Efficiency of noncompliance simultaneous first and second upper molar distalization: a three-dimensional tooth movement analysis.

Objective of this prospective study was the three-dimensional (3D) analysis of tooth movements after the noncompliance simultaneous distalization of the first and second maxillary molars. Ten patients (five girls and five boys; mean age: 13.2 years) with bilateral Class II molar relationships were treated with a noncompliance, fixed intraoral appliance. Upper second molars had already erupted in all cases. Dental casts and lateral cephalometric radiographs were taken immediately before placement and after removal of the appliance. The casts were 3D digitized and superimposed on a predefined area in the palate. The resulting holograms, as well as the cephalometric radiographs, were digitized and analyzed by means of customized cephalometric software. The whole procedure was repeated after a two- to four-week interval to estimate the error of both methods. The cast assessment of 3D sagittal and vertical tooth movements was more reliable than the cephalometric record. The average maxillary first molar distal movement was 2.8 mm. Anchorage loss was expressed by a 1.9-mm proclination of the central incisors. A substantial variation among patients and among the right and left side in the same patient was observed. Noncompliance simultaneous distalization of the first and second maxillary molars can be an efficient treatment option for the correction of Class II molar relationship. However, anchorage loss and individual variation have to be seriously considered. Bilaterally symmetrical effectiveness should not be relied upon.