2013 JCO, Inc. May not be distributed without permission. www.jco-online.

com

TECHNIQUE CLINIC
Second-Molar Correction with a
Modified Vacuum-Formed Retainer

hen orthodontic treatment

is finished before complete
eruption of the maxillary second
molars, the orthodontist is presented with a dilemma if the molars eventually erupt in buccally
displaced positions.
We have developed a method to correct such a displaced second molar using a vacuum-formed
retainer with an attached lingual
button. The procedure is shown
here in a young adult patient who
had previously undergone orthodontic therapy as an adolescent.
Procedure
1. Prepare a plaster cast, apply a
separating medium, and cement a
metal button about 5-6mm from

the lingual gingival margin of the

displaced second molar (A).
2. Vacuum-form and trim the
retainer* as usual, then cut away
the material covering the displaced
tooth, allowing space for the tooth
to move lingually. Remove the
acrylic from the head of the lingual button (B).
3. Bond a lingual button or buccal tube to the buccal surface of
the displaced molar.
4. Instruct the patient to wear an
elastic (1oz) between the two attachments whenever the retainer
is in place (C).
5. Check the progress of the molar
every four to six weeks. Once the
displaced tooth has been aligned
(in this case, after six weeks),
fabricate a new retainer (D).

Discussion
This simple modification of
a vacuum-formed retainer can be
easily fabricated in the orthodontic
office. If the practice owns buttonforming Thermopliers,* the clinician can place a similar button
within the retainer material itself.
Because patients may have
difficulty attaching elastics in this
region of the mouth, it is important for them to practice applying
and removing elastics several
times at the delivery appointment.
The vertical separation of
the teeth with the retainer in place
usually provides adequate clearance for molar movement, while
the intrusive forces applied by the
elastic prevent extrusion.
*Erkodur 1.5mm sheets, Erkodent Erich
+OPP 'MB( 0FALZGRAFENWEILER 'ERMANY
www.erkodent.com.

VOLUME XLVII NUMBER 1

XIAO-GUANG ZHAO,
BDS, MSD, PHD
Lecturer
Department of Orthodontics
(OSPITALOF3TOMATOLOGY
Sun Yat-Sen University
Guangzhou, Guangdong
China
xiaoguangzhao@gmail.com

JIU-XIANG LIN, BDS, PHD

Professor
Peking University School and
(OSPITALOF3TOMATOLOGY"EIJING
China

2013 JCO, Inc.

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