orthodontic

1. IMPLANTSIMPLANTS
ININ
ORTHODONTICSORTHODONTICS
Dr Tony Pious

2. • IntroductionIntroduction
• Classification of ImplantsClassification of Implants
• Materials used for ImplantsMaterials used for Implants
• OsseointegrationOsseointegration
• Use of Implants in OrthodonticsUse of Implants in Orthodontics

3. ..
• Implants are defined as alloplastic devices which are surgicallyImplants are defined as alloplastic devices which are surgically
inserted into or onto the jaw bone-inserted into or onto the jaw bone-BoucherBoucher
• Linkow-Linkow- Father of oral Implantology.Father of oral Implantology.

4. CLASSIFICATION OF IMPLANTS.CLASSIFICATION OF IMPLANTS.
Based on their locationBased on their location:-:-
• SubperiostealSubperiosteal
• TransosseousTransosseous
• EndosseousEndosseous

5. • Based on their configuration:-Based on their configuration:-
- Root form Implants- Root form Implants
- Blade/Plate Implants- Blade/Plate Implants
(Threaded or non threaded)
(Porous or nonporous).

6. • Based on the biologic adaptation at the interfaceBased on the biologic adaptation at the interface:-:-
--Implants which osseointegrate.Implants which osseointegrate.
-Implants which do not osseointegrate.-Implants which do not osseointegrate.
• Based on the loading characteristicsBased on the loading characteristics:-:-
-Nonlatency implants.-Nonlatency implants.
-Latency implants.-Latency implants.

7. • Based on anchorage requirementBased on anchorage requirement:-:-
-Direct anchorage.-Direct anchorage.
-Indirect anchorage.-Indirect anchorage.
• According to compositionAccording to composition:-:-
-Stainless steel-Stainless steel
-Cobalt-Chromium-Molybdenum (Co-Cr-Mo)-Cobalt-Chromium-Molybdenum (Co-Cr-Mo)
-Titanium-Titanium
-Ceramics.-Ceramics.

8. • Stainless steel:-Stainless steel:-
-18% Cr & 8% Ni.-18% Cr & 8% Ni.
-subjected to crevice & pitting corrosion.-subjected to crevice & pitting corrosion.
• Cobalt-Chromium-Molybdenum AlloyCobalt-Chromium-Molybdenum Alloy :-:-
-used in fabrication of custom designs such as-used in fabrication of custom designs such as
subperiosteal frames.subperiosteal frames.

9. • TitaniumTitanium:-:-most widely used metal for implants.most widely used metal for implants.
-Highly reactive & readily oxidises to form oxide.-Highly reactive & readily oxidises to form oxide.
-exist in 3 forms-exist in 3 forms
-Alpha-Alpha
-Beta-Beta
-Alpha-Beta phase (most commonly used).-Alpha-Beta phase (most commonly used).
Ti-6Al-4VTi-6Al-4V

10. • Ceramics:-Ceramics:- two typestwo types
Bioactive-HydroxyapatiteBioactive-Hydroxyapatite
Bioglass- contain oxides of Ca, Na,Bioglass- contain oxides of Ca, Na,
P & Si.P & Si.
• Miscellaneous:-Miscellaneous:-
-Vitreous carbon, Vitallium, Tantalum, Platinum,-Vitreous carbon, Vitallium, Tantalum, Platinum,
Tungsten, Alumina, Polymers & composites.Tungsten, Alumina, Polymers & composites.

11. MATERIALS USED FORMATERIALS USED FOR
IMPLANTSIMPLANTS
• In 16 &17In 16 &17thth
century –Ivory dental implants .century –Ivory dental implants .
• 2020thth
century-Metal Implant devices.century-Metal Implant devices.
• 1940 &1960’s-CoCrMo subperiosteal &1940 &1960’s-CoCrMo subperiosteal &
titanium blade implants.titanium blade implants.

12. • 1970’s-Non metal biomaterials1970’s-Non metal biomaterials
• 1982-Branemark Implant.1982-Branemark Implant.

13. BIOCOMPATIBILITY OF TITANIUMBIOCOMPATIBILITY OF TITANIUM
IMPLANTS.IMPLANTS.
• ““Passivity”.Passivity”.
• Modulus of elasticity .Modulus of elasticity .

14. BIOCOMPATIBILITY OF TITANIUMBIOCOMPATIBILITY OF TITANIUM
IMPLANTS:-IMPLANTS:-
• Titanium can be considered as composite material.Titanium can be considered as composite material.
• Chemical process at the Interface:Chemical process at the Interface:
Types of bonding by which biomolecules stick to the ImplantTypes of bonding by which biomolecules stick to the Implant
surface aresurface are
-Long range but weak van der waals interaction.-Long range but weak van der waals interaction.
-Short range, strong chemical bonding.-Short range, strong chemical bonding.
e.g.:-ionic & covalent bonds.e.g.:-ionic & covalent bonds.

15. CHEMICAL PROCESS THAT TAKE PLACE ATCHEMICAL PROCESS THAT TAKE PLACE AT
ANAN
IMPLANT-BIOTISSUE INTERFACE.IMPLANT-BIOTISSUE INTERFACE.

