<p>&nbsp;</p>

<p><img alt="Mesial Drift of the First Permanent Molar Solution - Click for Larger Image" src="https://www.ordont.com/images/problem-solution/Distalization-with-Gear.jpg" style="float:right; height:218px; width:220px" />One frequently prescribed appliance is a Removable Appliance with Adjustable Distalizing Gear. Anchorage is provided by acrylic contact with the palatal vault as well as acrylic coverage on the occlusal. The posterior bite block also serves to avoid restriction of movement from the opposing posteriors.</p>

<p>The gear is positioned just mesial to the molar to provide pressure to move the molar distally. An adjustment key provided with the appliance is used to activate the gear once each three to seven days. Most doctors will instruct the parents to adjust the appliance at home, thus providing continuous pressure between visits. One 90 degree turn of the gear provides approximately one-quarter millimeter of movement to the distal.</p>

<p>The patient will become accustomed to the appliance if it is placed without pressure for the first week. After the initial adjustment, slight discomfort and displacement can be expected for approximately one week. The appliance should then seat comfortably.</p>

<p>At the outset of the case, most doctors will schedule their patients once a month to check the progress of the case. An appliance that does not seat fully usually indicates lack of patient cooperation and the need for more continuous wear. The gear is reversed until the appliance seats once again and the patient is instructed that the appliance should be worn at all times.</p>

<p>The time required for initial movement in response to pressure varies between individual patients, depending on the patient&#39;s cooperation and reaction to orthodontic pressure. Lack of movement on a given patient would usually indicate a need for a more extended period of pressure rather than a greater amount of pressure.</p>

<p>Once the molar has been moved to the distal, a simple band and loop or lingual holding arch can be placed to maintain the molar position until eruption of the bicuspids.</p>
