JIOS

10.5005/jp-journals-10021-1106
CASE REPORT
Mini-implant-supported Molar Distalization

Mini-implant-supported Molar Distalization

1
Amit Goyal, 2JPS Kalra, 3Suchinder Singla

ABSTRACT

Temporary anchorage devices popularly called mini-implants or miniscrews 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 Angle’s 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: Mini-implants, Anchorage, Molar distalization.

How to cite this article: Goyal A, Kalra JPS, Singla S. Mini-implant-supported Molar Distalization: J Ind Orthod Soc 2012;46(4):
283-286.

INTRODUCTION movement of the anterior teeth or posterior teeth (or both)

without anchorage loss has become possible.13-19 Among
The nonextraction treatment of a Class II malocclusion without
these devices, the mini-implants have the advantages of easy
extraction requires posterior movement of the maxillary
placement and removal with minimal anatomical limitations
dentition, anterior movement of the mandibular dentition or a
because of their small size and low cost.17 Therefore, their
combination of both. Many appliances techniques have been
clinical applications have been expanded and they have been
developed and used to distalize the maxillary molars with
adopted for molar distalization.
positive clinical results. However, patient cooperation is a
Sliding mechanics with the aid of the mini-implant
serious problem; orthodontic mechanics requiring minimal
anchorage and its application for the treatment of skeletal
patient cooperation are desirable.1,2 Intraoral appliances for
Class I and II malocclusions have been described
maxillary molar distalization, such as the pendulum, push coils,
previously.17,18 Its application in nonextraction treatment,
magnets, superelastic nickel-titanium wires, the distal jet and
however, has not been widely discussed. The following case
the molar slider, do not require extensive cooperation from
report highlights the use of mini-implants as an anchorage aid
patients.3-11 These techniques effectively distalize both the first
for distalization of maxillary molars.
and second molars.
However, these appliances always exert reciprocal, adverse
DIAGNOSIS AND TREATMENT PLAN
side effects. Anterior teeth tend to move forward during
distalization of the molars and need to be retracted thereafter A 16-year-old female patient presented with a full cusp Angle’s
against the distalized molars. The forward movement of the Class II molar relation on the left side, end on molar relation
distalized molars during anterior tooth retraction often offsets on the right side, moderate crowding in the upper arch, mild
the treatment effect of the distalization appliances. 12 crowding in the lower arch, normal maxillomandibular
Furthermore, the treatment time is prolonged. These adverse relationship and a normal overjet and overbite (Fig. 1).
tooth movements or changes on the reactive part should be As she presented with a straight pleasing profile (Fig. 2),
eliminated, if possible. extraction was ruled out. Distalization of the upper molars
The solution to this obstacle has been provided by recent was planned and to prevent the proclination of the anterior
improvements in implant dentistry. With the use of dental teeth during distalization, mini-implants were sought to
implants, miniplates and implants as anchorage, the distal strengthen the anterior anchorage. The mild crowding in the
lower arch would be relieved by proximal stripping.
1
Senior Lecturer, 2Professor and Head, 3Professor
1-3
TREATMENT PROGRESS
Department of Orthodontics and Dentofacial Orthopedics, Guru Nanak
Dev Dental College, Sunam, Punjab, India Upper first molars were banded and 0.022" stainless steel
Corresponding Author: Amit Goyal, Senior Lecturer, Department of brackets were bonded only on upper first and second
Orthodontics and Dentofacial Orthopedics, Guru Nanak Dev Dental premolars. After aligning these posterior teeth, a segmental
College, Sunam, Punjab, India, e-mail: [email protected] 0.019" × 0.025" stainless steel wire was placed. A stiff
archwire is necessary to minimize the distal tipping and
Received on: 22/1/12 rotation of the molar. A nickel-titanium open coil spring was
Accepted after Revision: 24/4/12 inserted between the second premolar and the first molar to

The Journal of Indian Orthodontic Society, October-December 2012;46(4):283-286 283

