Introduction

This topic has at its core, the omnipresent question faced practically every time the orthodontists do a treatment plan for the patient. “Do we need to extract teeth or can the necessary space be created without extractions.” In the adult patients there is no clinically significant growth in the bone structure; therefore, alternative solutions must be found to obtain space in which the teeth can be moved to correct the malocclusion. Treatment options may differ depending on the amount of crowding, and whether the crowding has occurred in the maxilla or mandible. In the past, orthodontists had two main options to create the space in the arch. One was to expand the arch and the other was to extract. Whenever there is space deficiency, the methods of gaining space that strikes to our mind are extraction, expansion and stripping.

In 1930’s, Charles Tweed1, 2, 3 observed relapse after non-extraction expansion treatment and decided to retreat with extraction. Also at the same time Raymond. P. Begg4 of Australia concluded that non extraction treatment was unstable and put forward his study on Stone Age Man’s dentition and proposed extractions for greater stability of orthodontic treatment results. With the popularization of Begg’s concept there was a sudden restrain in the orthodontic thinking on the idea of expansion. According to Moyers (1988)1, 5 the non-extraction treatment modalities for Class II cases resulted where the malocclusion is due to aggravation of dental symptoms and has anterior posterior and vertical skeletal imbalance requires maxillary molar distalization to achieve class I molar and canine relationship.

The term distalization means, the displacement of a structure to a position farther posterior than that which is accepted at the onset of treatment. Appliance systems that are designed to produce distal movement of first molars and buccal segments have been available from a century. Traditionally extra oral appliances of one type or another have been used for many years. Extraoral traction may be applied to the upper arch in association with fixed or removable appliances, but the objective in all cases is to move the upper molars distally to provide space for alignment of incisors or overjet reduction. However, we the orthodontists of today are fortunate enough to have more intraoral techniques and appliances in our hands to gain space i.e. by distalizing molar.

Timing of Distalization 6

Different views have been expressed by different authors;

Dewel (1967) and Hass (1970) observed faster rate of molar distalization in patients in mixed dentition to those in the adult dentition.

Joseph M. Sims (1977) suggested that the patient should be treated before the age of 9 years as the root of the molar to be moved has not completed its growth and the orthodontic distal tipping or distal bodily movement is easier.

S.R. Langford and M.R. Sims (1981) illustrated that the distal movement of upper molar roots against adiacent unerupted teeth could cause resorption.

James J. Hilgers (1992) suggested that the distal movement of the first molars is most efficient before the eruption of upper second molars.

David J. Snodgrass (1996) stated that in the mixed dentition molar distalization should not be carried out until full development of the maxillary first molar roots. In the permanent dentitions, molar distalization is most effective before the full eruption of the second molar.

Bondemark (2006) suggested that it is more effective to distalize the first maxillary molars before the second molars have erupted. But from clinical experience, it is better to do molar distalization as early as possible before second molar eruption.

Classification 8

Conflict of Interest

The authors declare no relevant conflicts of interest.

Source of Funding

None.