(J lnd Orthod Soc 2002; 35:13-1-142)

0:....:...:....:=;.:..:.:..:...;=.:...:..:=
____"-_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ REVIEW

Effective Means of Intraoral Molar Distalization

- An Overview
D. N. KapoorOIArvp Razdan' O
lSridhar Kannan'O '

Correction of Class II malocclusion without extractions requires maxillary molar

distalization by means of intraoral or extraoral forces. Although headgears have proven
undoubtly useful in the correction of this skeletal anomaly. the constancy of forces
and the dependence on patient co-operation is of concern.
Since the 1980s various intra arch devices have been introduced such as the K loop
(V. Kalra). NiTi coil springs (Gianelly). Superelastic NiT! wires (Locatelli) . Repelling
magnets (Gianelly) . Fixed Piston appliance (Greenfield). Pendulum appliance (Hilgers) .
Lokar Distalizer (SCOII). Distal Jet (Carano) as well as combination of extraoral and
intraoral b rces (Cetlin and Tenhoeve) . Researchers have bcused on the simplicity and
efficiency of Ihese intraarch devices. which improves the continuity and constancy
of forces. Oral hygiene is easier to maintain and the need for patient compliance is
eliminated . A modified Nance appliance has olten been applied in conjunction with
these force delivery systems to increase anchorage during distal movement or keep
the molars in position fonowing distal movement. This paper presentation is an anempt
to update information regarding various intra oral distalizing appliances available
currently and discusses patients treated successfully by using NiTi coil springs (Ortho
organizer) by distalization for correction of class II molar relationship.

Introduction :

dentition. The headgears over the years have shown

to be effective in maxillary molar distalization with
movements in all planes of space. With the recent
trend more towards non extraction treatment, several
intra arch devices have been advocated to distalize
molars in the upper arch. Researchers have focused
on the simplicity and efficiency of these intraarch
devices, which improves the continuity and
constancy of forces . Oral hygiene is easier to
maintain and the need for palient compliance is
eliminated. Certain principles , as outlined by
Burstone' must be borne in mind . when designing
an ideal intraoral molar dislalization appliance.
Molar distalization is a lechnique that has
added a new column in the practice of every
onhodonfist to produce consistent, predictable and
high quality results. The goals of practicising with
efficiency and profitability are positively affected.
Since space is easier to gain in the maxillary
arch than in the mandible because of increased
trabecular structure of supporting bone and
increased anchorage afforded by palatal vault . the
distatl:t.ation of maxi ll ary molar becomes 01

Correction of Class II malocclusion without

extractions requires maxillary molar distalization by
means of intraoral or extraoral forces. Although
headgears have proven useful in the correction of
skeletal problems, as well as in providing anchorage
for extraction cases, the dependence on palient
cooperation is heavy.
William Kingsley (1892) described for the first
time headgear apparatus with which Class I molar
relationship of the molar could be achieved
successfully. Kloehn in 1947 started a long and
beneficial series of investigations and clinical
applications of occipital anchorage to the maxillary
Professor and Head. Department of Qfthodontics. Faculty
01 Dental Sciences. K.G:s, Medical College, lucknow
. Post Graduate Student , Department of Orthodontics.
Faculty 01 Dental Sciences. K.G.'s. Medical College .
lucknow
,. . Post Graduate Student. Department of Onhodontics.
Faculty of Dental Sciences. K.G: s. Medical College,
Lucknow

131

132 Effective Means of Intraoral Molar Distafization - An Overview - D. N. Kapoor/Anup Razdan/Sridhar Kannan
significant value for the treatment of cases with mild
to mode rate arch discrepancy and Class II molar
relationship associated with a normal mandible.

Indications:

An end on or full Angle's class II molar relationship due to maxillary protrusion. impacted.
unerupted and ectopic eruption of cuspids.
Situation requiring distal movement of molars
Mild to moderate arch discrepancy.
Class II molar relationship associated with normal
mandible.

