Comparison of 2 distalization systems supported by intraosseous screws

doi:10.1016/j.ajodo.2006.03.027

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 131, Issue 2, February 2007, Pages 161.e1-161.e8

https://doi.org/10.1016/j.ajodo.2006.03.027 Get rights and content

Introduction: The aim of this study was to compare the effects of 2 distalization systems supported by intraosseous screws for maxillary molar distalization. Methods: Forty subjects with skeletal Class I dental Class II malocclusion were divided into group 1 (8 girls, 12 boys) and group 2 (11 girls, 9 boys). An anchorage unit was prepared by placing an intraosseous screw in the premaxillary area of each subject. To increase the anchorage in group 2, we used an acrylic plate resembling the Nance button around the screw. The screws were placed and immediately loaded to distalize the maxillary first molars or second molars when they were present. Skeletal and dental changes were measured on cephalograms, and dental casts were obtained before and after distalization. Results: The average distalization times were 4.6 months for group 1 and 5.4 months for group 2. On the cephalograms, the maxillary first molars were tipped 9.05° in group 1 and 0.75° in group 2. The mean distal movements were 3.95 mm in group 1 and 3.88 mm in group 2. On the dental casts, the mean distalization amounts were 4.85 mm for group 1 and 3.70 mm for group 2. In group 1, the maxillary molars were rotated distopalatally to a moderate degree, but this was not significant in group 2. Mild protrusion of the maxillary central incisors was also recorded for group 1 but not for group 2. However, there were no changes in overjet, overbite, and mandibular plane angle measurements for either group. Conclusions: Immediately loaded intraosseous screw-supported anchorage units were successful for molar distalization in both groups. In group 2, side effects such as molar tipping and rotation were smaller, but distalization times were longer and hygiene was poorer.

Section snippets

Material and methods

Cephalograms and dental casts of 40 patients were obtained initially (T1) and after molar distalization (T2). In the first group, 20 patients (8 girls, 12 boys; 11.6-15.1 years of age) were treated with an intraosseous screw-supported maxillary molar distalization appliance with the vestibular force vector (appliance 1).¹ In the second group, 20 patients (11 girls, 9 boys; 12.3-15.4 years of age) were treated with an intraosseous screw and palatal acrylic supported maxillary molar distalization

Results

The first molars were successfully distalized into overcorrected Class I relationships in both groups. Distalization times ranged from 3 to 6.2 months for group 1, and 4.1 to 6.6 months for group 2 (Table I). All screws were stable after placement and after the distalization period.

The mean maxillary molar distalization amounts were 3.95 ± 1.68 and 3.88 ± 1.47 mm measured at the mesial buccal cusp tips in groups 1 and 2, respectively. The maxillary molar crowns tipped distally average amounts

Discussion

Because of esthetic and social concerns about headgear,1, 32 the severity of the surgery, and the discomfort during initial healing of the implants,²⁴ intraosseous screws have been widely used to provide anchorage for various types of tooth movements. Their potential for determining absolute anchorage, their small size, and the requirement of simple and less invasive surgical procedures could increase their clinical use.1, 34, 35, 36, 37, 38, 39 Most importantly, the small size of microscrew

Conclusions

The appliances in both groups were effective in distalizing the maxillary molars. The distalization period in group 2 was slightly longer than in group 1.

Tipping and rotation of the first molars were noticed in moderate amounts in group 1, whereas these side effects were insignificant in group 2. No significant vertical changes were observed during distalization in either group. Anchorage loss characterized by maxillary incisor protrusion and maxillary first premolar tipping were negligible for

References (51)

J.B. Gray et al.
Studies on the efficacy of implants as orthodontic anchorage
Am J Orthod
(1983)
A. Joseph et al.
An evaluation of the pendulum distalizing appliance
Semin Orthod
(2000)
A.A. Gianelly et al.
Japanese NiTi coils used to move molar distally
Am J Orthod Dentofacial Orthop
(1991)
A.A. Gianelly et al.
The use of magnets to move molars distally
Am J Orthod Dentofacial Orthop
(1989)
J. Ghosh et al.
Evaluation of an intraoral maxillary molar distalization technique
Am J Orthod Dentofacial Orthop
(1996)
W.E. Roberts et al.
Osseous adaptation to continuous loading of rigid endosseous implants
Am J Orthod
(1984)
P.R. Diedrich et al.
Distal movement of premolars to provide posterior abutments for missing molars
Am J Orthod Dentofacial Orthop
(1996)
H. Wehrbein et al.
Palatal implant anchorage reinforcement of posterior teeth: a prospective study
Am J Orthod Dentofacial Orthop
(1999)
M.S. Block et al.
A new device for absolute anchorage for orthodontics
Am J Orthod Dentofacial Orthop
(1995)
H.S. Park et al.
Treatment of open bite with microscrew implant anchorage
Am J Orthod Dentofacial Orthop
(2004)

