Professional Documents
Culture Documents
(TADS)
KOMAL RAWAL
PG 2ND YEAR
GUIDED BY: Dr. Srikanth
CONTENTS
Introduction
History
Classification
Placement sites
Armamentarium and procedure
Biological aspects of orthodontic implants
Clinical Applications
Advantages and disadvantages
Risks and complications
Conclusion
References
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It is defined as the nature and degree of Resistance to
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ORTHODONTIC ANCHORAGE
• 1923, Louis Ottofy defined it as
“the base against which orthodontic force or
reaction of orthodontic force is applied.”
Produce good
treatment result
Convenient Save time
with no need for
patient cooperation
History
Gainsforth and Higley (1945) first suggested the use of metallic screws as
anchors
a 3.4-mm-diameter
Creekmore and Eklund (1983) inserted a similar device below the nasal
cavity in 1983- to treat deep bite .
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1. Simple to Use
2. Inexpensive
3. Immediately Loadable
4. Small Dimensions
6. Immobile
7. Biocompatible
2. Miniplate implants
3. Disc implants (onplants);
Endosteal Transosseous
Sub-periosteal
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Based on composition:
Gold alloys
Stainless steel
Cobalt-Chromium-Molybdenum (Co-Cr-Mo)
Titanium
Ceramic Implants
Miscellaneous such as Vitreous carbon and composites
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Morphology
BLADE OR
SCREW TYPE DISC TYPE
PLATE TYPE
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(1995)
10 mm Diameter
2 mm Height
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Based on INTEGRITY TO THE BONE:
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Based on insertion method
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PARTS OF A MINISCREW
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Temporary anchorage devices – Ravindra nanda; Mosby
Based upon movement desired & accessories necessary for the movement
Button–Top:
Use for NiTi coil springs, Energy Chain elastics
Cross-Top:
Use for Archwires, Wire Ligatures
Bracket-Top:
Use for archwires, Energy chain, NiTi coil springs, elastics
Screw
Self Tap
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ADVANTAGES
The C-implant can be loaded immediately.
Small size, two part design, efficiency and low cost of C-implant make
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Based on length
Regular type
• 5- 7 mm
• Cylindrical neck- 1 mm
• Buccal area of maxilla and
mandible
Long type
• 5-6 mm
• For movable tissues
• Cylindrical neck – 2- 4mm
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Based on diameter
Minitype
• Used in anterior alveolus
• 1.4 mm
Regular type
• Used in areas where
bone quality is good
• 1.6 mm
Wide type
• Inadequate bone quality
• 1.8 mm
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for Implant Placement
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Dense Cortical Thick Porous Thin Porous Fine Trabecular
Bone Cortical Bone Cortical Bone Bone
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(Kravitz and Kusnoto 2007).
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Miniscrews for orthodontic anchorage: a review of available systems; Journal of Orthodontics2018
Based on Soft tissue considerations
“Safe zones”: a guide for miniscrew positioning in the maxillary and mandibular arch
“ Safe zones”: a guide for miniscrew positioning in the maxillary and mandibular arch , Paolo Maria
Poggio,Cristina Incorvati,StefanoVelo, Aldo Carano. Angle Orthodontist 2006,Volume 76, Number 2,191-197
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The order of safer sites, available in the
inter-radicular spaces in maxilla
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Region Diameter Length Purpose
Between Maxillary Canine & Premolar Buccally / 1.2 & 1.3mm, 7 - 8 mm Distal & Mesial movement molars
Between The Mandibular Canine & Premolar Intrusion of buccal teeth.
Buccally 1.2 & 1.3mm 5 - 7mm Protraction of molars.
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Region Diameter Length Purpose
Retraction of the maxillary anterior teeth
Between Maxillary 2nd Premolar, 1st Molar & 2nd
1.3 -1.6mm, 10-12 mm (Lingual ortho. Tx.)
Molars Palatally
Intrusion of maxillary molars.
