• PALATALLY POSITIONED
DISTALIZATION SYSTEM
• Pendulum appliance & its
modifications
• Distal jet & its Modifications
• Intraoral bodily molar distalizer
• Simplified molar Distalizer
• Keles slider
• Fast back appliance
• Nance appliance with NiTi coil
springs
• BUCCALLY POSITIONED
DISTALIZATION SYSTEM
• Jones jig & its modifications
• NiTi coil springs
• Magnets
• NiTi wires
• Bimetric distalizing arches
• Carriere distalizer.
• Also known as ACCO appliance.
• First introduced by Dr. Hebert Margolis 1969.
• The appliance consists of
• acrylic palatal section.
• modified Adams clasps on the first premolars.
• a labial bow across the incisors for retention .
• finger springs against the mesial aspects of the first molars.
• Need of creating space:
• Seating the finger spring
close to Cres.
• Allowing the distal drifting
of 2nd premolar.
• Separators for 1 week to creat space b/w 2nd premolar and 1st
molar.

• Using the ACCO, the molars should be moved distally until the crowns
are overcorrected by approximately 2 mm.
• Rate of Movement
• The rate of movement with the ACCO appliance
has not been assessed in a controlled group of
patients.
• with magnets is approximately 1 mm per month
• Byloff and Darendeliler noted 1.02 mm per month
with the use of the Pendulum appliance.
• Bondemark and Kurol moved first and second
molars distally 4 mm in 16 weeks with a repelling
samarium cobalt magnet appliance.
• Extrapolating this data, the rate of movement of the
molars with the ACCO would be comparable.
Advantages:
• applies a constantly acting force.
• Patients acceptance is good.
• provides an effective method to distalize molars
asymmetrically.

Disadvantages:
• Distal tipping of crown (to correct over correction or
high pull head gear with ACCO by Cetlin and Ten
Hoeve)
• Anchorage loss(if overjet increases >2mm,remove
labial bow,bond upper ant. And use Class II
elastics of 100gm,lip bumper for lower anchorage.)
• By Robert C. Wilson and William L. Wilson.
• Known as Bimetric Distalizing arch marketed by Rocky Mountain
Orthodontics.
• Bimetric arch:
• Anterior segment made of 0.022”ss.
• Posterior segment made of 0.040”ss.
• Elastic hooks at canine region in post. Segment.
• Omega stop at premolar region.
• 0.010x0.045” coil spring b/w distal leg of stop and facebow tube.
Reactivation of the arch
• First use of magnet for molar distalization is by Gianelly et al at 1989.
• Usually prefabricated repelling smarian cobalt magnets are used for
molar distalization.
• A maximal force of 225gm is provided when the magnets are ligated
together.
• As the inter-magnet distance increases the force value decreases.
• Every 4th week this appliance should be reactivated.

Distance (mm) Repelling force(cN)

0.25 215
0.5 170
1.0 115
2.0 60
3.0 30
4.0 20
• Due to anchorage loss forward movement of premolars,canine and
incisor causes increased over jet of 0.5-2mm
• Bondemark and Kurol stated that this forward movement can be
countered by Class II elastics.
• By magnets the amount of distal molar tipping is 7-14º which is ½ of
distal molar movement.
• Bondemark and Kurol modify the appliance to overcome this.
• They soldered a molar tube of 1.2mm diameter approx 10mm in length
lingually.
• A 0.9mm wire is placed through the molar tube and soldered to the 2nd
premolar band and embeded into the acrylic button.
• The tube piston must be parallel in both occlusal and sagittal views.
• This modified appliance reduce the tipping to 0-4º.
• Advantages:-
• Rapid result.
• Affords a precise control over the forces .
• Magnetic forces can be exerted through mucosa and bone.
• Disadvantages :-
• Require frequent activation.
• Easily corrode which leads to substance loss and disturbed
physical propertise.
• Expensive.
• Brittle.
• Marketed by American Orthodontics.
• Consists of :
• Active unit:
• Buccally positioned,consisting active arm or jig incorporating
NITi spring.
• Anchorage unit:
• Nance appliance.
Components of
active unit
6
3 4 5

1. Heavy round 1
wire(0.036”)
2. Light wire
3. Fixed Sheath
4. Hook
5. Sliding Sheath
6. Open coil spring

2
• Anchorage unit:
• Active unit and Activation:

