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Table of Contents
CASE REPORT
Year : 2012  |  Volume : 2  |  Issue : 2  |  Page : 136-140

Mini-implant supported molar distalization


Department of Orthodontics, and Dentofacial Orthopaedics, Guru Nanak Dev Dental College and Research Centre, Sunam, Punjab, India

Date of Web Publication10-Oct-2012

Correspondence Address:
Amit Goyal
Senior Lecturer, Department of Orthodontics, Guru Nanak Dev Dental College, Sunam, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-6781.102237

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   Abstract 

Temporary anchorage devices popularly called mini-implants or mini-screws are the latest addition to an orthodontist's armamentarium. The following case report describes the treatment of a 16-year-old girl with a pleasant profile, moderate crowding and Class II molar relationship. Maxillary molar distalization was planned and mini-implants were used to preserve the anterior anchorage. After 13 months of treatment Class I molar and canine relation was achieved bilaterally and there was no anterior proclination. Thus mini-implants provide a viable option to the clinician to carry out difficult tooth movements without any side effects.

Keywords: Anchorage, mini-implants, molar distalization


How to cite this article:
Goyal A, Shivalinga B M, Jyothikiran H, Patel V. Mini-implant supported molar distalization. J Dent Implant 2012;2:136-40

How to cite this URL:
Goyal A, Shivalinga B M, Jyothikiran H, Patel V. Mini-implant supported molar distalization. J Dent Implant [serial online] 2012 [cited 2019 Dec 9];2:136-40. Available from: http://www.jdionline.org/text.asp?2012/2/2/136/102237


   Introduction Top


The treatment of a Class II malocclusion without extraction requires posterior movement of the maxillary dentition, anterior movement of the mandibular dentition, or a combination of both. Many devices have been developed and used to distalize the maxillary molars and show positive clinical results. However, patient cooperation is a serious problem; orthodontic mechanics requiring minimal patient cooperation are desirable. [1],[2] Intraoral appliances for maxillary molar distalization, such as the pendulum, push coils, magnets, superelastic nickel-titanium wires, the distal jet, and the molar slider, do not require extensive cooperation from patients. [3],[4],[5],[6],[7],[8],[9],[10],[11] These techniques effectively distalize both the first and second molars.

Also these appliances always develop reciprocal, adverse side effects. Anterior teeth tend to move forward during distalization of the molars and need to be retracted against the distalized molars later. The forward movement of the distalized molars during anterior tooth retraction often offsets the treatment effect of the distalization appliances.[12] Furthermore, the treatment time is prolonged. These adverse tooth movements or changes on the reactive part should be eliminated, if possible.

The solution to this obstacle has been provided by recent improvements in implant dentistry. With the use of dental implants, miniplates, and implants as anchorage, the distal movement of the anterior teeth or posterior teeth (or both) without anchorage loss has become possible. [13],[14], [15,[16],[17],[18],[19] Among these devices, the mini-implants have the advantages of easy placement and removal, with minimal anatomical limitations because of their small size and low cost. [17] Therefore, their clinical applications have been expanded, and they have been adopted for distalization of the molars.

Sliding mechanics with the aid of the mini-implant anchorage and its application for the treatment of skeletal Class I and Class II malocclusions have been described previously. [17],[18] Its application in nonextraction treatment, however, has not been widely discussed. The following case report highlights the use of mini-implants as an anchorage aid for distalization of maxillary molars.


   Diagnosis and Treatment Plan Top


A 16-year-old female patient presented with a full cusp Angle's class II molar relation on the left side, end on molar relation on the right side, moderate crowding in the upper arch, mild crowding in the lower arch, normal maxillo-mandibular relationship and a normal overjet and overbite [Figure 1].
Figure 1: Pretreatment intraoral photographs

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As she presented with a straight pleasing profile [Figure 2], extraction was ruled out. Distalization of the upper molars was planned and to prevent the proclination of the anterior teeth during distalization, mini-implants were sought to strengthen the anterior anchorage. The mild crowding in the lower arch would be relieved by proximal stripping.
Figure 2: Pretreatment profile

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   Treatment Progress Top


Upper first molars were banded and 0.022" stainless steel brackets were bonded only on upper first and second premolars. After aligning these posterior teeth, a segmental 0.019"× 0.025" stainless steel wire was placed. A stiff arch wire is necessary to minimize the distal tipping and rotation of the molar. A nickel-titanium open coil spring was inserted between the second premolar and the first molar to provide the distalizing force. However, it was necessary to prevent the loss of anterior anchorage. Temporary anchorage devices, popularly called mini-implants were used to prevent the flaring of the anterior teeth.

Two titanium mini-implants (0.8 mm in diameter and 11 mm in length) were inserted between the second premolar and first molar on both sides in the upper arch. Stainless steel ligature wire (0.010" diameter) was tied to first premolar brackets from these mini-implants to prevent their mesial movement [Figure 3].