Amit Goyal et al

Fig. 1: Pretreatment intraoral photographs

brackets from these mini-implants to prevent their mesial

movement (Fig. 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.
Within 3 months, a molar distalization of 3 mm was
achieved on the right side and 5 mm was achieved on the left
side (Fig. 4). 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
Fig. 2: Pretreatment profile photograph showing a straight profile directly from the implants (Fig. 5).
After this, the closure of residual spaces and the final
provide the distalizing force. However, it was necessary to settling of occlusion was carried out (Fig. 6). The entire
prevent the loss of anterior anchorage. Temporary anchorage procedure took 13 months to complete.
devices, popularly called mini-implants were used to prevent
the flaring of the anterior teeth. TREATMENT EFFECTS
Two titanium mini-implants (0.8 mm in diameter and 11
mm in length) were inserted between the second premolar Good alignment was achieved in the maxillary and mandibular
and first molar on both sides in the upper arch. Stainless steel arches with a full cusp Class I molar and canine relation on
ligature wire (0.010" diameter) was tied to first premolar both sides without any premolar extractions (Fig. 7). The

Fig. 3: Placement of implants for anchorage reinforcement

284 JAYPEE
 JIOS

Mini-implant-supported Molar Distalization

Fig. 4: Intraoral photographs after completion of molar distalization

Fig. 5: Retraction of premolars and canine after Fig. 7: Post-treatment intraoral photograph
distalization of molars

profile was maintained (Fig. 8) and any proclination of anterior

teeth was avoided with the use of mini-implant anchorage.

DISCUSSION
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 forwardly placed anterior teeth
should be retracted back after creating space by distalizing
the molars and premolars. During this anterior tooth retraction,
the posterior teeth are used as anchorage so that the distalized Fig. 8: Profile of the patient after active orthodontic treatment

Fig. 6: Settling of occlusion using settling elastics

The Journal of Indian Orthodontic Society, October-December 2012;46(4):283-286 285

