Title Molar Distalization with Skeletal Anchorage is more efficient than Intraoral Anchorage for Class II correction
Clinical Question In Class II patients, is skeletal vs. intraoral anchorage more efficient for molar distalization?
Clinical Bottom Line For patients with Class II malocclusion, molar distalization with skeletal anchored appliances is more efficient than intraoral anchored appliances by reducing treatment time and having less secondary effects on the dentition. This treatment is within the capability of any orthodontist and is widely accepted by patients.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25138818Mariani, 201457 patients with mean age of 13.3 years and Class II malocclusionRetrospective Study
Key resultsThe fifty-seven patients included in the study were divided into two groups in order to compare intraoral and skeletal anchorage for molar distalization. Three serial cephalograms were taken at T0 before treatment, T1 after distalization and T2 after comprehensive treatment. After comparing T0-T1 statistically significant differences (p<0.01) were noted in the amount of distalization and skeletal changes encountered after distalization. The MGBM group (skeletal anchorage) achieved a mean value of 4.5 mm of distalization in 8 months and a molar correction of 5.9 mm compared to the Pendulum group (intraoral anchorage) that had a mean value of 2.5 mm of distalization in 9 months with a molar correction of 4.9 mm. Also, less proclination of upper incisors was found in the MCBM group. Avoiding incisor proclination in Class II patients is of vital importance because retraction of the incisors is usually a treatment objective for these patients. By taking into consideration faster rate of distalization and less dental effects, the skeletal anchorage approach gives clinicians a more efficient way to correct Class II malocclusions through molar distalization.
PMID 18947282Antonarakis GS /2008132 subjects in 13 prospective or retrospective clinical studies included Systematic Review
Key resultsThirteen studies were included in this study to evaluate the dental and skeletal effects of intraoral anchored appliance for molar distalization. The studies showed that the maxillary first molars demonstrated greater distal movement (p<0.001) compared to the mesial movement of the premolars or proclination of maxillary incisors. In regards to vertical movement, extrusive forces in the premolars and incisors resulted while distalizing with intraoral anchored appliances. Location of the appliance played a significant role, palatally placed appliances showed less distal tipping of the molar and mesial tipping of incisors compared to those placed buccally. Molar distalization is a viable treatment for correction of Class II correction, but the dental effects of intraoral anchored appliances have to be taken into consideration when evaluating the treatment goals of the patient.
25018770Cozzani M/201436 patients with mean age of 11.3 and molar Class II relationshipCase Control Study
Key resultsThe thirty-six patients that were evaluated were divided into two groups of eighteen participants each. The control group got the intraoral anchored device and the case group got the skeletal anchored device. Lateral cephalograms were taken before and after treatment when molar distalization was finalized. Patients with the skeletal anchorage had premolars distalize 2.8 mm compared to the control which actually mesialized 0.9 mm (p=0.001). Distalization was not statistically significant between both groups. Dental changes were statistically significant between both groups (p=0.036) with the control group having more secondary dental effects (mesial movement of premolars and increased proclination of incisors). Overall, both appliances showed similar distalization capability, but the bone anchored distal jet showed significant premolar distalization which can possibly decrease treatment time.
Evidence Search TADS [MeSH terms] AND Class II correction [MeSH terms] AND Distalization [All fields] AND intraoral anchorage [MeSH terms]
Comments on
The Evidence
Validity: The systematic review compared to the other studies would be the highest in the hierarchy of evidence, which showed that distalization appliances with intraoral anchorage show unwanted secondary effects in the dentition. The rest of the studies show a moderate level of validity being ranked lower in the evidence hierarchy but are still significant, showing that increased efficiency was encountered when comparing skeletal vs. intraoral anchored distalization appliances. Perspective: The gold standard for distalization at this point would be skeletally anchored appliances to reduce any secondary forces that can be applied to the dentition and to get a more reliable outcome. Skeletal anchorage for distalizing is relatively new so more clinical trials with larger sample size and long-term stability reports should be provided to determine if these movements are stable through time.
Applicability Molar distalization can be a clinically effective addition to Class II correction treatments for orthodontists. Distalization with bone anchorage devices can be especially effective in mild-moderate Class II patients that don’t want extractions.
Specialty (Oral Medicine/Pathology/Radiology) (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords Class II, molar distalization, skeletal anchorage, Class II treatment
ID# 3348
Date of submission 11/15/2018
E-mail parodilainez@livemail.uthscsa.edu
Author Marilena Parodi Lainez
Co-author(s) e-mail
Faculty mentor Dr. Ravikumar Anthony
Faculty mentor e-mail anthonyr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available