• Advantages :-
• pt compliance not needed,
• less pain,
• continous force,
• rapid distalization.
• Disadvantages:-
• anchorage loss,
• distal tipping of molar.
• Gulati et al recommend the use of bands with gingivally
positioned head gear tubes to allow the force vector pass closer
to the C res of 1st maxillary molar thus reducing the molar distal
tipping
• Thus the distalization spring can be positioned about 3mm more
gingival compared with the standard jones jig.
• Consists of:
 Nance button

 .032 TMA springs

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
• Nance button- extend to about
5mm from teeth
Preactivation and placement:
 Acc. To Hilgers this might seem to be an overactivation, but
about one-third of it is lost in placement, and the remaining
pressure is tolerated easily by the patient.
TRANSVERSE PLANE:
SAGGITAL PLANE:
• Force magnitude and activation
• Force range of 3.5g/degree
• 100-200gm of force on a molar
• Force generation:
• Stepwise activation
• Acc. To Hilgers activation of 45º and repeatation untill desired
molar position.
• Exerts 200-250gm of force
• For crossbite expansion mechanism incorporated for 12weeks.
• Single activation
• Acc to Joseph and Butchart single activation of 90º.
• Space openning:
• With in first 6 weeks 1-2 mm space opened mesial to first molar.
• It can provide 4-5mm of arch length.
• Influenece of fully erupted 2nd molar:
• Distalisation seems to be successfully achieved regardless of the
status of the 2nd molar.
• When the 1st molar moves to the distal the 2nd molar move with
them even the 2nd and 3rd molar are impacted due to the
remodelling process in the area of the tuberosity enable molar
distalisation.
• But Worms et al and Bondemark and Kurol oppose this statement.
• Influences of budding 2nd and 3rd molars:
• Graber,Bondemark et al,Gianelly et al ,Ten Hoeve,Jeckel and
Rakosi and Gianelly all have concluded that 1st molar distalisation
is impacted by 2nd molar.
• But Kinzinger et al states that various eruption stages of 2nd and
3rd molar have various impaction on 1st molar distalisation.
• 2nd molar tooth bud act as fulcrum and causes tipping of the 1st
molar.
• Fully erupted 2nd molar with 3rd molar tooth bud causing greater
degree of tipping.
• Germectomy of 3rd molar causes bodily distalisation of both
molar.
1. Byloff and Darendeliler incorporated an uprighting bend
of 10-15º in the saggital plane after distalization to
counter molar tipping.
2. M-Pendulum:
• Schuzzo, Pisani and Takemoto at 1999
• Adjustment loops are not distally located but are reversed to
the mesial to provide bodily movement.
• TMA springs are activated by 40-45º
3. Pendex:
• By Hilgers.
• Addition of mid palatal Jackscrew into the center of the Nance
button.
• Helps in avoiding the crossbite during distalization.
• One quarter turn every 3 day screw activation.
4.K-Pendulum:
European Journal of Orthodontics 29 (2007) 1–7 doi:10.1093/ejo/cjl028

• Modified by Kinzinger et al.

.
• Introduced by Locatelli R.et al in 1992.
• K-loop made of - .017 x .025 TMA
• Anchorage-Nance acrylic button.
• Loops are 8mm long , 1.5 mm wide
• Legs have 20 degree bend
• Inserted into molar and first premolar tube and
marked.
• Stops bent 1mm distal to the distal mark and
1mm mesial to the mesial mark and these stops
are 1.5mm long.
• These stops allow 2mm of activation.
• The 20° bends in the appliance legs produce moments counteract the
tipping moments created by the force of the appliance, and these
moments are reinforced by the moment of activation as the loop is
squeezed into place.
• Thus, the molar undergoes a translatory movement instead of tipping.
Open loop 1mm at (1); Open loop 1mm at (2); Open at (3) to
regain the 200 bent of mesial and distal legs

