RAJIVGANDHIUNIVERSITYOFHEALTHSCIENCES,

BANGALORE,KARNATAKA

ANNEXURE –II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE
AND ADDRESS / DR.SAPNA KATTI
POST GRADUATE STUDENT,
DEPT. OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS. RAJARAJESWARI DENTAL COLLEGE AND
HOSPITAL, MYSORE ROAD, BANGALORE-74
2 / NAME OF THE INSTITUTION / RAJARAJESWARI DENTAL COLLEGE
AND HOSPITAL
3 / COURSE OF STUDY AND SUBJECT / MASTER OF DENTAL SURGERY IN
ORTHODONTICS AND DENTOFACIAL
ORTHOPAEDICS
4 / DATE OF ADMISSION TO THE COLLEGE / 30.05.2013
5 / TITLE OF THE TOPIC:
EVALUATION OF THE EFFICIENCY OF MOLAR DISTALIZATION WITH A NEW APPLIANCE USING MICRO IMPLANT ANCHORAGE SYSTEM – A CLINICAL STUDY.
6 / BRIEF RESUME OF THE INTENDEDWORK:
6.1 NEED FOR THE STUDY :
Class II malocclusion is one of the most common problems in orthodontics. Conventional cases of class II molar relationship usually require distal movement of maxillary molars in order to achieve a class I molar and canine relationship. Headgear was used routinely for distal movement of maxillary molars.1-3 The difficulties involved with headgear wear and dependence on patient co-operation stimulated many investigators to develop intra oral devices and techniques for distal movement of molars.4-7Blechman and Smiley Gianelly used magnets for molar distalization8-10. Giannelly et al. used super elastic ni-ticoil springs for distal movement of maxillary molars.8,9 In 1922 Hilgers developed the pendulum appliance which consists of beta titanium springs.11,12 In 1996 investigators demonstrated that molars were distalized by these appliances but there was distal tipping also occurring. Keles and Sayinsu et al. developed intra oral bodily molar distalizer for molar distalization. TMA spring design composed of 2 pieces that enabled bodily movement of the molars13 which resulted in molar distalization without tipping but anchorage loss occurred.
The intra oral distalization devices developed in the last decade eliminated the need for patient co-operation. However, distal tipping and anchorage loss also occurred with most of these new devices. To prevent this anchorage loss micro-implant distalizer appliances are used.
This study is thus aimed to verify the efficiency of the Micro Implant anchorage system in distalizing the maxillary molars in cases of class II molar relationship and to measure the amount of the molar distalization as well as to measure the amount of the anchorage loss during distalization by analyzing cephalometric radiographs and study models.
6.2 REVIEWOFLITERATURE:
1. Jungi Sugawara et al. did this study on 25 non-growing patients(22F And 3M) successfully treated with SAS (Skeletal anchorage system). Lateral cephalometric radiographs in wide opening mouths were taken before treatment and immediately after debonding in all the subjects. The amount and the type of distalization, the difference between the predicted and resulting amounts of distalization and the relationship between the patients age and the amount of distalizationwere analyzed with wide opening cephalometric radiographs. The maxillary molars were predictably distalized in accordance with the individualized treatment goals without regard to patient age and extraction of the third or second molars. Hence it was concluded that the SAS is a viable noncompliance modality to move maxillary molars for distally correcting maxillary protrusions and malocclusions characterized by maxillary incisor crowding.14
2. GokhanOncag et al. did this study on 30 patients. The patients were divided into two groups of 15 cases each. The first group was the pendulum group, the patients [9girls, 6 boys] were treated with Hilgers pendulum appliance; the second group was the Implant group [10 girls; 5 boys] were treated with the osseointegrated implant – supported molar distalization technique combined with the pendulum springs.In the pendulum group significant distal tipping of the maxillary first molars and mesial tipping of the maxillary premolars were noted. Distalization of the maxillary first molars, mesialization of the maxillary first premolars and proclination of the maxillary left central incisor were significant in the linear measurements. In the implant group- the distal tipping of the maxillary first molars and first premolars and the increases in SNGoGn, FMA, Na Me, and Na ANS were significant. Intergroup comparisons showed that changes in the maxillary first premolars, maxillary central incisors, and vertical measurements were significant. Hence it was concluded that the use of palatal osseointegrated implants is reliable and provides absolute anchorage.15