16. STUDIES REGARDING THE STABILITYSTUDIES REGARDING THE STABILITY
OF THE IMPLANT MATERIALS.OF THE IMPLANT MATERIALS.
Gainesforth & Higley (1945):Gainesforth & Higley (1945):
-investigated the efficacy of Vitallium screw for orthodontic-investigated the efficacy of Vitallium screw for orthodontic
anchorage.anchorage.
-Screws were inserted into the ramus of 6 dogs and immediately-Screws were inserted into the ramus of 6 dogs and immediately
loaded to retract the maxillary cuspids.loaded to retract the maxillary cuspids.
--ResultsResults:-All the screws were lost within 16 to 31 days.:-All the screws were lost within 16 to 31 days.

17. Sherman(1978):-Sherman(1978):-
- Inserted Vitreous carbon implants in 6 dogs & allowed to heal for 70- Inserted Vitreous carbon implants in 6 dogs & allowed to heal for 70
days before applying a force of 175gms.days before applying a force of 175gms.
Results:-Results:-After 2wks only two implants were stable.After 2wks only two implants were stable.
Smith(1979):-Smith(1979):-
-- Investigated bioglass- coated aluminum oxide implants that wereInvestigated bioglass- coated aluminum oxide implants that were
allowed to heal for 12wks before loading them with 425gms of force forallowed to heal for 12wks before loading them with 425gms of force for
2-9wks.2-9wks.
Results:-Results:- All the Implants remained stable except for a slight movementAll the Implants remained stable except for a slight movement
when the force was doubled.when the force was doubled.

18.  Gray(1983):-Gray(1983):-
-Tested the bioglass implants & vitallium implants which were placed in-Tested the bioglass implants & vitallium implants which were placed in
femur of rabbits. After 28 days healing period, loads of 60,120,&180gmsfemur of rabbits. After 28 days healing period, loads of 60,120,&180gms
were applied.were applied.
Results:-Results:-No movement of the implants occurred.No movement of the implants occurred.
Eugene Roberts(1984Eugene Roberts(1984):-):-
Inserted pure titanium screws shaped implants into the femurs of rabbits &Inserted pure titanium screws shaped implants into the femurs of rabbits &
after a healing period of 6-12wks, the paired implants were loaded withafter a healing period of 6-12wks, the paired implants were loaded with
100gms of force for 12 wks.100gms of force for 12 wks.
Results:-Results:-Histologically increase in the bone mass in the area of loadedHistologically increase in the bone mass in the area of loaded
implant was seen.implant was seen.

19.  Eugene Roberts(1988):Eugene Roberts(1988):--
Examined histologic sections of dog mandibles containing rigid titaniumExamined histologic sections of dog mandibles containing rigid titanium
screws to compare the findings of bright field & polarized lightscrews to compare the findings of bright field & polarized light
microscopic illumination to microradiographs of mineralized sections.microscopic illumination to microradiographs of mineralized sections.
Results:-Results:-10% direct bone contact is sufficient to resist the implant10% direct bone contact is sufficient to resist the implant
movement.movement.
 Linder-Aronson(1990):-Linder-Aronson(1990):-tested the effectiveness of Branemark implants intested the effectiveness of Branemark implants in
monkeys.monkeys.

20. OSSEOINTEGRATION.OSSEOINTEGRATION.
• Term & concept of OsseointegrationTerm & concept of Osseointegration
--Branemark.Branemark.
““An intimate structural contact at the implantAn intimate structural contact at the implant
surface and adjacent vital bone devoid ofsurface and adjacent vital bone devoid of
any intervening fibrous tissue.”any intervening fibrous tissue.”

21. EVOLUTION OF THE CONCEPTEVOLUTION OF THE CONCEPT
OF OSSEOINTEGRATIONOF OSSEOINTEGRATION
• Vital microscopic studies of the rabbit fibula-titaniumVital microscopic studies of the rabbit fibula-titanium
chambered microscopes.chambered microscopes.
• Series of experimentsSeries of experiments:-:-
-Titanium fixtures for immobilization of autologous bone-Titanium fixtures for immobilization of autologous bone
grafts.grafts.
- Tooth implants studies for healing & anchorage- Tooth implants studies for healing & anchorage
stability.stability.

22. • Study done on dogs to find out the load bearingStudy done on dogs to find out the load bearing
capacity of implants.capacity of implants.
• Optical titanium chambers were implanted inOptical titanium chambers were implanted in
humans-to assess the tissue reactions ofhumans-to assess the tissue reactions of
titanium implants.titanium implants.

23. BIOLOGY OFBIOLOGY OF
OSSEOINTEGRATION.OSSEOINTEGRATION.
Hematoma
Callus formation

24. Bone remodeling
Fibrous tissue

25. PRINCIPLES OFPRINCIPLES OF
OSSEOINTEGRATIONOSSEOINTEGRATION
Factors important for reliable boneFactors important for reliable bone
anchorage of an Implanted device:-anchorage of an Implanted device:-
Implant biocompatibility:-Implant biocompatibility:-

26. PRINCIPLES OFPRINCIPLES OF
OSSEOINTEGRATIONOSSEOINTEGRATION..
• Implant Design:-Implant Design:-

27. • Implant surface:-Implant surface:-

28. • State of the host bed:-State of the host bed:-

29. • Surgical technique:-Surgical technique:-

30. • Loading condition:-Loading condition:-

31. USE OF IMPLANTS INUSE OF IMPLANTS IN
ORTHODONTICSORTHODONTICS
Growth StudiesGrowth Studies
AnchorageAnchorage
Orthopaedic
Orthodontic
-Expansion
-Protraction
-Intrusion
-Space closure
-Molar Distalization.

