Temporary anchorage devices in orthodontics

Gowri sankar. Singaraju

Professor of orthodontics
St Joseph dental college
Eluru

Sumant Goel
In private practice
Belguam
Ex .Professor & Head Of Orthodontics, Bagalkot and Belguam
Honorary Clinical Lecturer Dept. of Children Dentistry and Orthodontics, Prince Philip dental
hospital, Hongkong

Introduction of titanium implants in bone; many

orthodontists began investigating in using
Anchorage control is one of the most implants for the purpose of orthodontic
important aspects of orthodontic anchorage. Gainsforth and Higley(1945)
treatment. The success of orthodontic placed metallic vitallium screws in dog
treatment hinges on the anchorage ramus, Linkow(1969,1970) used
protocol planned for a particular case. mandibular blade-vent implants in a
Use of extraoral anchorage devices such patient to apply class II elastics,
as headgears requires full patient Sherman' (1978) placed the first
cooperation, which is sometimes not orthodontic implants. Block and Hoffman'
possible and is unpredictable. (1995) introduced the onplant to provide
Introduction of implants in orthodontics orthodontic anchorage.
have solved this problem. Implants have
become one of the best sources of CLASSIFICATION OF IMPLANTS FOR
reliable anchorage. Mini implants have ORTHODONTIC ANCHORAGE(4)
revolutionized the field of anchorage in 1. According to the shape and size:
orthodontics.(91-3) I) Conical (Cylindrical)
This new modality has been called by a) Miniscrew Implants
several names, some of the popular ones b) Palatal Implants
are c) Prosthodontic Implants
Mini implants II) Mini plate Implants
Microimplants III) Disc Implants (Onplants)
Skeletal anchorage 2. According to Implant bone contact:
Temporary anchorage device I) Osteointegrated
I) Non-osteointegrated
3. According to the application:
Use of implants as a source of anchorage
has number of advantages as compared I) Used only for
to traditional anchorage such as no orthodontic purposes.
patient cooperation, easy to use, (Orthodontic Implants) or TAD
shortening of treatment time, good ( temporary anchorage devices)
control on tooth movements. I I ) Used for prosthodontic
Branemark and co-workers" (1965) and orthodontic purposes.
reported the successful osseointegration

Table 1. showing the difference between conventional anchorage and implant

anchorage
TRADITIONAL ORTHODONTIC
character. ORTHODONTIC TREATMENT TREATMENT USING
IMPLANTS
Teeth and extraoral bony Implants
Anchorage Source
structures
Position of anchor teeth is Position is stable during
stability of anchorage
not stable during treatment treatment
 In order to get
sufficient anchorage,
maximum number teeth
must be included For direct anchorage teeth
are not necessary,
minimal number of teeth
Number of Anchor teeth
are needed for indirect force
on implant
anchorage

Treatment Efficiency Applying force on teeth, part More efficient as force is

of it is wasted, due to transmitted directly to the
periodontal implant
amortization
Duration of the treatment Treatment time prolonged Shortened treatment time
Patient's cooperation Obligatory Minimal
Treatment acceptability Most of treatment devices
restrict patients motion, don't Discomfort for patient is
meet esthetical requirements minimal

MINISCREWS(fig 1) Of al l orthodontic
i m pl ants , mi ni s crew s have gained
considerable importance due to less surgical insert and remove, and conform to the
procedure and easy installation. Titanium anchorage needs of the orthodontist/ The
miniscrews may be an ideal anchorage miniscrew can be loaded immediately with
system that fulfills the clinical needs of the forces in the range of 50 to 300. This
orthodontist. Some of their benefits include anchorage system can be used to support a
dependability, are well accepted by variety of orthodontic tooth m ovem ents
patients, can be immediately loaded, and in clinical s ituations involving
are simple to mutilated dentitions, poor cooperation