Timing :
A favourable time to move molars distally
appears to be in the mixed dentition, before the
eruption of the second molars, and an efficientlorce
system to move molars distally is a continuously
acting force .

maxillary first molar bands and repelling surfaces

are brought into contact by 0.14" ligature wire.
Forces measure to 200-225 gms but drop
substant ially as space opens beyond 1 mm .
Movement of 3 mm is seen in 7 weeks if second
molars are absent and 0.75- 1 mm per month if
present. Anchorage is reinforced by Nance
appliance and Class II elastics against an 0.016" )(
0.022 " sectional arch wi re. The rate of molar
dislalization using magna force is less than that
observed with conventional mechanotherapy. This
is in agreement with the findings of Owman et al.':<
and is supported by the work of Samuels~ that tooth
movement is proportional to force with some
biologically defined limits.

Principles of Appliance Design :

Magnitude of forces and moments.

Moment to force ratio.
Constancy of force and moments.
Bracket friction.
Minimal loss of anterior anchorage.
Bodily movement of molars to avoid lengthening
of treatment and unstable results.
Ease of use.
Cost.
Minimal chairtime for placement and reactivation.

Fig . , .- Repelling Magnets

Limitations:

2. 3-D Bimetric Di stalizing Arch

These are modular phase appliances designed

for multidirectional functional class II treatment and
were introduced by Wilson and Wi l son ~ (1987).
Maxillary molars and buccal segments are distalized
bilaterally or unilaterally without headgear.lt is
excellent if given in Class It Oiv 2 cases . II
distalizes molars to end on pOSition and allows
posteriorly locked mandible to advance immediately
to Class I position. Class II elastics allows the
functional release of any mandibular growth potential.
The anterior segment is of 0.022" Truchrome arch
while posterior segment is of 0.040" end section with
omega loops. Elgiloy open coil springs of 0.010" x
0.045" are placed between omega loop and buccal
tubes for activation. Movement achieved is 3 mm
in 2 months. Significant increase in inter bicuspid
width is possible with 3 D Bimetric Distalizing Arch
(Fig . 2) acting as 24 hour bucc inator muscl e
restrictor. Arch should be adjusted free of bucca l
teeth to avoid impingement of cheeks. II retracts
rapidly and is useful even in int rusion of anterior

High angle retrognalhic type of pattern

Third molars that have erupted or close to
eruption impede distalization
Treatment in vertical growth pattern should be
done conservatively with extraction
The present study is an attempt to update
information regarding various intraoral distalizing
appliances available. This article will also present
and discuss results obtained in lew patients treated
in the Department of Orth odontics, Faculty of
Dental Sciences, King George's Medical College,
Lucknow after distalization using Nance appliance
and NiTi coil springs.

Intra Oral Methods for Distalizing Molars

1. Aepelling Magnets
Intra arch repelling magnets (Fig . 1) used to
distalize molars were introduced by Gianelly et aF
(1988). These are prefabricated repelling SamariumCobalt magnet (SmC05) with a pole face 2 x 5 m.
The magnets are attached to headgear tube of

(J lod Dnhod Soc 2002: 35:131-142)

teeth . It is no l recommended for long f ace

syndrome patients.

, 33

compression range of 1.5 mm to the mola rs.

Anchorage is from Nance appliance which can be
anached to either first premolars. second premolars
or deciduous second molars. Reactivation of coil
springs requires liUle chair time. Patients are seen
at 4 - 5 week intervals and is a rapid method of
correction 01 Class II relationships . Correction
usually lakes place in 120-180 days.

Fig. 2: 8ime/ric Oistalizing Arch

3. Superelastic NiTi Wire :

Locatelli et af 6 (1992) used a 100 gm
NeoSentalloy wire (superetastic Nickel-Titanium
wire (Fig. 3) wi th shape memory for molar
distalization. Cnmp stops just distal to first premolar
bracket are placed 5-7 mm distal to anterior opening
of molar tube and hooks between lateral incisors and
canines . Excess wire is deflected gingivally into
buccal fold . As wire returns to original shape , it
exerts 100 gm distal force against molars.
Anchorage control is by placing Class II elastics
exerting force of 100-150 gm and is reinforced with
Nance appliance cemented to premolars. II first
molars do not move atleast 1 mm per month a
200 gm O.OIS" x 0.025" NeoSentalloy wire can be
placed . Advantage lies in its ease of insertion even
atler all teeth have been bracketed.

