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Main Instructor Department of Orthodontics, Chi-Mei Medical Center, Tainan City, Taiwan.
Department / Institution
Classification Case report
First molar missing is a common clinical finding in the adult orthodontic patient. When the first molar is lost, adjacent teeth usually tips to first molar space and then the mesial tilting molar can lead to periodontal problem. Treatment of missing first molar could be second molar upright, tooth implant, traditional bridge or molar protraction depend on the patient’s condition.
Molar protraction will be a good option with proper bone support and oral hygiene, but closure of first molar space by protracting the second and third molar is time taking and challenging, which easily results in anchorage loss, tipping of the molars and root resorption. Therefore, if we choose molar protraction to close first molar space, the anchorage control is more important. Many previous case reports used temporary anchorage devices (TADs) or miniscrews for anchorage; however, our case presented another method, that was using accessory springs as brake mechanism which increase anterior anchorage, resistance to retraction and protracted the posterior teeth into the extraction space.
This case presents an orthodontic treatment on 46-year-old female patient who had a convex profile with four first molar missing. Because the patient was afraid of implant surgery, the treatment plan was using molar protraction to replace tooth implant to close first molar space and rehabilitating functional occlusion.
「discussion and summary」
Second molar is an alternative treatment after cautious selection. This case demonstrates the brake mechanism can be taken into consideration for protracting then mandibular second molars into the first molar space. After 31-month treatment, this patient was satisfied with treatment results. 
Protraction of Second and Third Molars into Missing First Molar Space with Brake Mechanism: A Case Report.