32. GROWTH STUDIES:-GROWTH STUDIES:-
• Implants are the best means ofImplants are the best means of
reference points for studyingreference points for studying
the longitudinal growth studies.the longitudinal growth studies.

33. • Growth Rotations -Growth Rotations -Bjork &Bjork &
skeiller .skeiller .
• Growth of Cleft lip & palateGrowth of Cleft lip & palate
patients -patients - ShawShaw
..

34. ANCHORAGE:-ANCHORAGE:-
 Orthopeadic correction-Orthopeadic correction-
Two methods for obtaining the Skeletal anchorage:-Two methods for obtaining the Skeletal anchorage:-
• Intentionally Ankylosed teeth.Intentionally Ankylosed teeth.
• Endosseous Implants.Endosseous Implants.

35. • Maxillary Expansion:-Maxillary Expansion:-
-- Guyman(1980)Guyman(1980)
-Ankylosed teeth acted as abutments for-Ankylosed teeth acted as abutments for
palatal expansion in rhesus monkeys.palatal expansion in rhesus monkeys.
-Transmit the laterally directed forces-Transmit the laterally directed forces
across the midpalatal suture.across the midpalatal suture.

36. • After 8wk healing period 1-2 pound force was applied to the
ankylosed teeth.
• Palatal widening was seen due to skeletal expansion that was
periodically assessed during 13, 21, & 23 wks.

37. FRONTONASAL SUTURE EXPANSIONFRONTONASAL SUTURE EXPANSION
USING TITANIUM SCREWS.USING TITANIUM SCREWS.
-Kiumars Movassaghi et al(1995)
Pure titanium craniofacial plates were contoured into ‘L’ shape
with a 90 degree angle at the midpoint.
Plates were placed on either sides of the suture.
A distraction force of 55gms was activated across the sutures.

38. Increase in growth about 6mm was seen across
the frontonasal suture.

39. SUTURAL EXPANSION USING RIGIDLYSUTURAL EXPANSION USING RIGIDLY
INTEGRATED ENDOSSEOUS IMPLANTS.INTEGRATED ENDOSSEOUS IMPLANTS.Andrew Parr et al(1996)
Evaluated the use of endosseous implants
in the midface region,2 flanged titanium
implants were placed on either side of the
midnasal suture of rabbits.
Divided into two groups:
one group-1N & other group-3N force
was applied.
.

40. Distance between the implants increased significantly in the loaded
groups & higher in the 3N group.
 An open coil spring has been compressed between the
abutments to provide the expansion load.

41. ENDOSSEOUS IMPLANTS FOR MAXILLARYENDOSSEOUS IMPLANTS FOR MAXILLARY
PROTRACTIONPROTRACTION
--SMALLEY ETAL (1988)SMALLEY ETAL (1988)
Tantalum markers were placed in the cranial base, mandible, zygomatico
Temporal , zygomaticomaxillary, frontomaxillary, premaxillomaxillary
Sutures.

42. •A traction force of 600gm is used and protraction was done
till 8mm of anterior displacement of maxillary complex occurred.

43. IMPLANTS FOR INTRUSIONIMPLANTS FOR INTRUSION
Skeletal Anchorage:-Creekmore(1983)
-Vitallium bone screw placed below the
anterior nasal spine is used for intrusion of
Upper anteriors.
-6mm of upper incisor intrusion was seen
after one year.

44. IMPLANTS FOR SPACE CLOSURE.IMPLANTS FOR SPACE CLOSURE.
• Implanto-Orthodontics-Linkow.(1970).Implanto-Orthodontics-Linkow.(1970).
• Implant was used to replace the missing tooth.Implant was used to replace the missing tooth.
• Upper arch was consolidated using a fixedUpper arch was consolidated using a fixed
appliance & in lower arch only premolar andappliance & in lower arch only premolar and
molar were banded and connected by o.o4omolar were banded and connected by o.o4o
rigid wire.rigid wire.
Elastic

45. USE OF ENDOSSEOUS IMPLANT FORUSE OF ENDOSSEOUS IMPLANT FOR
CLOSURE OF EXTRACTION SITECLOSURE OF EXTRACTION SITE
• Endosseous Implants placed in the retromolarEndosseous Implants placed in the retromolar
region are used to close the atrophic extractionregion are used to close the atrophic extraction
site.site.
-Eugene Roberts (1989)
Pontic

47. Buccal view after mesial translation
of 2nd
& 3rd
molars.

48. Diagnostic models,2.5yrs
Of post retention.

49. ONPLANT & ORTHO-IMPLANT.ONPLANT & ORTHO-IMPLANT.
OnplantOnplant:-:-BlockBlock
&Hoffman.(1995)&Hoffman.(1995)
• It is a flat disk shaped fixtureIt is a flat disk shaped fixture
available in 8 and 10mm inavailable in 8 and 10mm in
diameterdiameter
• It has a HA coated surface forIt has a HA coated surface for
integration with theintegration with the
surrounding bone.surrounding bone.

50. ANIMAL STUDIES:ANIMAL STUDIES:
In the dog, the onplant has been exposed & connected to the contra lateral
2nd
premolar with a stainless steel spring activated to deliver 110z of force
.
5months later tooth moved towards the onplant by 8mm from its original
position.