Fig. 4: Jones JIG

Fig. 5: Jones JIG

5. Lokar Molar Distalizer :

Lokar Oistalizer was in troduced by Scotls
(1992). The prefabricated assembly (Fig. 6) consists
of mesial sliding component inserted into archwi re
lube of molars . Lokar appliance is best in

Fig. 3: Superelas/ic NiT; Wire

4. Jones Jig (Fig. 4, 5)

Jones and While 7 (1992) used an open coil
NiTi spring to deliver 70-75 gms of force over a

Fig. 6: Lokar Molar Distalizer

134

Elfec!ive Means of Intraoral Molar Olstalization . An Overview - D. N. Kapoor/Anup RazdanlSridhar Kannan

conjunction with Nance button constructed on

second premolars (Fig. 7). Molar tubes are not used.
therefore exlraoral and li p bumper forces may be
applied concurrently. T he Lokar Distalizer is
activated by compressing spring 1 to 2 mm short
of complete compression and movement is 1-3 mm
in 56 weeks. This appliance is offset to the buccal
and rests along the buccal sur1ace of premolars.

swmging arc or pendulum of forces to upper (irst

molars. The lingual sheath is made of 0.036" for
easy fit of 0.032" TMA spring. Activation before
appliance placement i.e. by spring being paraUelto
mid sagittal plane which produces 600 activation
after insertion. Force exerted is 200250 gm per
side and movement achieved is 5 mm in 34
months. Pendulum can also be incorporated with
mid palatal jack screw for expansion along with
distalizatlon (Pend-X) (Fig, 10) . The screw is
activated one quart er every 3 days. It is not
recommended for dolichofacial types with tongue
thrusting.

Fig. 7: Lokar Molar Dislalizer

6. Pendulum Appliance
This device was designed by Hilgers9 (1992)
and is a hybrid appliance (Fig. 8.9) using Nance
acrylic button in palate for anchorage along with
0.032" TMA springs delivering light continuous broad

Fig . 10: PendXPendulurn With MID palata l Jack

screw for expansion along with Oistafizalion
f.

Modified pendulum

Fig. 8: Pendulum Appliance

Scuzzo et al. lO (1999) modified Ihe ori ginal

appliance and called it Pendulum M and claimed
Ihat Pendulum M (Fig. 11) ensures true bodily
movemenl of molar crowns and roots. Horizontal
pendulum loop was inverted from the basic design.
Activation is by Simply opening it. This activation
produces buccal and distal uprighting of molar roots
and thus a true bodily movement Springs are
activated to 40.450 resulting in 125 gms of force
on each side. Terminal ends are straight rather than
looped in origina l appliance and there is little need
for reactivation.

Fig . 9: Pend X Pendulum Appliance

F;g. I I : Modified Pendulum

(J Ind Orthod Soc 2002; 35:131-142)

8. Fixed pisto n appliance :

Most intraoral distalizing appliance tend to tip
maxillary molar crowns distally. Greenfield 11 (1995)
designed an appliance for bodily movement of
maxillary molars. Th e appl iance components
comprises of 0 .036- SS tu bi ng (soldered to
bicuspids) and 0.030' SS wires (soldered to first
molars). Nance ca n be reinforced with 0.040" SS
wire (for control of anterior anchorage). Superelastic
NiTi wi re having 0.055' (internal diameter) is used
and 2 mm split rings as stops to mesial of buccal
and lingual tubes are added every 6-8 weeks. Force
exerted is 50 gms per tooth and movement
achieved is 1 mm per month. It does not interfere
with occlusal plane 12 thus maintaining control of
vertical dimension

