## 4 Intraoral Molar Distalization Methods
### Miniscrew-Assisted Frog Appliance  
[PERSON] et al. [50] redesigned the modified Nance appliance, which serves as the anchorage unit in the Frog appliance, by incorporating miniscrews, and introduced this modification in 2011. Anchorage was achieved using two screws placed on either side of the median palatal suture, posterior to the intersection of the line connecting the distal contact  
Figure 7: Beneslider appliance. points of the canine crowns in the rugae region with the midline. Aside from the modified anchorage unit, the rest of the appliance was constructed similarly to the conventional Frog appliance. It can be activated with a force of 200 g, and it has been reported that turning the Frog screw 3-5 times over a 4-5-week period results in an average distalization of 1-2 mm per month. [PERSON] et al. [17] investigated and compared the efficiency of two appliances for molar distalization, the modified Distal Jet and the traditional tooth-supported Distal Jet, for molar distalization and anchorage loss. In conclusion, the modified distal is an adequate compliance-free distalizing appliance that can be used safely for the correction of Class II malocclusions. In comparison with the traditional Distal Jet, the modified distal enables not only a good rate of molar distalization, but also a spontaneous distalization of the first premolars [17]. [PERSON] et al. [51] used a bone-supported modified pendulum appliance for molar distalization in 10 patients, placing an osseointegrated implant 7-8 mm posterior to the foramen incisivum for skeletal anchorage. After 7 months of treatment, the upper first molars exhibited 6.4 mm of distal movement and 10.9\({}^{\circ}\) of distal tipping, with distal movement also observed in the premolars, while no forward movement was noted in the incisors. Similarly, [PERSON] et al. [52] applied a modified pendulum appliance supported by two miniscrews in the palatal region in 15 patients. After 7-8 months of distalization, they reported that the first molars demonstrated 6 mm of distal movement and 11.3\({}^{\circ}\) of distal tipping, the second premolars showed 4.85 mm of distalization and 8.6\({}^{\circ}\) of distal tipping, and the upper incisors exhibited 0.5 mm of retrusion and 1.27\({}^{\circ}\) of palatal tipping. The modified pendulum appliance is shown in Figure 8.  
The modified palatal anchorage plate was introduced to the literature by [PERSON] et al. [53] in 2010. The modified palatal anchorage plate appliance was introduced to effectively distalize maxillary molars in adolescents [53]. It functions by rigidly attaching a palatal plate adapted to the curve of the palatal region in the transverse direction to the palatinal process of the maxilla, with one minivail on one side of the median palatal suture and two minivails on the other side. With three notches on the palatal plate, the direction of the vector that creates the distalization force can be adjusted differently. In this way, the distalization pattern can be modified according to the desired movement. [PERSON] et al. [53] evaluated the treatment effects of maxillary posterior tooth distalization performed by a modified palatal anchorage plate appliance with cephalospor derived from cone-beam computed tomography. In conclusion, the maxillary first molar was distalized by 3.3 mm at the crown and 2.2 mm at the root level, with distal tipping of 3.4\({}^{\circ}\) [53]. Figure 8: Modified pendulum appliance. The Keles Slider appliance was employed by [PERSON] et al. [43] bilaterally with support from a palatal implant. An 8 mm long and 4.5 mm diameter osseointegrable titanium implant was placed in the palatal region for anchorage. [PERSON] et al. [54] performed three-dimensional comparisons of changes occurring after maxillary first molar distalization with modified and tooth tissue-supported Keles Slider appliances. They reported that only dentoalveolar changes and maxillary first molar distalization were obtained in both appliance groups.