51. An expansion device soldered to a traspalatal bar & secured to the
expansion device to control molar distalization.
The 2nd
molars were bodily distalized 6mm in 11 months.

54. ORTHO-IMPLANTORTHO-IMPLANT
- Celenza & Hochman
•Similar to onplant but it is an endosseous Implant.
•Its surface is sandblasted and etched to
increase the adhesion to the surrounding bone

56. USES OF ONPLANT & ORTHO-USES OF ONPLANT & ORTHO-
IMPLANTIMPLANT
• Space closure.Space closure.
• Molar distalization.Molar distalization.

57. PALATAL BONE SUPPORT FOR PLACEMENTPALATAL BONE SUPPORT FOR PLACEMENT
OF AN ORTHODONTIC IMPLANT ISOF AN ORTHODONTIC IMPLANT IS
SUFFICIENT ENOUGH WITHOUT CAUSINGSUFFICIENT ENOUGH WITHOUT CAUSING
ANY DAMAGE TO THE NASAL FLOOR.ANY DAMAGE TO THE NASAL FLOOR.-Heinrich et al (1999)

58. IMPACTED TITANIUM POSTIMPACTED TITANIUM POST
FOR ANCHORAGEFOR ANCHORAGE
-Frederic Bousquet etal(1996)
•35-yr old female before treatment, showing
anterior crowding.

59. Titanium post
Titanium post & head of
Mechanical impactor.

60. Post impacted in interdental
septum between 1st
molar &
extraction site.
Rigid .040 wire connecting 1st
molar
tube to post.

62. Upper right posterior segment after 2 months
of retraction showing distal movement of
Premolar & no mesial movement of molar.

63. Cast models after 18 months of treatment.

64. MINI-IMPLANT FORMINI-IMPLANT FOR
ORTHODONTIC ANCHORAGE:-ORTHODONTIC ANCHORAGE:-
• Mini-Implant is 1.2mm in diameter andMini-Implant is 1.2mm in diameter and
6mm in length.6mm in length.
-Ryuzo Kanomi(1997)

65. After raising of mucoperiosteal flap
and denuding of bone, 2mm of round bur
is used.
Pilot drill used to enter bone same
Distance as the length of mini-implant.
Mini-Implant inserted with accompanying screw driver.

66. Mucosal punch used to remove soft-tissue
Surrounding head of mini-implant.
Two hole titanium bone plate attached
to head of mini-implant and tied to bracket
with ligature wire.

67. Patient at start of incisor intrusion.

68. MINI-IMPLANTS FOR SPACEMINI-IMPLANTS FOR SPACE
CLOSURE.CLOSURE.

69. MINI-IMPLANTS FOR MOLARMINI-IMPLANTS FOR MOLAR
INTRUSIONINTRUSION

70. SKELETAL ANCHORAGE SYSTEM FORSKELETAL ANCHORAGE SYSTEM FOR
OPEN BITE CORRECTIONOPEN BITE CORRECTION-Umemori , Sugawara etal (1999)
• Control of vertical dimension is
very important in correction of
anterior open bite
•‘L’ shaped titanium miniplates are used as a
Source of anchorage for intruding the molars.

71. • Procedure for miniplateProcedure for miniplate
insertion:-insertion:-

73. Pretreatment facial photographs
Pretreatment intraoral photographs

74. Post treatment intraoral photographs

75. ‘Y’ Titanium miniplate for intrusion &
distalization of maxillary molars.
(key ridge)
Straight titanium miniplate for
Intrusion of maxillary incisors.
(anterior ridge of piriform opening).

76. INTRUSION OF MAXILLARY ANTERIORINTRUSION OF MAXILLARY ANTERIOR
TEETH USING SASTEETH USING SAS
Before treatment
Intrusion of maxillary anteriors
After treatment

77. MICROIMPLANT (ABSOANCHOR)MICROIMPLANT (ABSOANCHOR)Kyung, Park et al
Recent among the implants – Microimplant.
To overcome disadvantages of conventional Osseointegrated implants like
-size, procedure of insertion, cost, & bulkiness.
Diameter is 1.2mm but available in different sizes.

79. Usually 4-5mm length of implant with 1.2-1.3mm diameter will
provide adequate retention, but in maxilla a microimplant of
6-8mm is used.
Microimplant insertion:-

80. Periapical radiograph to see the
root approximation.
• NiTi coil spring applied to maxillary buccal & lingual and
mandibular buccal microimplants.

81. MICRO IMPLANTMICRO IMPLANT
• Dimension of micro implant are 1.2mm in diameter &Dimension of micro implant are 1.2mm in diameter &
6mm in length.6mm in length.
-Park et al
28yr old female with CL-I bialveolar protrusion before treatment.

82. PLACED IN THE BUCCAL ALVEOLAR BONE BETWEEN 2PLACED IN THE BUCCAL ALVEOLAR BONE BETWEEN 2NDND
PREMOLAR &1PREMOLAR &1STST
MOLAR IN THE UPPER ARCH &MOLAR IN THE UPPER ARCH &
BETWEEN 1BETWEEN 1STST
MOLAR & 2MOLAR & 2NDND
MOLAR IN THE LOWERMOLAR IN THE LOWER
ARCH.ARCH.
Placement of maxillary microscrew.
Mandibular microscrew.

83. Initial maxillary canine retraction force applied with
tieback between micro-implant & canine.
After 2 months of treatment, maxillary
anterior retraction force applied with
nickel titanium coil spring.

84. Mandibular micro-implants between 1st
& 2nd
molars. Force
applied with elastic thread between microscrews & mandibular
archwire.

85. Mechanism of bodily retraction of anterior segment, with force
applied against microimplant passing near center of resistance
of six anterior teeth.
Mandibular microimplant uprights & intrudes the molars.

86. Patient after 18 months of treatment
.

87. Superimposition of pre & post- treatment cephalometric tracings.

88. MICRO-IMPLANT FOR ANCHORAGEMICRO-IMPLANT FOR ANCHORAGE
IN LINGUAL ORTHODONTICSIN LINGUAL ORTHODONTICS
19yr old female with skeletal CL-II malocclusion before treatment.

89. Palatal microscrew should be implanted into the alveolar bone
at 30-40 degree between 1st
& 2nd
molar to avoid root damage.

90. Lingual Sliding mechanics using nickel titanium coil springs
to microimplants.

91. Patient after 16 months of treatment.

92. Superimpositions of cephalometric tracings before & after treatment.

93. 28yr old female CL-II patient with lip protrusion & gummy smile
before treatment.

94. Insertion site measured from guide bar on bite-wing x-ray
Stab incision for flap reflection
Drilling through cortical bone only.
Microimplant insertion.

95. Maxillary .017x.o25 ss closing loop archwire & .016x.016ss overlay
intrusion archwire used to retract anterior teeth upward & backward.

96. Schematic of retraction wire.

97. Improvement in profile & gummy smile after treatment.

98. USE OF OSSEOINTEGRATED IMPLANTSUSE OF OSSEOINTEGRATED IMPLANTS
ININ
UNILATERAL CLEFT LIP & PALATE PTS.UNILATERAL CLEFT LIP & PALATE PTS.
• Unilateral cleft pts who needed maxillary lateralUnilateral cleft pts who needed maxillary lateral
bony defect in the alveolar region restrictsbony defect in the alveolar region restricts
orthodontic accomplishment.orthodontic accomplishment.
• Late secondary bone grafting to the cleft regionLate secondary bone grafting to the cleft region
followed by the insertion of the Osseointegratedfollowed by the insertion of the Osseointegrated
implants provides good retention to the maxillaryimplants provides good retention to the maxillary
arch.arch.
Hiroaki et al (1999)

99. BIBLIOGRAPHY.BIBLIOGRAPHY.
• Implants in dentistry-Hobkirk.Implants in dentistry-Hobkirk.
• Block & Kent- Oral Implantology.Block & Kent- Oral Implantology.
• Science of dental materials- Skinner.Science of dental materials- Skinner.
• Orthodontic principles & practice-Graber & Vanarsdall.Orthodontic principles & practice-Graber & Vanarsdall.

100. • Bone responses to orthodontic forces on vitreous carbon dentalBone responses to orthodontic forces on vitreous carbon dental
implants –Alan Sherman AJO:JULY 78.implants –Alan Sherman AJO:JULY 78.
• Bone dynamics associated with the controlled loading ofBone dynamics associated with the controlled loading of
bioglass coated aluminum oxide endosteal implants-John Smithbioglass coated aluminum oxide endosteal implants-John Smith
AJO:DEC 79.AJO:DEC 79.
• Ankylosed teeth as abutments for palatal expansion in rhesusAnkylosed teeth as abutments for palatal expansion in rhesus
monkeys. Guyman et al AJO :sep 83.monkeys. Guyman et al AJO :sep 83.
• Osseous adaptation to continuous loading of rigid endosseousOsseous adaptation to continuous loading of rigid endosseous
implants. AJO :AUG 84.implants. AJO :AUG 84.
• Osseointegrated titanium implants for maxillofacialOsseointegrated titanium implants for maxillofacial
protraction-Smalley et al AJO:OCT 88.protraction-Smalley et al AJO:OCT 88.

101. • Implant-Orthodontics-Linkow JCO MAY 70.Implant-Orthodontics-Linkow JCO MAY 70.
• Possibility of skeletal anchorage- Creekmore JCO APR 83.Possibility of skeletal anchorage- Creekmore JCO APR 83.
• Absolute anchorage device-Hoffman & block AJO MAR 95.Absolute anchorage device-Hoffman & block AJO MAR 95.
• Rigid implant anchorage to close a mandibular first molar extraction siteRigid implant anchorage to close a mandibular first molar extraction site
–Roberts et al JCO:DEC 94.–Roberts et al JCO:DEC 94.
• Osseointegration and its experimental background.-J.Prosth. dent sepOsseointegration and its experimental background.-J.Prosth. dent sep
83.83.
• Biocompatibility of titanium implants –kasemo. J.Prosth.dent jun 83.Biocompatibility of titanium implants –kasemo. J.Prosth.dent jun 83.
• Endosseous implants as anchorage to protract molars and close anEndosseous implants as anchorage to protract molars and close an
atrophic extraction site.-Roberts, Marshall AO sep 89.atrophic extraction site.-Roberts, Marshall AO sep 89.

102. • Frontonasal suture expansion in rabbits using titanium screws.-Movassaghi et al J.Frontonasal suture expansion in rabbits using titanium screws.-Movassaghi et al J.
of oral max. surg 95.of oral max. surg 95.
• Sutural expansion in using endosseous implants –Rabbit study-Parr AO may 96.Sutural expansion in using endosseous implants –Rabbit study-Parr AO may 96.
• Use of impacted titanium post for orthodontic anchorage –Bousquet et al JCO AUGUse of impacted titanium post for orthodontic anchorage –Bousquet et al JCO AUG
96.96.
• Mini-Implant-Ryuzo kanomi. JCO 97.Mini-Implant-Ryuzo kanomi. JCO 97.
• Skeletal Anchorage System-Sugawara JCO DEC 99.Skeletal Anchorage System-Sugawara JCO DEC 99.

103. • Micro-Implant anchorage for treatment ofMicro-Implant anchorage for treatment of
skeletal class-I Bialveolar protrusion-Hyo-skeletal class-I Bialveolar protrusion-Hyo-
Sang Park.2001 JUL JCO.Sang Park.2001 JUL JCO.

104. MAGNETSMAGNETS
ININ
ORTHODONTICSORTHODONTICS

105. • IntroductionIntroduction
• Types of magnetic materialsTypes of magnetic materials
• Properties of magnetsProperties of magnets
• Application of magnets in orthodontics.Application of magnets in orthodontics.

106. • In 1953, magnets were first used for dentureIn 1953, magnets were first used for denture
retention byretention by BEHRAN & EGAN.BEHRAN & EGAN.
• Use of magnets in orthodontic-Use of magnets in orthodontic- BLECHMAN &BLECHMAN &
SMILEY.SMILEY.

107. PROPERTIES OF MAGNETSPROPERTIES OF MAGNETS
• Flux DensityFlux Density

108. • In dentistry, ferromagnetic materials with static field areIn dentistry, ferromagnetic materials with static field are
used.used.
• Magnetocrystalline Anisotropy.Magnetocrystalline Anisotropy.
• Coercivity.Coercivity.

109. • Coulombs lawCoulombs law:-:-This law states that forceThis law states that force
between two magnetic poles is directlybetween two magnetic poles is directly
proportional to magnitude & inverselyproportional to magnitude & inversely
proportional to square of the distanceproportional to square of the distance
between them.between them.
• Curie pointCurie point:-:-Pierre Curie(1859-1906)Pierre Curie(1859-1906)

110. • High force to volume ratio.High force to volume ratio.
• Maximal force at shorter distances.Maximal force at shorter distances.

111. • No interruption of magnetic force lines byNo interruption of magnetic force lines by
intermediate media.intermediate media.
• No energy loss.No energy loss.

112. TYPES OF MAGNETICTYPES OF MAGNETIC
MATERIALSMATERIALS
• Platinum-cobalt (Platinum-cobalt (Pt-coPt-co))
• Aluminium-Nickel-Cobalt(Aluminium-Nickel-Cobalt(Al-Ni-CoAl-Ni-Co))
• FerriteFerrite
• Chromium-cobalt-IronChromium-cobalt-Iron
• Samarium Cobalt(Samarium Cobalt(SmCoSmCo))
• Neodymium-Iron-Boron(NdNeodymium-Iron-Boron(Nd22FeFe1414BB))

113. • AdvantagesAdvantages:-:-
-Continuous force is exerted.-Continuous force is exerted.
- Eliminates the patient co-operation.- Eliminates the patient co-operation.
-No friction.-No friction.
• DisadvantagesDisadvantages:-:-
-Tarnish & corrosion products are cytotoxic.-Tarnish & corrosion products are cytotoxic.
-Cost factor.-Cost factor.

114. • Biological effect of magnetic forces:-Biological effect of magnetic forces:-
AAronsonronson:-thinning of epithelium under attracting &:-thinning of epithelium under attracting &
repelling magnets.repelling magnets.
McDonaldMcDonald -- proliferative activity of fibroblasts inproliferative activity of fibroblasts in
presence of static magnetic fieldpresence of static magnetic field
Lars Bondemark & KurolLars Bondemark & Kurol studied changes in humanstudied changes in human
dental pulp and gingival tissue.dental pulp and gingival tissue.

115. CLINICAL APPLICATIONS OFCLINICAL APPLICATIONS OF
MAGNETS.MAGNETS.
Orthopaedic
- Expansion
-Growth modulation
Orthodontic -Tooth Intrusion
-Space closure
-Molar Distalization.
-Retainer.

116. • EXPANSIONEXPANSION:-:-Vardimon et al(1987)Vardimon et al(1987) demonstrateddemonstrated
palatal expansion using two types of magnetic devicespalatal expansion using two types of magnetic devices
in Macaca fascicularis monkeys.in Macaca fascicularis monkeys.
--Tooth borne applianceTooth borne appliance

117. • Tissue borne appliance (attached directlyTissue borne appliance (attached directly
to palate by endosseous pins).to palate by endosseous pins).

118. CHANGE IN THE INTER INCISALCHANGE IN THE INTER INCISAL
RELATIONSHIPRELATIONSHIP
Maxillary Protraction was related to A-P activity of the premaxillary suture
(primarily) & the transverse palatine suture (secondarily).

119. TRANSVERSE CHANGE AS MEASUREDTRANSVERSE CHANGE AS MEASURED
FROM BEFORE AND AFTERFROM BEFORE AND AFTER
TREATMENT MODELS.TREATMENT MODELS.
Intercanine change vs. Intermolar change

120. • Functional Orthopaedic Magnetic AppliancesFunctional Orthopaedic Magnetic Appliances:-:-
Vardimon(1989)Vardimon(1989)
--for correction of CL-IIfor correction of CL-II

122. 4 types of functional magnetic system:-

124. • Magnetic Twin BlockMagnetic Twin Block:-:-
Clark(1996)Clark(1996)
--Samarium cobalt magnetsSamarium cobalt magnets
were embedded in thewere embedded in the
inclined surface of theinclined surface of the
twin block in attractivetwin block in attractive
mode.mode.

125. • Magnetic Activator Device(MAD):-Magnetic Activator Device(MAD):-
--DarendilierDarendilier (1993) developed this magnetically active(1993) developed this magnetically active
functional appliance.functional appliance.
-MAD I-mandibular deviations-MAD I-mandibular deviations
-MAD II-CLII malocclusion-MAD II-CLII malocclusion
-MADIII-CLIII malocclusion-MADIII-CLIII malocclusion
-MADIV-skeletal open bite correction.-MADIV-skeletal open bite correction.

126. MAD-II
MAD II is used for correction of CL-II malocclusion.
It consists of upper& lower removable appliance , carrying magnets
in both buccal segments.

127. A 30 degree inclination of the occlusal surface of the magnet to the
basal surface produces an oblique force vector to correct a
CL-II malocclusion.

128. Mechanical retention of the appliance against the magnetic forces is by
clasps on the posterior teeth & in the anterior area by adding small amount
of composite on the labial surface so that the labial bow rests on it.

129. • A 10yr old pt with a skeletal & dental CL-II Div 1 malocclusion.
Overjet-6mm & Overbite-3mm.

130. After 4 months of night time wear

131. MAD-II FOR CORRECTION OF CL-II,DIVISIONMAD-II FOR CORRECTION OF CL-II,DIVISION
1 MALOCCLUSION.1 MALOCCLUSION.
Deep Bite
open Bite

132. MAD II appliance with transverse screw & two sagittal screws
incorporated in lingual side of the lower appliance to permit the
sagittal reactivation.

133. EARLY CL-III TREATMENT WITHEARLY CL-III TREATMENT WITH
MAGNETIC APPLIANCE.MAGNETIC APPLIANCE.
Patient before treatment.

134. • MAD IIIMAD III
Combined MED & MAD III appliance
Bonded upper plate ,with two
midpalatal Samarium cobalt magnets.
Removable lower plate with buccal
magnets.

136. Patient after 14 months of treatment.

137. • MAD - IVMAD - IV
Magnetic activator device IV uses anterior attracting &
posterior repelling magnets.

138. •MAD IV consists of removable upper &
lower plates each of which contains
three cylindrical neodymium magnets
coated with stainless steel.

139. MAD IV(a)
MAD IV( b)
MAD IV( c)

140. • Tooth IntrusionTooth Intrusion:-:-
Active Vertical Corrector-Active Vertical Corrector-DellingerDellinger(1986)(1986)
-Samarium cobalt magnets in the repelling mode-Samarium cobalt magnets in the repelling mode
are used.are used.

142. Pre-Treatment Post-Treatment

143. • Fixed Magnetic ApplianceFixed Magnetic Appliance:-:-
-introduced by-introduced by VARUN KALRA & CHARLES BURSTONEVARUN KALRA & CHARLES BURSTONE..
Appliance consists of an upper &lower acrylic splintsAppliance consists of an upper &lower acrylic splints
with samarium cobalt magnets in stainless steel castingwith samarium cobalt magnets in stainless steel casting
embedded in a repelling mode.embedded in a repelling mode.

144. Results:-
-Length of the mandibular condyle increased significantly in the treated group.
-the entire upper and lower arches intruded during the treatment.

145. • Tooth ImpactionTooth Impaction:-:- Vardimon,Graber,DrescherVardimon,Graber,Drescher
--Neodymium Iron Boron magnets can be usedNeodymium Iron Boron magnets can be used
to assist eruption of an impacted canine.to assist eruption of an impacted canine.

146. Vertical &Horizontal magnetic brackets were designed with the
magnetic axis magnetized parallel and perpendicular to the base of the
edge wise bracket.
•Vertical type –Impacted canines & incisors
.
•Horizontal type –Impacted premolars &molars.

147. Surgical procedure:-Surgical procedure:-
Palatal approach was used to expose the
maxillary canine.
Vertical magnetic bracket bonded on the palatal
crown surface of the impacted canine.

148. • A spacer of 2.5mm is positioned between the magnetic bracket &
loose intraoral magnet.
•Fixation of the intraoral magnet to the Hawley type retainer with self
curing acrylic followed by removal of spacer , to apply an attraction force
of 0.3N.

149. •Treatment progression of the magnetic attraction
after 3 months.
• Fixed appliance treatment stage.

150. AN ATTRACTIVE SOLUTION TOAN ATTRACTIVE SOLUTION TO
UNERUPTED TOOTH.UNERUPTED TOOTH.
-Sandler(1991)

151. •Upper left canine erupting through the mucosa.
•Larger magnet repositioned to allow further
movement.
•Sufficient eruption to allow attachment to be
placed.

152. Detailing with fixed Appliance. Post -treatment
ManciniMancini(1996)-force levels are sufficient enough to induce the(1996)-force levels are sufficient enough to induce the
cellular & biochemical changes required to produce orthodonticcellular & biochemical changes required to produce orthodontic
tooth movement.tooth movement.

153. space closure:-space closure:-
-Complex Intra & Interarch Mechanics:--Complex Intra & Interarch Mechanics:-Blechman(1985)Blechman(1985)
CL-II mechanics with a magnetic force
system in a CL-I extraction case

154. 3 magnet configuration to enhance3 magnet configuration to enhance
CL-II mechanicsCL-II mechanics
3 magnet configuration3 magnet configuration
used to simultaneouslyused to simultaneously
move all 4 canines distallymove all 4 canines distally

155. Intramaxillary magnetic force to move
Canine distally.

156. Pre-treatment. Upper canine retraction
Lower canine retraction Post-treatment

157. • Molar DistalizationMolar Distalization:-:-
--GianellyGianelly et al(1989):-repelling magnets in conjunctionet al(1989):-repelling magnets in conjunction
with a modified Nance appliance was used.with a modified Nance appliance was used.
Lateral view of magnets in position.

158. -A 11yr/F with a CL-II DIV I malocclusion in the late mixed
dentition period.
-Nance appliance was seated on the second deciduous molar.
Results:-Molar movement in distal direction-3.2mm
Deciduous molar movement in mesial direction-0.6mm

159. MOLAR DISTALIZATION WITHMOLAR DISTALIZATION WITH
REPELLING MAGNETSREPELLING MAGNETS
-Takami etal(1991)
The Molar distalization system uses two
opposing magnets for each maxillary quadrant.
.
• Nance appliance is placed to reinforce the anchorage.
• Constant magnetic force of 80z is applied.
• Magnets are reactivated for every 2wks

160. CASE FROM THE PRESENT STUDY BEFORE &CASE FROM THE PRESENT STUDY BEFORE &
AFTER RAPID MOLAR DISTALIZATION.AFTER RAPID MOLAR DISTALIZATION.

161. REPELLING MAGNETS VS. SUPERELASTICREPELLING MAGNETS VS. SUPERELASTIC
NI-TI COILS.NI-TI COILS.
• In simultaneous distal movement of maxillary first &In simultaneous distal movement of maxillary first &
second molarssecond molars
-Mean distal movement for supercoils is 3.2mm.-Mean distal movement for supercoils is 3.2mm.
-for magnets is 2.2mm.-for magnets is 2.2mm.
Bondemark & Kurol (1992).

162. • Magnetic Edgewise BracketsMagnetic Edgewise Brackets:-:-KawataKawata(1987)(1987)
-Samarium cobalt magnet with an edgewise bracket-Samarium cobalt magnet with an edgewise bracket
(o(o.018slot.018slot) .) .

163. Clinical application of magnetic brackets in crowded dental arch.
Cast models before & after treatment.

164. AUTONOMOUS FIXED MAGNETICAUTONOMOUS FIXED MAGNETIC
APPLIANCE.APPLIANCE.
• Treatment of CL-II bimaxillary protrusion withTreatment of CL-II bimaxillary protrusion with
magnets:-magnets:-
..
-Darendeliler & Joho
A13yr old female patient before treatment

165. •Ideal arch form using Bonwill-Hawleys method.
•Calculation of mesial & distal magnet cuts needed
to create proper arch form.
•Upper & lower magnetic arches before coating.

166. Lower magnets temporarily affixed to cast
for Indirect bonding.

167. Magnetic arches in place.

168. Additional magnet bonded to close median diastema
Patient after 6 months of treatment with AFA

169. • Propellant Unilateral Magnetic AppliancePropellant Unilateral Magnetic Appliance (PUMA)(PUMA)
- Chate(1995)Chate(1995)
 Magnets are use to stimulate costo-chondral bone graftMagnets are use to stimulate costo-chondral bone graft
in Hemi facial microsomia.in Hemi facial microsomia.

170. • RetainersRetainers:-:-Springate &Springate &
Sandler(1991)Sandler(1991)
-micro magnets made-micro magnets made
of neodymium iron boronof neodymium iron boron
magnets as a fixedmagnets as a fixed
retainer in a patient withretainer in a patient with
persistent diastema.persistent diastema.

171. • BibliographyBibliography:-:-
-Dentofacial Orthopedics with functional appliances-T.M Graber,-Dentofacial Orthopedics with functional appliances-T.M Graber,
Rakosi,Petrovic.Rakosi,Petrovic.
-Magnetic force systems in orthodontics-Blechman AJO 78.-Magnetic force systems in orthodontics-Blechman AJO 78.
-Rare earth magnets and Impaction-Vardimon AJO 91.-Rare earth magnets and Impaction-Vardimon AJO 91.
-Use of magnets to move the molars distally-Gainelly AJO 89.-Use of magnets to move the molars distally-Gainelly AJO 89.
-Magnetic vs Mechanical expansion with different thresholds and-Magnetic vs Mechanical expansion with different thresholds and
points of force application. Vardimon.AJO 87.points of force application. Vardimon.AJO 87.
-Effects of fixed magnetic appliance on the dentofacial complex.-Effects of fixed magnetic appliance on the dentofacial complex.
Kalra.AJO 89.Kalra.AJO 89.
-A new orthodontic force system of magnetic brackets. Kawata AJO 87.-A new orthodontic force system of magnetic brackets. Kawata AJO 87.
-An open bite correction with MAD IV. JCO 95. Darendeliler.-An open bite correction with MAD IV. JCO 95. Darendeliler.