135

continues even after the force has dissipated. Single

activation produces 4 mm distal molar movement
in 6 to 8 weeks and 1 mm anchorage loss is seen
dlJring 4 mm molar distalization.
10. Distal jet:
Carano and Testa ' ( 1996) designed an
appliance that can be used for either unilateral or
bilateral Class II correction. It consists of bilateral
tubes of 0.036' internal diameter anached to acrylic
Nance bulton (Fig. 14). NiTi coil springs exerting a
force of 150 gms for children and 250 gms for adults
is recommended. The springs are clamped on the
tube to exert a distal force . Bodily movement is
achieved as the force passes close to the center
of resistance. Reactivation is done by sliding the
clamp closer to first molar once a month. Once
distalizalion is completed the appliance can be
converted to a Nance retainer or passive Nance
appliance. Movement of 2-3 mm is seen in 4
months.

Fig. '2: Fixed Piston Appliance

9. Kloop molar dlstallzing appliance:

Introduced by Kalra ' 3 (1995). This appliance
consists of a K-Ioop to provide force and a Nance
bulton to resist anchorage . K loop is made of
0.01
0.05" TMA wire with each loop being 8 mm
long and 1.5 mm wide and is placed between first
premolar and first molar (Fig . 13). Activation is by
20 degree bends in appliance that produce moments
that counteract the tipping moments created by the
force of appliance. Thus molar undergoes translatory
movement instead of tipping . Root movement

r )(

.l~-'~
.~ ---

"

. l,

""

'

--

11 . Modified Distal jet appliance:

Quick and Harris 1s (2000) modified the original
Distal Jet appliance. The basis of the modification
is the rear entry of sliding section into lingual molar
sheath so that the appliance pulls rather than pushes
the molar distally (Fig. 15). The doubled back wire

.~.~

Fig. 14: Distal Jet

'

Fig. 13: K-Loop Molar Distalizing Appliance

,1

Fig . 15: Modified Distal Jet Appliance

136 Eflectlve Means 01 Intraoral Molar DistahzallOn An Overvi ew - D. N. Kapoor/Anup Razdan/Sridhar Kannan

is inserled into the lingual sheath from the distal

side. Either 0.030 or 0 .032 " wire is the most
preferred wire for sliding . Desired activation
produced is by compressing the coil spring between
distal end of the lube and the stop soldered to the
sliding wire. To reactivate the appliance. the safety
ligature is cut and the sliding wire is pulled oul
distally and a new longer section of coil is placed
over wire . No screw or Allen wrench is used, thus
simplifying the activation procedure.

12. Fixed palatal Expander :

Maxillary arch constriction and mesiopalatal
rolalion of upper first molars are two components
of mosl Class II malocc lusions that must be
correcled either before or during sagiltal correction .
Snodgrass 16 (1996) designed an appliance (Fig. 16)
and incorporated rota lion and dislalization
components of Pendulum appliance in his neN design.
It consisted of a framework 01 11 mm expansion
screw, two 0.032" TMA Pendulum springs and
occlusal rests. Springs were preactivated 8-10 mm
distally and the screw is activated twice a day IiU
desired expansion is achieved. II is useful in treating
unilateral class II with midline discrepancies.

100 gms superelastic coils . Gianelly l1 used

Japanese NiT! coil springs exerting 100 gms of force
to move maxillary molars distally. Move ment
achieved is Ithe 1.5 mm per month. Anchorage unit
is anterior acrylic button lor pa latal support.
Oistalization is accomplished early in treatment and
any undesired the movements can be correcled in
succeeding phases.
14. Superspring II :

The Super spring II designed by Klapper 1'

(1999) is a flexible spring element that attaches
between the maxillary molar and mandibular canine
(Fig . 18). It is designed to rest In the vestibule .
making it impervious to occlusal damage and

Fig. t 8: Supe(spring 1/

Fig. 16: Fixed Palatal Expander

13. NITI Coli Springs:

Pieringer et a/ 17 (1997) used SentaUoy red coil
springs (G AG) exerting a force 01 150-200 gms on
sectional arch wires from first premolars to molars
(Fig . 17). The concept of using coil springs for
dislalization was introduced by Miura who used