Cited by (47)

Retrospective comparison of two different miniscrew-supported molar distalization methods applied in the buccal and palatal regions
2024, Journal of the World Federation of Orthodontists
To compare dentofacial effects of distalization with miniscrew-supported pendulum and infrazygomatic crest miniscrews.
The study included 36 patients whose lateral cephalometric radiographs were obtained before (T0) and after (T1) distalization. Patients were divided into two groups according to the treatment methods: 1) distalization with miniscrew-supported pendulum (MSP) (n = 19; 14 girls and 5 boys; mean age 16.9 ± 1.46 years) and 2) distalization with infrazygomatic crest (IZC) miniscrews (n = 17; 8 girls and 9 boys; mean age 17.0 ± 1.68 years). Dental, skeletal and soft tissue measurements were performed on lateral cephalograms taken from individuals.
A significant molar distalization was achieved both in the MSP group (3.52 ± 0.76 mm at 8.71 ± 2.02 months) and the IZC group (3.5 ± 0.74 mm at 9.7 ± 2.5 months) (P < 0.001 for both). Premolar distalization was significantly lower in the MSP group (1.73 ± 1.09 mm) than in the IZC group (2.81 ± 0.79 mm) (P < 0.01). Significant molar tipping was observed in both groups (P < 0.001), while no significant difference was found between the groups (P > 0.05). Retrusion of maxillary incisors were significantly higher in the IZC group (2.75 mm) than in the MSP group (0.98 mm) (P < 0.01). A significant difference was found between the two groups with regard to the changes in overjet and overbite (P < 0.05).
Both distalization methods were found to be effective in achieving a Class I molar relationship in patients with Class II malocclusion.
Clinical effectiveness of buccally and palatally anchored maxillary molar distalization: The miniscrew-supported 3-dimensional maxillary bimetric distalizing arch vs the Beneslider
2022, American Journal of Orthodontics and Dentofacial Orthopedics
This study aimed to investigate the dentoalveolar and skeletal changes achieved with a novel miniscrew-supported 3-dimensional maxillary bimetric distalizing arch (3D-MBDA) and the Beneslider. In addition, the study aimed to compare these changes between each other and with an untreated control group.
Sixty-five patients with bilateral Class II molar relationship and fully-erupted maxillary second molars were included in the study. Of these patients, 23 received the miniscrew-supported 3D-MBDA (group 1), 21 received the Beneslider (group 2), and 21 served as untreated control subjects (group 3). Lateral cephalometric films and dental casts, taken at the beginning and the end of maxillary molar distalization, were analyzed to study the differences between the groups.
The crown distalization of the first molars was similar between the treatment groups (group 1, 3.1 mm; group 2, 3.3 mm); however, root distalization was significantly more in group 1 (5 mm) when compared with group 2 (1.7 mm). The first molars tipped 6.2° in the mesial direction in group 1 and 8.2° in the distal direction in group 2. The mesiobuccal cusp tip of the first molars extruded for 1.2 mm and increased vertical dimensions in group 2, whereas it intruded for 1.7 mm in group 1. Meanwhile, aforementioned parameters presented insignificant changes throughout the observation period in the control group. Inter-first molar width increased significantly in group 2 (2.7 mm). Distalization time was similar between the groups (group 1, 14 months; group 2, 15 months). The distalization rate was higher in group 2 (0.27 mm/mo) than in group 1 (0.23 mm/mo) measured from the crowns; however, it was similar between the groups (group 1, 0.25 mm/mo; group 2, 0.19 mm/mo) when measured from the trifurcation point.
The miniscrew-supported 3D-MBDA was more effective in distalizing molar roots and maintaining vertical parameters and dental arch width while tipping the molars mesially. In contrast, the Beneslider distalized molar crowns faster, resulting in significant distal tipping.
Maxillary expansion and first molar distalization achieved simultaneously by using a palatal miniscrew-system appliance: Report of two patients
2022, AJO-DO Clinical Companion
