Dr.

RAHULTIWARI
Post Graduate Student
 Alloplastic device which is surgically
inserted into or onto the jaws.
 Orthodontic anchorage is defined as
“resistance to unwanted tooth movement
 According to Newton’s third law of motion,
every action has an equal and opposite
reaction
 The goal is to maximize desired tooth
movement and minimize undesirable
effects.
 Hence to minimize this undesirable side
effects we need implant.
 As absolute anchorage in maximum retraction requirment such
as high angle bimaxillary protrusion.
 In caseof miisng teeth for example missing molar,mini screw
implant provide anchorage as well as manage space judiciously
.
 To achieve difficult tooh movements such as naterior/posterior
instrusion,en mass distalization of upper nad lower
arches,molar uprightining and molar distalization.
 In adjunctive adult orthodontics for difficult tooth movements.
 In 1945, Gainsforth and Higley used
vitallium screws and stainless steel wires
in dog mandibles to apply orthodontic
forces. However, the initiation of force
resulted in screw loss. In 1969,
 Linkow placed blade implants to anchor
Class II elastics to retract teeth, but he
never presented long-term results.
 In 1964, Brånemark et al observed a firm
anchorage of titanium to bone with no
adverse tissue response.
 In 1969, they demonstrated that titanium
implants were stable over 5 years and
osseointegrated in bone under light
microscopic view.
 Since then, dental implants have been
used to reconstruct human jaws or as
abutments for dental prostheses. The
success has been attributed to the
material, surgical techniques, and the
manner that implants are loaded.
 In1984, Roberts et al corroborated the
use of implants in orthodontic anchorage.
Six to 12 weeks after placing titanium
screws in rabbit femurs, a 100-g force
was loaded for 4 to 8 weeks by stretching
a spring between the screws. All but 1 of
20 implants remained rigid. Titanium
implants developed osseous contact, and
continuously loaded implants remained
stable. The results indicated that titanium
implants provided firm osseous
anchorage for orthodontics and
dentofacial orthopedics.
 Retromolar implants were described by
Roberts and colleagues (1990) and the
palatal implants were introduced by
Wehrbein and Merz (1998).
 Both are used for indirect anchorage,
meaning they are connected to teeth that
serve as the anchorage units.
 Creekmore and Eklund inserted one
such device below the nasal cavity in
1983, but it was not until 1997 that Kanomi
described a mini-implant specifically
designed for the orthodontic use.
 These are used as direct anchorage.
 In contrast to the osseointegrated
implants, these devices are smaller in
diameter and are designed to be loaded
shortly after insertion
 Based on composition
Biotolerant(stainless steel,chromium-
cobalt alloy
Bioinert (titanium,carbon)
Bioactive(hydroxylapatite,aluminium
oxide
 Based on site of insertion
Palatal/lingual
Buccal
Based on mode of insertion
Self drilling
Self tapping

Based on head type

Hook head type
Bracket head type
Circle head type
 Based on shape
Cylindrical
Conical
Jang et al reported cylindrical screw -88% success rate
while with conical screw its 95%
 The head of the mini implant can be
designed for one point contact with a
hole through the neck, as in Dual Top
Anchor System, the Lin/Liou Orthodontic
Mini Anchorage Screw (LOMAS) and the
Spider Screw.
 A hook (LOMAS) or a button (Abso-
Anchor) can also be used.
 A bracket like head design, on the other
hand, offers the advantage of three
dimensional control and allows the screw
to be consolidated with a tooth to serve
as indirect anchorage.
 Examples of this type include Aarhus
Mini Implant, Dual Top Anchor System
and Temporary Mini Orthodontic
Anchorage System.
 Another design factor is the cut of the
threads. With self drilling mini screws
like Aarhus Mini Implant, Dual Top
Anchor System and LOMAS, the apex of
the screw is extremely fine and sharp, so
that the pilot drilling is unnecessary in
most cases.
 The transmucosal portion of the neck
should be smooth. It is also important that
screws be available with different neck
lengths for various implant sites.