Fig. 17: NITi Coil Springs

allowing for good hygiene. The spring's open hetical

loop is twisted like a J hook into Ihe mandibular
archwire. On the maxillary end , a special oval tube
serves as the maxillary first molar attachment.
During opening and closing movements, tower helical
attachment hinges on Ihe mandibular archwire
throl,lgh an arc of 90 (Fig . 19). A longer spring is
used for non extraction cases and shorter springs for
full Class II extraction cases. Moderate continuous
dislaHzing force upto 5 oz Is exerted . Excellent for
TMO patients who require orthodontic treatment after
splint therapy.

Fig. 19: Sup8fspring II

(J Ind Orthod Soc 2002 ; 35:131-142)

15. First Class Appliance:

With the objective 10 minimize anchorage loss
Forlini et al 20 (1999) devised an appliance (Fig. 20)
tor rapid distalizalion of maxillary first and second
molars. The vestibular component comprised of
formative screws soldered to the buccal side of first
molar bands. Split rings are welded to second
premolars and stop screws maintain distal position
of molars atier active movemen t has been
completed. Palatal component comprised 01 wider
butterfly shaped button . NiTi coil spring (0.010" x
0.045") of 10 mm length was used to achieve
bodily movement of 4-8 mm in 28-95 days.

137

ban ds for receiv ing sectional arch wi res .

Distal ization can be accomplished either with
sagillaly preactivated delta loops and long vertical
legs or with straight sectional wires and push coil
springs.
17. Franzulum Applian ce :
Gaining space in the mandible is more difficult
than in the maxil la. The most commonly used
intraoral appliances are lip bumpers. lingual arches
and removable appliances with screws or springs
which depend on patient compliance for their
success. 8y loff et al 23 (2000) devised the
Franzulum appliance based on pendulum for distalizing mandibular molars (Fig. 22) . The anterior
anchorage unit comprised of an acrylic bullon
positioned lingually and inferiorly to mandibular
anterior teeth and extending from mandibular canine
to canine. The acrylic should be aUeas! 5 mm wide

Fig. 20: First Class Appliance

16. Palatal Orthodontic Implants:

Fig. 22: Franzulum Appliance

Idea of implant in median maxillary sulure for

anchorage was originally by Triaca 2 \. Mannchen 22
(1999) implanted miniature gold fixation screws into
the alveolar bone between roots of teeth in young
patients. Maxillary suture is a more reliable location
than the alveolar bone between roots of teeth , for
anchorage in adults. The basic principle of the
appliance is to provide a rigid platform that is not
attached to any single tooth . A yoke shaped palatal
bar 0.036 )( 0.072" made of Remaloy stainless
steel wire with 4.5 mm long 0.022 x 0.02 8"
rectangular tubes are attached on each end. 0.022"
(Fig. 21). Damon SL brackets are welded to molar

to avoid mucosal trauma and to dissipate the reactive

force produced by the reactive components. Rests
on the canine and first premolars are made of 0 .032~
stainless steel wires and tubes between the second
premolars and first molars receive the active
components (Fig. 23) . The posterior distalizing unit
uses NiT; coil springs (GAC) about 18 mm length
which apply an initial force of 100-120 gms per side.
The active part of the appliance runs lingually at a
level close to the center of resistance of the molars
to produce an almost pure bodily movement.

Fig. 21 : Palatal Orthodontic Implants

Fig . 23: Franzulum Appliance

138

Effective Means of Intraoral Molar Distalization - An Overview - D. N. Kapoor/Anup Razdan/Sridhar Kannan

18. C-Space Regainer :

24

Chung st al
(2000) used a removable
appliance called Ihe C-Space Regainer to achieve
bodily molar movement without significant incisor
flaring. It consists of a labial framework formed from
0.036" SS wire, and an acrylic splint. A closed helix
is bent into the framework in each canine region
(Fig . 24) . An open coil spring (0.0 10"xO.040") is
soldered distal to the helix and 0.028" ball clasps
are used to retain the appliance. Open coil spring
should be 130% of lenglh between soldered point
and mesial edge of head gear. When compressed it
will exert 200 gms of force and move molars distally
about 1-1.5 mm per month .

