Temporary Anchorage Devices

• IN ORTHODONTICS
 Temporary Anchorage Devices

• IN ORTHODONTICS

Ravindra Nanda, BDS, MOS, PhD

UConn Orthodomic Alumni Endowed Chair
Professor and I-lead
Department of Craniofacial Sciences
Chair, Division of Onhodontics
School of Dental Medicine
University of Connecticut I-Iealth Center
Farmington, Connecticut

Flavio Andres Uribe, ODS

Assistant Professor
Division of Orthodontics
Departmem of Craniofacial S<:ienCe$
School of Dental Medicine
University of ConnecliuH Health Center
Farmington, ConnedinJ(
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 Contr ibutors
Aim Acar, DDS, PhD
Associate ?rofessor
Department of Orthodontics
Fawlty of Demistry
Marmara University
Istanbul, Turkey
Geoq~e Anka, DOS, MS
Associate Professor
Department of Orthodontics
Nihon University DenIal College
Tokyo, Japan
I lead Orthodontist
Sekido Onhodomic Office
Tama -shL Tokyo, Japan
Peler R. Oi~-dri ch, Prof Or Dr
Department of Orthodontics
University of Aachen
Aachen, Germany
Nejat Erw rdi , DDS, PhD
!'rofessor
Depanmem of Onhodomics
Faculty of DentistI)'
Marmara University
Istanbul, Turkey
Ulrike B. Fri tz, Prof Dr
Departmem of Orthodomics
University of Aachen
Aachen. Germany
Peter Goellner, Dr moo dent
Depanmem of Onhodomics
University of Jl.erne
Berne, Switzerland
Private Onhodomic Practi<:c
Bcrne, Switzerland
Brilla A. Jun g. Dr med dent
Depanmem of Onhodontics
lohannes Gutenberg-University .\Iainz
Mainz, Germany
Ryuzo Kanomi, DDS, PhD
Private Praaice. Onhodomics
Himeji, Japan
Hiroshi Kawa mura, DDS, DOSc
Professor and Chair
Depanment of Maxillofacial SurgeI)'
To ho ku University
Se ndai, Miyagi, Japan
Martin Kunkel, £>Tor Dr mcd, Dr med dem
Senior Consuham
Departmem of Oral and Maxillofacial SUl);cry
Johannes CUlenberg-Unj"crsily Mainz
Mainz, Germany
Monen Godtfredscn Laursen, DDS
Clinical Assistant Professor
Oll,anment of Orthodontics
University of Aarhus
Aarhus, Denmark
Certified Specialist in Orthodontics
('rival!' and Community Orthodontic Prod;ce
Aarhus, DenmJrk
Ke.Hoon lee, DDS, PhD
Assistam Professor
Depanmcnt of Onhodonlics
College of DentistI)'
Yonsei University
Seoul, Korea
lames Chen g-Yi Lin , DDS
Clinical Assistant Professor
Depanment of Onhodontics and Pediatric Demistl)'
School of DentistI)'
National Defense Medkal University
Taipei. Taiwan
Al1cnding Orthodontist
Department of Onhodontics and Craniofacial
Demistl)'
Chang Gung Memorial Hospital
Taipei, Taiwan
Dr. lames Lin and Associates' Orthodontic and
Implant Ce nter (privale practice)
Taipei, Taiwan
Eric Jein-Wein Li o u, DDS, MS
Associate Professor
Depanmen! of Onhodontics
Graduate School of Cr;miofacial Medicine
Chang Cung University
Taoyung. Taiwan
Associate Professor and Oirector
Depanment of Onhodontics and Craniofacial
DentistI)'
Chang Gung Memorial Ilospital
Taipei, Taiwan
vii
viII ConlriDulon

Rln e Melsen, Dr Odont, DOS Yo ung·Chd "ark, DDS, rhO

Profasor Professor alld De~n
OepJrunent of Onhodo11lks Dt>panment of Orthod0!11ics
Univt'nity of AJrhu5 College of Dentistry
School of Demisuy Yonse' lIniwlsilY
A.rhus, Denmark Seoul. Korea

