles Slider

http://www.h-s-dentaltechnik.at/

Keles Slider

http://www.h-s-dentaltechnik.at/

Nance button+ ABP

Keles Slider

http://www.h-s-dentaltechnik.at/

Nance button+ ABP

Activation Screw

Keles Slider

Keles Slider

SS wire (0.040”)

Keles Slider

SS wire (0.040”)NiTi Coil Spring

Keles Slider

SS wire (0.040”)NiTi Coil Spring

Adjustable screw

Keles Slider

SS wire (0.040”)NiTi Coil Spring

Adjustable screw

Distalization = 0.89 – 4mm

Jones JigG

Jones JigG

Jones JigG

Jones Jig

Jones Jig

Distalization = 2.85 – 4.92mm

Aims of this meta-analysis • Quantify and to compare the amounts of molar

distalization and anchorage loss of conventional and skeletal anchorage methods in the correction of Class II malocclusion with intraoral distalizers

Methods• Based on the PRISMA guidelines

Preferred Reporting Items for Systematic Reviews and Meta-

Analyses

Methods• Based on the PRISMA guidelines

Main question• Was defined with the PICO format

Main question• Was defined with the PICO format

PICO format Question

Population Subjects with Class II malocclusion

Intervention Intraoral distalizers with conventional anchorage

Comparison Intraoral distalizers with skeletal anchorage

Outcome Efficiency in the correction of Class II malocclusion

Main question• Was defined with the PICO format

PICO format Question

Population Subjects with Class II malocclusion

Intervention Intraoral distalizers with conventional anchorage

Comparison Intraoral distalizers with skeletal anchorage

Outcome Efficiency in the correction of Class II malocclusion

Search strategyDatabase Key words LimitsPubMed Distalizers OR distalization appliance OR

orthodontic distalization OR noncompliance appliances OR first molar distalization OR upper molar distalization OR maxillary molar distalization

English language; humans, 1970 to September 2010

Embase Distalizers OR distalization appliance OR orthodontic distalization OR noncompliance appliances OR first molar distalization OR upper molar distalization OR maxillary molar distalization

Only English; humans, 1970 to September 2010

Web of Science Distalizers OR distalization appliance OR orthodontic distalization OR noncompliance appliances OR first molar distalization OR upper molar distalization OR maxillary molar distalization

English language; only articles (not reviews, letters, abstracts, meetings, and editorials);1970 to September 2010

Scopus Distalizers OR distalization appliance OR orthodontic distalization OR noncompliance appliances OR first molar distalization OR upper molar distalization OR maxillary molar distalization

English language; only articles (not reviews, letters, abstracts, meetings, and editorials);1970 to September 2010

Cochrane Library

Distalizers; distalization and appliance; orthodontic and distalization; noncompliance and appliances, first and molar and distalization; upper and molar and distalization; maxillary and molar and distalization

Search strategyDatabase Key words LimitsPubMed Distalizers OR distalization appliance OR

orthodontic distalization OR noncompliance appliances OR first molar distalization OR upper molar distalization OR maxillary molar distalization

English language; humans, 1970 to September 2010

Embase Distalizers OR distalization appliance OR orthodontic distalization OR noncompliance appliances OR first molar distalization OR upper molar distalization OR maxillary molar distalization

Only English; humans, 1970 to September 2010

Web of Science Distalizers OR distalization appliance OR orthodontic distalization OR noncompliance appliances OR first molar distalization OR upper molar distalization OR maxillary molar distalization

English language; only articles (not reviews, letters, abstracts, meetings, and editorials);1970 to September 2010

Scopus Distalizers OR distalization appliance OR orthodontic distalization OR noncompliance appliances OR first molar distalization OR upper molar distalization OR maxillary molar distalization

English language; only articles (not reviews, letters, abstracts, meetings, and editorials);1970 to September 2010

Cochrane Library

Distalizers; distalization and appliance; orthodontic and distalization; noncompliance and appliances, first and molar and distalization; upper and molar and distalization; maxillary and molar and distalization

MeSH Terms

MeSH Terms

MeSH Terms

MeSH Terms

MeSH Terms

Meta-Analysis• Articles divided into 2 groups

Conventional or skeletalno distinction between different types of distalizers

• Only articles of medium and high quality were included

Forest plots for molar distalization with conventional anchorage

Molar distalization with skeletal anchorage

Premolar movement with conventional anchorage

Premolar movement with skeletal anchorage

Conclusions• There was scientific evidence that both anchorage

systems are effective for distalization

• However, with skeletal anchorage, there was no anchorage loss when direct anchorage was used