This case report describes the treatment of two children by simultaneous rapid maxillary expansion and distalization of the maxillary permanent first molar using an appliance supported by skeletal anchorage. There was extensive unilateral mesialization of the maxillary permanent first molar in both children, probably because of premature loss of the deciduous second molar, causing a Class II subdivision and insufficient space for the eruption of the second premolar. Unilateral posterior crossbite was also present in both patients. Two mini-implants were placed in the anterior region of the palate, and a diversified intraoral appliance was designed to concomitantly perform the expansion and distalization. In addition to successfully obtaining the two movements, a molar Class I relationship, space to allow eruption of the second premolar, and crossbite correction were achieved. This case report showed that the appliance made it possible to achieve these movements without producing the side effects usually associated with them.
Class II malocclusion treatment with a customized dual force distalizer
2021, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
This could be explained as a result of the previous leveling and alignment mechanics and minimal anchorage loss because of the use of the anterior biteplane during the distalization phase (Fig 4). Palatal appliances have reported smaller distal tipping when compared with buccal appliances because the distalization force could be located closer to the center of resistance of the maxillary molars.9,12,13,16-18 When associating a palatal force with mini-implants as a direct anchorage, smaller distal tipping and no anchorage loss of premolars should be expected.6,12,18
Intraoral distalizers associated with skeletal anchorage provide the major benefit of promoting molar distalization with minimum anchorage loss and patient cooperation. This case report presents the treatment of a 17-year-old female with Class II Division 2 malocclusion, maxillary dentoalveolar protrusion, mild mandibular retrusion, increased overjet, deepbite, and lip incompetence. The treatment plan involved initial maxillary molar distalization with a customized version of the skeletally anchored dual force distalizer (DFD). The customized DFD used smaller mini-implants and included a fixed anterior biteplane. The device applied simultaneous forces from the buccal and palatal sides directly to the molars using nickel-titanium coil springs and allowed orthodontic mechanics in the mandibular teeth. An overcorrected Class I molar relationship was obtained after 6 months. After the distalization phase, retraction mechanics began with retraction loops and using a modified transpalatal bar reinforced with the mini-implants as anchorage. Moreover, the finishing phase was performed with multiloop edgewise archwires and intermaxillary elastics to enable an individualized control of each tooth. Total treatment time comprised 2 years 4 months, and significant improvements regarding the facial and occlusal perspectives were noticed. Similarly, these favorable changes remained stable during the 2-year follow-up period. The customized version of the skeletally anchored DFD followed by fixed appliances showed effectiveness and stability in Class II malocclusion treatment.
Maxillary molar distalization in treatment of angle class II malocclusion growing patients: Uncontrolled clinical trial
2020, International Orthodontics
Citation Excerpt :
Fuziy et al. [38] and Bolla et al. [33] reported minor expansion between premolars cusp tips with the distal jet and pendulum distalizers. The maxillary first premolars revealed mesial tipping and this is consistent with the results of Gelgor et al. [19]. The results revealed a decrease in the overjet shown as maxillary incisor retroclination by 5.36° ± 1.45 and significant retraction of the maxillary incisors by 0.66 ± 0.52 mm.
This study was conducted to evaluate the clinical effectiveness treatment effects of a simple buccal technique for maxillary molar distalization using direct buccal skeletal anchorage.
After sample size calculation, fourteen female patients with bilateral Class II molar relationship (age 11–14 years) were selected from the clinic of the Department of Orthodontics, Faculty of Dentistry, Mansoura University, Egypt. After the application of the eligibility criteria, only eleven patients remained to final evaluation. The criteria included: erupted second maxillary molars, mild to moderate maxillary crowding not exceeding 6 mm with/without increased overjet and non-extraction treatment in the lower arch. After alignment and levelling, a miniscrew (1. 8 mm diameter – 0. 8 mm long) was placed buccally between the maxillary second premolar and the first molar in each side. The maxillary molar distalization was done using 250 grams of force produced from NiTi closed coil spring stretched to a buccal miniscrew. Records including cephalometric x-rays and study casts were taken for all patients before and after molar distalization. Statistical evaluation was performed for the data obtained from analysis of cephalometric tracing and cast photocopies.