Table 2. TYPES AND FEATURES OF ORTHODONTIC IMPLANTS

ORTHODONTIC IMPLANTS

SI.
No.
MINI SCREWS PALATAL MINI PLATES ONPLATES

Every structure Every structure

Median suture of Median suture of
Anatomical sites for where where
the palate, the palate,
1 implantation there is enough there is enough
paramedian paramedian
cortical bone cortical bone

Patient's age no age Used after no age Used after

contraindications ossification of the contraindications ossification of the
median suture of median suture of
2
the palate the palate

Time of Loading Immediate loading Loading after

healing

3. Loading after Loading after

osseointegration is osseointegration
complete (3-6 is complete (3-6
months) months)

Perforation of the
Only perforation of
mucosa and bone Flap surgery Flap surgery is
Type of Surgery the mucosa is
4 preparation is is needed needed
needed
needed

Pain and
Minimum patient's Pain and Swelling Swelling Pain and Swelling
Postsurgical period
5. discomfort remains for a week remains for aremains for a week
week

6 For Orthodontic For Orthodontic For Orthodontic

For Orthodontic
anchorage, anchorage, anchorage,
duration anchorage, removed
removed removed removed after
after treatment
after treatment after treatment treatment

Size 3,3mm diameter, 2mm 10mm diameter,

1, 2-2, 3mm 4-6mm length diameter,5m m 2mm thickness
7. diameter,6-14mm length(screw)
length

MINIPLATES: ( fig 2)The Miniplate 1. The head component is exposed

Implants are comprised of bone plates
and fixation screws. The plates and screws
are made of commercially pure titanium
that is biocompatible and suitable for
osseointegration. The miniplate consists of
the three componentsthe head, the arm,
and the body
intraorally and positioned outside of the
dentition so that it does n o t i n t e r f e re
with tooth movement. The head
component has three continuous hooks for
attachment of orthodontic forces. There
are two different types of head components
based on the direction of the hooks.
Onplants ( fig 3)These are button type 4. Where asymmetrical tooth movement is
implants used in the palatal region. They needed
serve as anchorage source for expansion as 5. To treat borderline cases with non
well maxillary protraction. extraction method
6. Doing extreme orthodontics when patient
Common Indications for placement of is not willing to undergo orthognathic
implants (5-8) surgery
Mini implants are used most beneficially .
where three dimensional stable anchorage is SITES OF PLACEMENT:
needed, some of these situations are:
1. Where you can not afford any movement MAXILLA(fig4)
of reactive units (maximum anchorage case) Infrazygomatic crest area.
2. Patient with several missing teeth making Tuberosity area.
it difficult to engage posterior units Between 1st and 2nd molars buccally.
3. For difficult tooth movements, eg intrusion Between 1st molar and 2nd premolar
of anterior and posterior segments and buccally.
distalisation Between canine and premolar
 buccally. Between 1st and 2nd molars buccally.
Between incisors facially. Between 1st molar and 2nd premolar
Mid palatal Area. buccally.
Between canine and premolar
MANDIBLE( fig 5) buccally.\
Retromolar Area.

Methods of placement Uprighting of molars,

(1) Pre-tapping method: In this Mesiodistal tooth movement,
method the miniscrews is driven into the Open bite correction (archived by
tunnel of bone formed by drilling, making intruding posterior. Molar
it tap during implant driving). This method is Intrusion teeth: skeletal
used when we use small diameter miniscrews anchorage)
(2) Self tapping: Here a slight notch Molar Mesialization:
is made and then the screw is tapped in
bone. Distalization of 1st and 2nd
(3) molars (Graz implant supported
(1) miniscrews is driven directly into bone pendulum: GISP)
without drilling.
Intrusion of anterior teeth as
. Uses of orthodontic
well as molars
implants( fi g 6)( 1-11)
Onplants for expansion and
protraction of maxillaorthopedic
Used for retraction of anterior
use.
teeth (Class II Div I ),
.
CONCLUSION:
Implants provide absolute anchorage i.e.
complete bone anchorage. Implants have
revolutionized the field of anchorage in
orthodontics. So by choosing a correct
anchorage source we can get good results in
orthodontic treatment
References
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.
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