Anchorage in beggs technique /certified fixed orthodontic courses by Indian dental academy


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Anchorage in beggs technique /certified fixed orthodontic courses by Indian dental academy

  1. 1. Anchorage & Its Management In Stage I Of Begg INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Anchorage  Webster “a secure hold sufficient to resist a heavy pull”  In orthodontics “nature and degree of resistance to unwanted displacement offered by an anatomic unit, when used for purpose of effective tooth movement”
  3. 3. Anchorage management  Involves restricting movement of one group of teeth while facilitating movement of other teeth.  Successful anchorage management is key to successful orthodontic treatment.
  4. 4.  “Anchorage preparation is most important step in clinical orthodontics” (Tweed)  Begg light wire appliance develops its total anchorage potential from with in the mouth.
  5. 5. Relationship of tooth movement to force  Conc. the force needed to produce tooth movement, where it is desired  Dissipate the reaction force over as many other teeth as possible keeping the pressure in PDL of anchor teeth as low as possible
  6. 6.  A threshold, below which pressure would produce no reaction  perfect anchorage control  since it would only be necessary to be certain that the threshold for tooth movement was not reached for teeth in anchorage unit.
  7. 7.  Amount of tooth movement α mag. Of pressure ,up to a point.  After this, AOTM is indep. Of magnitude of pressure
  8. 8.  Optimum orthodontic force level for movement is the lightest force & resulting pressure that produces a near maximum response  Force > that ,equally effective but would be unness. traumatic & stressful to anchorage
  9. 9. Anchorage situations  Reciprocal anchorage force applied to teeth & to arch segments are equal ,so the force distribution in PDL
  10. 10. Anchorage value  Anchorage value of any tooth  roughly eq. to its root surface area  5 & 6 in each arch is appro. eq. in surface area to 1,2 & 3 Freeman’s anchorage value diagram
  11. 11. Reinforced anchorage  By adding more resistance units.  It is effective because with more teeth (extraoral structures) in the anchorage, reaction force distributed over a larger PDL area.
  12. 12. Stationary anchorage  Bodily movement of one group of teeth against tipping of others
  13. 13. Anchorage bend  In begg’s technique anchorage is used For retraction and intrusion  Derived from single bend (anchorage bend)
  14. 14. Anchorage bend  Formerly called the tip-back bend.  Bend whose vertex faces occlusally  Placed in buccal segment at some point mesial to the tube.
  15. 15. The manner in which anchorage is obtained for vertical movements When initial arch wire is inserted the AB  ant. Portion should rest in mucobuccal fold  Engaged in brackets wire will exert force on molar, occlusal pressure on mesial end of tube and gingival pressure on distal end
  16. 16.  This will tend to cause Extrusion of mesial cusp & root Intrusion of distal cusp & root Distal tipping of crown Mesial tipping of root
  17. 17. These tendencies encounter certain resistance Ex. Of mesial cusp opp. Occl. Force Int. of distal cusp  bone Distal tipping of crown 2nd & 3rd molars Mesial tipping of root bone on mesial surface  Resistance not equal magnitude prevent effect of anchorage bend
  18. 18.  If arch wire viewed from side, mildly gingival curve reflect force for overbite correction  resistance to movement exhibited by molar  The amount of constant light force, optimal for intruding the anterior at a minimal level to produce movement of molars.
  19. 19. The manner in which anchorage is obtained for retraction After arch wire attached  class II elastic between I.M.H of upper arch wire & hook on mesial end of lower molar tube.  Tend to pull molar forward & retract anteriors
  20. 20.  AB counteract mesial pull  If appro. Ab and elastics are used (proper m/f) tooth lean upright,& if move, bodily
  21. 21.  At the same time e retract ant. Ling. by tipping  The amount of force exerted by elastic Optimal for tip the anterior backwards At a minimal level to move of molars forward bodily.
  22. 22.  Amount of force exerted by wire & elastics is important if desired movements are to be attained with minimal anchorage loss, throughout the Rx.
  23. 23. Orthodontic Judo  Based on using the opponent’s greater strength and weight to his disadvantage  Enable a weak & small man to overcome a large & strong man, based on scientific principles of leverage and balance
  24. 24. The crown tipping tendency can be used to advantage ↓ by simply eliminating the stabilizing resistance supplied by wires and elastics attached to other teeth ↓ crown takes the path of least resistance and net result crown movement.
  25. 25. Attainment of beneficial crown tipping movement resulting from root tipping force or prevention of detrimental crown movements by these forces is called orthodontic judo
  26. 26. Three elements  Lever arm( arch wire)  Area of High resistance (bone around roots)  Area of low resistance (area around crown)
  27. 27.
  28. 28. Operation boot strap: net distal movement of anchor molars with judo mechanics  Under certain conditions, and relatively early in Rx  light forces can induce a backward movement of anchor molar crown,  which in themselves are being used to move ant. teeth backward  Contravention to Newton’s 3rd law  Like lifting yourself off the floor with your own bootstrap
  29. 29. AB force in first stage & net distal movement of upper molars  AB tends to tip the molar roots forward and crown backward  Net effect of widespread difference between the high resistance root tipping and the low resistance crown tipping  More crown movement
  30. 30.  If molar mesially inclined at comm. of Rx , net distal movement of crown to upright position can be sig. for class II correction incr. arch length in nonext. Cases.
