This document discusses various methods and appliances used for orthodontic expansion and molar distalization. It begins with an introduction to expansion, including its objectives and historical background. It then covers topics such as indications, contraindications, classifications of expansion appliances, biomechanics, and types of appliances used for rapid, slow, and surgically-assisted maxillary expansion as well as molar distalization. Examples of specific appliances discussed include headgear, bimetric arch designs, and devices using coils, magnets, or nickel titanium wires for moving molars distally. The document concludes that proper case assessment is important for consistent results with expansion and distalization procedures.
3. Hippocrates
“Among those individuals where heads are
long shaped, some have thick necks, strong
members and bones, others have strongly
arched palates, their teeth are disposed
irregularly crowding one over the other
and they are suffering with headaches and
ottorrhea”.
Historical background
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5. A.Coleman 1877 described coffin
spring
Field: coffin can cause separation of
MPS in very young children
Farrar: “separation of superior maxilla
at the symphysis”
Supported by Clark L Goddard,
E.S.Talbot and A.E.Matteson.1893
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8. Marked narrowing of the arches
Unilateral or bilateral cross bite
Mand prognathism with reduced anterior
development of the maxillary base
Steep palate with septal deviation and mouth
breathing due to enlarged adenoids
Cleft lip and palate
Mild arch length to tooth material deficiency.
(1mm of expansion in post = 0.7 mm increase in
arch perimeter)
INDICATIONS
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10. CLASSIFICATION OF APPLIANCES
According to the rate of expansion
– Slow
eg W arch, Quad helix, Coffin spring
– Rapid
eg Hyrax, Isaacson
– Surgically assisted
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11. According to appliance attachment
– Removable
eg Active plate and Functional appliances
– Fixed:
• Tooth borne
eg, Biedeiman appliance, Minn expander
• Tooth/Tissue borne
eg Derichsweiler type, Haas type.
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12. According to modality employed
– Orthodontic expansion
– Passive expansion
– Orthopedic expansion
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13. REGULATION OF EXPANSION
Rate of expansion
Form of the appliance
Age of the patient
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14. Rapid maxillary expansion
Orthopedic expansion
Force levels of upto 10-20lbs per day
Active phase 2-4 weeks
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15. REQUIREMENTS OF AN RME
APPLIANCE
Rigidity
Tooth utilization
Expansion( dilating unit and action)
Economy of time and material
Hygiene
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16. Banded type of appliances
Hass type
Derichsweiler type
Isaacson type
Biedeimann type
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18. Instructions on how to expand
Zeibe in 1930 : 180 degree rotations per day
Upto age of 15 years : the turn 180 degree is
given as 90 degree in the morning and 90
degree in the evening.
15-20 years : overall rotation of 180 is
possible by splitting the rotation into 4 turns
of 45 degree each with approx equal time
lapse between them.
Age over 20 years : 45 degree turn in the
morning and 45 in the night initially
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19. Zimring and Isaacson in 1965 :
Young or growing patients: two turns each day
for the first 4-5 days and one turn each day for
remainder of rme treatment.
Adult patients: two turns each day for the first
two days and one turn each day for the next 5-7
days and one turn eac other day for the
remainder of the rme treatment.
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20. HAZARDS OF RME
Oral hygiene
Length of fixation
Dislodgement and breakage
Tissue damage
Infection
Failure of suture to open
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22. Relapse and Retention
The object of retention is to hold the
expansion while all other forces generated
by the expansion have decayed away.
It is essential for the fixed appliance to act
as the retention appl in the first three
months.
Wertz observed that some relapse is seen
in the forward and downward movement of
the max.
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23. SLOW MAXILLARY EXPANSION
Story and Ekstrom: Slow expansion allows
physiologic adjustments and reconstitution of
sutural elements over a period of about 30 days.
2-4 lbs of force, a little higher for older
patients.
1 mm expansion per week.
S. E. has also been associated with more
physiologic stability and less potential for relapse
than with R. M.E.
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30. OTHER METHODS OF EXPANSION
NITI AND OTHER ARCH WIRES
MAGNETS
TRANSPALATAL ARCH
SURGICALLY ASSISTED EXPANSION
ULTRA RAPID EXPANSION
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31. Ultra-rapid maxillary expansion
of Chatellier
The procedure involves local anesthesia
and results are obtained within 1 to 3
days
As a rule, the ultra-rapid method is
performed over a period of 3
appointments
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34. Magnets
M. ALI DARENDELILER
Two repelling samarium cobalt magnets
Pins and tubes were placed to guide the
separation of the palate.