 Diameter of the drill has to be smaller than external diameter
of screw
 If drill has same or larger external diameter than mini screw to
be used ,there would be no PRIMARY stabality as the thread
would not anchored in bone,resulting in premature loss of
screw
 GNATHOUS AND PHILIPS-recommend diameter of
drillshould be 70-85% of external diameter of screw.
 This means mini screw with a diameter of 1.6mm, adrill with
diameter of 1.2mm should be used.
 Central drilling means to produce a small crypt or dimple or
depression in surface of bone at intended mini screw
penetration point.
 Its done incases where pre drilling can be difficult eg posterior
access site ,dense bone
 The drill point can slip on dense cortical surface before
actually penetrating the bone
When drill tip slips off ,the bone and adjacent tissue can get
damage
 Producing a DIMPLE or DEPRESSION with central drill
helps to reduce risk.
 After a dimple is created then pilot drill is less likely o slip
 Significant advantage of mini screw is that they can be
loaded immediately after insertion
 Immediate loading is not possible but also it may
positively affect the osseous density around screw
 Degree of immediate loading vary widely depend
upon design of mini screw
Herman and cope recommended-force between 50-30 cN
Melson recommend force not more than 50cN
Buchler et al load not more than 600 cN
 Implant materials. The material must
be
 nontoxic and
 biocompatible,
 possess excellent mechanical properties,
provide resistance to stress, strain, and
corrosion.
Implant Size
Mini implants (6 mm long, 1.2 mm in
diameter)
Standard den tal implants (6-15 mm long,
3-5 mm in diameter
 Since mini screw mostly insert between
roots, amount of interradicular space is
crucial in determining the insertion site
and maximum diameter of screw.
 Poggio et al ,Sung et al,Park et al :has
concluded that ideal diameter should be
from 1.2 -1.5
 Miyawaki et al :All screws with diameter
less than 1.5 were lost prematurely
wherease those with diameter of 1.5mm
or more had 85% succcess rate
 Clinically miniscrew with diameter 1.5
mm or 1.6 mm are recommended
 Depending on region of bone in dental
implant total thickness available range from
4mm-16mm
 Screw longer than 10mm causes iatrogenic
perforation on lingual side of mandible or in
maxillary sinus
 Length is secondary importance,the
thickness of cortical plate through which it is
inserted is more crucial factor
 Thicker corthical plate more reliable
anchorage
 The Spider Screw is a self-tapping
miniscrew available in three lengths—7mm,
9mm, and 11mm—in single-use, sterile
packaging.
 The screw head has an internal .021" × .
025"slot, an external slot of the same
dimensions, and an .025" round vertical slot.
It comes in three heights to fit soft tissues of
different thicknesses: regular, with a thicker
head and an intermediatelength collar; low
profile, with a thinner head and a longer
collar; and low profile flat, with the samethin
head and a shorter collar.
 All three types are small enough to avoid
soft-tissue irritation, but wide enough for
orthodontic loading.
 The biocompatibility of titanium ensures
patient tolerance, and the Spider Screw’s
smooth, self-tapping surface permits
easy removal at the completion of
treatment.
 Because miniscrews rely on mechanical
retention rather than osseointegration for
their anchorage, the orthodontic force
should be perpendicular to the direction
of screw placement.
 Applied forces can range from 50g to
200g, depending on the quality of the
bone and the orthodontic movement
desired. If any mobility is noted
immediately after placement or during
tooth movement, the screw should be
inserted deeper into the bone, or
replaced with a longer screw to engage
the opposite plate of cortical bone.
 The diameter of the mini screw will
depend on the site and the space
available. In the maxilla a narrower
implant can be selected if it is to be
placed between the roots.
 If stability depends on insertion into the
trabecular bone, a longer screw is
needed, but if the cortical bone will
provide enough stability, a shorter screw
can be chosen.
 The length of the transmucosal part of the
neck should be selected after assessing
the mucosal thickness of the implant site.
 Possible insertion site include, in the
Maxilla: the area below the nasal spine,
the palate,the alveolar process, the
infrazygomatic crest, and the retromolar
area.
 In the Mandible: the alveolar process,the
retromolar area and the symphysis.
