Maxillary molar anchorage preservation

Drs. Larry W. White and Francesca Scilla Smith use Anchorage Posterior Occlusal Guides for maxillary molar anchorage preservation.

Drs. Larry W. White and Francesca Scilla Smith discuss a technique for maxillary molar anchorage preservation

Maxillary molar anchorage has perplexed orthodontists since the beginning of premolar extraction therapies. Every clinician knows from sad experience that maxillary molars easily displace and rotate mesially when challenged with mesial space and force. Obvious and early remedies — e.g., transpalatal arches,1 Nance arches,2 intermaxillary Class II elastics,3 and headgears4 (Figure 1) — proved incapable of providing reliable molar anchorage. More recently, the use of miniscrews has enjoyed some popularity although they require local anesthesia while also bringing more expense and often equivocal stability. Melsen and Fiorelli5 have advocated the use of occlusal anchorage enhancements using Triad® light-cure gel (Dentsply Sirona, Charlotte, North Carolina) (Figure 2).

Figure 1: The Nance (left) and a transpalatal arch (right) have been used as maxillary molar anchorage in first premolar extraction patients
Figure 2: Occlusal pads made of Triad® Gel (Dentsply Sirona, Charlotte, North Carolina) to reinforce maxillary molar and premolar anchorage in first premolar extraction patients

Recently, a variation of the Melsen and Fiorelli occlusal pads has proven effective and doesn’t require the occlusal coverage of mandibular molars and premolars, while providing a more defined stop for the maxillary second premolar when maxillary first premolars have been extracted (Figures 3 and 4). This places an occlusal stop solidly against the maxillary second premolar and, as seen, prevents the maxillary posterior teeth from moving forward. For want of a proper name, these are called Anchorage Posterior Occlusal Guides, aka, APOGs.

Figure: 3: A typical Class II malocclusion that will require the removal of maxillary first premolars
Figure 4: Note the anchorage pads made of Triad gel (blue arrows) extended vertically to engage the maxillary second premolars having allowed the alignment of the anterior teeth, while preventing the mesial movement of the maxillary posterior teeth

The APOGs are made using the Bite Ramp Mini Mold™ (Ortho Arch Company, Schaumburg, Illinois). The mold is filled with the Triad gel and applied to the distal occlusal surface of the mandibular first premolar and light-cured. If upon removing the mold, the APOG doesn’t touch the maxillary second premolar, a small amount can be applied to the scaffolding of the bite ramp until it makes contact with the upper tooth. If the mold touches prematurely, it is easily smoothed to fit with an air turbine bur.

Clinicians can apply APOGs easily and quickly with minimum armamentarium, small cost, and no laboratory involvement, while using the ever-present occlusion as reinforcement for posterior maxillary anchorage in maxillary premolar extraction patients.

After reading Anchorage Posterior Occlusal Guides, check out Dr. Larry White’s 50-year orthodontic career here:

Francesca Scilla Smith, DDS, MS, was born and raised in Arezzo, Italy. She graduated summa cum laude at the University of Florence Dental School and obtained her orthodontic degree from Nova Southeastern University College of Dental Medicine in Fort Lauderdale, Florida, with a master thesis on conventional and digitally driven indirect bonding. Dr. Scilla Smith practices orthodontics in Dallas, Texas.



Larry White, DDS, MSD, FACD, is a graduate of Baylor Dental College and Baylor Orthodontic Program and now has an orthodontic practice in Dallas, Texas.

  1. Melsen B, Bonetti G, Giunta D. Statically determinate transpalatal arches. J Clin Orthod. 1994;(10):602-606.
  2. Nance HN. The limitations of orthodontic treatment; mixed dentition diagnosis and treatment. Am J Orthod. 1947;33(4):177-223.
  3. Kesling PC. The Tip-Edge PLUS® Guide and the Differential Straight-Arch® Technique. 6th ed. TP Orthodontics: La Porte, IN; 2006.
  4. Melsen B. Effects of cervical anchorage during and after treatment: an implant study. Am J Orthod. 1978;73:(526-540).
  5. Melsen BG, Fiorelli G. Biomechanics in Orthodontics. 3rd ed. Aarhus: Denmark; 2013.

Stay Relevant With Orthodontic Practice US

Join our email list for CE courses and webinars, articles and mores

Subscribe Today

Orthodontic Practice US is a leading dental journal and your publication for Orthodontic continuing education, Orthodontic case studies, and more. Subscribe to Orthodontic Practice US today!

Online Dental CE

Earn 16 dental continuing education credits as an Orthodontic Practice US subscriber per year.

Other Dental Publications
Dental Sleep Practice
Endodontic Practice
Implant Practice
Orthodontic Practice

MedMark Media is the leading interactive marketing and advertising company specializing in marketing and advertising, custom media, and public relations for the U.S. dental industry.

AGD PACE MedMark White

Copyright © 2024 Orthodontic Practice US - Dental Journal and Online Dental CE | MedMark LLC
15720 North Greenway Hayden Loop, Suite #9 Scottsdale, AZ 85260 | All rights Reserved | Privacy Policy | Terms & Conditions

Scroll to Top