supplemental force system is used to provide a

moment that torques the root distally, a significant
amount of anchorage may be lost as the molar
assumes an upright position . Patient compliance
with headgear is usually required to attain net bodily
movement. Since distalization is usually
accomplished early in treatment and any undesired
movements can be corrected later on, second phase
of molar uprighting is necessary in which patients
often must wear headgear. So, we recommend
distalization with Nance appliance and coil springs
which is easy to fabricate. economical and effective
for achieving the main objective of molar correction
from class II to class I.
Presentation of cases treated by dlstalizing
molars using Nance holding and NiTI open coils
springs.

Case 1

Fig. 24: C-Space Regainer

Critical Appraisal :
In the mixed dentition, the appliance should
not be placed until full development of the maxillary
first molar rools. In most Class II cases , the
intraoral distalizing appliances accomplishes its goal
within six months without the need for patient
cooperation . In all of these systems, orthodontic
forces are applied to the crowns of the upper first
molars and the molar movement consists mainly of
tipping and rolation of the crowns as openly
acclaimed by Gianelly2. Jones 1 , Hitgers9 , Carano 14
Kalra'l. None of the Intraoral appliances for molar
distalization have been completely successful in
avoiding undesirable biomechanical side eHects as .
advocated by Jecke~5. Although Scuzzo st a/ 10
modified pendulum appliance and Green fields at
a/ II fixed piston appliance have claimed that thei r
appliance can produce true bodily movement of the
maxillary molars, we strongly believe that unless a

A 12 years old female came with a complaint

of protruding upper front teeth. The patient had good
facial esthetics and harmony of facial lines. She
presented with end on molar relationship on both
sides with overjet of 7 mm and overbite of 5.5 mm .
Maxillary arch length discrepancy was 8 mm. Upper
incisor inclination to SN and PP was 1180 and 1280
respectively and incisal edge 5 mm in front of NA
line. Upper molar to PTV was 9 mm. Both 8NA and
SNB were within average normal range. TuberOSity
space was suHicient to accommodate both th ird
molars.
Treatment plan involved distalization of first
motars to overcorrected Class I relation , Nance
holding arch was attached to first premolars and
010 x 030 NiTi open coil spring (Ortho Organizers)
was compressed 10 mm in excess of interbracket
span between first premolars and first molars .
Du ring this period of stabil ization Class "
elastics were applied on upper premolars from
lower molar ( lower stabilizing arch was placed
beforehand). The desired molar relation was
achieved within 4 months and then a modified
Nance was given on first molar for stabilization.
Upper Molar to PTV decreased to 7 mm and bite
was opened by 3.5 mm. Cephalometric superimposition showed bodily movement of molars
du ring distalization with insignificant tipping and
an anchorage loss of 1 mm (Table 1).

Case 2
A 13 years old female came with a complaint
of forwardly placed upper front teeth. The patient had
good facial esthetics and harmony of facial lines.
8he presented with end on molar re lationship on

(J Ind Orlhod Soc 2002: 35: 131-142)

Case 1

139

12YrslFemaie
Linear Measurements

U6-PP
Ul-PP
SN-U6
SN-U1

71
118

Pre-Tt
9
52
7
Ove~et
OverMe
55

Post Tt Tt Change
1
84
116
12
73
2
116
2

PTV-U6
PTV-UI

60.2

Post Tt Tt Change
7
2
50.5
1.5
1.5
5.5
3.5
2
61.1
0.9

--_.../'-------~
I
~_

''/: i / AIII ..

\' 1 '.,. .....

r..