 Huang, Shotwel,Wang (AJODO 2005)
 One way to evaluate the possibility of
damaging the periodontal ligament
(PDL) is to calculate the safety distance.
 Safety distance: Diameter of the implant
+ PDL space (normal range 0.25 mm ±
50%) minimal distance between implant
and tooth (1.5 mm)
 Example: Safety distance (mm) of mini-
implants when inserted between roots
1.2 (0.25 + 50%) (1.5 +1.5) 4.575.
Therefore, the distance between roots
needs to be at least 4.6 mm to reduce the
risk.
 Gautam P,Valiathan A (AJODO 2006)
 Safety distance: Diameter of the implant
+ 2 X [PDL space (normal range 0.25 mm
± 50%)] minimal distance between
implant and tooth (1.5 mm)
 Example: Safety distance (mm) of mini-
implants when inserted between roots
1.2 2 X(0.25 + 50%) (1.5 +1.5) 4.9.
Therefore, the distance between roots
needs to be at least 5 mm to reduce the
risk.

 After the local anesthetic is applied, the
implant area is washed with .02%
chlorhexidine.
 Even when self drilling screws are used,
pilot drilling may be required where the
cortex is thicker than 2mm, as in the
retromolar area or the symphysis, because
dense bone can bend the fine tip of the
screw. The pilot drill should be .2-.3 mm
thinner than the screw and should be
inserted to a depth of no more than 2-3mm.
 If a manual screwdriver is used for insertion,
it is immediately evident when the a root
has been contacted, and any damage will
be minimum. In tests where notches were
intentionally created, histological analysis
showed spontaneous repair by the
formation of cellular cementum.
 If the screw is inserted with a low speed
drill, there is a greater chance of not
detecting a root due to lack of tactile
sensation.
 Whenever possible, the mini implant
should be inserted through attached
gingiva. If this is not possible, thescrew
can be buried beneath the mucosa so
that only a wire, a coil spring, or a
ligature passes through the mucosa.
 In the maxilla, the insertion should be at
an oblique angle, in an apical direction;
in the mandible, the screw should be
inserted as parallel to the roots as
possible if teeth are present.
 The alignment of roots can be assessed by extendingthe height
of conttour from buccal cusp tip of clinical crown
 Additionally the depression between the nebighouring root
contourcan be palapated which represent the configuration of
root alignment and is major indicator in insertion site
 The safe linterdental areais estimated by making linear
indention with a periodontalprobe
 When clinical crown exhibit considerable mesiodistal
inclination the interdental area should be assessed accordingly.
 A coronally placed miniscrew is to be on
firm attached gingiva but the risk of root
damage increases because of conical shape
of roots
 In constrast subapical or periapical insetion
may cause soft tissue impengement.
 Therfore MUCOGINGIVAL junction is the
insertion point which minimize possible root
damage while preventing root damage.
 Insertion angle(Occlusogingival)
A 45 degree angulation relative to occlusal
plane is considered acceptable.
 Insertion path (Mesiodistal)
A good clinical guideline is direction of
proximal contact area,since configuration of
interradicular space reflect direction of contact
surface viewed from occlusal surface.
 Zygoma Anchorage System (ZAS) has
been developed, in which the miniscrews
are placed at a safe distance from the
roots of the upper molars. Because of its
location and its solid bone structure, the
inferior border of the
zygomaticomaxillary buttress, between
the first and second molars, is chosen as
the implant site. Combining three
miniscrews with a titanium miniplate can
bring the point of force application near
the center of resistance of the first
permanent molar.
 The upper part of the Zygoma Anchor is
a titanium miniplate with three holes,
slightly curved to fit against the inferior
edge of the zygomaticomaxillary
buttress. A round bar, 1.5mm in diameter,
connects the miniplate and the fixation
unit. A cylinder at the end of the bar has a
vertical slot, where an auxiliary wire with
a maximum size of .032" × .032" can be
fixed with a locking screw.
 The plate is attached above the molar roots
by three self-tapping titanium miniscrews,
each with a diameter of 2.3mm and a length
of 5mm or 7mm. The miniscrews do not
need to be sandblasted, etched, orcoated.