After 2mm reactivation

• Developed by Carano and Testa of Italy in 1995.
• Consists of:
• Nance acrylic button.
• Two bilateral tube embeded in the acrylic.
• Anchore unit:
• Basic design similar to pendulum appliance.
• Appliance is anchored by banding of the 1st or 2nd premolar or 2nd
decidous molar.
• More anchore loss in case of banding 1st premolar.
• Bands are connected to acrylic portion by 0.036” wire.
Distalising unit:
• Bilateral tube (0.036” diameter) imbeded in acrylic.
• A SS wire with in the lumen of the tube is placed like a piston and
extended posteriorly , making a bayonet bend and inserted into the
lingual sheath of 1st molar band.
• NiTi coil spring and activation collar(screw clamp) are placed in each
tube.
• Distally directed force is generated by compressing the coil spring.
• Activation collar is retracted distally and mesial set screw on each tube
is locked onto the tube to maintain force.
• Activation once in every 4-6 weeks in 5-6months treatment..
• Reduce barrel diameter.
• Single screw placed more mesially which provide 7mm extension of
the barrel leads to extended working range.
• Introduction of Lexan Ball as posterior stop.
• Vertical component of the lock leads to more accessible position with
easier visualization (mesially & occlusally).
• The position of the telescopic unit is parallel but 4-5 mm superior to
the occlusal plane.
• Leads to line of action at level of Cres limiting molar tipping.
• Shallow palate leads to more tipping.
• Originally the telescopic unit were not fabricated absolutely parallel
to the occlusal plane and inclined 3º superiorly to the cranial
base;this reduce extrusion of molar but lead to more tipping.
• Expansion needed:-telescopic unit positioned parallel to a line passing
through the contact point of posterior teeth.
• Expansion not needed:- 5º inward to a line passing through the contact
point of posterior teeth.
• As the force is applied lingually irt to 1st molar there would be a mesial
rotation of buccal cusp.
• Encountered by incorporating a compensatory bend at the double deck
portion of the bayonet wire that insert into the lingual sheath.
• Bands are placed on the maxillary first molars and on either the
maxillary second premolars or the second deciduous molars.
1. Vestibular components.
2. Palatal components.
.
• Activate each vestibular screw one quarter turn once daily in a counter
clockwise direction.
• Introduced by Ahmet Keles and Korkmaz Sayinsu
• Introduced by Keles .
• Stabilising wire diameter 0.040”ss.
• NiTi coil spring:
• Long -2cm
• Diameter -0.045”
• 0.016” thick
• Placed b/w the tube and lock in the wire.
• As the wire passes 5mm apical to the gingival margin of 1st molar and
parallel to the occlusal plane,the line of force is close to the Cres which
leads to reduced distal tipping ,extrusion and molar rotation.
• The amount of force generated with the full compression of the 2cm open
coil spring is about 200gm.
• After the desired molar distalisation by cutting the premolar wire
attachment and removing the bite plane the appliance can be used as
nance holding arch for retention.
 Bilateral
• Molar distalisation of 4.1mm.
• Distal tipping and molar
rotation were not observed.
• Treatment time 5.5month.
• 1st premolar move forward
2.7mm.
• Incisor protruded 2.05mm
and proclined 3.45º.
• Overjet increased 2.2mm &
bite decreased by 1.9mm
Unilateral
• Molar distalisation of 4.9mm.
• Distal tipping and molar
rotation were not observed.
• Treatment time 6.1month.
• 1st pre molar move forward
1.3 mm.
• Incisor protruded 1.8mm and
proclined 3.2º.
• Overjet increased 2.1mm
&bite decreased by 3.12mm
• TPA CONSTRUCTION:
• The TPA is placed on a piece of white paper and two lines
are drawn along the terminal ends (rotating component) of
the TPA with a black pen .
• Additional lines are drawn with a red pen, with a 20- degree
angle passing through the distal end of the helix of the wire.
• The TPA is activated on both sides with the help of a bird
peak pliers .
• Two equal and opposite moments are generated on
both molars.
• Two equal and opposite forces are generated on
both sides, which would also help to increase the
intermolar width between the mesial cusp tips of the
first molars.
• The activation of the TPA is checked on both sides
and then placed in the mouth.
• History of bone anchored appliance:
Introduced by appliance
Byloff et al(2000) the Graz implant-supported pendulum
appliance
Keles¸ et al(2003) osseointegrated palatal implant with Keles
slider appliance.

Carano et al(2005) distal-jet in conjunction with a miniscrew

anchorage system
Karaman intraosseous screw with their distalization
et al(2002) and Gelgor et al(2004) mechanics containing compressed coil springs.
• Titanium intraosseous screw:
• 2.0 mm diameter x 8 mm length.
• Inserted in the anterior paramedian
region of the median palatal
suture,7–8 mm posterior to the
incisive foramen and 3–4 mm lateral
to the median line.
• Treatment time:-7months
• Distal molar movement:-6.4mm
• Distal tipping of maxillary 1st molar:-10.9º
• No intra oral molar distalizer can provide effective controll on
anchorage loss.
• But Kinzinger and Diedrich in 2008 stated in their study that k –
pendulum provide most bodily molar distalizer with less tipping.
• Antonarakis and kiliaridis comparing the palatal and buccal acting
appliance and concluded that palatal acting appliance showing less
tipping and and better molar distalization but notable anchorage
loss.