3. Ibrahim ErhanGelgor et al. did this study on 40 subjects with skeletal Class I and dental Class II malocclusion and subjects were divided into two groups; group 1 (8 girls; 12 boys ) and group 2 (11girls; 9 boys ) and were compared to study the effects of two distalization systems supported by intra osseous screws for the maxillary molar distalization. An anchorage unit was prepared by placing an intraosseous screw in the pre maxillary area of each subject. To increase the anchorage in group 2, they used an acrylic plate resembling the Nance button around the screw. The screws were placed and immediately loaded to distalize the maxillary first molar or second molar when they were present.Skeletal and dental changes were measured on the lateral cephalograms and the dental casts were obtained before and after the treatment. It was concluded that immediately loaded intraosseous screw-supported anchorage units were successful for molar distalization in both groups. In group 2, side effects such as molar tipping and rotation were smaller, but distalization times were longer.16
4. Gero S M Kinizinger et al. did this study on 10 patients (8 girls,2 boys; average age:12 years 1 month) with dentoalveolar Class II malocclusion and dental arch discrepancy. Two paramedian miniscrews (length-8-9 mm; diameter-1.6 mm) were placed in the anterior area of the palate in ten patients. Skeletonized distal jet appliances fitted with composite to the first pre molars and the collars of the mini screws were used for the bilateral molar distalization, and the coil springs were activated with the distalization force of 200 cNon each side. It was concluded that the skeletonized distal jet appliance supported by additional miniscrew anchorage allows translatory molar distalization. Although the anchorage design combining 2 miniscrews at a paramedian location and the periodontium of 2 anchorage teeth does not offer the quality of stationary anchorage, it achieves greater molar distalization in total sagittal movement than conventional anchorage designs with an acrylic button.17
5. Giovanni Oberti et al. did this prospective study which included 16 patients(12boys,4 girls) with an average age of 14.3 years at the beginning of the treatment,with maturation stage 3 of the cervical vertebral maturation method corresponding to the skeletal maturation spurt with Class II molar relationship. Study models and lateral cephalograms were taken before and after the distalizing movement to record significant dental and skeletal changes with the help of Wilcoxon test. The correlation between inclination and distalization was not significant, indicating predominantly bodily movement. The teeth anterior to the first molar moved distally also; the second premolars distalized an average of 4.26 mm, and the incisors retruded by 0.53. Hence it was concluded that the dual-force distalizer is a valid alternative distalizing appliance that generates controlled molar distalization with a good rate of movement and no loss of anchorage.18
6. Young-Hee Oh et al. did this study on 23 patients [mean age 22.1±5.17 years]. These patients were treated with the distalization of the posterior teeth against micro implant anchorage and without the extraction of the pre molars or other teeth except the third molars.The pretreatment and post treatment cephalometric radiographs and the dental casts of these patients were analyzed. The soft tissue, skeletal and dental measurements in the vertical and anteroposterior dimensions were analyzed.The changes in the inter premolar and the inter-molar widths and the rotations of the molars were analyzed with the dental casts. Hence it was concluded that with microimplant-aided sliding mechanics, clinicians can distalize all posterior teeth together with less distal tipping and this technique seems effective and efficient to treat patients who have mild arch length discrepancy without extractions.19
6.3 AIMSANDOBJECTIVESOFTHESTUDY :
  1. To investigate the efficiency of Micro–Implant Anchorage System to distalize the molars.
  2. To measure the rate of Distalization.
  3. To measure the amount of anchorage loss.
MATERIALS AND METHODS :
7.1SOURCE OF DATA :
This study will be done on patients who report to department of Orthodontics, RajaRajeswari Dental College and Hospital, Mysore Road, Bangalore with a desire to undergo Orthodontic treatment and after diagnosis and treatment planning those patients needing Molar Distalization as a space gaining method for treatment.
7.2METHOD OF COLLECTION OF DATA :
15 Patients will be selected of both the sexes having the Angles Class II molar relationship with moderate space requirement in the anterior segments.
INCLUSION CRITERIA
  1. Caseswith Class II molar relationship needing space.
  2. Caseswith Horizontal to Average growth pattern.
EXCLUSION CRITERIA:
  1. Severe skeletal Class II CASES
  2. Severe Vertical growth pattern
  3. Severe Tooth size/ Arch length discrepancy
  • Informed consent will be taken from the patient, parents or guardians.
  • Patients medical history is reviewed before conducting the study.
PRETREATMENT DIAGNOSTIC RECORDS
  • Study models
  • Photographs , Intra oral and Extra oral and Occlusal views
  • OPG , Cephalogram , IOPA
ABOUT THE APPLIANCE:
COMPONENTS OF THE APPLIANCE -
  1. Sliding zig made with 036 round tube soldered with a hook
  2. O18 Stainless Steel Arch wire
  3. Micro-implant (8mm length and 1.2 mm diameter)
  4. Ni ti open coil spring MBT Prescription


