When primary molars are lost prematurely, bicuspids will often erupt mesially -- eliminating the space in the arch needed for the cuspids. When this occurs, the bicuspids and the first molars need to be moved distally to regain the cuspid space. This can be accomplished with this Upper Sagittal design. It uses two sagittal screws with the cut in the acrylic just mesial to the first bicuspids. By the nature of the design, some reciprocal movement of the anteriors will occur. To assure that the majority of the movement is in the distal direction, it is imperative that the second molars are removed and smooth occlusal bite planes placed over the posteriors -- this to eliminate any occlusal forces that might interfere with the distal movement. Appliance anchorage is of primary concern and is achieved by using multiple clasping (illustrated by use of four Adams Clasps). This appliance is best used when the molars and bicuspids are fairly well aligned along the posterior arch. Note: Many practitioners like to add cuspid retraction hooks to this appliance. This allows them to retract the cuspids at the same time that the space is created.