Uprighting a mesially-tipped molar with a mini-implant-supported lever

This case report presents a technique for uprighting a mesially-tipped mandibular second molar by using a mini-implant-supported lever designed to direct the force vector lingually and apically. A 38-year-old male was referred for molar uprighting before implant placement in the mandibular right second premolar and first molars. To avoid low bone density in the retromolar triangle and mobile soft tissue in the retromolar pad, a mini-implant was strategically placed on the distal side of the mandibular right second molar to ensure better bone quality and minimal soft tissue irritation. A lever extension was placed in the bracket slot on the mini-implant head using the novel subslot overtie method through the hole beneath the bracket. This setup directed the distal traction force through the molar's center of resistance in the occlusal plane, preventing undesirable rotational moments. To generate an intrusive force on the distal marginal ridge, an elastomeric chain configured in a slingshot manner was applied from a button on the mesial surface of the second molar to the lever extension, crossing over the occlusal surface. The treatment was completed within 5 months. For retention, a minitube was bonded to the distal surface of the second molar and ligated into the lever. Using this lever extension allowed ideal placement of the mini-implant, enabling a straightforward force application that included an intrusive component while minimizing unwanted movements.