Distal movement of upper incisors in nonextraction cases without spacing

In some Class Il/l cases, it may be decided that the treatment should be on a non-extraction basis, and that the upper buccal segments need to be moved distally, to allow subsequent retraction of the upper incisors toward PIP. If the movement is minimal (1-3 mm), first molar rotation solves most of the problem (Fig. 7.21). A headgear and sliding jig are helpful in this situation. I lowever, when the required movement is 3 mm or more, this becomes a challenging situation for the patient and orthodontist alike, irrespective of the treatment mechanics in use.

There will be a requirement to use sophisticated treatment mechanics to move upper molars and then premolars distally, using one of the many devices available for (his purpose, normally supported with headgear. There are claims in the literature6 that this can be achieved on a regular basis, but only the most cooperative patient will achieve the planned tooth movements. Typical treatment mechanics are shown in sequences on pages 194 and 195.

This treatment approach results in a long treatment time, and the planned treatment goals are not always reached. Therefore, in some cases, the authors will abandon the non-extraction concept and consider loss of upper second molars.7"9 This greatly facilitates the treatment mechanics, and there is evidence11' that upper third molars subsequently erupt into good position in more than 80% of cases (Case DO, p. 215). If third molars are absent or poorly situated, then upper bicuspid extraction may be more appropriate.

Fig. 7.21 Correction of upper first molar rotation can provide 1-3 mm of favorable distal movement of the buccal surfaces towards Class I. The bendback should be 2-3 mm distal to the end of the first molar tube, or there can be restriction of rotational correction.

Fig. 7.20 Occlusal view of sliding mechanics, used to retract upper incisors after premolar extractions. With anchorage support from a headgear, a palatal bar, or Class II elastics, it is possible to maintain the position of upper molars and retract the six anterior teeth into the available space.

Fig. 7.21 Correction of upper first molar rotation can provide 1-3 mm of favorable distal movement of the buccal surfaces towards Class I. The bendback should be 2-3 mm distal to the end of the first molar tube, or there can be restriction of rotational correction.

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