The maxillary first molars were distalized with a rate of 0. 89 ± 0. 30 mm (95% CI 0.76–1.02) (P < 0.001) and distalization amount of 4.09 ± 0. 92 mm (CI 3.68–4.50) (P < 0.001). They were distally tipped by 2.48° ± 6. 16 (CI −0.26–5.21) (P = 0.073) and rotated distopalatally by 11.89° ± 5.86 with negligible change in their vertical position about 0.11 ± 0.63 mm (CI −0.40–0.17) (P = 0.411). There was no anchorage loss evident by the distal movement of all the maxillary teeth (P < 0.001). Overjet significantly reduced by 0. 86 ± 0. 50 (CI 0.52–1.20) (P = 0.004).
Maxillary molar distalization using a closed coil and buccal miniscrew is an effective and non-compliance dependent technique in a relatively short time.
Cette étude a été menée pour évaluer les effets thérapeutiques d’une technique vestibulaire simple avec ancrage direct squelettique vestibulaire pour la distalisation molaire chez des patients en croissance.
Après calcul de puissance, quatorze patientes avec classe II bilatérale (âge 11–14 ans) ont été sélectionnées dans le Département d’Orthodontie de la Faculté d’Odontologie de l’université Mansoura en Égypte. Selon les critères d’éligibilité (secondes molaires en place, encombrement arcade-dent modéré n’excédant pas 6 mm avec ou sans surplomb horizontal, sans extractions à l’arcade mandibulaire), seulement onze patientes ont constitué l’échantillon. Après alignement et nivellement, une mini-vis (diamètre 1,8 mm – longueur 0,8 mm) a été placée vestibulairement entre les deuxièmes prémolaires et premières molaires maxillaires de chaque côté. La distalisation molaire a été réalisée avec une force de 250 g produite par un ressort fermé en NiTi étiré jusqu’à la mini-vis vestibulaire. Des téléradiographies de profil et des moulages ont été réalisés avant et après la distalisation. L’évaluation statistique a été conduite à partir des données céphalométriques et des moulages.
les premières molaires ont été distalées avec un taux de 0,89 ± 0,30 mm/mois (95% CI 0,76–1,02) (p < 0,001) et la quantité de distalisation était de 4,09 ± 0,92 mm (CI 3,68–4,50) (p < 0,001). Elles ont été distoversées de 2,48° ± 6,16 (CI −0,26–5,21) (p = 0,073) et distorotées de 11,89° ± 5,86 avec un changement positionnel vertical négligeable de 0,11 ± 0,63 mm (CI −0,40–0,17) (p = 0,411). Aucune perte d’ancrage évidente n’est apparue à la suite du mouvement distal des molaires maxillaires (p < 0,001). Le surplomb horizontal a été réduit de 0,86 ± 0,50 (CI 0,52–1,20) (p = 0,004).
La distalisation molaire maxillaire avec ressort et mini-vis vestibulaires est une technique effective avec une relative rapidité et ne sollicitant pas la compliance du patient.
Effects of zygoma-gear appliance for unilateral maxillary molar distalization: A prospective clinical study
2016, American Journal of Orthodontics and Dentofacial Orthopedics
The aim of the study was to evaluate the dentoskeletal effects of the zygoma-gear appliance used for unilateral maxillary molar distalization in patients with Class II subdivision malocclusion.
This prospective clinical study consisted of 21 patients (9 boys, 12 girls; mean age, 15.68 ± 2.18 years) with unilateral Class II malocclusion treated using the unilateral zygoma-gear appliance supported by a zygomatic miniplate inserted on the Class II malocclusion side. The dentoskeletal effects of the system were evaluated using cephalometric lateral and panoramic films with a paired t test.
The mean amount of distalization for the maxillary first molar was found to be 5.31 ± 2.46 mm (P <0.001) in 0.45 ± 0.12 years, showing an amount of 0.98 mm of distalization per month. It was also accompanied by a slight intrusion (0.76 ± 2.85 mm; P >0.05) and distal tipping (6.39° ± 5.39°; P <0.001) of the maxillary molars. The maxillary premolar also spontaneously moved distally 1.63 ± 1.90 mm (P <0.01) with distal tipping (4.05° ± 3.47°; P <0.001). Moreover, the inclination of the maxillary incisors and overjet were decreased (−1.59° ± 1.45°, P <0.001; and −0.29 ± 0.63 mm, P <0.05; respectively) showing no anchorage loss. No statistically significant changes were found for the skeletal and soft tissue measurements (P >0.05).
The zygoma-gear appliance system is an effective method for unilateral maxillary molar distalization.

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Online onlyOriginal articleComparison of 2 distalization systems supported by intraosseous screws

Section snippets

Material and methods

Results

Discussion

Conclusions

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Original article
Comparison of 2 distalization systems supported by intraosseous screws