Within a month the right molar was distalized by 2 mm and the left by 1 mm. The lower arch was also bonded and 0.014" nickel-titanium wire was placed after proximal stripping. Distalization was continued in the upper arch [Figure 4].
Figure 3: Placement of implants for anchorage reinforcement

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Figure 4: Intraoral photographs after 1 month

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Within 3 months a molar distalization of 3 mm was achieved on the right side and 5 mm was achieved on the left side [Figure 5]. A transpalatal arch (TPA) was then placed and the second molars were also banded. The open coil springs were now placed between the first and second premolars to push the second premolar distally. After distalizing the second premolar, the rest of the maxillary arch was bonded and the first premolar and the canine were retracted with elastic chains directly from the implants [Figure 6].
Figure 5: Intraoral photographs after completion of molar distalization

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Figure 6: Retraction of premolars and canine

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After this the closure of residual spaces and the final settling of occlusion was carried out [Figure 7]. The entire procedure took 13 months to complete.
Figure 7: Settling of occlusion using zig-zag elastics

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   Treatment Effects Top


Good alignment was achieved in the maxillary and mandibular arches with a full-cusp Class I molar and canine relation on both sides without any premolar extractions [Figure 8]. The profile was maintained [Figure 9] and any proclination of anterior teeth was avoided with the use mini-implant anchorage.
Figure 8: Final occlusion

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Figure 9: Profile of the patient after active orthodontic treatment

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   Discussion Top


Intraoral distalizing appliances cause an adverse, reciprocal mesial movement of the anterior teeth and premolars during distal movement of the molars. This adverse forward movement of anterior teeth is inevitable using an intraoral molar distalization appliance. The forward moved position of the anterior teeth should be retracted back after creating space with the distal movement of the molars and premolars. During this anterior tooth retraction, the posterior teeth are used as anchorage so that the distalized molars are moved forward, which offsets the efficiency of distalization. [12] Moreover, the overall movement of the anterior teeth is a round-trip movement. On the other hand, distal movement using mini-implants is a group movement of buccal segment teeth. There is no forward movement of the anterior teeth in mini-implant-aided mechanics. Therefore, these procedures did not produce any adverse side effect on the anterior teeth.

Antonarakis and Kiliaridis found in their systematic review that tooth-borne distalizers could move maxillary molars distally on average 2.9 mm; however, the associated undesirable incisor mesial movement was 1.8 mm. [20] In our case the findings indicate that reinforcement of anchorage with orthodontic implants increased the amount of molar distalization. The distal movements of the maxillary molars in the studies with comparable distalization techniques were from 3.9 to 6.4 mm. [21],[22],[23],[24],[25],[26],[27],[28] At the same time, the maxillary incisors remained stable. This implies better outcomes produced by mini-implant reinforced distalization than by tooth-borne distalizing appliances.


   Conclusions Top


Mini-implants can be used successfully for distal movement of posterior teeth. They shorten treatment time and prevent the flaring of anteriors. So in cases where extraction is contraindicated, molar distalization using implants is the best option.

 
   References Top

1.Gray JB, Steen ME, King JG, Clark AE. Studies on the efficacy of implants as orthodontic anchorage. Am J Orthod 1983;83:311-7.  Back to cited text no. 1
    
2.Byloff FK, Kärcher H, Clar E, Stoff F. An implant to eliminate anchorage loss during molar distalization: A case report involving the Graz implant-supported pendulum. Int J Adult Orthodon Orthognath Surg 2000;15:129-37.  Back to cited text no. 2
    
3.Hilgers JJ. The pendulum appliance for Class II non-compliance therapy. J Clin Orthod 1992;26:706-14.  Back to cited text no. 3
[PUBMED]    
4.Joseph A, Butchart CJ. An evaluation of the pendulum distalizing appliance. Semin Orthod 2000;6:129-35.  Back to cited text no. 4
    
5.Gianelly AA, Bednar J, Dietz VS. Japanese NiTi coils used to move molar distally. Am J Orthod Dentofacial Orthop 1991;99:564-6.  Back to cited text no. 5
[PUBMED]    
6.Gianelly AA, Vaitas AS, Thomas WM, Berger DG. Distalization of molars with repelling magnets. J Clin Orthod 1988;22:40-4.  Back to cited text no. 6
[PUBMED]    
7.Gianelly AA, Vaitas AS, Thomas WM. The use of magnets to move molars distally. Am J Orthod Dentofacial Orthop 1989;96:161-7.  Back to cited text no. 7
[PUBMED]    
8.Locatelli R, Bednar J, Dietz VS, Gianelly AA. Molar distalization with superelastic NiTi wire. J Clin Orthod 1992;26:277-9.  Back to cited text no. 8
[PUBMED]    
9.Carano A, Testa M. The distal jet for upper molar distalization. J Clin Orthod 1996;30:374-80.  Back to cited text no. 9
[PUBMED]    
10.Bolla E, Muratore F, Carano A, Browman SJ. Evaluation of maxillary molar distalization with the distal jet: A comparison with other contemporary methods. Angle Orthod 2002;72:481- 94.  Back to cited text no. 10
    
