Case Report
Volume 3 Issue 5 - 2016
A Novel Method of Altering the Buccal Segment Relationship
Stefan Abela1, Michael Cheung2, and Huw G Jeremiah3
1Post CCST Specialist Registrar, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
2Specialist Orthodontic practitioner, Slough, UK
3Consultant in Orthodontics, Adden brookes Hospital, Cambridge NHS Foundation Trust Hospitals, Cambridge, UK
*Corresponding Author: Dr Stefan Abela, Outpatient Department, Norfolk and Norwich University Hospital Colney Lane, Norwich, NR4 7UY.
Received: February 02, 2016; Published: February 12, 2016
Citation: Stefan Abela., et al. “CA Novel Method of Altering the Buccal Segment Relationship”. EC Dental Science 3.5 (2016): 617-625.
Abstract
Aims: This paper presents a novel way of altering buccal segment relationships in the maxillary arch with a very practical and non-expensive patient-compliant method, primarily utilizing intra-oral elastics.
Materials: Four successful cases are presented utilizing this technique. The first case details the successful management of a 29-year-old Asian female, the second case details the successful management of 15-year-old caucasian female, the third case describes the management of a 16-year-old caucasian male and the fourth case describes the management of a 24-year-old caucasian female.
Results: All the presented cases had the buccal segment relationship altered utilizing this innovative technique. The buccal segments corrected were half a unit class II and was also utilizing to correct asymmetric buccal segment relationships.
Discussion: The suggested technique represents a new and innovative way of assisting the clinician (to) correct buccal segment relationships. This technique does not require any patient cooperation apart from the class II inter maxillary elastic wear.
Conclusion: This technique should be available to the clinician when correcting unilateral or bilateral class II buccal segment relationships.
Keywords: Buccal segment; Molar relationship; Fixed appliances; Intra-oral elastics; Orthodontics; Treatment mechanics
Introduction
Molar correction is an important part of routine orthodontic treatment and its classification is usually based on the type of treatment mechanics utilized, during the treatment [1]. This could either be patient-compliance dependent or patient-compliance independent.
Molar relationship is typically altered in the correction of class I and class II malocclusions without significant skeletal involvement [2].
Headgear is the classical method of distalising molars [3], as it can be used for asymmetric molar distalisation [4]. Its use however, has declined over the past decade due to unsatisfactory clinical results [5], patient compliance and safety issues. Safety features of headgear are described very well in the literature [6,7].
Alternative methods include;
1. Pendulum appliance [8]
2. Jones jig appliance [9]
3. Distal Jet appliance [10]
4. Keles slider [11]
5. Repelling magnets [12]
6. Compressed springs [13]
7. Molar distalising bows [14]
8. Herbst Appliance [15]
9. Temporary anchorage devices [16]
10. Forsus™ appliance [17,18]
11. Advan Sync™ 2 [19]
Clinical interest in the above appliances has varied over the last two decades however appliances that do not require patient compliance have been favoured. Techniques that do not rely on patient cooperation are more reliable and effective [16].
Recent literature has incessantly focused on the success of bone-anchored devices in the retromolar area for antero-posterior movement of molar teeth [20,21].
Adverse effects of molar distalising techniques include tipping of the first molars however advantages include treatment completion on a non-extraction basis and better patient acceptability.
The aim of this paper was to investigate and introduce a very effective and practicable method of altering the buccal segment relationship using intermaxillary elastics.
Method
A standard sequence of progressive alignment arch wires were was followed until all the teeth in both the labial and buccal segments were fully leveled and aligned. The sequence consisted of round nickel titanium arch wires followed by rectangular forms of the same type. The final insertion was completed with rectangular stainless steel wires which prevented the occurrence of any potential rotations of the wire in the slot or molar tubes. A 0.019” x 0.025” stainless steel wire lessened tipping of the molars as there is less slop in the bracket system. The upper wire can be sectioned mesial to upper first molar tubes or second premolar. The sectioned wire can then be cinched upwards (Figure 2c). OrthoCare (UK) Limited, 3/16”, 4 ½ oz, 4.8mm, 126 grams intermaxillary elastics were placed from the lower second molar hooks to the cinched wire in the upper arch. The intermaxillary elastics had to be worn full time including eating and sleeping with the elastics in situ. The appearance of a gap, with full compliance, at the rate on average of 1mm per month, should be witnessed. The aim was to alter the molar relationship to a ¼ unit III position for good buccal inter digitations. The upper first molars may be slightly extruded and tipped a result (Figure 2d on the left buccal segment). A 0.018” stainless steel continuous wire may be inserted to level and intrude the upper first molars. Intra maxillary power chain can be used from the upper second molar to the loop (or a Kobayashi hook on the upper canines) to retract the labial segment to close the gap created. The patient‘s use of Class II intermaxillary elastics is ideally continuous with the main aim being that of reinforcing anchorage.
Case Report 1
A 29-year-old Asian female, R.K. with a clear medical history presented with a class III incisor relationship on a class I skeletal base complicated by a class II buccal segment relationship bilaterally and a shift of the lower centre line to the left by two millimetres in relation to the facial midline. The patient’s past dental history included extractions of upper first premolars.
The treatment plan consisted of extractions of lower right and lower left second premolars and upper and lower fixed appliances. Treatment commenced in April 2006 and the process of sequential arch wire changes was finalized by placing a 0.019 x 0.025-inch stainless steel arch wire in both the upper and lower arches. The upper arch wire was sectioned mesial to the upper second premolars and cinched upwards. Class II intermaxillary elastics, OrthoCare (UK) Limited, 3/16”, 4 ½ oz, 4.8 mm, 126 grams were placed on a full-time basis in January 2007 and correction of the molar relationship was completed by July 2007.
Figure 1a and 1b below illustrate the pre- and post-optreatment effects, whilst figure 1c illustrates the alteration following completion of treatment.

