title: Molar distalization with pendulum appliances in the mixed dentition: effects on the position of unerupted canines and premolars.
abstract: BACKGROUND
  The pendulum appliance allows for rapid molar distalization without the need for patient compliance. Its efficiency has been confirmed in a number of clinical studies. However, the potential interactions and positional changes between the deciduous molars used for dental anchorage and the erupted and unerupted permanent teeth have yet to be clarified when this appliance is used for molar distalization in the mixed dentition.
  
  
  METHODS
  Twenty-nine patients in the mixed dentition each received a modified pendulum appliance with a distal screw and a preactivated pendulum spring for bilateral distalization of the maxillary molars. The patients were divided into 4 groups based on dentition stages: patient group 1 (PG 1, n = 10) was in the early mixed dentition; patients had resorption of the distal root areas of the deciduous molars being used for dental anchorage, and the unerupted premolars were located at the distal margin of the deciduous molar root region. Based on radiographs taken before placement of the pendulum appliance, patient group 2 (PG 2, n = 10) was diagnosed as having a central location of the unerupted premolars. In the third group (PG 3, n = 4), the first premolars were already erupted and could be integrated into the dental anchorage, but the canines were not yet erupted. In the fourth group (PG 4, n = 5), the first premolars and both canines were fully erupted.
  
  
  RESULTS
  Statistical analysis of the measured results showed significant differences in the side effects between PG 1 and PG 2. In patients being treated with pendulum appliances, the anchorage quality of the deciduous molars that were already partially resorbed in the distal root area was comparatively reduced. Consequently, the mesial drift of the deciduous molars and incisors was increased, without impairing the extent and quality of the molar distalization. Anchorage loss in the supporting area had no direct impact on the sagittal position of the unerupted premolars in the early mixed dentition.
  
  
  CONCLUSIONS
  If permanent teeth have already started to erupt in the supporting area, additional space restrictions should be avoided in patients with critical topography, especially if there is little space for the unerupted canines. At this stage of the mixed dentition, premolar extraction or augmentation of the supporting area with extraoral headgear offers a therapeutic alternative to intraoral distalization appliances with exclusively dental anchorage.
authors.affiliation: Department of Orthodontics, University of Aachen RWTH, Aachen, Germany. GKinzinger@ukaachen.de
authors.forename: Gero S M
authors.initials: GS
authors.lastname: Kinzinger
authors.forename: Heinrich
authors.initials: H
authors.lastname: Wehrbein
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gross
authors.forename: Peter R
authors.initials: PR
authors.lastname: Diedrich
mesh_terms: D000704:Analysis of Variance; D001641:Bicuspid / Q000503:physiopathology; D002508:Cephalometry; D002648:Child; D000075202:Contraindications; D003481:Cuspid / Q000503:physiopathology; D003799:Dental Stress Analysis; D003818:Dentition, Mixed; D019229:Dentition, Permanent; D005260:Female; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000209:etiology; D008437:Maxilla; D008963:Molar; D052280:Orthodontic Anchorage Procedures / Q000379:methods*; D009967:Orthodontic Appliances / Q000009:adverse effects; D014078:Tooth Eruption; D014087:Tooth Movement Techniques / Q000295:instrumentation*; D014097:Tooth, Unerupted / Q000503:physiopathology*