CASE REPORT The effectiveness of a single osteointegrated implant combined with pendulum springs for molar distalization Gökhan Öncag ˘, a Sercan Akyalçın, b and Fatih Arıkan c Bornova-Izmir, Turkey The aim of this report was to present the clinical efficiency of a single osteointegrated implant combined with pendulum springs for molar distalization. A 15-year-old girl sought treatment for irregular anterior teeth and poor smile esthetics. A novel appliance was designed that combined osteointegrated implants with 0.032-in beta-titanium wire and pendulum springs. The treatment results were evaluated from lateral cephalometric radiographs. Distalization of the maxillary first molars was achieved in 6 months. Total treatment time was 21 months. Facial esthetics improved as a consequence of treatment. This appliance design offers reliable molar distalization, even when absolute anchorage is required. (Am J Orthod Dentofacial Orthop 2007;131: 277-84) T ooth-borne anchorage is a significant limitation in modern orthodontic treatment, because teeth move in response to forces. 1 When maximum anchorage is required during orthodontic treatment, additional aids are often needed to support the anchor- ing teeth. 2 Extraoral appliances are effective for distal- izing teeth, but patient cooperation can be a problem. Conventional intraoral molar distalization techniques such as Schwarz plate-type appliances, 3 Wilson distal- izing arches, 4,5 removable spring appliances, 6-10 distal jet, 11 intermaxillary elastics with sliding jigs, 12,13 mag- nets, 8,14-16 and pendulum appliance 17-21 are also fre- quently used in this fashion. However, anchorage has always been a major disadvantage of these appliances. Therefore, attempts have been made to use implants as anchorage units for orthodontic appliances. 22-29 Con- ventional implants in alveolar bone do not offer enough room to host the entire mechanical system. According to many studies, the hard palate is a suitable temporary anatomic site for implant placement. 2,30-35 Therefore, we aimed to unite an osteointegrated implant, placed in the median-sagittal region of the hard palate, with pendulum springs for molar distalization. Pendulum springs, which can easily be bent and adapted to the palatal region, were preferred for their convenience to deliver the distalizing force to the maxillary first molar. DIAGNOSIS The patient, a girl, 15.1 years of age, had no history of significant medical problems. Her oral hygiene was fair. The dental casts and intraoral examination indi- cated a bilateral Class II molar relationship (Figs 1 and 2). Her maxillary left canine was in supravestibular position. There was also a midline shift of 3.5 mm to left in the maxillary arch. Her face was symmetrical from the front; the profile was mildly convex with an obtuse nasolabial angle, retrusive lips, and prominent nose and chin. The measurements of the lower lip to the H line, lower lip to E line, and upper lip to E line (Table) indicated a dished-in profile, for which many clinicians avoid extracting teeth for orthodontic purposes. 36,37 Her smile-arc relationship was preserved; however, she lacked of a full radiant smile despite her wide lip extension. This was due to a poor buccal ratio relation- ship and retroclined maxillary incisors. She had no temporomandibular joint problems. In addition to the Class II molar relationship, she had an overjet of 4 mm, an overbite of 3 mm, and approximately 8 mm crowding in the maxillary arch. Cephalometric analysis showed an ANB angle of 2° The maxillary incisors were retroclined, whereas the mandibular incisors were mildly proclined. Cephalo- metrically, her vertical skeletal measurements were considered to be within normal ranges (Table). This type of Class II malocclusion with anterior, posterior, and vertical skeletal balance is due to aggravation of dental symptoms. From the Faculty of Dentistry, Ege University, Bornova-Izmir, Turkey. a Associate Professor, Department of Orthodontıcs. b Research assistant, Department of Orthodontıcs. c Research assistant, Department of Periodontology. Reprint requests to: Sercan Akyalçın, Ege Üniversitesi Dishekimlig ˘i Fakül- tesi Ortodonti Anabilim Dalı, 35100 Bornova-I ˙ zmir, Turkey; e-mail, sercanakyalcin@gmail.com. Submitted, February 2005; revised and accepted, July 2005. 0889-5406/$32.00 Copyright © 2007 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2005.07.015 277