Figure 1: Pre-treatment photographs.

Figure 1b: Post-treatment photographs.

Figure 1c: Comparison of pre- and post-operative treatment effects on the buccal segment relationship.

Case Report 2
A 15-year-old Caucasian female, M.A. presented with a class I incisor relationship on a class I skeletal base complicated by moderate crowding in both the upper and lower arches. In addition she presented with half unit class II molar relationship on the right side and full unit class II molar relationship on the left. The treatment plan consisted of extractions of the upper first premolars and the lower secondpremolars followed by upper and lower fixed appliances. Treatment commenced in April 2009 and the upper 0.019 x 0.025-inch stainless steel archwire was sectioned and cinched upwards in September 2009. Class II intermaxillary elastics, OrthoCare (UK) Limited, 3/16”, 4 ½ oz, 4.8 mm, 126 grams were placed on a full-time basis. Molar correction was completed in September 2010.
Figure 2a illustrates the pre-treatment photographs whilst figure 2b illustrates the molar correction utilising the technique recommended by the authors.

Figure 2a: Pre-treatment photographs.

Figure 2b: Treatment photographs illustrating molar relationship alteration and technique of archwire sectioning for application of intermaxillary elastics.

Figure 2c: Treatment photographs illustrating intermaxillary elastics from lower 7s to upper cinched wire.

Figure 2d: Treatment photographs illustrating intermaxillary elastics from lower 7s to upper continuous stainless steel wire with loops as well as intra maxillary elastics from upper 7s to loop to close space.

Figure 2e: Post-Treatment Photographs.

Figure 2f: Comparison of pre- and post-operative treatment effects.

Case Report 3
A 16-year-old Caucasian male, M.B. presented with a class II division 2 incisor relationship on a class I skeletal base complicated by an asymmetric molar relationship. The molar relationship was half unit class II on the right side and class I on the left side. The treatment plan consisted of upper and lower fixed appliances on a non-extraction basis. Treatment commenced in April 2007 and the upper 0.019 x 0.025-inch stainless steel arch wire was sectioned and cinched upwards in January 2009. Class II intermaxillary elastics, OrthoCare (UK) Limited, 3/16”, 4 ½ oz, 4.8mm, 126 grams were placed on a full-time basis. Molar correction was completed in March 2009.
Figure 3a illustrates the pre-treatment photographs whilst figure 3b illustrates the molar relationship change utilizing the technique recommended by the authors.

Figure 3a: Pre-treatment photographs.

Figure 3b: Treatment photographs illustrating molar relationship alteration and technique of arch wire sectioning for application of intermaxillary elastics.

Figure 3c: Pre- and post- treatment alteration of the molar relationship.

Case Report 4
A 24-year-old Caucasian female, S.K. presented with a class II division 2 incisor relationship on a class I skeletal base complicated by a lower centre-line shift to the left in relation to the facial midline. In addition she presented with half unit class II molar relationship on the right side and a class-I molar relationship on the left. The treatment plan consisted of upper and lower fixed appliances on a non-extraction basis. Treatment commenced in October 2008 and the upper 0.019 x 0.025-inch stainless steel arch wire was sectioned and cinched upwards in March 2009. Class II intermaxillary elastics, OrthoCare (UK) Limited, 3/16”, 4½ oz, 4.8mm, 126 grams were placed on a full-time basis. Molar correction was completed in May 2009.
Figure 4a illustrates the pre-treatment photographs whilst figure 4b illustrates the molar correction utilizing the technique recommended by the authors.

Figure 4a: Pre-treatment photographs.

Figure 4b: Treatment photographs illustrating the alteration of the buccal segment relationship

Figure 4c: Pre- and post- treatment alteration of the molar relationship.