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The T-Zone: Median vs. Paramedian Insertion of
Palatal Mini Implants
ARMAMENTARIUM
CONTRA
ANGLED
SCREW
DRIVER
HANDLE
STRAIGHT
SCREW
DRIVER
HANDLE
MANUA
DRIVER TIP L GUIDE
DRILL
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Temporary anchorage devices – Ravindra nanda; Mosby
Mini screw supplied in steralized capsules
INSERTION PROCEDURE
Local anesthesia
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Horizontal position of interdental insertion
contours
probe
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Vertical positioning
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2.
Palm Grip
Finger Grip -
Finishing
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Soft tissue penetration
Incision not required – insertion on firm tissue such as
attached gingiva
Minimal incision of 2-3 mm - movable tissue – visualize
underlying bone
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Infiltration anesthesia
Indentation on interdental
depressed area
Marking of vertical level of
insertion point
Insertion point marked on
gingiva
Initiation of insertion
Maintenance of insertion
path – interproximal area
from occ view as reference
Manipulation of
surrounding gingival soft
tissue
POSITIONING- STENTS
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A SIMPILIFIED STUNT FOR THE ANTERIOR
MINSCREW PLACEMENT
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JIFFY JIG
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BUCCAL
OCCLUSAL
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• Mark site for micro implant placement
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Biological aspects of orthodontic
implants
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POST IMPLANT OSSEOINTEGRATE MECHANICALLY
PERIOD D RETAINED
BIOLOGICAL
IMMEDIATE RESPONSE
Biofilm , formation of - TAD’s
blood clot
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Temporary anchorage devices – Ravindra nanda; Mosby
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Various clinical applications of TADs
include
Retraction cases needing maximum anchorage
Molar protraction
Molar uprighting
Molar intrusion
Molar distalization
Intrusion of teeth
Maxillary expansion
Forced eruption of teeth
Skeletal malocclusions
Anchorage for the periodontally compromised patients and
Treatment of occlusal canting.
Extended range of treatment
Usual changes during anterior teeth retraction with sliding
mechanics- Anterior and posterior segment rotates around
center of rotation of each segment (red dots); These changes
can easily be prevented with precurved archwires
For bodily retraction – lever arms extended from main arch
Line of force – becomes closer to center of resistance
Labial space is limited in the vestibule, and labial lever arms
may cause discomfort and an unesthetic appearance.
Space is abundant in the palatal area, so palatal lever arms can
be applied in the desired directions
Appliance construction for bodily movement in lingual
orthodontics
Miniscrew on
palatal slope
Extending the lever
arm from main arch
Correction of midline
Occlusal cant
beginning of upper arch intrusion and stabilization of the
upper arch in the miniimplant and extrusion of the lower
arch with intermaxillary elastics
Intrusion
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3)SOFT-TISSUE COMPLICATIONS
Aphthous ulceration
Soft-tissue coverage of the miniscrew head and Auxiliary
Soft tissue inflammation, infection, and peri implantitis
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Risk factors can be controlled to increase the success rate.
Predictive factors for infection:
(a) An increased distance to the attached gingiva,
(b) An increased probing depth around the miniplate, and
(c) A decrease in oral hygiene frequency. Furthermore, increased age
also contributes albeit slightly to raising the infection rate.
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Conclusion
Implants for the purpose of conserving anchorage are welcome
additions to the armamentarium of a clinical Orthodontist. They help
the Orthodontist to overcome the challenge of unwanted reciprocal
tooth movement.
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REFERENCES
Miniscrews for orthodontic anchorage: a review of available
systems; Journal of Orthodontics2018
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• Temporary anchorage devices – Ravindra nanda; Mosby
• Intraoral Hard and Soft Tissue Depths for Temporary Anchorage Devices
Antonio Costa, Semin Orthod 11:10-15 ;2005
• “JIFFY JIG” A QUICK CHAIR SIDE MICRO IMPLANT GUIDE, Journal of the
Asian Pacific Orthodontic Society,dec 2011.
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Tray-Grid Guide for Accurate Mini-implant Insertion, The Journal
of Indian Orthodontic Society · April 2012.