MAGNETS IN ORTHODONTICS

Magnetic force systems were initially used to aid retention of dental prosthesis. The widespread use of magnets in prosthetic dentistry was prevented because of cost of magnets and inadequate magnetic properties. Introduction of small, powerful and permanent rare earth magnets which are also reasonably priced has lead to magnets becoming more popular. The use of magnets for orthodontic tooth movements was first described by Blechman and Smiley in 1978. In recent years , magnets and magnetic force has been suggested as an alternative to traditional orthodontic devices such as elastics , springs and arch wires. Many latest studies have shown that magnetic devices offer an optimum and biologically safe force generating system not only for denture retention but also for orthodontic tooth movement. ADVANTAGES AND DISADVANTAGES OF MAGNETIC FORCE: There are several advantages of magnetic force over conventional force system when used for orthodontic tooth movement-----i. ii. iii. iv. v. vi. vii. viii. ix. x. Constant force , no force decay over time. Predictable force level. Less patient discomfort. Force system is frictionless. Better directional control. Rapid tooth movement , thus less treatment duration. More biologically acceptable tooth movement. Minimum appliance adjustment. Less chair side time. Minimum patient co-operation.

Although magnets have several advantages , they also have many disadvantages. The disadvantages arei. ii. iii. IV. Corrosions of magnets. Bulkiness of magnets. Brittle in nature. Thermal sensitivity.

SYSTEMIC EFFECTS OF MAGNET-------- 1979: Cerny found that SmCo magnets did not produce any adverse effects on blood cells. (Reff: Australian Orthodontic Journal 1979;6:64-70) 1985: Blechman concluded that there was no increase in urinary cobalt level at six months intervals of magnet use. (Reff:AJO 1985;87:201-210) 1987: Kawata et al. did not find any significant change in ascorbic acid, calcium and citric acid concentration level in blood after clinical use magnets. (Reff:AJO-DO1987;92:241248) 1993: WHO reports suggested that static magnetic fields up to 2T showed no significant health effects. 1993: McDonald found increased proliferation of fibroblast in presence of static magnetic field generated by SmCo magnets. (Reff:Bioelectromagnetica1993;14:187-196) 1995: Donohue et al. concluded that the biological effects of the corrosion products of magnets resulted in a range of effects from no cytotoxic effect to mild cytotoxic effect. (Reff:Journal of Applied Biomaterials 1995;6:69-74) 1998: Bondemark et al. concluded that static magnetic field had no effect on human buccal mucosa after a long term exposure (9 months) when used clinically , histologically and immunohistochemically. (Reff:European Journal ofOrthodontics 1998;20:211-218) CLINICAL APPLICATION OF MAGNETS-----Almost all types of tooth movements are possible with magnetic force. Magnets can be used for-------- Tooth movement Retention Relocation of impacted tooth Maxillary expansion Open bite Distalization of molar Functional appliance

PAIN FREE AND MOBILITY FREE ORTHODONTICS

In American Journal of Orthodontics 1998 , Dr. Blechman told magnetic orthodontics is pain free and mobility free.

Discomfort & pain is the leading cause of poor compliance during orthodontic treatment. Some degree of mobility also can be noted during orthodontic treatment because during this process, bone resorption rate exceeds deposition rate. During chewing , this mobility also causes pain. Magnetic force also generates rapid tooth movement without root resorption & periodontal disturbances. Treatment time is shorter. The magnetic field is responsible for the reduction of pain because it block the sensory nerve pathway. It can block almost 80% of action potential. Magnetic fields were used to accelerate human fracture repair. It also promotes bone fragment revascularization with more expansion of vessels. Some neurologists and sport physician use magnet to treat pain for osteoarthritis & sports injury. By applying specially designed magnets, patient feel pain relief in 10 minutes & healing time is dramatically shortened. Accelerated healing is due to increased blood flow due to relaxation of capillary wall. Magnetic orthodontics is mobility free because here bone deposition is almost equal to the rate of deposition. .(Reff:AJO-DO 1998 Apr(379-383) Tooth movement causes increase stress that induce increase bodys citric acid level. Traditional appliances causes increase of 46% of normal citric acid level which is significant. But magnetic force increase 22% of normal citric acid level which is not significant.

Some clinical cases done by magnetic force system are mentioned below----

Reff:AJO-DO 1991 Dec(494-512)

Here bilateral impacted canine present

Flap removed, exposure of teeth, fixation of magnets on the teeth by itching , bonding and composite. Then flap closed.

Upper appliance made with self cure acrylic resin. 2 magnets attach with it with self cure acrylic , just opposite to the canines. No clasp needed due to attractive force system.

Canines emerged into mouth.

After alignment of canines with fixed orthodontic treatment.

Reff:AJO-DO 1991 Dec(494-512)

Impacted lower third molar which destroy lower 2nd molar. Lower 2nd molar with periapical lesion.

2nd molar extracted, flap removed, attachment of magnet with 3rd molar with light cure acrylic, then flap closed.

Lower appliance.

A magnet attach with lower appliance with self cure to the occlusal surface of 3rd molar.

Eruption of 3rd molar with bracket.

Reff: AJO-DO 1991Dec (489-493)

Unerupted upper left canine.

Position of 2 magnets one attach with impacted canine , another with appliance.

Appliance with magnet.

Canine erupt with magnet within 4 months only.

Reff: Cases Journal 2008,1:382

Patient with impacted upper left canine.

Tooth is palatally placed because a bulge is present on palatal side.

OPG of the patient.

Exposure of the tooth & bonding a magnet with the impacted canine.

Removable appliance.

A magnet attach with wire extension arm with the removable appliance. The position of the magnet can be altered by adjusting the extension arm.

At the 3rd month, 3 mm of canine had erupted above the gingiva. At the 12th month, 2/3rd of crown had erupted & it was ready for further alignment of the tooth. Palatal impaction was brought buccally by adjusting the extension arm.

Reff:AJO-DO 1997 AUG (187-193)

Horizontal crown-root fracture of mandibular left canine.

Pulpectomy followed by sealed with ca(oh)2 Filled with temporary filling Fixation of magnet with light cure composite.

Magnet with lower appliance placed in mouth.

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Extrusion of the tooth after 11 months of treatment. Note the relationship of root apex before and after treatment.

CONCLUSION-----

Magnets are used successfully for tooth movement but they are not routinely used. Magnets and the magnetic force system is better device for theoretical & academic purpose. Not easily one can practice in day-to-day life. Need to bo very thorough in magnetic physics. Also they are expensive. Thus the main & only idea of all these discussion are to review the work of various authors , to learn from them , enjoy them & to think different.

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