APPLIANCE DESIGN:
The selected cases after considering the above mentioned inclusion and exclusion criterias will be bonded with 022 slot (MBT prescription) appliance. Bonding of the brackets will be avoided on the first and the second bicuspids. After initial leveling and aligning a sliding zig is made of 036 round tube soldered with a Stainless Steel hook as shown in the picture (b). The length of the hook should be equal to the distance of the molar tube to the center of resistance (furcation point). The sliding zig along with the Ni-Ti open coil spring(c) is spread to reach of distal of canine bracket passively. A micro implant (a) shall be inserted between Ist and IInd bicuspid or between the molar and 2nd bicuspid at the same level of the hook depending on the availability of the safe implant placement zone. The sliding zig shall be pulled back using a Stainless Steel ligature to the implant (d). The force exerted on the molar will be measured using a Dontrix gauge and kept around 200 grams.
EVALUATION OF DISTALIZATION:
In the study we will be investigating the efficiency of the Micro-Implant anchorage system to distalize molar, measure the amount of distalization and measure the amount of anchor lossin the form of proclination of the incisors.This will be done with both cephalometric evaluation and study model evaluation.
EVALUATION OF DISTALIZATION: [THROUGH CEPHOLAMETRICS RADIOGRAPHS]

CEPHALOMETRIC LANDMARKS:
1. U6mp - Occlusal midpoint of maxillary first molar
2. U5 - Vestibular cusp tip of maxillary first molar
3. U1 - Incisor tip of maxillary central incisor
4. U6mc - Cusp of maxillary first molar
5. U6f - Furcation point of maxillary first molars
6.Midpoint of metallic bearing
CEPHALOMETRIC PLANES:
7. FH -Frankfort horizontal
8. MP - Mandibular plane
9. y-axis- Perpendicular from FH to Sella
10.U6mp – FH -Occlusal midpoint of maxillary first molarto Frankfort horizontal
11.U1 – FH -Incisor tip of maxillary central incisor to Frankfort horizontal
12.MP – FH -Mandibular plane to Frankfort horizontal
SAGITTAL LINEAR MEASUREMENTS
  1. U6mp to y-axis-Occlusal midpoint of maxillary first molarto - Perpendicular from FH to Sella
  2. U5 to y-axis- Vestibular cusp tip of maxillary first molar to - Perpendicular from FH to Sella
  3. U1 to y-axis -Incisor tip of maxillary central incisor to - Perpendicular from FH to Sella
VERTICAL LINEAR MEASUREMENTS
  1. U6mp to FH -Occlusal midpoint of maxillary first molarto Frankfort horizontal
  2. U6mc to FH - Furcation point of maxillary first molar to Frankfort horizontal
  3. U5 to FH -Vestibular cusp tip of maxillary first molarto Frankfort horizontal
  4. U1 to FH -Incisor tip of maxillary central incisorto Frankfort horizontal
ANGULAR MEASUREMENTS
  1. U6mp to FH -Occlusal midpoint of maxillary first molar to Frankfort horizontal
  2. U1 to FH -Incisor tip of maxillary central incisor to Frankfort horizontal
  3. MP to FH - Mandibular plane to Frankfort horizontal
EVALUATION OF DISTALIZATION:ON STUDY MODELS