Square holes in the center of the screw
heads accommodate a screw- driver for
initial placement, while pentagonal outer
holes are used to remove the screws at the
end of treatment.
 To place the anchor, an L-shaped
incision, consisting of a vertical incision
mesial to the inferior crest of the
zygomaticomaxillary buttress and a small
horizontal incision at the border between
the mobile and attached gingiva, is made
under local anesthesia. The
mucoperiosteum is elevated, and the
upper part of the anchor is adapted to
the curvature of the bone crest.
 Three holes with a diameter of 1.6mm
each are drilled, and the Zygoma Anchor
is affixed with the three miniscrews. The
cylinder should penetrate the attached
gingiva in front of the furcation of the first
molar roots at a 90° angle to the alveolar
bone surface.
 Orthodontic forces can be applied to the
anchor immediately after implantation.
 The ZAS uses three miniscrews,
increasing total anchorage over other
types of implants.
 Because the miniscrews and miniplate
have excellent mechanical retention,
immediate loading is possible. The point
of application of the orthodontic forces is
brought down to the level of the furcation
of the upper first molar roots.
 The vertical slot with the locking screw
makes it possible to attach an auxiliary wire,
which can move the point of force
application some distance from the anchor.
The connection between the anchor and the
conventional fixed appliance can easily be
adapted to changing anchorage needs
throughout treatment. Therefore, the ZAS
seems to be an effective alternative to
conventional extraoral anchorage.
 Anterior retraction with sliding mechanics is usually
accomplished by placing elastomeric chain or nickel
titanium springs between hooks on the anterior teeth
and the second molars.
 The anterior and posterior segments rotate around the
center of rotation, which causes bowing of the
archwire.
 A precurved archwire can be used to prevent this side
effect.
 The use of miniscrews for anchorage reinforcement produces
somewhat different mechanics.
 Because the force used during retraction is not reciprocal,
either the entire arch will rotate around the center of rotation.
 In cases of severe protrusion, where absolute anchorage is
required in both arches, these mechanics can produce posterior
open bite and deep overbite
 The use of precurved archwires will result in an even stronger
intrusive
force on the posterior segment. Following are several possible
solutions to these problems
 In occlusal plane-mini screw causes distal in
movement in posterior region.Thus molar
tor-in often incorporated in conventional
sliding archwire is eliminated with
miniscrew appliance design
 In frontal plane:-the level of mini screw site
should be predetermined at same height on
either side of the arch.Mini screw placed at
different level on two side of the same arch
causes rotation/canting of occlusal plane.
 Intrusion of single molar-
 Extruted molar requires pure molar intrusion along its long axis without
extrusion of adjacent teeth.
 For this line of force should pass through C resistance both on lateral and
frontal view to prevent possible bucco lingual and mesio distal tipping
during intrusion.
 Cresi of upper first molar is expected to be at center of occlusal table
,close to palatal root.
 The lineof force should pass through C resistance.
 So mini screw inserted on- mesial interdental area on buccal surface and
distal interdental area on palatal surface or vice versa
 tn this way combined bilateral force from buccaland palatal side wil
produce line of force passing through C resis of molar including pure
intrusion without tipping
 When molar on both sides need to be symmerically
intruted on the midpalate.
 The intrusive force is delivered through transpalatal
bar connecting both molars.
 TPA needs to be slightly expanded to prevent molar
from tipping palatally.
 Anterior-posterior position ,miniscrew should be on
line connecting the central fossa of both molars
 Implant placed between canine and premolar.
 Move one molar at a time to obtain controlled mvement.
 Initially ,force to protract the first molar is generted using coil
spring from TSAD.
 With mesial movement of molar there will also be
accompanying moment to tip molar forward.
 After most of the protraction of first molar ,a tip back bend is
given to upright this molar(with a ligature wire consolidation
from premolar to molar)and coil spring is attached to second
molar.
 This tip back bend helps in uprighting the root of first molar
while second molar is been protracted

Mini screw inserted between first and second molar
 and elastic engaged to protract molar.