Table 1
both sides with overjet of 6 mm and overbite of
6 mm. Maxillary arch length discrepancy was 8 mm.
Upper incisor inclination to SN and PP was 102 and
11 50 respectively and incisal edge 5 mm in front of
NA line. Upper molar to PTV was 7 mm . 80th SNA
and SNB were wi thin average normal range.
Tuberosity space was sufficient 10 accommodate
both third molars.
Treatment plan involved dislalizalion of first
molars 10 overcorrected Class I relation , Nance
holding arch was attached 10 first premolars and
0

Case 2

010 x 030 NiTi open coil spring (Ortho Organizers)

was compressed 10 mm in excess of interbracket
span between first premolars and first molars. The
desired molar relation was achieved within 4Y2
months and then a modified Nance was given on
first molar for stabilization. Upper Molar to PTV
decreased to 6 mm and bile was opened by
3 mm. Cephalometric superimposition showed
bodily movement of molars during distalization
along with insignificant lipping and an anchorage
loss of 1 mm (Table 2) .

13YrslFemaie

Angular Measurements

U6-PP
U1-PP
SN-U6
SNoUt

Pre-Tt
70
115

60
102

Post Tt Tt Change
4
6
49
5
3
3
3
3
67.5
0.5

Post Tt Tt Change
67
3
106
9
5
65
101

Table 2

140 Effective Means of Intraoral Molar Distalization . An Overview - D. N. Kapoor/Anup Aazdan/Sridhar Kannan
Case 3
A 15 years old female came with a complaint
of irregularity of upper front teeth and labially
blocked out canines. The patient had good facial
esthetics and harmony of facial lines. She presented
with Class II molar relation of 4 mm on both sides
with ove~et of 3 mm and overbite of 5 mm. Maxillary
arch length discrepancy was 7 mm . Upper incisor
inclination to SN was 91 0 and to Palatal plane was
102 and incisal edge 4.5 mm in front of NA line.
Upper molar to PTV was 15 mm. Both SNA and
SNB was within average normal range. Tuberosity
space was sufficient to accommodate both third
molars.

molar relation with overjet of 7 mm and overbite of

6 mm. Maxillary arch length discrepancy was 10
mm . Upper incisor inclination to SN and PP was
1080 and 11 ~ . Upper molar to PTV was 11 mm .
Tuberosity space was sufficient to accommodate
both third molars.
Treatment plan involved distalization of first
molars to overcorrected Class I relation , Nance
holding arch was attached to first premolars and
010 x 030 NiTi open coil spring (Ortho Organizers)
was compressed 10 mm in excess of interbracket
span between first premolars and first molars. The
desired molar re latio n was ac hieved within
5 months and then a modified Nance was given

15V-.m.Ie
Angular

Pre-Tt
U6PP
U1-PP
SN-U6

102

SN4Jl

91

83

Measur~ 'lP'1I ,

Pre-Tt
15
44
3

Post n Tt Change
86

71

5
65.4

Post TI Tt Change
11
4
47
3

3
66.5

2
1.1

Table 3
Treatment plan involved distalization of first
and second mola rs en masse to overcorrected
Class I relation , Nance holding arch was attached
to first premolars for anchorage and 0.010 x
0.030 NiTi open coil sp ring (Ortho Organizers)
was compressed 10 mm in excess of interbracket
span between first premolars and first molars. The
desired Class I molar relation was achieved within
5 months. Upper Molar to PTV decreased to
11 mm and bite was opened by 2 mm. Cephalometric superimposition showed that the mola rs
during distalization had lipped and an anchorage
loss of 1 mm on right and 1.5 mm on left side
was observed (Table 3).
Case 4
A 14 years old female came with a complaint
of forwardly placed upper front teeth. The patient had
good facial esthetics. She presented with Class II

on first molar for stabilization. Upper Molar to PTV

decreased to a mm and bite was opened by
3 mm . Cephalometric superimposition showed
that the molars during distalizalion had tipped and
an anchorage loss of 1.5 mm was observe d
(Table 4).
Case 5
A 13 years old female came with a complaint
of forwardly placed chin . She had mandibular
prognathism and anterior cross bite. After the case
was analyzed it was found that there was maxillary
deficiency and dentoalveolar retrusion with mild
maxillary anterior crowding and had horizontal
growth pattern . Lower facial height was decreased
and patient was given delaire for a period of 6
months . ANB decreased f rom -5 to - 1. SNA
advanced by 2" and SNB decreased by 2" Le . 78
to 8D" (SNA) and 83 to 81 (SNB ,l. - SN increased

(J Ind OnhOd Soc 2002: 35:131-142)

Case 4

14 Y rs/Fema1e
l mear Measurements

Angular Measuremenls
Pre-Tt
U6-PP
U1 -PP
SN-U6
SN-Ul

62
117
55

108

Post Tt Tt Change
65
3

110
59
102

141

PTV-U6
PTV-U1
Overjel

0vertli1.
POS1: FH

Atii:TH

Pre-Tt
11
57

Post Tt Tt Change

55

3
3

4
3

68.1

67.8

1.7

Tabte 4
from 1100 to 1160 Le . signifying dentoalveolar
protrusion . IMPA decreased from 85.6 to 840 and
FMA i ncrease d by 2. After this skeletal
correction , molars were in an end on relationship
wi th mild maxillary anterior c rowding a nd
dentoalveolar protrusion. These factors led to
distalization of molars to achieve Class I molar
relationship and eliminate crowding . Distalization
was accomplished by NiTi open coil springs and
molars were dislalize 3 mm from each side
to achieve super Class I molar relation (Table 5) .

Case S

Summary
Five patients req uiring molar distalization
ranging in age from 12 10 15 years were selected
for the study. The Nance appliance consisted of
two premolar bands , connected by a soldered
palatal framework, and en anterior acrylic sh ield
for palatal support. The button was large enough
to provide adequate anchorage and stability.
extending to about 5 mm from the teeth. Actual
distalization was done by NiTi Coit springs on
sectional arch wires . Molars moved distally 1 to

15Yrs/Female

linear Measurements

Angular Measurements
U6-PP
U1PP
SN-U6
SN-Ul

Pre-TI
90
121
80

110

Pre-Tt
10
49

Post Tt TI Change
84
6
122
1

11<

;'.1>: ", :<11. (' xll"< :li:y;

Table 5

Post TI Tt Change
t2
2
59
10

-,
7

2
2

3
5

71

70

142

Effective Means of Intraoral Molar Dislalizalion - An Overview - D. N. Kapoor/Anup Aazdan/Sridhar Kannan

1.5 mm/month with 8 to 10 mm activation of 100

gm coils with little loss of anchorage . Since the
reaction force of the coil moves the wire anteriorly,
the function of the stop agains t the premolar
brackets is to ensure that the wire cannot move
past the first premolars thus placing the reaction
force on the Nance appliance . Accordingly the
anchorage unit remains the palate as well as
incisors. The appliance did not interfere with the
occlusal plane , thus maintaining control , of the
vertical dimension. None of our patients has made
any negative comments about the comfort, feel or
ease of speech of the Nance appliance. No signs
of palatal irritation was observed during the course
of treatment.

Inferences:
Molar distalization if done on careful selected
cases with critically planned biomechanics can
correct molar relation and provide some useful arch
length in mild to moderate discrepancy. It is observed
that premolar move forward approximately 1 mm in
about 4-5 mm of molar distalization .The amount of
anchorage loss with NiTi coil springs is similar to
that reported with magnets. K-Ioop, pendulum . If
necessary anchorage can be reinforced by attaching
a straight pull or high pull headgear with a force of
150 gm to the premolars.
The Nance appliance appea rs to be an
effective method 01 moving maxillary posterior teeth
distally. With both intra oral and intra maxillary
fixation. it does not require patient compliance . Our
resu lt s indicate however that comp lex three
dimensional movements occur along with the
desired distalization . No correlation could be
established between amount of distalization or
duration of treatment and the amount of tipping .
Since distalization is usually accomplished
early in treatment, any undesired movements can
be corrected in succeeding phases. Therefore we
strongly believe that the advantages of the Nance
appliance with Ni Ti coil springs outweigh their
disadvantages.
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