Direct Molar Distalisation

This 13 year old girl had previous surgical exposure of both upper central incisors and removal of severely hypoplastic 2nd molars. The treatment plan could not be finalized until the incisors were brought into the arch, when it became clear that she needed overjet reduction (from 8mm) and correction of a ¼ and a ½ unit class II buccal segment relationships. Asymmetrical distalisation of the maxillary arch was indicated, but class II elastic traction was contra-indicated because of the short upper incisor root lengths.

A 1.5mm diameter, 9mm body length Infinitas mini-implant was inserted, palatal and mesial to the upper 1st molar palatal roots, following removal of a circular piece of mucosa using the Infinitas mucotome. A 3D Infinitas stent was used for accurate positioning of the mini-implants by directly guiding the slow handpiece-driven instruments.

Direct traction was applied to hooks bonded onto the 1st premolar palatal surfaces, and then indirectly to the incisors via labial elastic chain. The buccal teeth were distalised by up to 4mm. Therefore, this case demonstrates the benefit of a customised stent for accurate insertion of mini-implants, and the flexibility of this palatal approach for direct distalisation of up to ½ unit.