Bilateral distalization of maxillary first molars in a group of adult patients after extraction of maxillary second molars using infra-zygomatic mini-implants: A prospective clinical trial

•All Cases treated with our infra-zygomatic gear distalizer appliance resulted in successful distalization of the maxillary first molar, reaching Class I molar relationship.•A significant amount of distalization (4.03 ± 0.62) occurred after an average duration of 6.4 months.•The rate at which maxillary first molar distalization occurred was an average of 0.61 ± 0.18 mm per month.•The maxillary first molars showed a significant intrusion of 1.37 ± 0.83 mm.•No changes in the three-dimensional position of the maxillary anterior segment had occurred throughout the trial. It is now possible to predictably distalize maxillary first molars in nongrowing patients with the infra-zygomatic gear distalizer and to improve malocclusions without having to extract the premolars and regardless of the patient's compliance. The purpose of this study was to investigate the amount and rate of distal movement of the maxillary first molars using our proposed appliance after extraction of maxillary second molars. Ten nongrowing female patients successfully treated with our proposed appliance were the subjects of this study. The amount, rate, and type of distalization, were analyzed through upper jaw cone beam computed tomography (pre- and post-treatment) and scanned casts taken on a monthly interval. The average amount of distalization of the maxillary first molars was 4.03 mm at the crown level and 2.88 mm at the root level. The rate of distalization had an average of 0.61 mm per month with a maximum of 0.79 mm in the first month because of the regional acceleratory phenomena after extracting the maxillary second molar. The maxillary first molars were distalized in a significant manner and all patients reached a Class I relation within an average duration of 6.4 months. The proposed appliance proved to be a viable noncompliance modality to distalize maxillary first molars correcting maxillary Class II malocclusions characterized by maxillary protrusion or maxillary incisor crowding.