Without lever arm,line of force generate mesial tipping
of molar and
premolar area.may lead to bowing of archwire in
 To achieve constant translation of molar in maintaining
arch shape-a lever arm made of rigid SS wire is placed
on molar so that line of force from miniscrew will go
through C resistance of molar.
 Place screw in retromolar region distal to
molar that needs to be uprightining
 On mesial side of tooth ,a button is
bonded and a elastic e chain attached
from button to screw.
 In 1995, a 2-stage hydroxylapatite-coated
titanium subperiosteal implant (Onplant,
Nobel Biocare, Göteburg, Sweden) was
developed. This system has several
characteristics: disc shaped, 10 mm in
diameter, 2 mm thick, coated with
hydroxyapatite on the side against bone,
and smooth titanium facing soft tissue
with a threaded hole where abutments
will be placed.
 After biointegration with tissue, the disc
is exposed by punch technique (removal
of a patch of tissue at the center). A ball-
shaped abutment is connected, to which
orthodontic devices will be attached.
Onplants have been shown, to provide
sufficient anchorage to move and anchor
teeth.
 In 1996, a 1-stage endosseous
orthodontic implant for palatal
anchorage was presented (Orthosystem,
Straumann). This system has a diameter
of 3.3 mm and endosseous length of 4 or
6 mm. The self-tapping design provides
good initial stability with fewer
procedures and less instrumentation
during surgery.
 A groove above the transmucosal part
can hold a transpalatal bar (square wire,
0.032 0.032 in, stainless steel), whichcan
be clamped by a cover and screwed
tightly to the implant. Many studies have
demonstrated its success in maxillary
tooth retraction and stabilization of
anchorage teeth.
 The midsagittal area has relatively low
vertical bone height, and complete
ossification of the suture is rare before 23
years of age (Schlegel et al 2002). For
most adults, osseointegration is
uneventful. However, the paramedian
region might be more optimal for
adolescents to avoid connective tissue of
the suture and interaction of its growth.
 Gunduz E et al AJODO 2004
 In this study, 85 patients who received
orthodontic treatment with palatal
implants in 2 clinics in Austria completed
questionnaires. The results show that
most patients got used to their implants
in about 2 weeks; 95% were satisfied with
the treatment, and 86% would
recommend the treatment to other
patients.
 In addition, 75% of the patients found the
orthodontic construction between the
anchor teeth and the palatal implant less
comfortable than the implant itself,
whereas 7% found the palatal implant
less comfortable. Approximately 24
months of treatment with the palatal
implant is tolerable for patients; this is
the average orthodontic treatment time.
 Chen F, Terada K, HandaK.
 The purpose of this study was to compare
the anchorage effects of different palatal
osseointegrated implants using a finite
element analysis. Three types of cylinder
implants (simple implant, step implant,
screw implant) were investigated. Three
finite element models were constructed.
 Each consisted of two maxillary second
premolars, their associated periodontal
ligament (PDL) and alveolar bones,
palatal bone, palatal implant, and a
transpalatal arch. Another model without
an implant was used for comparison.The
horizontal force (mesial 5N, palatal 1N)
was loaded at the buccal bracket of each
second premolar, and the stress in the
PDL, implant, and implant surrounding
 The results showed that the palatal
implant could significantly reduce von
Mises stress in the PDL (maximum von
Mises stress was reduced 24.3-27.7%).
The von Mises stress magnitude in the
PDL was almost same in the three models
with implants. The stress in the implant
surrounding bone was very low. These
results suggested that the implant is a
useful tool for increasing anchorage.
Adding a step is useful to lower the stress
in the implant and surrounding bone, but
adding a screw to a cylinder implant had
 Chen F,Terada K, Hanada K,Saito I.
Angle Orthod.2006
 The purpose of this study was to compare
the anchorage effects of an
osseointegrated palatal implant (OPI)
with a nonosseointegrated palatal
implant (NOPI), using finite element
analysis. One model, whichwas
composed of two maxillary premolars,
periodontal ligament (PDL), alveolar
bone, a palatal implant, palatal bone, a
bracket,band,and TPA,was created on
 The palatal implant was treated as either
NOPI or OPI. The force on the premolars
was investigated under three conditions:
a mesiodistal horizontal force, a
buccolingual horizontal force, and a
vertical intrusive force. The PDL stress
was calculated and compared with a
model without an implant.