11.Keles A, Isguden B. Unilateral molar distalization with molar slider (two case reports). Turk Ortonti Dergisi 1999;12:193-202.  Back to cited text no. 11
    
12.Ghosh J, Nanda RS. Evaluation of an intraoral maxillary molar distalization technique. Am J Orthod Dentofacial Orthop 1996;110:639-46.  Back to cited text no. 12
[PUBMED]    
13.Roberts WE, Nelsen CL, Goodacre CJ. Rigid implant anchorage to close a mandibular first molar extraction site. J Clin Orthod 1994;38:693-704.  Back to cited text no. 13
    
14.Umemori M, Sugawara J, Mitani H, Nagasaka H, Kawamura H. Skeletal anchorage system for open bite correction. Am J Orthod Dentofacial Orthop 1999;115:166-74.  Back to cited text no. 14
[PUBMED]    
15.Creekmore TD, Eklund MK. The possibility of skeletal anchorage. J Clin Orthod 1983;17:266-9.  Back to cited text no. 15
[PUBMED]    
16.Park HS. The skeletal cortical anchorage using titanium microscrew implants. Korean J Orthod 1999;29:699-706.  Back to cited text no. 16
[PUBMED]    
17.Park HS. The use of micro-implant as orthodontic anchorage. Seoul: Nare Pub Co; 2001. p. 5-192.  Back to cited text no. 17
    
18.Park HS, Bae SM, Kyung HM, Sung JH. Micro-implant anchorage for treatment of skeletal Class I bialveolar protrusion. J Clin Orthod 2001;35:417-22.  Back to cited text no. 18
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19.Park HS, Kwon TG, Sung JH. Nonextraction treatment with microscrew implant. Angle Orthod 2004;74:539-49.  Back to cited text no. 19
[PUBMED]    
20.Antonarakis GS, Kiliaridis S. Maxillary molar distalization with noncompliance intramaxillary appliances in Class II malocclusion. A systematic review. Angle Orthod 2008;78:1133- 40.  Back to cited text no. 20
[PUBMED]    
21.Gelgor IE, Karaman AI, Buyukyilmaz T. Comparison of 2 distalization systems supported by intraosseous screws. Am J Orthod Dentofacial Orthop 2007;131:161.e1-8.  Back to cited text no. 21
    
22.Gelgor IE, Buyukyilmaz T, Karaman AI, Dolanmaz D, Kalayci A. Intraosseous screw-supported upper molar distalization. Angle Orthod 2004;74:838-50.  Back to cited text no. 22
    
23.Escobar SA, Tellez PA, Moncada CA, Villegas CA, Latorre CM, Oberti G. Distalization of maxillary molars with the bone-supported pendulum: A clinical study. Am J Orthod Dentofacial Orthop 2007;131:545-9.  Back to cited text no. 23
[PUBMED]    
24.Kinzinger GS, Gulden N, Yildizhan F, Diedrich PR. Efficiency of a skeletonized distal jet appliance supported by miniscrew anchorage for noncompliance maxillary molar distalization. Am J Orthod Dentofacial Orthop 2009;136:578-86.  Back to cited text no. 24
    
25.Kircelli BH, Pektas, ZO, Kircelli C. Maxillary molar distalization with a bone-anchored pendulum appliance. Angle Orthod 2006;76:650-9.  Back to cited text no. 25
    
26.Oncag G, Seckin O, Dincer B, Arikan F. Osseointegrated implants with pendulum springs for maxillary molar distalization: A cephalometric study. Am J Orthod Dentofacial Orthop 2007;131:16-26.  Back to cited text no. 26
    
27.Oberti G, Villegas C, Ealo M, Palacio JC, Baccetti T. Maxillary molar distalization with the dual-force distalizer supported by mini-implants: A clinical study. Am J Orthod Dentofacial Orthop 2009;135:282.e1-5.  Back to cited text no. 27
    
28.Polat-Ozsoy O, Kircelli BH, Arman-Ozcirpici A, Pektas ZO, Uckan S. Pendulum appliances with 2 anchorage designs: Conventional anchorage vs bone anchorage. Am J Orthod Dentofacial Orthop 2008;133:339.e9-17.  Back to cited text no. 28
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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    Abstract
   Introduction
    Diagnosis and Tr...
   Treatment Progress
   Treatment Effects
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