Micro Implant Anchorage in Orthodontics / 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 18
th
and 19
th
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 Posterior
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 .021x.025
external slot of.021x.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. chief complaint
2. medical/dental history review
3. intra/extra oral examination
4. evaluation of existing prosthesis
5. 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


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