Kuniaki Miya;imas DOS, MS, PhD A. "orrodi RillO, DDS, Ph D

Adjunct ProftSSOr Pri\'at~ Praclice
Department of Orthodontics Leiria, Portugal
5t. Loui~ University Ce llier for AdvJnced DentJI
Ed u('d lion J~ffery A. Rohens, DDS, MSD
St. Louis. Missouri Privatl" Practice
Roben~ Onhodontio.
~lIrO$ h; Nilgil5al.:a, DDS, DDSc IndialldpoliJ. Indiana
Clinical Professor
lkpanmfnt of Maxillofacial Surgei)' W, Eugene Roben s, D DS, I'h o , DH ClMoo)
Tohoku University Jdr.lb,lk Professor and Head
Sendai, Miyagi, Japan Senion or O rth odontics
Director lndi.ln.l Uni"'N~ity School of Dentistry
Oepannmu of Oral Surgery Jndian.lpolis, Indiarm
Miyagi Children's Il ospil~l Aswciatc Professol
Scndai, Miyagi, lapall Depanmcnt of Ordl and Maxillofadal hnplanwlogy
Unil'l'rsity of Lille JJ
Ravindra N and;!., 80S, .\IDS, Ph D 1'3OIhy of Medicine
UConn Onhodontic Alumni Endowtd Chair jjll~, 1'r3l\ce
Pro(~r and Head
Departmenl ofCr.mlofilcbl SCiences Junji Sug~ ... ~r~, DDS, DO Se:
Chair, Division of Orthodontics Visi ting ClinicaJ Ilrofl!SSOr
SChool of Dclltal Medicine Dil'ision of Onhodontics
l1niver~ity of Connw iCl.U Jlcahh ('.enter Depannti'nt ofCrd lliofacia l &iencl'
r.rming\On, Connectiwt S<:hool of Dental M~didne
Uni\'enoity of ConnOClirut
Makolo Nish im ura. ODS, DOSe: Farmington, ConlWClicul
Pan·Timl' lecturer Director
Division of Oral Dysfunction Sdl'l\CI' SAS Onhodonlic Centn'
Ikpanml'nt of Onll Ileahh and Dt"'o'elopmcnt Sdrncn tchiban<ho Dt:ntal Office
Graduate School of Dcmisty Sendai, Miyalli, r~p,lIl
lohoku University
Scndai, lap~n Flaviu Andrl'$ Uribe, DDS
Orthodomk Faruhy Assistant t'rofi'nor
liAS Orthodonlic Centre O;"~5ion of Orthodontics
Ichiban..o:ho Dental Offi~ Depanmi'r>t of Cr.lniof;x:ial Scil"11«5
Sfndai, Miragi, Japan Se:hool of 0e0l~1 Medicine
lI ni\'~noity of Connl'Clirul ~Icahh Centl'!'
li yo·Sang I'.lfk, DDS, MS, PhD Farmingtun, Conn«ticut
tI.$!IOCi~te Prof"sor
Dl'p~r1mem of On hod on tics Serda r O ~ iit1ll"~~ DDS, Ph D
"rungllQok National University Asso<'iate [>rofl'5Wr and Chair
School o{ DenTistry Dt:panment of Onhodontics
Dal'Su, Korca Ca.ziantep Unl\'cfljity
Clininl Director in the Student Clinic Faculty of Dl'nti$l/Y
Depdnml'nt of Onhodonlia GniJntep, l"ur"ty
K)'I.Iugpook Uni""nity liosptl.. l
O.legu, I{nru