 The result showed that OPI could reduce
PDL stress significantly. (The average
stress was reduced by 14.44% for the
mesiodistal horizontal force, 60.28% for
the buccolingual horizontal force, and
17.31% for the vertical intrusive force.)
The NOPI showed almost the same
anchorage effect as OPI.
 The stress on the NOPI surface was
higher than that on the OPI surface, but
the stress was not high enough to result
in failure of the implant. These results
suggested that waiting for
osseointegration might be unnecessary
for an orthodontic implant.
 Thiruvenkatachari B, Pavithranand A,
Rajasigamani K, Kyung HM.(AJODO
2006)
 The purpose of this study was to compare
and measure the amount of anchorage
loss with titanium microimplants and
conventional molar anchorage during
canine retraction. METHODS: Subjectsfor
this study comprised 10 orthodontic
patients (7 women, 3 men) with a mean
age of 19.6 years (range, 18 to 25 years),
who had therapeutic extraction of all first
 After leveling and aligning, titanium
microimplants 1.3 mm in diameter and 9
mm in length were placed between the
roots of the second premolars and the
first molars. Implants were placed in the
maxillary and mandibular arches on 1
side in 8 patients and in the maxilla only
in 2 patients.
 After 15 days, the implants and the
molars were loaded with closed-coil
springs for canine retraction. Lateral
cephalograms were taken before and
after retraction, and the tracings were
superimposed to assess anchorage loss.
 The amount of molar anchorage loss was
measured from pterygoid vertical in the
maxilla and sella-nasion perpendicular
in the mandible. RESULTS: Mean
anchorage losses were 1.60 mm in the
maxilla and 1.70 mm in the mandible on
the molar anchorage side; no anchorage
loss occurred on the implant side.
CONCLUSIONS: Titanium microimplants
can function as simple and efficient
anchors for canine retraction when
 Oyonarte R, Pilliar RM, DeporterD,
Woodside DG
 Bone response to orthodontic loading
was compared around 2 different types of
osseointegrated implants (porous
surfaced and machined threaded) to
determine the effect of implant surface
geometry on regional bone remodeling.
 METHODS: Five beagles each received 3
implants of each design in contralateral
mandibular extraction sites. After a 6-week
initial healing period, abutments were placed,
and, 1 week later, the 2 mesial implants oneach
side were orthodontically loaded for 22 weeks.
All implants remained osseointegrated
throughout orthodontic loading except for 1
threaded implant that loosened. Back-scattered
scanning electron microscopy and
fluorochrome bone labeling techniques were
used to compare responses around the 2 types
 RESULTS: The loaded, porous-surfaced
implants had significantly higher
marginal bone levels and greater bone-
to-implant contact than did the
machined-threaded implants.
CONCLUSIONS: Significant differences in
peri-implant bone remodeling and bone
formation in response to controlled
orthodontic loading were observed for
the 2 implant designs. Short, porous-
surfaced implants might be more
effective for orthodontic applications
than machine-threaded implants
 If implants are planned for future
prosthetic abutments, a standard healing
protocol should be followed.
 Direct orthodontic forces generate less
stress on implants due to limited force
imposed ( 3N, about 300 g).The stress is
far less for indirect anchorage because
implants are used to stabilize teeth.
 During surgery, assessment of bone
quality and initial implant stability are
important. With dense bone and
satisfactory stability, immediate loading
might be feasible.
 Threaded implants provide superior
mechanical interlock as compared with
cylindrical designs. Thus,waiting time
should be longer for nonthreaded
implants.
 Complete osseointegration is favorable
but not essential for effective orthodontic
anchorage implants. However, stable
mechanical retention or partial
osseointegration is required, and
implants should not be overloaded
during healing.
