Mandibular molar displacement secondary to the use of forces to retract the maxilla

Using previously described computer-aided techniques, we have been able to characterize quantitatively the displacements of the lower first molar associated with the use of several different therapeutic modalities that are conventionally employed to retract the maxilla in the treatment of Class II malocclusion. The total displacement of the molar has been partitioned into two components associated respectively with displacement of the entire mandible and with local interosseous migration (dental compensation) of the molar within the mandible. A further attempt has been made to partition treatment-associated effects from nontreatment-associated effects. While considerable variability in effect was observed within each sample on a case-by-case basis, some important normative trends did emerge. Contrary to our expectations, it was found that in each of the treatment groups, the mean local intraosseous rotational effect (Table IIB.2) was of greater magnitude than the mean effect of mandibular rotation (Table IIB.1). The character of the intraosseous rotation differed significantly (P less than 0.05) between the control group and each of the treatment groups. In the control group, a mean mesial crown tipping (that is, "proclination") was noted. In each of the treatment groups, a mean distal crown tipping ("uprighting") was noted. In both the cervical and intraoral groups, the lower molar tended to displace mesially more than in the control or high-pull groups. This mesial displacement derived from the mesial displacement of the mandible (Table IIC.3), rather than from displacement of the tooth within the bone (Table IIC.4). In both the high-pull and the intraoral groups, the lower molar erupted within the mandible significantly more than in the control and cervical groups (Table IIC.6). The statistically significant supereruption/extrusion of the upper molar in the cervical group (Table IIC.2) was not accompanied by an associated inhibition of the eruption of the lower first molar (Table IIC.6). In general, it seems reasonable to infer that the growth-related displacement of the mandible influenced the final position of the lower first molar more profoundly than did the treatment-associated displacement of the upper molar.