Sunil Wadh wa, DDS
Assislalll Professor
Depanlnelll of Craniofacial Sciences
Unive rsity of Conne<:tiUIl
School of Dental " tedicine
Farmington. Connecticut
Contrlbulors ix
Heiner Wehrbeill. Prof Dr lIIed. Dr mOO dent
Professor and I lead
Depanmen\ of Onhodomics
Johannes Gutenberg·University Mainz
Mainz. Germany
 Preface
I'aliem (OmpliaJlc~, anchorage preservation, and I<lek
of anchor unih orum present a perplexing problem for
onhodontisl$, mainly because of a lack of effective
devircs. lieadgear, which is used [0 (onuaE anchorage
and requires palient cooperation, is a dcvict that has
bct'n used in onhodomics for a1 leas! 100 ycars. Despite
longeYily in the field. howe... er, the Us.! of headgeu has
enjoyed only moderate succt'SS. In recen t }'i'ars, with Ihe
introduction of temporary anchorage deviCd (TAOs) , a
paradigm shirt has occurred in the overall perspective
toward paliem compliance, prewrVlnioll of anchor.tgl',
and fadliLllion of (realmI'm for V<1rious difficul t maiO(-
dU5ionf. i\s happ"'IIS with cve'Y innovation, th .. learn-
ing ruIW is SIel"p as a result of lack of evidence-based
pl"O$pe(live studies ~I.lled 10 slability. applications. and
long-If.m results.
No one person can claim to bt! an expert in the appli-
cation ofTADs, since the technique is youn!! ~nd lcsults
are ~till short term. For this reason, I invi tl'd clinicians
who have been instrumental in pioneering this tech-
nique to participate in the cre~tion of this book. They
haw helped nle to compile a book that b clea r and
concise in describing some of the basic prindplt:$
involved in the applkation of TAOs for differen1 types
of mal occJu5io ru. TIle book is not dt:$ignl'd to be an
exhaustive compendium of every application of 1"ADs
that has been reported . Instead, the primary emphasis
is on the detaill'd description of m.. thods that have
been shown to be successful and have the potential to
become mainstrea m in clinical orthodonti cs. The tcrt
will app;:JI to both academics and clinicians, since
equal importance has be£n given to both thcoletical
and practical aSpc<:ls. Each chapter covel"$ il$ topics in
great delllit and is accompanied by exteru;ve illustra·
tions and Il"ferenct:$.
ORGANIZAnON
Part I, 6iologial Perspettive, addresses the use of
endosseous rnini.screws and the biOlogical rnponse
to TAOs. Chapter I leviews the historical p.."rspE"Clivf of
implant development relative 10 the current (oncepts
of bone physiology, surgery, healing. a nd integration. It
i$ written to help clinidans develop a Kientilk perspec-
liv~ (or the effective use of miniKI"eWS. Chapter 2 looks
at bone biology and the factors that predict stabi lit)'
behi nd m«han icaliy retained ,lI1d 05scous·integrated
o rthodontic TAI>$.
P~ rt II , Diagnosis ~nd Treatmen t Planning. looks
at thl'$l' aspCCI5 for orthodontic rasa that require
skeletal ancho rage Chapter J reviews idea) sites for
the placement of mini-implants and how to apply orth·
odontic fo"... using three·dimensional finite ~)~ment
models (3D I'F.M). Chapter 4 provides a unique ~r.
spective of !h~ I{. ] system, since the chapter au th or
designed the I{· I System. Chapter 5 det,llls what factol"!i
should be add ressed when deciding to usc skeletal
anchorage, including the indications (or when skeletal
anchorage shou ld be used ~nd the possible failu~ and
advi'T"So.' dftcts.
p~" Ill , "i"mecha nlcs Consi der.ltion s, offers prag.
matic d iscussions r<gardillg the appl ication of sound
biomechankal prindpll!$ involved in mOOng le-eth with
the help of skeletal ~n(horagc. Chapter 6 addresses
th e fundamenlal biomechanial principles of minl_
screw·driven orthodontia and explains the practial
appl ication of these principles. Chapter 7 reviews
different dinial Kcnari05 in which skeletal anchorage
may provide an advantage to convention al trcatment
mechanics.
I'a n IV, Anchorage Device Systems and Clin ical
Applicatio ns, exl,lores the different types of anchoTa!,'"
device systems and the "clinical applications" oflhese
systems, with an emphasis on practical applications and
avoidance of common mistakes and pitfalls. Chapter 8
addresses the applianCC$. mechanics. and t~atment
strategies for orthognath ic· like orthodontics in Class I
and II dentoalveolar protrusion, dass 1II delltoal\'oolar
protrusion. anterior open bite. and Class II mandibular
