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Bone anchorage is a promising new field in orthodontics and already a wide variety of bone anchorage devices (BADs) are available commercially. This review aims to assist clinicians by outlining the principles of bone anchorage and the salient features of the available systems, especially those that may influence the choice of a specific BAD for anchorage reinforcement.
BACKGROUND: This article reviews the use of temporary anchorage devices (TADs) for maxillary molar intrusion. TYPES OF STUDIES REVIEWED: The authors reviewed clinical, radiographic and histologic studies and case reports. The studies provided information regarding the application, placement and biological response of orthodontic TADs. RESULTS: TAD-supported molar intrusion is controlled and timely and may be accomplished without the need for full-arch brackets and wires. Supraerupted maxillary first molars can be intruded 3 to 8 millimeters in 7.5 months (approximately 0.5-1.0 mm per month), without loss of tooth vitality, adverse periodontal response or radiographically evident root resorption. CLINICAL IMPLICATIONS: True molar intrusion can be achieved successfully with orthodontic TADs, re-establishing a functional posterior occlusion and reducing the need for prosthetic crown reduction.
UNLABELLED: Recently, there has been a dramatic increase in the use of implantable devices as direct adjuncts to orthodontic treatment. Whereas the use of conventional dental implants has been researched extensively, the body of literature associated with the more recent uses of implantable devices in orthodontics is relatively small. Currently, a limited number of such devices are used to aid in orthodontic treatment. The options include conventional titanium endosseous dental implants, palatal implants, titanium miniscrews (also known as micro- or mini-implants), and mini-bone plates. Integration of dental implants or implantable devices into contemporary orthodontic practice has the following possible advantages: serving as a means of increasing orthodontic anchorage, virtually eliminating patient compliance issues with regard to wearing of appliances, decreasing overall treatment time, and occasionally permitting orthodontic treatments previously thought to be impossible without surgery. CLINICAL SIGNIFICANCE: This article is a review of the currently available options for use of implantable devices as sources of temporary skeletal anchorage in orthodontics.
This paper describes the treatment of a female patient, aged 23 years and 5 months, with a Class II division 1 malocclusion, who showed severe anterior protrusion and lower anterior crowding. Specially-designed orthodontic mini-implants were placed bilaterally in the interdental space between both the upper and the lower posterior teeth. Both lower first molars showed severe apical lesions. Therefore, the treatment plan consisted of extraction of both upper first premolars and lower first molars, en masse retraction of the upper six anterior teeth, lower anterior alignment, and protraction of all the lower molars. C-implants(R) were used as substitutes for maxillary posterior anchorage teeth during anterior retraction and as hooks for mandibular molar protraction. The correct overbite and overjet were obtained by intruding and retracting the upper six anterior teeth into their proper positions. The dentition was detailed using conventional orthodontic appliances. The upper C-implants contributed to an improvement in facial balance, and the lower C-implants made it possible to protract the lower second and third molars with less effect on the axis of the lower anterior teeth. The active treatment period was 29 months and the patient's teeth continued to be stable 11 months after debonding.
OBJECTIVE: To evaluate the maxillary molar distalization and anchorage loss in two groups, one before (MD 1 group) and one after (MD 2 group) eruption of second maxillary molars. MATERIALS AND METHODS: After a sample size calculation, 20 patients were recruited for each group from patients who fulfilled the following criteria: no orthodontic treatment before distal molar movement, Class II molar relationship defined by at least end-to-end molar relationship, space deficiency in the maxilla, and use of an intra-arch NiTi coil appliance with a Nance appliance to provide anchorage. Patients in the MD 1 group were without any erupted second molars during the distalization period, whereas in the MD 2 group both the first and second molars were in occlusion at start of treatment. The main outcome measures to be assessed were: treatment time, ie, time in months to achieve a normal molar relation, distal movement of maxillary first molars, and anterior movement of maxillary incisors (anchorage loss). The mean age in the MD 1 group was 11.4 years; in the MD 2 group, 14.6 years. RESULTS: The amount of distal movement of the first molars was significantly greater (P < .01) and the anchorage loss was significantly lower (P < .01) in the group with no second molars erupted. The molar distalization time was also significantly shorter (P < .001) in this group, and thus the movement rate was two times higher. CONCLUSIONS: It is more effective to distalize the first maxillary molars before the second molars have erupted.