Dental casts of all the subjects will also be measured with the help ofVernier Caliper to investigate the efficiency of the Micro-Implant anchorage system to distalizethe maxillary molars, measure the amount of distalization and measure the amount of anchor loss.
7.3 METHOD OF STATISTICAL ANALYSIS:
Statistical significance will be calculated using Wilcoxon test.
Any other suitable statistical test may be performed at the time of data analysis.
7.4 DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS, ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY?
YES.
  • Lateral cephalogram
  • Study models
  • Photographs
  • OPG
  • IOPA
  • Photographs
7.5 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.4?
YES.
8.REFERENCES:
  1. Kloehn SJ. Evaluation of cervical traction of the maxilla and maxillary first permanent molar . Angle Orthod. 1961;31:91–104
  2. Wieslander L. The effect of force on craniofacial development. Am J Orthod. 1974;65:531–538
  3. Baumrind S, Korn EL, Isaacson RJ, West EE, Molthen R. Quantitative analysis of the orthodontic and orthopedic effects of maxillary traction. Am J Orthod. 1983;84:384-393
  4. Cangialosi TJ, Meistrell ME, Leung MA, Ko JY. A cephalometric appraisal of edgewise Class II nonextraction treatment with extraoral force. Am J OrthodDentofacialOrthop. 1988;93:315–324
  5. Ferro F, Monsurró A, Perillo L. Sagittal and vertical changes after treatment of Class II Division 1 malocclusion according to the Cetlin method. Am J OrthodDentofacialOrthop. 2000;118:150–158
  6. Haas AJ. Headgear therapy: the most efficient way to distalize molars. SeminOrthod. 2000;6:79–90
  7. SchiavonGandini MR, Gandini LG, da Rosa Martins JC, Del Santo M. Effects of cervical headgear and edgewise appliances on growing patients. Am J OrthodDentofacialOrthop. 2001;119:531–539
  8. Bondemark L, Kurol J, Bernhold M. Repelling magnets versus superelasticNiTi simultaneous distal movement of maxillary first and second molars. Angle Orthod. 1994;64:189–198.
  9. Keim RG, Berkman CH. Intra-arch maxillary molar distalization appliances for Class II correction. J ClinOrthod. 2004; 37:505–511.
  10. Hilgers JJ. The pendulum appliance for Class II non-compliance therapy. J ClinOrthod. 1992;26:706–714
  11. Bussick T, McNamara JA. Dentoalveolar and skeletal changes associated with the pendulum appliance. Am J OrthodDentofacialOrthop. 2000;117:333–343
  12. Gianelly AA, Vaitas AS, Thomas WM. The use of magnets to move molars distally. Am J OrthodDentofacialOrthop. 1989; 96:161–167.
  13. Keles A, Sayinsu K. A new approach in maxillary molar distalization: intraoral bodily molar distalizer. Am J OrthodDentofacialOrthop. 2000;117:39–48.
  14. Jungi Sugawara, Reiko Kanzaki, Ichiro Takahashi, Hiroshi Nagasaka, and Ravindra Nanda:Distal movement of maxillary molars in non-growing patients with the skeletal anchorage system.Am J OrthodDentofacialOrthop. 2006;129:723-33.
  15. GokhanOncag, OzlemSeckin, and Faith ArikanOsseointegrated implants with pendulum springs for maxillary molar distalization: A cephalometeric study
[Am J OrthodDentofacialOrthop. 2007; 131:16-26.
  1. IbrahimErhanGelgor, Ali IhyaKaramar and Tamer Buyukyilmaz;Comparision of 2 distalization systems supported by intraosseous screws. Am J Ortho DentofacialOrthop2007;131:161.e1-161.e8.
  2. Gero S M Kinizinger, Norbert Gulden, FarukYildizhan and Peter R. Diedrich: Efficiency of skeletonized distal jet appliance supported by mini-screw anchorage for noncompliance maxillary molar distalization. Am J OrthodDentofacialOrthop 2009; 136:578-86.

9 / SIGNATURE OF THE
CANDIDATE
10 /

REMARKS OF THE GUIDE

11 / 11.1.NAME & DESIGNATION
OFGUIDE / Prof. Dr. RAJKUMAR S. ALLE, M.D.S, DNB
PROFESSOR AND HEAD,
DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS,
RAJARAJESWARI DENTAL COLLEGE AND HOSPITAL, BANGALORE.
11.2 SIGNATURE OF GUIDE
11.3.CO-GUIDE (If any)
11.4.SIGNATURE
11.5 HEAD OF THE
DEPARTMENT / Prof. Dr. RAJKUMAR S. ALLE, M.D.S, DNB
PROFESSOR AND HEAD,
DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS,
RAJARAJESWARI DENTAL COLLEGE AND HOSPITAL, BANGALORE.
11.6.SIGNATURE
12 / 12.1. REMARKSOFTHE
CHAIRMAN & PRINCIPAL
12.2. SIGNATURE