mrognathism. Chapter9 details the management of the
occlusal plane using TAOs and looks at the d imensions
of occlusal plane in space and force application and
dC','ices. Chapter 10 reviews the treatment limitations
Ihat corne with missing teeth, tooth movement using
TAOs, and Wllgenital l1li~sing teeth. Chapter II
addresses various methods for bone anchorage, includ·
ing microimplams, rl!$()rbable screws, bracket head-
type microimplants, and noninvasive miniplatl'S.
Chapter 12 prOOdn information on mini· or micro·
screw implanli. Chapltt 13 detai ls the adv~ntagl'S and
disad\Olntagt' of using titanium miCtO$O"ev."S, as well as
screw design, implant insertion , typical implant sit ts.
complications. and (ailure rates. Chapter 14 looks at the
U!K' of conve ntional dent.ll implants versus TAOs for
orthodont ic anchorage.
Part V, Ske leta l Anchorage, condudes the book by
looking specifically m the different aspects of skeletal
an(horage. Chapter 15 .lddle~ th ... features of or-
thodontic miniplatcs and Krews, indications (or skt'll"l~1
anchorage systems (SAS) treatment. timing of treat·
ment positioni ng of miniplall'S, orthodontic mechan-
ics ofSAS, and ~orgica) procedures for implantation and
removal of miniptatl'$. Chaplet" 16 detdil$ ,he cJinial
U!K' of different onhodomk implants 10 correct diffemtt
mdlocdusions. 111e tre3tmetlt methods Pll':5ented in this
chapttt are wmpared with the conventional method
and the benefil$ of the implant method are c!.tri fied.
,I
Chapler 17 revi~s the analomic·.. 1 consider,uion~ in
PJlalal implam placement. r~diogr~phic evalualion of
bone height aI Ihe implJnI Sill', prt'pannion oflhl' surgi-
cal lemplate for posi tioning the implant, Ihe surgical
nll'thod, "",a lu.llion o f lhe impl'lIl1 pl" c.emem method,
and voHious orthodontic mcchanio used wi th p,llat,ll
implallls. Chaplcr 18 looks at a.unmotl ly used 5kelclal
ort hodonti c anchot:lge deviO"S and discusses their dini-
{";I i uSt' and polemial benefits. Sp<.'Cifi{";llly, the chaplet"
focuw:s on the USt' of pal~lal implants for orthodontic
t'UUllerll l.lsks.
CONTRIBUTORS
Thl'" amhOTs who ha,·coontributed to th is book are dini-
("lll>' 3aivl': many of them are engJgt.-d in ciini{";ll and
labomlory reS<'arch ill bone biology, tooth move ml'"lll ,
dinical onhodunllcs. and biomechanics. Thl'"re{o,,~,
mos, of the argurnents pUI forw...d in this textbook are
based on currenl research finding:;. I lowever, wrn-n con _
dusillC evidence W;t$ nOI available, we presented 3 con-
S<'nsus founded on 3 significant dCPlh of Cl<perien(f ,rnd
J\'ailable scielllific d(ua.
NOTE FROM THE EDITOR
I was fonun,lIe to work with 3 group of 3U1hol'!l who
are among the mOst prominent in the field of ortho-
dontia. We hope Ihal ourdfor15 will St'IVC as a stimulus
for further r~3rd1 in Ih ;~ incll:.tsingly impott3nt ~""~
of clinical onhodomia and also provide the much·
ne«led impetus loward gt'nual acceptabililY ofTADs in
day-Io-day onhodontics.
 Acknowledgments
lowe a heanfelt thanks 10 my contribUlOrs. Without
their cooperation, this effor! could not have come to
fruition. They are innovators. scientists. and super clini-
cians in the trucst sense, and they haw helped 10 pioncrT
a new way 10 address the correction of malocdusions_ I
hope they will appreciate the final result and will forget
about my constant pleas to meet deadlines,
Flavio Uribe deserves special Te<ogllilion for helping
me prepare this book during every slage of its develop-
melll. I am very fonunate 10 have a colleague like him,
who in his own righl is a thoughtful clinician and a
prolific wriler. A special thanks to Sunil Wadhwa for his
advice and comments. which were easy to incorporate
in development of the book
I also express my gratitude both 10 Caby Hrkko, who
during her residency did exhaustive literature resear(h
that was instmmental in helping me decide on potemial
contributors. and Madhur Upadhyay. who help<.'<1 me
in the fin al stages of preparing the manUKript, espe-
cially with proofreading o(various chapters.
A book like this is nOI possible without the cn(Our·
ageme1l1 o( the publisher. I express my sincere thanks
to Senior Editor John Dolan (or laking up this project
and h~lping me at every step, and my deep grati!Ud~ 10
Counney Sprehe. my developmental editor, (or being
the driving fOf((' for Ihis book (,om day one.
Ravindra Nanda
lIiii
 Contents

