Limited Anchorage on Permanent Mandibular First Molar is Solved With New, Simplified Appliance

Treatment of a permanent mandibular first molar that has mesially migrated and inclined is difficult in the mixed dentition due to the limited anchorage provided by the remaining primary canine and first molar. If the patient happens to have a stainless steel crown in one of these teeth, bonding brackets to this limited anchorage tooth becomes extremely difficult and unpredictable. The article will be a step by step development and clinical use with illustrations. Regaining lost posterior space has been described in the literature using active lingual arches, lip bumpers, utility arches and removable split saddles. In the authors experience the designs that they will present allows for a more precise, predictable, and easier correction of these malocclusions. The authors will also present an Echeverri Dental Center fabricated version of the Halterman appliance, used to de-impact a mesial impacted second permanent molar, on an intellectually delayed patient.