The midpalatal magnets (each 10mm×5mm×5mm)
produced 500g of force, which declined to 250g
during the three weeks between activations
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35. Transpalatal Arches
An important auxiliary used in fixed appliance
therapy with several indications one of which
is expansion or constriction but of small
measures of upto 1-2 mm.
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36. Surgically assisted maxillary
expansion
The resistance in the maxilla separation can
be due to either of the following reasons:
mid palatal synostosis
mid palatal interlocking
circum maxillary rigidity
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37. The tech has been described in 3 stages:
Stage 1 A and B
Stage 2 A and B
Stage 3 A and B
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39. Stage 2 (over the age of 30)
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40. Stage 3 (over the age of 40)
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41. Expansion of cleft palate
cases
Excessive anterior collapse coupled to little or no
posterior collapse
More fan wise expansion needed to restrict
posterior Expansion. Screws of longer thread of
upto 18mm expansion
More difficult to retain due to clinical crowns not
developed properly
Unilateral expansion both cap splints and bands
can be used
Formation of fistula could be a complication
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42. Expansion of the mandibular arch
Stable expansion is difficult to attain in the
lower arch
Present studies state that expanding the upper
arch allows for spontaneous expansion of the
lower arch.
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43. CONCLUSION
Expansion of the arches has seen its ups and downs in the
past. More and more documentation of the effects and
stability of this procedure has thrown a new light on its
clinical application.
Whether it is slow, rapid or ultra rapid expansion, proper
diagnosis and case assessment is very essential to ensure
consistent results. As more and more cases are being
treated without extractions due to profile considerations,
expansion of the arches forms a valuable adjunct to treat
a wide variety of clinical presentations.
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45. Class II Malocclusion
Non-Extraction treatment
Non-Compliance therapies
Treatment - Molar Distalization
Space regaining procedure
-Mesial migration of first permanent molars
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46. Indications for Molar
distalization
1. In a growing child
- to relieve mild crowding
- causes permanent increase in arch
length of about 2mm on each side.
2. Late mixed dentition
- When lower E space –utilized for relief of
anterior crowding,
- Upper molars distalized to get a class I
relation
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47. Indications for Molar
distalization
3. Non-growing patient
- To regain lost arch length
- Blocking out of canines
4. Upper second molar extraction
- Lower arch normal
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48. Indications for Molar distalization
Class I malocclusion- with highly placed canine/impacted
canine
Lack of space for eruption of premolars due to mesial migration of
permanent first molars
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49. End on molar relationship
with mild to moderate space
requirement
Cases with less than a full
cusp class II molar
relationship
Indications for Molar
distalization
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50. Indications for Molar
distalization
Good soft tissue profile
Borderline cases
Mild to moderate space discrepancy with
missing 3rd
molars/2nd
molars not yet
erupted
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51. Indications for Molar
distalization
Axial inclination :
Mesially angulated upper
molars
Normal or Hypodivergant
growth pattern
Late mixed dentition with
mild crowding of anteriors
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52. Case selection
1. Normal or near normal mandibular arch
2. Late mixed dentition-ideal
- Early permanent dentition-growth still left in maxillary
tuberosity area.- 16-17 yrs-males
14-15 yrs-females
3. Molars placed normally- buccolingually
4. 3rd
molars-absent –stacking of upper molars – unsuitable
5. Profile considerations- well developed nose & chin
6. High MPA- contraindicated-wedging effect
7. Space discrepancy- not very severe
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53. Classification
1. Location of appliance
Extra-oral
Intra-oral
2. Position of appliance in mouth
Buccal
Palatal
3. Type of tooth movement
Bodily movement
Tipping movement
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54. Classification
4. Compliance needed from patient
Maximum compliance
Minimum or No compliance
5. Type of appliance
Removable
Fixed
6. Arches involved
Intra-arch
Inter-arch
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55. Various appliances used for
Molar Distalization :
Headgears
Wilson Bimetric arch design
Crozat appliance
Crickett appliance
Modified Nance Lingual appliance
Schmuth and muller double plates
Molar distalization with magnets
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56. Various appliances used for
Molar Distalization
Use of Super elastic NiTi
Jones Jig
The Pendulum appliance
Claspring
Removable molar distalization splint
Fixed piston appliance
The K-loop appliance
The distal jet
Using Implants
Fixed functional appliances
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57. Distalization using Headgears
Very efficient
Reciprocal forces are not transmitted to other teeth
Molar movements depends on direction of force in relation to
the C Res of the molar & magnitude of force
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59. Straight pull headgear
Class II Malocclusion with
no vertical problems
Prevent anterior migration
of maxillary teeth, translate
them posteriorly
Buccal force to molar -
Expansion of inner bow
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60. Cervical Headgear
Short face Class II
maxillary protrusive
cases with low MPA
& Deepbites
Extrusive &
distalizing effect
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61. High pull Headgear
Produces intrusive &
Posterior direction of pull
Long face class II patients
with high MPA
Force through c res –
Intrusion & distal
movement of molar
6-8 months – class II-
classI
Adv-effective, no reciprocal forces
Disadv- Patient compliance
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62. Bimetric system for Molar
Distalization
Dr.Wilson-Tandem yoke
with bimetric arches for
molar distalization
Tandem yoke-.045” round
tube – slides on .040” end
section of the bimetric loop.
