IMPLANTS AND ANCHORAGE IN ORTHODONTICS .ppt

INTRODUCTION
It is a complete orthodontic treatment system designed for those goal oriented orthodontists who would like to treat efficiently to a predetermined goal and reach that goal on a routine basis. It is designed to quantify the anchorage requirements of the orthodontic problem and thus clarify the necessary treatment steps needed to reach the goal.
SPECIALITY - SYSTEM
Banded or bonded edgewise appliance.
Built-in tip, torque & offset.
Analysis and treatment planning chart with a step by step treatment procedure for seven different extraction & non-extraction choices.
Timing chart aids in estimating the time needed for each step, and a self check chart helps determine when to proceed with the next treatment step.
EVOLUTION
Charles Tweed was first to advocate anchorage.
He used standard edgewise appliance, the tip, torque & offset bends had to be placed in each edgewise arch.
Disadvantage.
EVOLUTION
Reed Holdaway- preangulation of the edgewise appliance in the mandibular buccal segments.
Larry Andrews – first to introduced the completely preadjusted appliance (straight wire appliance)
Level anchorage system – combination of straight wire appliance with anchorage preparation as described by Holdaway.
Preadjustments of the Level anchorage appliance
Two choices of distal crown tip for the mandibular buccal teeth: regular & major.�The choice depends on the severity of the malocclusion and is determined by use of the analysis chart.� REGULAR MAJOR
Measuring the severity of the malocclusion
1.Depth of the curve of spee.
2.Lower arch discrepancy.
3.Space to upright the lower anteriors.
4.Lower buccal anchorage to retract the canines
5.Anchorage to correct the ANB
6.Anchorage in relation to the mandibular plane angle.
7.Anchorage to retract the upper anteriors in extraction cases.
ANCHORAGE
Tooth Anchorage- Axial inclination
Anchorage savers –
Headgear.
Palatal bar.
Delaying extraction of the maxillary premolars.
Lip bumpers & Functional appliances.
The analysis chart
Limits of the dentition – boundary within which the correction of the malocclusion must take place.
Stability – lower incisor in angulation and a linear measurement in millimeters to N-B line. Upper incisor it is related in angulation and a millimeter measurement to N-A & interincisal angle.
The analysis chart
3. Anchorage –preparation.

4. Function – canine protected occlusion.

5. Tissue response- force & tooth movement.

6. Vertical control

7. Tongue posture
Analysis chart
Analysis chart
Instructions for using the analysis chart
Treatment steps, timing & self-checks
STEP-I
STEP-II
STEP-II
STEP-III
STEP-III
STEP-IV
STEP-V
STEP-VI
STEP-VI
FINISHED CASE
Advantages
Precise treatment plan- analysis chart
Arch wire bending been reduced .
Efficiency is improved- treatment steps & self-checks for each step.
Nitinol arches are extremely smooth & resilient as resul

1.  To preserve what is normal
 To prevent the undesired movement
 To get the desired movement
To keep it as intra oral as possible

THE BIGGEST CHALLENGE

2.  Innumerable attempts and
innovations
 Success very subjective
 Dogmatic following
 The latest in the inventory

4. Versatility in providing anchorage
Helping in bringing about tooth movements
which have been of a great challenge to the
orthodontist like intrusion of upper and
lower molars

5. Being as intraoral as possible
Less invasive though it is a surgical
procedure

6. SKELETAL ANCHORAGE
SYSTEM

7. For Orthopedic correction
Transverse
Vertical
Sagittal

8. For Orthodontic correction
Aligning
Leveling
Retraction

9. Pre-Christian era - Artificial materials
~1945, Vitallium screws
~1970, Linkow-Endosseous blade implants
Carbon implants (Osseointegration ?)
~1975, Kawahara et al Bioglass coated ceramic
implants
~1977, Branemark et al-Osseointegration
Hydroxy apatite
crystals

10. ~1983, Creekmore possibility of skeletal
anchorage
~1989, Roberts – titanium implants
~1991, Higuchi & James – Titanium fixtures
~1998, Costa et al – Miniscrews
~1999, Umemori et al – SAS for open bite
~2003, Giuliano Maino

11. CLASSIFICATION
~Based on position
Sub-periosteal
Transosseous
Endosseous

15. SPECIFICITY
~Maximum load >< quantity of
Osseointegration dependent on surface area
& tissue contact
TIME OF LOADING
~4-6 months after fixation

16. THE DIMENSIONS OF THE IMPLANT SHOULD
BE CONGRUENT WITH THE AMOUNT OF
BONE AVAILABLE AT THE POINT OF
INSERTION
~3-4mm in diameter
~6-10mm in length
~Length >< 1/ Diameter

23. MINIPLATES

24. TYPES OF MINIPLATES
L shaped Titanium

Y-shaped Ti
Straight Ti

25. ANATOMICAL SITES
Mandibular body- intrusion
Retromolar pad- distal movement
Key ridge- distalization
Anterior ridge of piriform opening- intrusion

26. SURGERY & HEALING TIME
Local anesthesia
Elevate mucoperiosteal flap
Bone exposed
Plates fixed

27. Application of FORCE ?
Wound healing !

28. Prophylaxis
~Antibiotics
~Antiseptic mouthrinses
~Oral hygiene

29. MECHANICS
A rectangular archwire to conserve torque
Elastic thread (3-4 weeks)
Steel ligatures