OBJECTIVES: To compare levels of tumor necrosis factor (TNF)-alpha while applying continuous and heavy interrupted forces. MATERIALS AND METHODS: A hybrid retractor was used in the first group. In the second group, rapid canine distalization through periodontal distraction was performed. Gingival crevicular fluid samples were collected from the distal sides of the canine teeth before attaching the appliances and at 1 hour, 24 hours, and 1 week after the force was applied. RESULTS: In the hybrid reactor group, concentration of TNF-alpha decreased at 1 week according to 24-hour measurements. In the rapid canine distalization group, it severely increased at 1 hour. In the evaluation of between-group differences, significantly higher values were determined in the rapid canine distalization group at 1 hour and 1 week. CONCLUSIONS: Heavy interrupted force induces a rapid release of TNF-alpha, and the tissue response continues for a longer time period. To avoid the harmful effects of heavy interrupted force, there might be feedback mechanisms that prevent the mediators from increasing excessively.
OBJECTIVE: To evaluate the potential anchorage of bicortical microimplant for tooth movement. METHODS: Five bicortical microimplants were inserted in the interradicular area of the second premolar (P2) in one side of the mandible (test side), 5 monocortical microimplant in the contralateral region (control side) in 5 beagle dogs. A total of 100 g force was generated between the implant and the fourth premolar (P4) in two sides. M1-P4, CA-IB and CA-M1 were measured biweekly. At the end of loading, specimens with P4 segments were cut and grounded to 70 microm to calculate the bone-to-implant contact (BIC). RESULT: All the bicortical microimplants remained stable during the treatment periods, while 1 monocortical microimplant was lost within 1 week. Mesial movement of P4 was ( 3.92+/-0.22) mm in the test side, (2.03+/-0.15) mm in the control side (P<0.05). Analysis showed no difference of the BIC between the bicortical microimplants and the monocortical microimplants. CONCLUSION: The bicortical microimplant may be used as orthodontic anchorage for mesial movement of posterior tooth.
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A miniplate with tube (C-tube) was placed in the interdental spaces between both left and right upper second premolars and first molars in a 15-year-8 month-old male patient with a Class II malocclusion who with severe anterior protrusion and lower anterior crowding. The treatment plan consisted of extracting both upper first premolars, en masse retraction of the upper six anterior teeth and lower anterior decrowding. C-tubes were used as substitutes for posterior dental anchorage during upper anterior retraction. The particular design of the C-tubes made it possible to retract fully with minimal gingival irritation. The correct overbite and overjet were obtained by intruding and retracting the maxillary incisors to their proper positions and this correction remained stable for at least 27 months after debonding. Also, facial balance was improved. The active treatment period was 14 months. The application of this new appliance, consideration of case selection, and sequence of treatment are presented.
OBJECTIVE: To evaluate the clinical stability of the palatal implant anchorage system in orthodontic treatment. METHODS: Sixteen osseointegrated implants (5.0 mm in diameter, 6 mm length) were inserted in the median palatal suture area of 19 patients with malocclusion (average age: 18.22 +/- 7.10 years, from 11 years to 35 years 1 month) as anchorage of active orthodontic treatment with MBT appliance. The standard lateral cephalogram after implant placement and before implant removing was taken to compare the radiological parameters. RESULTS: The successful rate of palatal implant anchorage was 84.2%. The average duration of 16 palatal implant was 23.08 +/- 8.06 months (from 10 months to 36 months). There were no statistical differences in all parameters from the implant placement to the end of treatment. IL-X was from (62.88 +/- 5.85) mm to (62.45 +/- 6.70) mm, IL-Y was from (36.66 +/- 5.41) mm to (37.96 +/- 4.90) mm, IAP-PP was from (73.81 +/- 8.84) degrees to (74.72 +/- 9.22) degrees, IAP-Y was from (62.09 +/- 9.33) degrees to (63.85 +/- 10.96) degrees, U6-Y is from (20.80 +/- 5.87) mm to (21.49 +/- 6.00) mm. CONCLUSIONS: Stable palatal implant anchorage was maintained during active orthodontic treatment.