Discussion
This method of patient-compliant molar distalisation utilizing intermaxillary elastics has produced excellent results and eliminated the need of headgear. The individual variation in patients’ response can’t be overcome.
The advantages with this technique are as follows:
a. Compliance is easier than headgear or other adjunct appliance
b. It is non-invasive
c. Relatively quick, molars distalised within 3 to 6 months
The disadvantages are as follows:
1. Works less well in adult male patients
2. May extrude and tip the molars, but extrusion can be corrected
3. Upper 3rd molars may need to be extracted
4. May debond molar tubes when wire is turned up after sectioning
The success of this method is further supported by recent evidence. A systematic review conducted by Flores-Mir., et al. suggests that there is minimal effect of second and third molar eruption stage on the magnitude of first molar distalisation [22].
Cases requiring full unit correction will result in longer treatment times as bodily movement would be the preferred method as opposed to molar tipping [23].
Having identified a clinical successful technique, future studies could focus on the radiological evidence of molar distalisation and eventually carrying out a clinical trial comparing this method with other established methods.
Conclusion
This article has demonstrated that it is possible to change the buccal segment relationship utilizing inter maxillary elastics following sectioning and cinching back of rectangular stainless steel arch wires. It also demonstrated that this is possible in cases requiring unilateral and bilateral correction.
Bibliography
  1. Ferguson DJ., et al. “A comparison of two maxillary molar distalizing appliances with the distal jet”. World journal of orthodontics 6.4 (2005): 382-390.
  2. Angelieri F., et al. “Comparison of the effects produced by headgear and pendulum appliances followed by fixed orthodontic treatment”. European journal of orthodontics30.6 (2008): 572-579.
  3. Ciger S., et al. “Evaluation of post treatment changes in Class II Division 1 patients after non extraction orthodontic treatment: cephalometric and model analysis”. American journal of orthodontics and dentofacial orthopedics: official publication of the Ameri-can Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 127.2 (2005): 219-223.
  4. Baldini G. “Unilateral headgear: lateral forces as unavoidable side effects”. American journal of orthodontics77.3 (1980): 333-340.
  5. Doruk C., et al. “The role of the headgear timer in extra oral co-operation”. European journal of orthodontics 26.3 (2004): 289-291.
  6. Samuels RH and Brezniak N. “Orthodontic face bows: safety issues and current management”. Journal of orthodontics 29.2 (2002): 101-107.
  7. Hilgers JJ. “The pendulum appliance for Class II non-compliance therapy”. Journal of clinical orthodontics JCO 26.11 (1992): 706-714.
  8. Carano A and Testa M. “The distal jet for upper molar distalisation”. Journal of clinical orthodontics JCO 30.7 (1996): 374-380.
  9. Keles A. “Maxillary unilateral molar distalization with sliding mechanics: a preliminary investigation”. European journal of orthodontics 23.5 (2001): 507-515.
  10. Bondemark L., et al. “Repelling magnets versus superelastic nickel-titanium coils in simultaneous distal movement of maxillary first and second molars”. The Angle orthodontist 64.3 (1994): 189-198.
  11. Gianelly AA., et al. “Japanese NiTi coils used to move molars distally”. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 99.6 (1991): 564-566.
  12. Jeckel N and Rakosi T. “Molar distalization by intra-oral force application”. European journal of orthodontics 13.1 (1991): 43-46.
  13. Burkhardt DR., et al. “Maxillary molar distalization or mandibular enhancement: a cephalometric comparison of comprehensive orthodontic treatment including the pendulum and the Herbst appliances”. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 123.2 (2003): 108-116.
  14. Papadopoulos MA., et al. “Noncompliance maxillary molar distalization with the first class appliance: a randomized controlledtrial”. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 137.5 (2010): 586 e1- e13.
  15. Cacciatore G., et al. “Active-treatment effects of the Forsus fatigue resistant device during comprehensive Class II correction in growing patients”. Korean journal of orthodontics 44.3 (2014): 136-142.
  16. Cacciatore G., et al. “Treatment and post treatment effects induced by the Forsus appliance A controlled clinical study”. The Angle orthodontist 25 (2014): 1010-1017.
  17. Al-Jewair TS., et al. “A comparison of the MARA and the AdvanSync functional appliances in the treatment of Class II malocclusion”. The Angle orthodontist 82.5 (2012): 907-914.
  18. Papadopoulos MA., et al. “Clinical effectiveness of orthodontic mini screw implants: a meta-analysis”. Journal of dental research 90.8 (2011): 969-976.
  19. Mao LX., et al. ““[Clinical study of ramus implant anchorage for mandibular arch distalization]”. Shanghai journal of stomatology 20.5 (2011): 500-505.
  20. Flores-Mir C., et al. “Efficiency of molar distalization associated with second and third molar eruption stage”. The Angle orthodontist 83.4 (2013): 735-742.
  21. Karlsson I and Bondemark L. “Intraoral maxillary molar distalisation” The Angle orthodontist 76.6 (2006): 923-929.
Copyright: © 2016 Stefan Abela., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


August Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the August issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for September Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the September issue of respective journals. Submissions are accepted on/before August 15, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk