Micro implant anchorage in orthodontics /certified fixed orthodontic courses by Indian dental academy

MICRO IMPLANT ANCHORAGE
IN
ORTHODONTICS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


INTRODUCTION
Oral implantology has recently become the object of
growing attention.
Successful long term Osseo integration,has greatly
increased the use of dental implants over the last 3
decades.
Other than replacing missing teeth,implants can also be
used to enhance orthodontic treatment
-as a source of absolute anchorage,
-for orthopedic anchorage,
-as abutments for restorations,
-in osteogenic distraction.

During active treatment,orthodontic anchorage aims to
limit the extent of detrimental,unwanted tooth
movement.
The ability of Osseo integrated implants to remain
stable under occlusal loading has led orthodontists to
use them as anchorage units without patient compliance


History
The earliest implantation in the sense of reimplantation,
Date back to pre-Christian times .
In 18th and 19th centuries artificial materials were used
as implant materials but were proved to be failures and
were abandoned.
Endosseous implants became a major influence within the
oral implant Surgery due to the work of Branemark who
achieved constant Long term success rates with oral
endosseous implants.
In the early 1930s the introduction of stainless metals
and the development of a cobalt-chromium-molybdenum
alloy (vitallium) gave new impulses to implant surgery.

Dahl(1945),first published the use of subperiosteal
vitallium implants to effect tooth movements in dogs
Linkow (1966),described endosseous blade implants with
perforations for orthodontic anchorage.
Kawahara etal(1975), developed ,Bioglass-coated ceramic
implants for orthodontic anchorage
Various bioactive ceramics such as glass ceramics(Bromer
etal 1977,Hench etal 1973),tricalcium phosphate ceramics
(Luhr and Riess,1984) and hydroxy appetite ceramics
(Hajek and Newesely,1963; Jarcho etal, 1977)

Branemark (1969,1977) the mentor of modern
implant surgery ,described the high compatibility and
strong anchorage of titanium in human tissue and coined
the term “Osseointegration”
Creekmore (1983) reported the possibility of skeletal
anchorage in orthodontics
Higuchi and James (1991) used titanium fixtures
For intraoral anchorage to facilitate orthodontic tooth
movement.
Costa etal (1998) used miniscrews for orthodontic
anchorage
Ume mori etal (1999) used SAS for open bite correction.

CLASSIFICATION
Based on their position:
-subperiosteal,
-transosseous,
-endosseous
Based on material of construction:
-titanium,ideal material
-gold alloys,
-vitallium,
-cobalt-chromium,
-vitreous carbon,
-aluminium oxide ceramics

Based on their design:
-screw type
-cylindrical type
-blade type
-onplant


Indications for implant therapy.
motivated,cooperative,good oral hygiene
growth of alveolar process should be completed


Contraindications for implant therapy
Absolute contraindications:
-severe systemic disorders; osteoporosis,
-psychiatric disease,e.g.pyschoses,dysmorphobia.
-alcoholics,drug abusers
Relative contraindications:
-insufficient volume of bone,
-poor bone quality,
-pts undergoing radiation treatment,
-insulin-dependent diabetes,
-heavy smokers


TITANIUM AS AN IDEAL IMPLANT MATERIAL
Titanium is a reactive metal -forms an oxide layer on
contact with air, water or any electrolyte,which
protects it from chemical attack including aggressive
body fluids
Titanium is inert in tissue – i.e.,no ions are released
which are reactive with the body tissues


Titanium possesses good mechanical properties


-tensile strength=st.steel
-tough and malleable,makes it insensitive
toshock loading and will yield on heavy
loads
-corrosion resistant

Titanium is a bioactive material -bone grows into
rough surface of the metal and bonds with
metal leading to
osseointegration

Uses of implant-based anchorage

• Retracting and realigning anterior teeth with no Posterio
support
• Closing edentulous spaces in first molar extraction sites
• Mid-line correction when missing posterior teeth,
• Intruding/extruding teeth,
• Protraction or retraction of one arch
• Stabilization of teeth with reduced bone support
• Orthopaedic traction

Measurement of alveolar bone height

Tissue response following implant placement
Stage I;Woven callus (0-2wks)
-bridging callus forms within a few millimeters from
the margin of implantation site,
-stability of the approximating segments is
important for efficient bridging callus formation

Stage II;Lamellar compaction (2-6wks)
-is the period of lamellar compaction,
-callus matures and achieves sufficient strength
for loading.