Part I BIOLOGICAL PERSPECTIVE

Chapter I EndO$seot)s Mlniscrews: Historical, Vascular. aM Imegration Perspectives, 3
W. Eugene ROOms and Jeffery A. Roben$
Chapter 2 Biological Response to OrthodOntiC Temporary Anchorage Devices. 14
Sunil WadhwII ""d Ramndm Nand"

Part II DIAGNOSIS AND TREATMENT PLANNING

Chapter 3 Radiographic EvalUiltion of Bone Sites for Mini-lmplant Placement 25
Kuniaki Mi,'a jima
Chapter 4 Miniature Osseorntegrated Implants for Orthodontics Anchorage, 49
Ryuw Kanllm; and IV. Euge"e Rolwm
Ch apter 5 FaclOr'> in the Decision to Use Sl:eletal Anchorage, 73
/line Mei5ell and Monell Godtfrl'dsen tauf$I!r1

Part III BIOMECHANICS CONSIDERATIONS

Chapler 6 Biomecnanical Principles in Mmi5Crew-Dr1ven OrthodOntio. 93
Young-Chel ['ark all(/ Kee·/oon I.£e
Chapter 7 Skeletal Anchorage Based on BiorTle<hanics. 145
I'I,w;o A"dre, Uribe lind Rm~'II(Jra Nail/itt

Part IV ANCHORAGE DEVICE SYSTEMS AND CLINICAL APPLICATIONS

Chapter 8 Appliances, Mechanics, and Treatment Strategies Toward Orthognathic-Like Treatment Results, 167
Eric Jein-lVein Liou mul I"mes Cheng-Yi Un
Chapter 9 Controlled Occlusal Plane Changes Using Temporary Anchorage Devices, 198
Gcorge Alibi
Chapter TO Man<!gement of Missing Teeth Using Temporary Allchorage Devices. 223
George A li bi
Chapter 1 I Skeletal AnchO(age: Different Approaches. 238
A. Ko.,-odi Rino
Chapter 12 Clinical Application of Microimpjants, 260
H)'o-Snng I'ark
Chapter 13 Clinical Suitability of Titan ium Mrcroscrews fO( Oithodontic Anchorage, 287
Ulrike B. fritz ami PCler R. Diedrich
Chapter 14 Treaunem Planning With Endosseous Implants fO( Orthodontic Anchorage and ProsthodontiC
RestO(atiom, 295
1'1"'10 Amlre5 Uribe Ilml R"r'indra Nan/iii

Part V SKELETAL ANCHORAGE

Chapter 1 5 Skeletal Anchorage System Using Orthodontic Miniplates, 317
Junji $uga",ara, MakOID Nishimura, /-lirwhi Nagruaka, ",,,I Hiroshi Ka",amura
Chapter 16 Bone Anchorage: a New Concept in OrthodontICS, 342
Nejat £rverdi mid Serdar OJ",,m<'Z
Chapter 17 Palatal Anchorage. 374
Nejlll En-erdi ""d Ahu A(<lr
Chapter 18 Sl:eietal Anchorage in OrthodOntiCS USing Palatal Implants. 392
Heiner lVehrbein, Brilra A. lung, Martin Kunkel, ami Peler GOellner
 PART I
BIOLOGICAL PERSPECTIVE