Amit Goyal et al

molars are moved forward, which offsets the efficiency of 10. Bolla E, Muratore F, Carano A, Browman SJ. Evaluation of
distalization using intraoral distractors.12 Moreover, the maxillary molar distalization with the distal jet: A comparison with
other contemporary methods. Angle Orthod 2002;72:
overall movement of the anterior teeth is a round-trip as they
481-94.
are proclaimed during the distalizing of the molars and then 11. Keles A, Is¸ Guden B. Unilateral molar distalization with molar
retracted into the created space. On the other hand, distal slider (two case reports). Turk Ortonti Dergisi 1999;12:
movement using mini-implants is a group movement of buccal 193-202.
segment teeth. There is no forward movement of the anterior 12. Ghosh J, Nanda RS. Evaluation of an intraoral maxillary molar
teeth in mini-implant–aided mechanics. Therefore, these distalization technique. Am J Orthod Dentofacial Orthop
procedures did not produce any adverse side effect on the 1996;110:639-46.
13. Roberts WE, Nelsen CL, Goodacre CJ. Rigid implant anchorage
anterior teeth.
to close a mandibular first molar extraction site. J Clin Orthod
Antonarakis and Kiliaridis found in their systematic review 1994;38:693-704.
that tooth-borne distalizers could move maxillary molars 14. Umemori M, Sugawara J, Mitani H, Nagasaka H, Kawamura H.
distally on average 2.9 mm; however, the associated Skeletal anchorage system for open bite correction. Am J Orthod
undesirable incisor mesial movement was 1.8 mm.20 In the Dentofacial Orthop 1999;115:166-74.
present case, the findings indicate that reinforcement of 15. Creekmore TD, Eklund MK. The possibility of skeletal anchorage.
J Clin Orthod 1983;17:266-69.
anchorage with orthodontic implants increased the amount of
16. Park HS. The skeletal cortical anchorage using titanium
molar distalization. The distal movement of the maxillary microscrew implants. Korean J Orthod 1999;29:699-706.
molars in the studies with comparable distalization techniques 17. Park HS. The use of micro-implant as orthodontic anchorage.
were from 3.9 to 6.4 mm.21-28 At the same time, the maxillary Seoul: Nare Pub Co 2001:5-192.
incisors remained stable. This implies better outcomes 18. Park HS, Bae SM, Kyung HM, Sung JH. Micro-implant anchorage
produced by mini-implant reinforced distalization than by for treatment of skeletal Class I bialveolar protrusion. J Clin Orthod
2001;35:417-22.
tooth-borne distalizing appliances.
19. Park HS, Kwon DG, Sung JH. Nonextraction treatment with
microscrew implant. Angle Orthod 2004;74:539-49.
CONCLUSION 20. Antonarakis GS, Kiliaridis S. Maxillary molar distalization with
noncompliance intramaxillary appliances in Class II malocclusion.
Mini-implants can be used successfully for distal movement
A systematic review. Angle Orthod 2008;78:1133-40.
of posterior teeth. They shorten treatment time and prevent 21. Gelgor IE, Karaman AI, Buyukyilmaz T. Comparison of
the flaring of anteriors. So, in cases where extraction is 2 distalization systems supported by intraosseous screws. Am J
contraindicated, molar distalization using implants might be Orthod Dentofacial Orthop 2007;131:161.e1-8.
the best option. 22. Gelgor IE, Buyukyilmaz T, Karaman AI, Dolanmaz D, Kalayci
A. Intraosseous screw-supported upper molar distalization. Angle
REFERENCES Orthod 2004;74:838-50.
23. Escobar SA, Tellez PA, Moncada CA, Villegas CA, Latorre CM,
1. Gray JB, Steen ME, King JG, Clark AE. Studies on the efficacy Oberti G. Distalization of maxillary molars with the bone-supported
of implants as orthodontic anchorage. Am J Orthod 1983;83: pendulum: A clinical study. Am J Orthod Dentofacial Orthop
311-17. 2007;131:545-49.
2. Byloff FK, Kärcher H, Clar E, Stoff F. An implant to eliminate 24. Kinzinger GS, Gulden N, Yildizhan F, Diedrich PR. Efficiency of
anchorage loss during molar distalization: A case report involving a skeletonized distal jet appliance supported by miniscrew
the Graz implant-supported pendulum. Int J Adult Orthod anchorage for noncompliance maxillary molar distalization. Am J
Orthognath Surg 2000;15:129-37. Orthod Dentofacial Orthop 2009;136:578-86.
3. Hilgers JJ. The pendulum appliance for Class II noncompliance 25. Kircelli BH, Pektas¸ ZO, Kircelli C. Maxillary molar distalization
therapy. J Clin Orthod 1992;26:700-13. with a bone-anchored pendulum appliance. Angle Orthod
4. Joseph A, Butchart CJ. An evaluation of the pendulum distalizing
2006;76:650-59.
appliance. Semin Orthod 2000;6:129-35.
26. Oncag G, Seckin O, Dincer B, Arikan F. Osseointegrated implants
5. Gianelly AA, Bednar J, Dietz VS. Japanese NiTi coils used to
with pendulum springs for maxillary molar distalization: a
move molar distally. Am J Orthod Dentofacial Orthop 1991;99:
564-66. cephalometric study. Am J Orthod Dentofacial Orthop
6. Gianelly AA, Vaitas AS, Thomas WM. Distalization of molars 2007;131:16-26.
with repelling magnets. J Clin Orthod 1988;22:40-44. 27. Oberti G, Villegas C, Ealo M, Palacio JC, Baccetti T. Maxillary
7. Gianelly AA, Vaitas AS, Thomas WM. The use of magnets to molar distalization with the dual-force distalizer supported by mini-
move molars distally. Am J Orthod Dentofacial Orthop implants: A clinical study. Am J Orthod Dentofacial Orthop
1989;96:161-67. 2009;135:282.e1-5.
8. Locatelli R, Bednar J, Dietz VS, Gianelly AA. Molar distalization 28. Polat-Ozsoy O, Kircelli BH, Arman-Ozcirpici A, Pektas ZO,
with superelastic NiTi wire. J Clin Orthod 1992;26:277-79. Uckan S. Pendulum appliances with 2 anchorage designs:
9. Carano A, Testa M. The distal jet for upper molar distalization. J Conventional anchorage vs bone anchorage. Am J Orthod
Clin Orthod 1996;30:374-80. Dentofacial Orthop 2008;133:339.e9-17.

286 JAYPEE