Stage III;Interface healing (2-6wks)
-begins at the same time callus is completing
lamellar compaction,
-callus starts to resorb and remodeling of
devitalized interface begins.

Stage IV;Maturation (6-18wks)
-bone matures by a series of modeling and
remodeling process
-callus completes resorption(modeling)

Long term maintenance
Repetitive loading results in microscopic cracks
Which if accumulates lead to structural failure.
Osteoclasts resorbs oldest and most weakened
Bone which maintains structural integrity.
This remodeling of the interface and supporting
bone helps in long term maintenance of rigid
osseous fixation.

MINI-IMPLANTS
Conventional-3.5-5.5mm dia, 11-21mm length

Small in size;1.2mm dia,6mm length

mini-implant for
cuspid retraction

For molar intrusion


For molar distalization

For anterior intrusion


Steps in placement of mini implant
(Osseointegrated)
1.Reflection of mucoperiosteal
Flap and denuding of bone

2.Pilot drill used to enter same
Distance as length of mini-implant


3.Mini implant inserted

4.Implant site sutured


5.Gingival tissue exposed
Over head of mini implant

6.Soft tissue surrounding head
Of mini-implant


7.titanium bone plate attached
to head of mini-implant


NON OSSEOINTEGRATED MINI IMPLANTS:
(Spider screw)
Advantages:
 small in size,
 inexpensive,
 simple to place and remove,
 immediately loadable,
 well tolerated by patients,

spider screw
-is a self-tapping titanium mini screw
-available in three lengths-7mm,9mm,& 11mm.
-screw head has an
internal slot of .021”x.025”
external slot of.021”x.025”
round vertical slot of .025”


Available in three forms
Regular-thicker head & intermediate length collar

Low profile-thin head & long collar

Low profile flat-thin head & shorter collar

Site for placement:
should have enough bone depth to accommodate
the screw &
2-3mm of bone width to protect adjacent dental
roots and anatomical structures
typical insertion areas
-maxillary tuberosity
-retromolar areas
-edentulous ridges
-interradicular septi
-palate
-anterior alveolar process


Determination of screw placement site:

Acrylic surgical index


SURGICAL PROCEDURE

Osseous site preparation with
1.5mm pilot drill

Spider screw insertion with
low speed
Contra-angle(30rpm)

Screw removal

Immediately after removal

Seven days later

Case Report

Extrusion of maxillary molars-pre Rx


Intrusion of premolar & molars
using coil springs & elastics to spider screw


Post-Rx –after intrusion of molars


Treatment planning phase
•

problem list & patient desires

•

initial evaluation
1.
2.
3.
4.
5.

chief complaint
medical/dental history review
intra/extra oral examination
evaluation of existing prosthesis
diagnostic impressions/articulated
casts
6. radiographs (panoramic and
periapical, CT scan or tomography
– as indicated)
7. photographs

Problem list &
treatment
considerations


TEETH – NUMBER & EXISTING CONDITION
INCLUDING:
prognosis of remaining teeth
size, shape & diameter of existing dentition
tooth & root angulations & proximity
mesiodistal width of edentulous space
**Need: minimum of 6-7mm between teeth to facilitate
implant placement (based on 3mm fixture)
> 1.5mm between implant and natural teeth
7mm from center of implant – to center of implant for
edentulous area
**If more than 10mm mesiodistal space – then single
tooth implant not recommended


bone support – quality & quantity (Lekholm

& Zarb classification)

quality: best is thick compact cortical bone w/ core of
dense trabecular cancellous bone
best region is mandibular symphysis; poorest in posterior
regions

quantity: required for implant placement:

6mm buccal-lingual width w/ sufficient tissue volume
8mm interradicular bone width
10mm alveolar bone above inferior alveolar (IAN) canal or
below maxillary sinus
**If inadequate bone support, may need ridge or site
augmentation:
ramus or chin graft (autograft)
DFDBA (allograft)
Bio-Oss(xenograft)
**implants should be placed at a minimum of 2mm from the
inferior alveolar (IAN) canal or
below the maxillary sinus


Thank you
For more details please visit


Micro implant anchorage in orthodontics /certified fixed orthodontic courses by Indian dental academy

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