"
 CHAPTER 1
Endosseous Miniscrews: Historical, Vascular,
and Integration Perspectives
W. Eugene I?obens and Jeffery A. I?oberts
T he explosive development of temporary anchorage
devices (TAUs) presents a professional dilemma for
onhodomists. Ahhough a large body of evidence sup-
pons oSSRoimegmrl'd anchorage, mOSt miniscrew and
microscrew systems currently are HOI d..sjgn~'() for
osseous integrution (osscointegration) and were mar·
keted with liu le or no fundamcnwl scientific verifica -
lion. Clinical applications have superseded the scientific
rationale for their effective use. In the :lbscnce of ade-
quate (evidence-based) research, dinicians must rely
on a limited number of b<lsi(. 5(ience studies, supple-
mented by scientific interpolation of fundamental data
derived from investigations of other Iypes of endosS<'-
OllS implants. Historically, the ClilTent surge in mini·
screws resembles the initial devdopmem of denwl
implants. At present the only reliable rne~ns for dis·
criminaling among miniscrew sy5lemli is using Ihe fun ·
damental prillciplcs of bone biology, osscoimegratioll,
and biocomp~tibility. TIle "state ofth~ "n " is "clinician,
beware:
','his chapter reviews the historical perspective of
implam deve!opmem rel~tive W omenl concepts of
bone physiology, surgery. healing. and imcgration. nle
purpose is \0 help clinicians develop a sciemific peTSPff'
ti,'C for effcctive use of mini~uews" Bone physiologk.l1
principles arc im ponam in selecting 3 device and devel.
o ping a realistic perspective for using it crfectively to
treat specific malocclusions, No single system is optimal
for all clinical applications. n'e anchorage n~·..:ds of
each patient are unique bt>eause of the nature of the
malocdusion, the hosl response to the inv,\siwdevice( s),
and the biomechan ical approaches favored by the
cl inician,
DEFINITION AND DESIGN
The TADs (Ompose a broad array of implants used
to suppon onhodontic treaune1l1, As presently defined.
all TADs are invasive devices and are b-e5t resented for
problems that cannOI be effectively managed with
convemional mech anics (Figure \-1, A) . 11Ie anchorage
componem may be a biocompatible wire allached 10
the en,tosseous base of an implant design~'d for pros·
thetic use. Funhermore, a nonfunctional osseoime-
grated implant may serve as an abutment for surgically
assisted. rapid palatal expan~ion (I'igure \ . 1. 8) . ·I'h..,
products with the longest clinical histOJY of efficacy are
os~oimegra ted fixture~ originally designed for pros·
thetic purposes. '·'
Most current mini5Cl'eW5 are titanium (1i) or tita-
nium aHoy and are manufadured with a smooth.
machined surface that is nOI designed 10 osscoilllegratc.
By definition. TAOs are temporary devices; no long·(;>ITn
functiona l or esthetic role is planned. Thus. most TADs
are removed a(ter orthodontic treatment Howe\'er.
some osscointegrated TADs may be covered with saft
tissue (· put 10 sleep") or retained for sustained I)ros·
thetic funnion (see Fi gure I-I. B) . At present, Ihe mOSI
common TADs include miniscrews. microsocws, min·
ia ture implallts (mini·implants). pal'lml implan ts.
modified bone plates. and retromolar im plants, as well
~s functionally loaded prosthetic implanlS. In addition,
a TAD may be a temporary prosthetic component (e.g..
bracket allae,hed 10 gold crown) that is removed after
treatment (Fib'\lre 1-2). '111erefore. TADs can range from
nonintegrated miniscrews 10 implant·$upponed pros-
theses (ISPs) wilh lemporary onhodontic altlchments.
BACKGROUND
At the Bone Research Laboratory at the UniveJ1'iily of
Padlic in San Francisco, the authors performed a series
of experiments 10 develop onhodontic anchorage
devices.'·· .. Titanium miniscrt'ws. 2 mm in diameter
with an acid·el(hed surface, were tested in rabbils. dogs.
and monkeys from 1980 to 1988. "I'h .. de"ices were very
predictable when pla(ed in exlraoral sites such as rab·
bit femur a nd nasa l bones. ~""" but the intraoral use of
Ihe miniscrews in dogs and monkeys was less success-
ful (failure ratc. - 25%·50%). Failure was defined as
3
4 PART I BioIogic.. 1 P.-np«live