.018 retractor
.045” coil spring for
distalizing
Intermaxillary traction
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63. Coil spring- between molar
tube & the yoke
Elastics- 12 hours a day
Headgear – at night
The Omega adjustable
stop –to modify & control
arch length
Crimpable .040”tube
.061 Omega loop
Coil springs &
intermaxillary hooks.
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64. Bimetric arch modified by Dr.
Jayade
Class II correction- Distalization + expands canine-
premolar area- unlocks the occlusion
A mild-moderate class II div 2 with normal mandibular
arch-easily corrected
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65. Bimetric arch modified by Dr.
Jayade
Archwire design:
.016”premium wire
Premolars bonded if
expansion is required
Teardrop shaped loop
Bite opening bend
Mild toe-in
2mm activation
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66. Elastic load reduction principle:
Class II elastics – used sequentially
T.P Green – 1st
week
Pink - 2nd
week
Yellow – next 2-3 weeks
Initial heavy force- to resist forward
pushing force of new wire- force
transferred distally
Later Molar uprights-mesially directed
archwire force decreases- support with
light forces.
Extrusive component of class II- kept to a
minimum
Borderline cases –Non extraction
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67. Modified Nance and Lingual
appliances for unilateral tooth
movement Ghafari JCO 1985
Nance holding arch :
Palatal arch attached to first molar
bands , embedded in an acrylic
"button"
space maintainer in the maxillary
arch,
support maxillary posterior
anchorage during tooth movement
Modified Nance holding arch and
modified lingual arch:
Anchorage for unilateral
distalization of posterior teeth
No patient compliance required
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68. Modified Nance and Lingual
appliances for unilateral tooth
movement
Modified Nance holding arch
12 yrs/M
Skeletal & Dental class I
Right side- distoocclusion
2nd
premolar- 3.5 mm space
R – 1st
PM & molars banded
Segmental .019 x .025 NiTi
Open coil spring
4 months
No labial movement of incisors
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69. K-Loop Molar Distalizing
Appliance
Valrun Kalra –
JCO 1995
K-loop – forces - .017 x .025 TMA
Nance button – anchorage
8mm long , 1.5 mm wide
Legs- 20 degree bend
Inserted into molar and first
premolar tube, marked
Stops bent 1mm distal , 1mm
mesial
Stops- 1.5mm long
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70. K-Loop Molar Distalizing
Appliance
Valrun Kalra –
JCO 1995
Reactivated 2mm 6-8
weeks later
Molars move by 4mm,
premolars by 1mm
Anchorage can be
reinforced by headgear
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72. Removable molar distalization splint
Dr. Karrodi Ritto JCO 1995
Splint – 1.5mm Biocryl-Biostar machine
More esthetic & comfortable
Bilateral- 1st premolar- 1st
premolar
Unilateral – Premolar – Opposite Molar
Two internal clasps – retention
NiTi open coil spring- 220 gm force
1.5mm-2mm/month
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73. Distalization of Molars with
Repelling Magnets Gianelley etal JCO
1988
Anchorage – Modified Nance
appliance
Wire extending from 1st
premolars
Acrylic button anteriorly
contacting the incisors
Auxillary wire with a loop at its
end soldered - premolars bands
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74. Distalization of Molars with
Repelling Magnets
Incisor brackets – passive
sectional wire- maintain incisor
alignment
Repelling surfaces of magnets
brought into contact by passing
an .014 ligature through the loop,
then tying back a washer anterior
to the magnets
Force- 200-225 gms , dropped as
space opened
3mm in 7 weeks
Anchor loss – 1mm
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75. Japanese NiTi coils used to move
molars distally -Gianelly AJO
1991
100 gm superelastic coils
Nance appliance with bite plate
in anterior region
.016 x .022 wire with stops
abutting distal wings of premolar
and molars
Coil – between 1st
premolar and
the molars
.018 “ uprighting spring placed
in vertical slot of
premolars,directing crowns
distally
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76. Japanese NiTi coils used to move
molars distally
2nd
molars erupted- Class II elastics
Rectangular wire – 10 degree lingual root torque
Once distalized, Coils &Nance appliance are removed, insert .