 Ohmae et al, 2001 reported a study on
Dog jaws in which Titanium mini-implant
were loaded using 150g force for12-18
wks after 6 wks healing period. All
implants remained stable. Periimplant
bone at loaded implants was equal to or
slightly greater than unloaded ones.
 Trisi and Rebaudi, 2002 reported on
Human Titanium (Biaggini, Ormco)
implants.
 Force of 80-120g/8-48 wks was applied
after 8 wks healing period.
 All implants remained stable and
osseointegrated. Bone remodeling
around implants was observed.
 Akin-Nergiz et al,1998
 Orthopedic force (2 N/12 wks- 5N/24)
after healing period of 12wks was
applied on Dog jaws using Titanium (ITI)
implants). Implants had no displacement
for any force level.
 Deguchi T, et al (J Dent Res. 2003)
quantified the histomorphometric
properties of the bone-implant interface
to analyze the use of small titanium
screws as an orthodontic anchorage and
to establish an adequate healing period.
Overall, successful rigid osseous fixation
was achieved by 97% of the 96 implants
placed in 8 dogs and 100% of the
elastomeric chain-loaded implants.
 All of the loaded implants remained
integrated. Mandibular implants had
significantly higher bone-implant contact
than maxillary implants. Within each
arch, the significant histomorphometric
indices noted for the "three-week
unloaded" healing group were:increased
labeling incidence, higher woven-to-
lamellar-bone ratio, and increased
osseous contact.
 Analysis of these data indicates that
small titanium screws were able to
function as rigid osseous anchorage
against orthodontic load for 3
months with a minimal (under 3
weeks) healing period.
 Disadvantages include longer treatment
time, financial concerns, andanatomical
limitations. However, the benefit from
superior anchorage and time saved by
using implant anchorage often exceeds
the healing time after surgery.
 Implant surgery does cost more than
other treatments. If implants will be used
in the prosthetic treatment plan, the fee is
offset. In addition, implant anchorage
reduces the risk of jeopardizing existing
dentition. Application of implants might
be limited by the amount and quality of
bone. Therefore, thorough evaluation is
critical before treatment.
 Intrude/extrude teeth. It is difficult to
intrude or extrude teeth, particularly
molars. Implant anchorage greatly
facilitates these movements. Mini-
implants (1.2 mm in diameter, 6 mm in
length), which can be placed between
roots or apical to a tooth, are more
feasible. Pure intrusion or extrusion
cannot be achieved. If the implant is at
the facial side for intrusion, only intrusion
plus protrusion can be accomplished.
Also, care should be taken not to involve
the periodontal ligament and prevent
 Close edentulous spaces. Missing first
molars or congenital missing teeth are
common. Because of reduced anchorage,
implants in retromolar areas have been
used to translate teeth into edentulous
areas.
 Titanium screws can be placed to
protract molars and close the spaces of
congenital missing premolars.
 This treatment is superior to others when
adjacent teeth are intact or have large
pulp chambers, making preparation
undesirable. Plaque control is more
complicated with fixed partial dentures,
which increase the risk of caries and
endodontic or periodontal disease.
 If the translated tooth is tipped, it should
be uprighted to prevent a mesial angular
bony defect.
 Reposition malposed teeth.
Preprosthetic corrections of tilted
abutments are not unusual. Adequate
anchorage for tooth movement is often
impossible when there are several
missing teeth. Realignment of molars by
using the remaining teeth is complicated
because of limited support. Implants
facilitate uprighting the abutment teeth
at the end of a long edentulous ridge. If
carefully planned, dental implants used
to upright teeth can be restored as
implant-supported prostheses in
 Reinforce anchorage. Palatal implants
have been developed to reinforce
anchorage. An endosseous orthodontic
implant anchor system (Orthosystem,
Straumann,Waldenburg, Switzerland) has
been designed and can be used in Class
II malocclusion patients in whom no
extraction or extraction of maxillary first
premolars and retraction of anterior teeth
are planned.
