Efficiency of a pendulum appliance for molar distalization related to second and third molar eruption stage

A modified pendulum appliance, including a distal screw and special preactivated pendulum springs (built-in straightening activation and toe-in bending), was used for bilateral maxillary molar distalization in 36 adolescent patients in various stages of the molar dentition. The patients were divided into 3 groups (PG 1-3) according to the stage of eruption of their second and third molars. In PG 1 (18 patients), eruption of the second molars had either not yet taken place or was not complete. In PG 2 (15 patients), the second molars had already developed as far as the occlusal plane, with the third molars at the budding stage. In PG 3 (3 patients), germectomy of the wisdom teeth had been carried out, and the first and second molars on both sides had completely erupted. Analysis of cephalograms to identify any changes in the sagittal plane showed that, in the direction of distalization, a tooth bud acts on the mesial neighboring tooth like a fulcrum, and that tipping of the first molars in patients in whom the second molar was still at the budding stage was thus greater. In patients whose second molars had erupted completely, the degree of tipping was greater again when a third molar bud was located in the direction of movement. After previously completed germectomy of the wisdom teeth, almost exclusively bodily distalization of both molars is possible, even without bands being applied to the second molars. However, if the first and second molars are distalized simultaneously with a pendulum appliance, the duration of therapy will be longer, greater forces will have to be applied, and more anchorage will be lost. Statistical analysis of the results of dental-angular measurements showed significant differences in the degree of molar tipping and reciprocal incisor protrusion. The degree of distal tipping of first molars was less in patients with erupted second molars (PG 2 and PG 3) than in those whose second molars were not yet erupted (PG 1). For instance, the measured angles were 0.9 degrees +/- 3.43 degrees (to the palatal plane) and 0.8 degrees +/- 3.4 degrees (to the anterior cranium floor) in PG 2, and -0.33 degrees +/- 0.58 degrees and 0.67 degrees +/- 2.08 degrees, respectively, in PG 3, contrasting with respective values of 5.89 degrees +/- 3.74 degrees and 5.36 degrees +/- 3.49 degrees in PG 1. Tipping of erupted second molars was much more marked in PG 2 (7.92 degrees +/- 5.83 degrees to the palatal plane and 7.55 degrees +/- 5.28 degrees to the anterior cranium floor), but much less pronounced in PG 3 (2 degrees +/- 1.73 degrees to the palatal plane and 2 degrees +/- 2 degrees to the anterior cranium floor) than the corresponding movement of the second budding-stage molars in PG 1 (4.06 degrees +/- 2.15 degrees and 3.97 degrees +/- 2.27 degrees, respectively). The degree of incisor protrusion occurring reciprocally with molar distalization was much less in these patients (measured angles of 3.28 degrees +/- 1.97 degrees and 2.89 degrees +/- 2.17 degrees to the palatal plane and anterior cranium floor, respectively) than in the patients presenting different stages of the dentition (angles of 5.5 degrees +/- 3.33 degrees and 6.03 degrees +/- 4.29 degrees, respectively, in PG 2, and angles of 5.5 degrees +/- 3.28 degrees and 6.67 degrees +/- 3.09 degrees, respectively, in PG 3). Moreover, measurement of dental casts in the horizontal plane showed not only the targeted mesiobuccal rotation of both maxillary molars, but also a vestibular drift of the unbanded second molars.