AIMS: Previous studies on maxillary molar distalization have usually concentrated on only one appliance and featured small sample sizes. The purpose of this retrospective study was two-fold: (1) to determine the skeletal, dental, and soft tissue effects of 3 molar distalization appliances, 2 of which do not depend upon patient compliance (ie, distal jet and Greenfield molar distalizing appliance) and 1 that does (ie, sagittal appliance combined with cervical headgear); and (2) to determine differences in treatment effects among the 3 appliances. METHODS: Pretreatment and post-distalization cephalometric radiographs were obtained for each appliance (14 females and 11 males for the distal jet; 12 females and 13 males for the Greenfield molar distalizing appliance; and 17 females and 13 males for the sagittal appliance with headgear). RESULTS: Pretreatment to transition evaluation showed significant distal movement of the first molars for the distal jet (3.4 mm), the Greenfield molar distalizing appliance (3.9 mm), and the sagittal appliance with headgear (2.1 mm). Distal tipping of the first molar was seen in all samples, but significantly more so in the Greenfield molar distalizing appliance (6.5 degrees +/- 6.6) and the sagittal appliance with headgear (13.5 degrees +/- 8. 1) than in the distal jet (3.2 degrees +/- 2.8). CONCLUSIONS: Maxillary molar distalization was effective using the distal jet, the Greenfield molar distalizing appliance, and the sagittal appliance with headgear, but better control of molar bodily movement was reported with the distal jet.
Frankel appliance treatment was used from the age of 9 years 3 months to 10 years 7 months, which is 16 months overall. At 12 years 2 months, region. At 14 years 5 months, fixed appliances were placed for a period of 16 months. A positioner was used from 14 years 8 months until 16 years 3 months, which is an 18 month period.
BACKGROUND: Intrusion of the maxillary molars is difficult to accomplish using traditional methods of anchorage. AIMS: To describe methods of maxillary molar intrusion with the aid of micro-implants. METHODS: Micro-implants provide stable intra-oral anchorage and enable the maxillary molars to be intruded without the usual side effects. Three adult patients are presented showing how micro-implants can be used to intrude the maxillary molars. In the first patient micro-implants were placed in the alveolar process between the second premolar and first molar, in the second patient micro-implants were placed in the palatal alveolar process between the first and second molars, and in the third patient a micro-implant was placed in the palate paramedially. A transpalatal bar was used to prevent bucco- or linguoversion of the molars during intrusion. CONCLUSIONS: The maxillary molars can be intruded with intra-oral anchorage derived from microscrew implants.
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Anchorage control is essential for successful orthodontic treatment. Each tooth has its own anchorage potential as well as propensity to move when force is applied. When teeth are used as anchorage, the untoward movements of the anchoring units may result in the prolonged treatment time, and unpredictable or less-than-ideal outcome. To maximize tooth-related anchorage, techniques such as differential torque, placing roots into the cortex of the bone, the use of various intraoral devices and/or extraoral appliances have been implemented. Implants, as they are in direct contact with bone, do not possess a periodontal ligament. As a result, they do not move when orthodontic/orthopedic force is applied, and therefore can be used as "absolute anchorage." This article describes different types of implants that have been used as orthodontic anchorage. Their clinical applications and limitations are also discussed.