 Park HS, Lee SK, Kwon OWAngle
Orthod. 2005
 The purpose of this study was to quantify
the treatment effects of distalization of
the maxillary and mandibular molars
using microscrew implants. The success
rate and clinical considerations in the use
of the microscrew implants were also
evaluated. Thirteen patients who had
undergone distalization of the posterior
teeth using forces applied against
microscrew implants were selected.
 Among them, 11 patients had mandibular
microscrew implants and four patients
had maxillary implants, including two
patients who had both maxillary and
mandibular ones at the same time. The
maxillary first premolar and first molars
showed significant distal movement, with
no significant distal movement of the
anterior teeth.
 The mandibular first premolar and first
and second molars showed significant
distal movement, but no significant
movement of the mandibular incisor was
observed. The microscrew implant
success rate was 90% over a mean
application period of 12.3 +/- 5.7 months.
The results might support the use of the
microscrew implants as an anchorage for
group distal movement of the teeth.
 Treat partial edentulism. Treatment is
complicated in patients with
malocclusion and many missing and
periodontally compromised teeth.
Fortunately, implants in edentulous areas
to provide orthodontic anchorage and
later serve as prosthetic abutments have
been considered a proper
interdisciplinary approach.
 Transitional implants have been applied
in these situations.
 Correct undesirable occlusion.
Correcting Class III anterior crossbite
with conventional methods is not always
satisfactory. Retracting the entire
mandibular arch with dental implants is
possible. Localized crossbite can be
treated by bonding implants and teeth to
avoid full-mouth treatment. Protracting
maxillary arches can be achieved by
using implant anchorage.
 Provide orthopedic anchorage. Palatal
implants can be used to elicit palatal
expansion. This applies to partially
edentulous patients or children with
congenital diseases that result in facial
developmental defects or missing teeth.
Implants in congenital anomalies can
promote orthodontic and orthopedic
therapy and accelerate jaw movement by
sutural distraction.
 In orthopedic treatment the forces are
transmitted to the bones by a tooth; this
implies skeletal as well as dental effects.
 Tooth splinting or controlling force
vectors can minimize undesirable
movement, but it cannot be avoided.
Skeletal movement can be accomplished
by using teeth as anchorage, but dental
side effects often limit the amount of
movement.
 Implants can overcome the limitations by
guiding forces directly to the bones.
 Facial skeletal movement by implant
anchorage has also been evaluated.
(Smalley et al 1988)
 A 600-g force was applied until 8 mm of
maxillary displacement occurred. All
implants remained stable over 12 to 18
weeks. The findings also showed the
possibility of controlling the direction of
protraction.
 To evaluate the application of implants in
sutural expansion, animal studies have
been conducted. (Parr JA et al 1997)
 Two titanium implants were placed on
either side of the internasal suture in 18
rabbits, which were divided into an
unloaded control group and 2 test
groups. After 8 weeks, each test group
was loaded with a force of 1 Newton (N)
or 3 N. All implants remained stable for
12 weeks.
 Several congenital facial anomalies and
developmental defects present
anchorage challenges. Case reports
using dental implants for orthopedic
movement and acceleration of jaw
movement by sutural distraction have
been reported. Nonetheless, the optimal
load, which has not been determined yet,
for sutural expansion is the lowest above
the woven bone threshold that effectively
separates it.Therefore, further studies are
needed to determine the optimal load.
• While endosseous dental implants
are intended to resist the heavy,
intermittent forces of occlusion,
orthodontic forces are
considerably lower and more
sustained. Therefore, the
requirements of an orthodontic
anchor implant may be quite
different.
 The Modular Transitional Implant, 1.8mm
in diameter, is available in lengths of
14mm,17mm,and 21mm.It was designed
to support a temporary fixed prosthesis
during the healing phase associated with
placement of permanent implants, and to
be removed when the permanent
implants are restored.
 Currently, dental implants have become
predictable and reliable adjuncts for oral
rehabilitation.
 Osseointegrated/ Non osseointegrated
implants can be used to provide rigid
orthodontic or orthopedic anchorage.
Although initial results are encouraging,
the risks and benefits must be thoroughly
evaluated.
 In the future, as developments occur in
the implant technology, they may have a
significant role as anchorage
reinforcement aids.
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