Figure I-I
A. ~~. a.", III. p~ni~lIY~~'l\ulous nuJocdusion in 4J-Y" ••.()Id WOmdn compliuted by
in ... lin-depe-ndml di.loon n,dlilU' ,....d end-51• •nul d; ... ~ ... II. I.di .t'lfOmolu Impl.nI
(TAD) was used 10 ~I;gn and I1l(lW 1M [hird molu maially to "'f\~ .as an arn.umem for 3
6nd pro:Olhn,s; it will 1M' rt'ITIO'-U fkQ,,, ... of!h~ P.l,iml', tw.llh probl~ onhogrmhi<"
5Uf8I'f}' ..-u rIOI a vi.ble option. The rompromi ... trl"ltmtnl in dlt m""iII~f}' arch wal pfr-
prostlletic alignmemlo opm 'pM~ oow«n tht l1'flh md mcn~ IIw Idl segment maially.
The riglll mAXiIl~f)· implam In th~ lubefosiry region wn origin~lly " Icmpordf)' ancho",~
device (TAD), but il w,1I ft'tainw 10 5<:"'" "s a posterior abutment for a removable pania)
denmfr.

mobililY or exfolialion of Jhe anchora~ filnure. Similar
10 current reports."" there were 5ignificMlI anatomical
limitations rd3tive to where min;screws could be- plaud.
Funhennore. sofl ti$SlU' irritalion of cheek. tongue. and
alveolar mUC0$3 was a significant problem. The biome-
chanical possibilities "·ere wmpromised bec:ause of a
lack of torsio,,~1 resistan«-. panicularly when immedi-
ately loaded. Unlt5s m;niscrews are os5tOimcgrated, Ihe
m,»t reliable mechanics are for the line of force to pass
through the implam, nOI ideal for treaUnenl of mo§t
malocclusions, The use of lever am,s 10 improve Ihe line
of force may result in unfavor.lblc mO!llen~' on the
implant.
It Is impomnt to nOll' that the limitalions of Ihe
miniscrews tested more than 20yearsago in Ih~ authors'
laboratory are similar to Ihe omenl predictability for
these devicts."" ThUs. it is apparent that Ihe biological
efficaq of miniscrews is lagging th~ rapid increasc in
their dinical usc. This s<:.mario is ~imilar 10 Ih~ initial
d('\·elopmem of denial implanl$ befOTe Ihe well-
documenled introduction of "osseoinlegralion" in Ihe
early 19805."
The 2· mm, acid·et(hed Ti minis<:rt..'W$ develop·ed in
Ihe alllhors' laboralory were never used in patients
b«ause th e intraoral animal data were considered inad_
equale 10 secure institutional review board (tRill
approv~1 for a clinicallrial. Because of the long history
of clinical su(c~ without any serious complicatioru
(e.g., osteomyelitis. neoplasms), siandard 8ranemark
(Swedish) prosthetic fu:lura wer~ adapted for orth-
odontic anchora~. These relatively large implants (3.75
x 7 mm) could not be- placed in the alveolar ridge if
space closure and arch consolidation were Ih~ objectl\le$
of Iftatment (S« Fig. \.]). I'or malldibular anchorage.
Ihe retromolar area was selected as the optimal si ll'.
Indirect anchorage evolved as the mosl effectiw mecha.
nism for mOSI applications. ' To a lesser exlent, the
luberosity region oflhe m<lJCilia has served as ~n OS5COI.IS
si ll' for anchorage implanu (S« Ag. 1-1 . B) A prospec·
tive clinical trial of implanl anchora~ denlonstrnied
that mseointegraled anchorage is a highly reliable clini·
cal procedure."
The machine tools and methods fot manufacturing
11 and Ti alloy screws h,we improved dramJtically in
Ihe past 20 years, as illuSlraled by Ihe functional designs
of supramucosal heads for mJny mini..:rew syslems. AI
present. the major problem with TADs is the inabili ty
10 achieve osseoimegr.Jlio n routindy with mOSI current
devices. To ou r knowledge. the osseointegrated 1(-1
SYSlem (S« Chapter 4) developed by 0,- Ryuw Kanami
is Ihe only OMrointegraled miniscrew for orthodontic
i1pplicalion.·... As m;niscrew tf'chnology matures. other
osseoimegraled systems will likely (-"'Ol>"t.
PERSPEcnVES
Dental impla1l1 ancllora~ has progressed from non·
imegraled screws (19405)' 10 osseointegraled devkts
(1972 10 presenl). The firsl documemed UM: of osseo;n·
legraled unhodontic anchorage apparently W~i in a
patient trEated from 1912 to 1975 by Dr. Tom Iionon
(Columbus, Gwrgia) and Dr. lIilt Tatum (Opelika,
Alabama). Dr. Iionon corrected a buccal cr055b;lc
(scissors·bi te) with a bite plate and crOS$-claslics
anchored by an ossrotntegrated 11 blade implant.
cmtom·made and plaud by Dr. Hilt Tatum, a pioneer
in the field of implant dentiSlry. In addilion 10 pl~c­
ing the firsl osseointegrated implall\ fat orthodontic
 E"dosseous M,,,,u,ews: Historical. VaKu'ar. arid I"trq,atio" Perspectives 5

