Anchorage - 12undercuts.files.wordpress.com › 2017 › 01 › anchorage-2.pdf · 2.Extra oral...
Transcript of Anchorage - 12undercuts.files.wordpress.com › 2017 › 01 › anchorage-2.pdf · 2.Extra oral...
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Dr .Talal Elzawawy BDS, MSc (orthodontist)
Anchorage
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Danube university of Krems, Austria
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Objectives
* What is anchorage ?
* Classification of anchorage.
* What is loss of anchorage ?
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anchorage * Anchorage is a resistance to unwanted tooth movement.
* The aim of anchorage is to mini-mize the unwanted tooth movement and maximize the desired tooth movements.
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assessing anchorage requirements
* Anchorage requirements should be considered in three dimensions, anteroposteriorly, vertically and transversely.
* When considering anchorage management it is important to assess the following:
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1- Space requirements : * Maximum anchorage support is required when all or most of the space created is required to correct the crowded teeth.
More crowding more anchorage
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2- The type of tooth movement to be achieved:
* Tipping occurs when the crown of a tooth moves in one direction and the root moves by in the opposite direction.
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* Bodily movement occurs when both the crown and the root move in the same direction
Bodily movement more anchorage
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3. The number of teeth to be moved:
* As the number of teeth to be moved increases so more anchorage need.
4. The distance of the movement required:
* The greater the distance the teeth are to be moved, the greater anchorage need.
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5. Aims of treatment: * In cases with a Class II molar relationship, anchorage needs will be greater if a Class I molar (and canine) relationship is to be achieved rather than a Class II molar (and Class I canine) relationship.
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6.Root surface area of the teeth to be moved: * The large root surface area giving you more anchorage.
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7.Occlusal interdigitation and occlusal interferences: * Occlusal interferences can prevent or slow tooth movement.
8. Bone quality: * Maxillary bone is less dense than mandibular bone, so anchorage loss is more rapid in the maxillary arch
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Classification of anchorage
1.Intra oral anchorage A. Simple anchorage: One tooth against another. B. Intramaxillary compound anchorage: Multiple teeth are used in an anchorage unit in the same arch.
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Classification of anchorage C. Intermaxillary compound anchorage: Multiple teeth in opposing arches, like intermaxillary elastics.
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Classification of anchorage D. Reciprocal anchorage: Two groups of teeth of equal size are pitted against each other, resulting in movement of both units,like quadhelix ,cross elastics
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Classification of anchorage E. Stationary/absolute anchorage: This can only be achieved when using an osseintegrated implant
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Classification of anchorage
2.Extra oral anchorage
A. Headgear
B. Face mask (reverse headgear)
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Reinforcement of Intra oral anchorage
Anchorage reinforcement can be achieved by using the teeth, soft tissues and skeletal structures intra-orally. Increasing the number of teeth in the anchorage
unit: Using as many teeth as possible into an anchorage unit will aid in increasing anchorage, and decreasing the unwanted tooth movement
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Differential extraction pattern: Extracting teeth closer to the site of crowding reduces the amount of tooth movement required and the risk of anchorage loss.
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Care with initial intra-arch orthodontic mechanics:
Engagement of severely displaced teeth in the early stages of alignment may increase anchorage loss.
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Bodily movement of teeth: * Bodily movement requires more force
than tipping movements and is therefore more anchorage need.
* Use of large rectangular stain-less steel
arch wires will ensure bodily movement.
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Transpalatal, Nance and lingual arches : * They are linking contralateral molar teeth. * Joined with an arch bar, usually 1 mm diameter
stain-less steel. * When connects across the vault of the palate
(transpalatal arch). * When contacts the anterior palatal mucosa
(NANCE appliance). * Around the lingual aspect of the lower arch
(lingual arch) * They are using the basal bone to augment the
anchorage
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Intermaxillary anchorage: * Anchorage from one arch can be used to
reinforce anchorage in the other. * Class II elastics will be run anteriorly in the
upper arch to posteriorly in the lower.
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* Class III elastics are run anteriorly in the
lower to posteriorly in the upper
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Removable and functional appliances: * They increase anchorage by their palatal
coverage * Can be used alone or to reinforce anchorage
in conjunction with a fixed appliance * Anteroposteriorly inclined bite-blocks * Transversely expansion screw * Vertically bite-plane
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Temporary anchorage devices (TADs) Also known as orthodontic bone anchorage devices They classified to: 1. Mechanical retention a– Screw design b– Plate design 2. Osseointegration
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Screw design or miniscrews
* No osseointegration is required. * They are small in size. * Ease to use. * The head and neck configuration has been
adapted to facilitate placement of auxiliaries to the fixed appliance.
* Can usually be removed without anaesthesia.
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* They can provide anchorage either Direct anchorage: is achieved when forces are applied directly to the TAD. Indirect anchorage: is achieved when the TAD is linked to the anchorage teeth, and then the orthodontic forces are applied to this anchorage unit.
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Direct anchorage
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Plate design or Miniplate systems * These are based on maxillofacial bone
plates, with a transmucosal portion projecting into the mouth to allow connection to the fixed appliance.
* They can provide good anchorage. * Require a surgical procedure to place them
and remove them.
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Osseointegrated implants * They are shorter and wider diameter than
those used in restorative dentistry.
* They provide Stationary or absolute anchorage.
* useful if large or difficult tooth movements are required.
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* They need to be left for 3 months after
placement to allow osseointegration.
* Due to their size they are restricted to being used in edentulous areas.
* Requires a complex surgical procedure with bone removal at the completion of treatment.
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2.Extra oral anchorage A. Headgear Headgear can be used for:
* Extra-oral anchorage holds the posterior teeth in position, preventing unwanted mesial movement of the anchorage unit.
* Extra-oral traction applies a distal force to the
posterior teeth to achieve tooth movement in a distal direction, and to restrict the growth of the maxilla.
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B. Face mask (Reverse headgear) A face-mask or reverse headgear has two uses. * Tooth movement: moving the posterior
maxillary teeth mesially. * Skeletal changes: advancement of the maxilla
can be achieved in patients with CLIII malocclusion.
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Loss of anchorage Undesirable movement and failure to achieve correction of a malocclusion (movement of anchor unit). Due to : * Failure to correctly plan anchorage requirements at
the start of treatment. * Repeated breakages of anchorage devices. * Failure to wear intermaxillary elastics. * Patient compliance specially with extra oral devices.
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Loss of anchorage Signs of anchorage loss :
* Tipping of anchor teeth. * Closure of extraction space by movement of another
teeth. * Proclination of anterior teeth. * Increase in over jet. * Change in molar relation.
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Case for discussion
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