Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 62

Faculty Files

Figure 5. Total arch distalization with a modified
C-palatal plate
more prone to soft-tissue irritation, so cone-beam
computed tomography imaging is necessary for
proper placement. With palatal positioning of
TSADs, it is possible to distalize molars more than
3 mm without repositioning while reducing the
risk of sinus and root perforations, but in most
cases, molar tipping and extrusion of the maxillary molars remain concerns.
Can a modified C-palatal plate expand our treatment options for Class II patients?
In 2014, a new palatal anchorage called the
modified palatal anchorage plate (MPAP) was
introduced by Dr. Kook and our research team as
an alternative to the previously reported types
of palatal anchorage molar distalization appliances.9 It has been found to effectively distalize
the posterior teeth in adults and adolescents. A
finite element analysis suggested that distalization with a palatal plate provides bodily molar
movement without tipping or extrusion and a
simultaneous orthopedic effect similar to that of
headgear. In 2017, Dr. Kook and I collaborated to
publish a case study on a modified C-palatal plate
(MCPP) that was more refined than the original
MPAP (Figure 5).10 With MCPPs, it is possible to
effectively retract the maxillary dentoalveolar
complex while efficiently controlling the vertical
force vector (Figure 6).11 By applying force to the 10
mm notch, the force passes through the CR of the
maxilla, making it possible to achieve transla-

62	

Figure 6. Three different force systems created
by MCPP; by applying the forces to the 10-mm
notches, these forces pass through the center of
resistance of the maxilla, allowing bodily movement of teeth during intrusive retraction
tional tooth movement parallel to the occlusal
plane during the distalization of the maxillary
dentition. Using MCPPs, orthodontists can now
actively prevent molar tipping and extrusion that
used to cause unfavorable clockwise rotation
of the mandible with other types of maxillary
molar distalization strategies.12,13 The application
of MCPPs has resulted in significant amounts of
total arch distalization without significant effects
on the transverse dimensions or changes to the
oropharynx airway space.14 From our study on the
retention phase that was recently published in
the American Journal of Orthodontics & Dentofacial Orthopedics, palatal plates showed minimal
dental, skeletal, and soft-tissue changes at 3
years posttreatment,15 presenting with just a 12%
relapse of distalization and 35% of intrusion from
the initial changes achieved on the maxillary first
molar. Thus, palatal plates are a viable treatment option for maxillary total arch distalization
(Figure 7).15 For those who are interested, you can
find step-by-step instructions in my book Temporary Anchorage Devices in Clinical Orthodontics,
detailing how to fabricate, position, and use
MCPPs on your patients.
Will the use of miniscrews and C-palatal plates
cause problems with unerupted wisdom teeth
after the upper dentition is distalized?
In adolescent patients, the amount of distalization of the maxillary first molar was 20% greater
when there was an unerupted maxillary second

PCSO Bulletin    Summer 2020



Pacific Coast Society of Orthodontists Bulletin Summer 2020

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