Anchorage In Orthodontics

Introduction

Orthodontic tooth movement

Force Active components???

Introduction

Active components Generate forces In one direction Equal and opposite force Newton’s third law of motion

Introduction  Desired tooth movement is inevitably asso with an opposing force. Anchorage units Anchorage loss Anchorage management .

M.”  Active elements and resistance elements. Graber :  “The nature and degree of resistance to displacement offered by an anatomic unit when used for the purpose of effecting tooth movement.Definitions Moyers :  “ Resistance to displacement.” . T.

or (sometimes) by the palate. head or neck (via extraoral force). or implants in bone.” “Resistance to reaction forces that is provided (usually) by other teeth.”  .Definitions Proffit :  “Resistance to unwanted tooth movement.

premolars) to close the extraction space in order to achieve selected treatment goals.Definitions Nanda :  “The amount of movement of posterior teeth (molars.” Reversal of anchorage .

Classification – Moyers Anchorage Intraoral Intramaxillary Intermaxillary Simple Stationary Reciprocal Single Compound Reinforced Muscular Extraoral Cervical Occipital Cranial Facial .

Classification Nanda : 1. B anchorage : moderate Relatively symmetric space closure (50%) 3. C anchorage : mild / non critical 75% or more of space closure by mesial movement of posterior teeth . A anchorage : critical / severe 75 % or more of the extraction space is needed for anterior retraction . 2.

Classification .

Classification   Burstone Group A: Postr teeth contribute less than one quarter to total space closure Group B: Postr teeth contribute from one quarter to one half to total space closure Group C: Postr teeth contribute more than one half to total space closure   .

Biologic Aspect Of Anchorage  Anchorage value Teeth to be moved Active components Anchorage Extraoral vs intraoral anchorage .

Biologic Aspect Of Anchorage  Factors affecting anchorage value Force magnitude Physiologic force concept F/A .

Biologic Aspect Of Anchorage  Surface area Major determinant Lower incisor vs molar anchorage First principle of orthodontic anchorage .

pressure within the pdl should be kept as low as possible Heavy forces .Biologic Aspect Of Anchorage  For a tooth or group of teeth acting as anchorage unit.

Biologic Aspect Of Anchorage  Pressure Response Curve for Anchor Teeth (A) and Teeth to be Moved (M)  Pressure in the PDL of A is less than the pressure in the PDL of M .

Biologic Aspect Of Anchorage   2nd factor – pressure distribution Single force vs force couple Second principle of orthodontic anchorage .

100-150 g Intrusion .50-75 g Rotation .125g .75.50-75 g Uprighting.Biologic Aspect Of Anchorage  Proffit Tipping – 50-75 g Bodily .50-75 g Extrusion .

Biologic Aspect Of Anchorage  Tooth which is free to tip has a less anchorage value than a tooth which is restricted in tipping by the application of a force couple .

of roots and root morphology Multirooted > single rooted Longer rooted > shorter rooted Triangular shaped root > conical or ovoid root Larger surface area > smaller surface area .Biologic Aspect Of Anchorage  3rd factor – no.

Biologic Aspect Of Anchorage     4th factor – neighbouring structures Quality of the alveolar bone Traumatic extraction 2nd molars inclusion .

Biologic Aspect Of Anchorage    Soft tissues Fixed app incorporating lip bumper Palatal button .

Types of anchorage

Simple Anchorage: ‘Dental anchorage in which the manner and application of force tends to displace or change the axial inclination of the teeth that form the anchorage unit in the plane of space in which the force is being applied.’

Types of anchorage
 

Stationary Anchorage: ‘Dental anchorage in which the manner and application of force tends to displace the anchorage unit bodily in the plane of space in which the force is being applied.’ Refers to the advantage that can be obtained by pitting bodily movement of one group of teeth against tipping of another

Types of anchorage

Eg: Retraction of mandibular incisors using first molars as anchorage Considerably more than Simple Anchorage

Types of anchorage   Reciprocal Anchorage: Anchorage in which the resistance of one or more dental units is utilized to move one or more opposing dental units Dissipation of equal and opposite forces Diastema closure   .

Types of anchorage  Correction of posterior cross bite through cross elastics .

Types of anchorage Close to reciprocal anchorage .

Types of anchorage   Multiple or Reinforced Anchorage: Multiple dental anchorage: Reduces pressure on the anchor units moving them down the slope of the pressure-response curve Tissue .borne anchorage:  .

Types of anchorage  Cortical Anchorage: Torquing the roots of posterior teeth outward against the cortical plate to inhibit their mesial movement  .

