Biomechanical Considerations in Treatment with Miniscrew Anchorage

Part 1- Sagittal plane Part 2-Horizontal & Transeverse planes

MIN-HO JUNG, DDS, MSD, PHD TAE-WOO KIM, DDS, MSD, PHD

J Clin Orthod 2008

Introduction
Anchorage control is one of the most important aspect of orthodontic treatment. Traditionally extraoral anchorage has been used to reinforce intraoral anchorage. But, the disadvantage is the patient co-operation

Introduction
The use of miniscrews for reinforcement of orthodontic anchorage has become increasingly popular in recent years . Especially in adult patients who do not want to wear extraoral appliances

Structure of an Implant
Implant

Head
(Serves as)

Body

Abutment in prosthetic rehabilitation

Attachment source for elastics & coil springs in orthodontic treatment

The portion that is embedded in the bone is termed as Body.

2.

1.

It is of 2 types

The portion that is embedded in the bone is the BODY

Plate type

Screw type

The Body is divided into 2 types

a)
b)

Screw type
Plate type

Introduction
Property Prosthodontic implant Orthodontic implant

Composition

Titanium

Titanium

Duration of use

Permanent

Temporary

Type of load Diameter

Axial Large

Non axial Small

 Miniscrews are
convenient, save time, and produce good treatment results with no need for patient cooperation.

In some patients treated with miniscrews, however, mechanical factors can produce unusual changes or side effects. The present article explains these mechanical variations and provides tips for solving the problems

The sagittal plane

Anchorage reinforcement is most commonly needed in patients with severe protrusion. In conventional retraction with sliding mechanics after first premolar extractions, the molars typically move forward 3.63.8mm.
Anterior retraction with sliding mechanics

What happens when miniscrews are used for anchorage reinforcement?

EITHER OR

ROTATION OF ENTIRE ARCH AROUND COResistance

ROTATION OF ANTERIOR SEGMENT AROUND COResistance

Miniscrews in cases of severe protrusion

DEEP OVERBITE

POSTERIOR OPEN BITE

The use of precurved archwires will result in an even stronger intrusive force on the posterior segment

Redirecting the Retraction Force

To pass through center of resistance of the anterior segment Which is located between the lateral incisor and canine roots, 6.76mm above the cervical area

Redirecting the Retraction Force

Limitations : 1. Higher line of force promotes irritation of soft tissue by elastomeric chain or coil springs because of archwire curvature 2. Limited width of gingival tissue precludes high placement of miniscrew 3. Insertion in the mobile mucosa increases the risk of inflammation around the miniscrew and may lead to failure

Optimum position of the miniscrew

Posterior Intermaxillary Elastics

Light 3/16" intermaxillary elastics, worn only at night, can prevent posterior open bite Not recommended for patients with vertical skeletal patterns

Vertical Retraction Forces

Apically positioned miniscrews and occlusally oriented hooks produce more vertical retraction force INDICATIONS: In patients with gummy smiles or other factors favoring intrusion of an entire arch To control overbite during retraction in cases of deep overbite.

Anterior Biteplanes
Occlusal plane rotation due to forces of occlusion can be prevented by bonding anterior bite planes to the lingual surfaces of the anterior teeth at the beginning of retraction

Additional Anterior Miniscrews

Additional anterior miniscrews create vertical force to counteract occlusal plane rotation and maintain torque. In a patient with a gummy smile or over -erupted upper incisors

Anterior miniscrews positioned between roots of lateral incisors and canines

The Horizontal Plane

Center of resistance of anterior and posterior segment of the upper arch in horizontal plane

 If the anterior teeth are retracted en masse, each segment moves around its center of resistance

 If miniscrews are used for anterior retraction,

the right and left quadrants rotate around each center of resistance, and the molars tend to tip palatally

To counteract these effects TPA and lingual stabilizing arch are necessary

The Transverse Plane

Intermaxillary elastics used to correct midline deviation

Miniscrew anchorage used for correction of midline deviation

Patient with midline deviation and occlusal plane canting Upper midline shifted to left of facial midline Lower midline are shifted to right of facial midline

Use of anterior midline elastics

increases canting of occlusal plane.

Anchorage from upper left and lower right miniscrews used to correct midline deviation and occlusal plane canting

Patient with occlusal plane canting and deviation of upper and lower midlines to right of facial midline.

Conventional use of miniscrew anchorage

Increases canting of occlusal plan

Miniscrew added in upper anterior region for vertical correction of occlusal plane canting

Age / Sex: 32yr/ F C/O: PROTRUSIVE profile H /o: mandibular first molar extracted in her teenage class II div 1 malocclusion Overjet : 13mm Deep overbite Lower midline deviated to right Occlusal plane cant Upper left quadrant Lower arch

Miniscrew anchorage used to retract anterior teeth and correct occlusal plane canting.

Long hooks soldered to archwire for bodily movement of maxillary anterior teeth

Additional miniscrews in the anterior region

Lower arch

Age : 26yr/ F C/o: right TMJ discomfort and mandibular anterior crowding Severe class III molar relation Lower midline shifted to left

Slight rotation of mandibular occlusal plane and development of overbite

Conclusion
If the clinician keeps in mind these probable side effects which can be caused in the sagittal , horizontal and transeverse planes by the use of miniscrews and takes proper measures to counteract them , best results can be achieved.