Korean J Orthod.  2015 Sep;45(5):236-244. 10.4041/kjod.2015.45.5.236.

Three-dimensional analysis of the distal movement of maxillary 1st molars in patients fitted with mini-implant-aided trans-palatal arches

• Miresmaeili A
• Sajedi A
• Moghimbeigi A
• Farhadian

• KMID: 2068518
• DOI: http://doi.org/10.4041/kjod.2015.45.5.236

Abstract

OBJECTIVE
The aim of this study was to investigate three-dimensional molar displacement after distalization via miniscrews and a horizontal modification of the trans-palatal-arch (TPA).
METHODS
The subjects in this clinical trial were 26 Class II patients. After the preparation of a complete set of diagnostic records, miniscrews were inserted between the maxillary 2nd premolar and 1st molar on the palatal side. Elastic modules connected to the TPA exerting an average force of 150-200 g/side parallel to the occlusal plane were applied. Cone-beam computed tomography was utilized to evaluate the position of the miniscrews relative to the adjacent teeth and maxillary sinus, and the direction of force relative to molar furcation. The distances from the central point of the incisive papilla to the mesiopalatal cusps of the 1st maxillary molars and the distances between the mesiopalatal cusps of the left and right molars were measured to evaluate displacement of the maxillary molars on the horizontal plane. Interocclusal space was used to evaluate vertical changes.
RESULTS
Mean maxillary 1st molar distalization was 2.3 +/- 1.1 mm, at a rate of 0.4 +/- 0.2 mm/month, and rotation was not significant. Intermolar width increased by 2.9 +/- 1.8 mm. Molars were intruded relative to the neighboring teeth, from 0.1 to 0.8 mm.
CONCLUSIONS
Distalization of molars was possible without extrusion, using the appliance investigated. The intrusive component of force reduced the rate of distal movement.

Keyword

Orthodontic anchorage procedures; Tooth movement; Dental models

MeSH Terms

Bicuspid
Cone-Beam Computed Tomography
Dental Models
Dental Occlusion
Humans
Maxillary Sinus
Molar*
Orthodontic Anchorage Procedures
Palate
Tooth
Tooth Movement

Figure

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  Figure 1 Mini-implant-aided trans palatal arch molar distalizing appliances include a horseshoe shaped palatal bar inserted in the palatal sheath, and two miniscrews between the 1st molar and 2nd premolar. They exert a traction force from the anterior helix to the miniscrews. A, Before the start of treatment; B, after the completion of distalization.

• 

  Figure 2 The measurements on digital models. A, Distance between mesiopalatal cusps of both side first molars and incisive papilla; B, angle between the lines connecting incisive papilla to distopalatal cusp of the first molar and mesiopalatal cusp to distopalatal cusp of the first molar.

• 

  Figure 3 Evaluation methods of vertical teeth movement by three-dimensional digital model. A, Before treatment; B, after treatment. The red areas are contact areas, which are more marked on the right first maxillary molars before treatment than after treatment. Red marks are stronger on premolars and second molars after treatment, which is an additional sign of first molar intrusion.

• 

  Figure 4 Demonstrations of the lines of traction force by cone-beam computed tomography (CBCT) images. A, Right sagittal view; B, left sagittal biew; C, coronal view. In right and left sagittal views of the CBCT scan, the angle between the lines of traction from the helix to the minscrews relative to the occlusal plane clearly indicate the apical direction of distal driving force. The coronal view shows the divergent distal driving force as the expansion component of applied force.

• 

  Figure 5 The sequence of changes in dentition. A, Before treatment; B, at the start of appliance placement and leveling; C, after the completion of distalization, and D, after debonding.

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