Types of anchorage  Intramaxillry anchorage/ traction  Resistance units are situated within the same jaw .

Types of anchorage  Intermaxillary anchorage/ traction Resistance units situated in one jaw are used to effect tooth movement in the other jaw  Class III traction Class II traction .

Palatal and lingual arches Maintain intermolar width Restrict mesial tipping Correction of rotations .

Two couple orthodontic appliance system : Transpalatal arches  Two bracket system Cinched Passive and rigid   .

Two couple orthodontic appliance system : Transpalatal arches  Bilateral expansion .

Two couple orthodontic appliance system : Transpalatal arches  Bilateral constriction .

Bend Bilateral First order activations (Mesiofacial Rotations) .Two couple orthodontic appliance system : Transpalatal arches  Symmetrical V.

Two couple orthodontic appliance system : Transpalatal arches Clinical uses  Required in non-extraction T/t To counter the M-Li rotations produced by space closing forces Before initiating head gear therapy   .

Two couple orthodontic appliance system : Transpalatal arches To decrease the arch perimeter To close any remaining posterior spaces To seat the molar properly for a classII molar finish Mesiolingual Rotations .

Two couple orthodontic appliance system : Transpalatal arches  Symmetrical V.Bend Bilateral Second order activations (M-D tipping) .

Two couple orthodontic appliance system : Transpalatal arches •Correction of unilateral classII dental malocclusion .

Bend Bilateral Third order activations (Facial Root Torque) •To upright the molar roots .Two couple orthodontic appliance system : Transpalatal arches  Symmetrical V.

Bend Unilateral First order activations (Mesiofacial Rotations) •Correction of unilateral classII dental malocclusion .Two couple orthodontic appliance system : Transpalatal arches  Asymmetrical V.

Bend Unilateral First order activations (Mesiolingual Rotations) Unilateral Loss of molar anchorage is required .Two couple orthodontic appliance system : Transpalatal arches  Asymmetrical V.

Two couple orthodontic appliance system : Transpalatal arches  Asymmetrical V.Bend Unilateral Third order activations (Facial Root Torque) •To correct the unilateral cross bites .

Two couple orthodontic appliance system : Transpalatal arches Step bends .

Anchorage and choice of extraction .

Anchorage and choice of extraction .

Anchorage and choice of extraction .

Anchorage and choice of extraction .

Extra oral anchorage H E A D G E A R S .

Extra oral anchorage   Principle use Forces derived from EOA Stabilize the position of the teeth Produce tooth movement Orthopedic changes Extra oral anchorage Extra oral traction .

Extra oral anchorage  Mild cases Cases with severe crowding and overjet Severe cases – additional space is required even after extraction   .

Extra oral anchorage  Application of EOF Face bow .

Extra oral anchorage  Stops – inner bow .

Extra oral anchorage  J hook head gear fig .

Extra oral anchorage   Directional control Effects of EOF depends on Duration Direction Magnitude 1 ounce – 30gms .

Extra oral anchorage  Types of head gears .

Extra oral anchorage Basic concept for types of head gears .

Extra oral anchorage  Relationship to the occlusal plane Low pull High pull Medium pull .

Extra oral anchorage  Low pull head gear Extrusion of the molars .

Extra oral anchorage undesirable .

Extra oral anchorage  High pull head gear .

Extra oral anchorage Intrusion of the molars undesirable .

Extra oral anchorage  Medium pull head gear .

Extra oral anchorage  Protraction head gear .

Extra oral anchorage  Orthopedic effects Restrict forward and downward movement 350-450 gms/each side – 14hrs/day .

Extra oral anchorage .

Segment – between the lips Expansion – distalization .Extra oral anchorage  Practical aspects Good fitting bands Inner bow – passive Should not contact any teeth Ant.

Extra oral anchorage  Mandibular arch Use of class III intermaxillary traction with head gear .

Mechanical aspect of anchorage Sliding mechanics Force is required for 2 purposes Bone remodeling Frictional resistance Controlling and minimizing friction is an imp. Aspect of anchorage control .

Mechanical aspect of anchorage   Friction ??? Frictional force Nature of surface at the interface (rough or smooth. modified by lubricants) Independent of the apparent area of contact . chemically reactive or passive.

Mechanical aspect of anchorage  Real contact occurs only at a limited number of small spots: Asperities .

Mechanical aspect of anchorage  Metal wire in a ceramic bracket Stick slip phenomenon .

Mechanical aspect of anchorage    2 other factors can affect the resistance to sliding Interlocking of surface irregularities Extent of plowing In clinical practice friction is largely determined by the shearing component  .

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