~'ere Il'lapse ofClus II. Division I malocclusion in 47·Y"'ar·old brach),<<'Phalic woman. A

deep·bi!~ malocclusion w.s (feat<"d 35 yean earlier wilh o."",ion of (OUf fin. pll'molaf$.
A. T",atment fequiml o~ning SJ)KG 10 replaa th~ mandibulu p",molUll with implants.
8. Onhooomic brackn.....,re att.KhW to the wu ""Il~m for the crowIl1 brio", inVGtirt3
and ClS,ing in gold. C. TIlt crowns "'Ith allach«l brackeu sen>ed :as TAOs for kwling and
finMirt3 the mandibul.r ,"th. O. Afte. uea,men, 'he gold crowns ~ mvonnl and the
brackm rem<ro-ed ,,~th a .10...., The crowns we", poli,t.ro and reuined :as tM ~nn.nem
proslhesu.

anchorage. Dr. Tatum was the developer of the maxil·
lary sinus bone graft procedure" and numerou~ other
dental implant innOvations'»'"
TIlt: field of dental implamology originally embraced
what was actually all osseointegratioll "failure" (fibrous
implant interface) with the semiphysiologkal tl'nn
"pseudoperiodomium.""'''' Ilowever. subsequent
research demonstrated that Ihl' fibrous interfa<e W<I$
aaually ava§(\llar scar lissu£; funhermore. mobile
implanl$ wilh a "pseudoperiodomium" had a high
failure ratf'. TItanium bladf' or cobalt~hromium alloy
(Vitallium) blade dental implants have had many
years o f (un(lio'131 ~JVice. Most favorable repons
involve blades ,hal achieved ossrointegrntion despite
being immediately loaded!'" The mOS! reliable
dental implant devices currently in use are osseoin(e·
grated systems. based directly or indirectly on the
biological concept introduced by Brlnemark and
his (oliegul'S.'L" l"i~ developmenlal progression
likely will repeal ilself with Il!$pea to miniscrew$
because osseoimegralion is a mature technology wilh
high reliability. Extension of the biol«h nology of