Effects of conventional anchorage on premolar root development during treatment with a pendulum appliance

By metrically analyzing orthopantomograms, we aimed in this study to retrospectively investigate whether maxillary premolars used as anchoring teeth during molar distalization with pendulum appliances would reveal inhibited root development.

The upper molars were distalized with a modified pendulum appliance (Pendulum K) in 36 adolescents (14 males, 22 females, mean age 12.3 years). Mean treatment period was 19.5 weeks. Orthopantomograms of each patient were taken at the start (time point T1) and after completion of molar distalization (time point T2). The enlargement of the posterior region was ascertained individually quadrant by quadrant for each radiograph, followed by measurement of the vestibular tooth lengths of the premolars whose root development was for the most part not yet complete. To assess further root development in the premolar region, the differences were calculated between tooth lengths at the start and end of treatment.

During treatment with the pendulum appliance a general increase in tooth lengths in the anchorage region was observed (1.37 +/- 1.70 mm, p<0.0001). Differentiated by dental age, we noted increases in tooth lengths of patients with second molars in the budding stage (patient group PG 1: 0.93 +/- 1.37 mm, p<0.0001) as well as of patients with fully-erupted second molars (patient group PG 2: 1.81 +/- 1.88 mm, p<0.0001). Both groups demonstrated greater increases in the second premolars than the first premolars; the increases group-wise were larger in PG 2 than PG 1. However, both the group comparison (PG 1 versus PG 2) and the side comparison (right versus left) (differentiated into first and second molars) showed no statistically relevant differences. Visual assessment of the radiographs revealed no evidence of treatment-related root deviations.

A highly complex system of forces acts on the anchoring teeth during molar distalization with the conventionally-anchored Pendulum K. However, the Pendulum K appliance's specific biomechanics make it possible to transfer the reactive forces and moments to the anchorage unit so that they remain within the physiological range, allowing uninhibited premolar root development. This also applies after completed eruption of the second molars, when the treatment period and hence duration of exposure to the active and reactive forces and moments arising during molar distalization are comparatively increased.