016 x .022 “ wire with stops + High pull headgear to upright
roots of molars
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77. Molar distalization with
Superelastic NiTi wire Gianelly JCO
1992
100gm Neosentalloy upper
archwire
3 markings
Stops crimped, hook added
Insert wire such that posterior
stop abuts mesial end of molar
tube, anterior stop abuts distal of
premolar
Anchorage reinforced by class II,
or Nance appliance
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78. NiTi Double Loop system for
simultaneous distalization of first and
second molars Giancotti JCO 1998
Mandibular molars and 2nd
premolars
banded, other teeth bonded
Lip bumper- prevent extrusion
Maxillary molars and bicuspids –
banded, aligned
80 gm Neosentalloy – maxillary
archwire placed – marked
1. Distal to 1st premolar
2. 5mm distal to 1st
molar tube
Stops crimped on markings
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79. NiTi Double Loop system for
simultaneous distalization of first and
second molars
Sectional NiTi archwires –
crimp stops
1. Mesial and distal to 2nd
premolar
2. 5mm distal to 2nd
molar
tube
Uprighting springs on 1st
bicuspids
Class II elastics
Simultaneous, bodily
movement
24yr/f, class II div I
5months- overcorrected
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80. NiTi Double Loop system for
simultaneous distalization of first and
second molars
Minimal patient co-operation
Ideal for simultaneous distalization
Anchorage easily controlled , without need for TPA/Nance
Due to streching of transeptal fibres, 1st
molars can be
distalized using lighter 80 gm force
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81. Pendulum Appliance for class II non-
compliance therapy
JAMES J. HILGERS,JCO 1992
Nance button
.032 TMA springs
Broad swinging arc
(Pendulum) of force from
midline of palate to upper
molars
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82. Pendulum Appliance
Fabrication :
Pendulum springs consist of
1. Recurved molar insertion
wire
2. Horizontal adjustment loop
3. Closed helix
4. Loop for retention in acrylic
button
Springs- close to center of
Nance button
Anterior portion- retention-
occlusally bonded rests
- Band
upper 1st
premolars, solder
retaining wire to the bands
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83. Pendulum Appliance
Nance button- extend to about 5mm
from teeth
Anterior retention loops fixed on
model, later soldered to bicuspid
bands
Acrylic pressed against the palatal
vault
Pendulum springs inserted
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85. Pendulum Appliance
Preactivation and placement:
Springs bent parallel to midline of the
palate
Molar bands cemented
Anterior portion of appliance later
cemented
Pendulum spring brought forward &
engaged in lingual sheath
As molar distalizes, moves on an arc
towards midline- counteracted – opening
horizontal loop
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86. Pendulum Appliance
Reactivate if required
Reavtivated by pushing it distally towards the midline
Stabilize after correction
Nance appliance
Full arch bonding – continous wire with omega loop
Headgear for few months
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90. Open Coil Jig
Jones, White –JCO 1992
Oct
Richard D. Jones
American Orthodontics
Open coil NiTi spring
Nance appliance
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91. 1. Heavy round wire
2. Light wire
3. Fixed Sheath
4. Hook
5. Sliding Sheath
6. Open coil spring
3
1
2
5
6
4
Open Coil Jig
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92. Open Coil Jig
Advantages…
Reactivation
4-5 mm distalization in 3-4 months
Disadvantages-
-Tipping
- Cannot use with fully banded treatment
- Breakage
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93. Distal jet Appliance
Aldo Carano, Mauro Testa
JCO 1996
Fixed lingual appliance
Appliance design :
Wire extending from acrylic
through tube ends in a bayonet
bend-inserted into lingual sheath
Coil spring
Clamp
Anchor wire to 2nd
premolar
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Only one of the repelling magnets could slide on the pins for activation of the MED. Self-polymerizing acrylic was added every three weeks to re-establish contact between the magnets