  31. 31. For net distal movement  molar crown should freely move back  No binding of arch wire in tube  Do not bend the end of arch wire  Do not use tie back ligature to molar tube
  32. 32. AB force in first stage with or without net distal movement of lower molars  Lower molar crown also have tendency to tip back  Controlled by varying the force of class II elastics  11/2 – 21/2 ounce (nonext.) crown may tip back more & root tip forward less
  33. 33.  21/2 – 31/2 ounce (ext.) both crown & root may tip, uprighting the tooth but imparting little or no distal tipping  Net distal movement is proportional to amount of elastic force
  34. 34. The location and degree of angulations of A.B, depends upon  Types of arch wires  Location of extraction space, if any  Depth of overbite  Hazard of occlusal impingement and distortion aids  Inclination of anchor molars
  35. 35. Variations in the angulations of AB Stage of treatment  In stage 1- usually greater than stage 2 except for open bites  Little if required in stage 3.
  36. 36. Depth of overbite  In avg. deep bite cases – anterior segment of wire rest passively at the depth of mucolabial fold  In open bite caseto keep the anchor molar of both jaws upright against the mesial pull of elastic and wire. After OB correction ↓ to prevent dev. excessive OB or distal tipping of molars.
  37. 37. Rate of progress of case  If progress is unsatisfactory, ↑ bend or relocate bend closer to molar tube. Inclination of anchor molar at the commencement of the treatment  If molars are inclined mesially ↓ AB, so that wire rests passively in mucolabial fold.
  38. 38.  On severe mesial inclinationNo AB initially Later for uprighting molar  unilaterally mesial inclined molar the increased intrusive force on that side can be prevented by using vertical elastics and arch wires.
  39. 39. Variation in location of AB Stage 1 of treatment placed forward to the molar tooth to permit it to slide back to tube during space closer but not to enter the tube
  40. 40. At the commencement of treatment distal to premolar or tip of buccal cusp Mild overbite/open bite cases formed as gentle curve located at the head of bicuspid bracket
  41. 41. Nearer to molar tube  Occlusal impingement  Difficulty and delay in overbite correction  non extraction case  In first molar extraction cases  In second bicuspid extraction cases
  42. 42. The rate of progress and amount of space remaining  When progress rapid placed farther forward  If little space remains placed far enough forward to assure that old teeth will come into proximal contact before AB reach the molar tube.
  43. 43. Location of AB in loop arch wires  used for 2-3 appointments placed far enough forward to assure that it will not slide back and reach the molar tube.
  44. 44. Causes of loss of Anchorage in stage I and its prevention
  45. 45. Vertical loop touching the labial surface of the teeth  A loop resting but not touching labial surface of ant. teeth  As the crown tip lingually  loop is moved towards the teeth  inhibit further free tipping of ant. Teeth in same arch, may affect opp. Arch also.
  46. 46. Prevention  Proper arch wire fabrication  Proper location of loops & limitation of the number of loops  Slightly labial inclination of loops in severe crowding cases
  47. 47. Vertical loop impinging on the gingival tissue  Prevent free tipping but less than if touching the tooth  If impinge on gingiva become imbedded by next visit  Prolong first stage I
  48. 48. Prevention  Care modification of loops  Slightly labial inclination of loops when arch first applied  Do not modify the loop without removing from mouth
  49. 49. Intermaxillary hooks not cranked out  Vertical portion of I.M.H resting snugly against the canine  +ve braking mechanism Prevention  I.M.H should be cranked out before arch wire is applied  Use horizontal circle
  50. 50. Distal leg of I.M.H sliding against the lock pin & becoming engaged in canine bracket  Prevents free and simple tipping of canine crown  Usually happen when loop arch wire are used to unravel ant. Crowding
  51. 51. Prevention  I.M.H should be cranked far enough labillay, engage against the mesial surface of bracket  Use horizontal circle
  52. 52. Elastic over the I.M.H engaging the labial surface of canine  Not major cause  Due to using thick elastics or two elastics Prevention  Modify I.M.H so that elastic not produce undesirable pressure  Use horizontal circle
  53. 53. Lock pin binding the arch wire in the bracket  If one or more ant. teeth are bind Prevention  Use special safety lock pins  If conv. Pins, tails should be bend before head strike the arch wire
  54. 54. Cuspid forced out into buccal plate  Improper arch wire form  Causes drag teeth can not tip freely
  55. 55. Prevention  Place the distal ends of arch wire in molar tubes, see if wire lies so far labially in canine region
  56. 56. Too strong elastic force  Use proper intermaxillary elastic force  2-21/2 ounce  Molar will come forward
  57. 57. Wearing more than one elastic Pt. must be properly educated in  function of elastics  Danger of wearing more elastics
  58. 58. Elastics not worn continuously  Intermittent wearing causes anchor tooth to become loose  Ant. Teeth hardly move  Prolong Rx  anchorage loss Prevention  Proper patient education
  59. 59. Arch wire accidentally engaged in the slot of second premolar  Increases friction  In mes.ling molar rotation wire may acci. engage Prevention  Use of bypass clamp  Remove the premolar band for first 6 weeks
  60. 60. Arch wire binding in buccal tube  If arch wire too short to protrude through the distal end of molar tube  When cut to proper length, cause internal burring (not removed by ordinary polishing) Prevention  Make always slightly longer than necessary  Do not cut the end of wire until all modifications and bends, 1/8”should protrude
  61. 61. End of arch wires striking the second permanent molar  Retards and sometimes stops the distal sliding of arch wire (usually in upper molar)
  62. 62. Prevention  Extend the arch wire farther distally through the 1 molar tube not only to prevent striking but also to move 2nd molar lingually  If impossible, cut it short enough to allow it to slide freely until next visit
  63. 63. End of arch wire penetrating the gingival tissue  Usually distal end of lower arch  Gingival tissue (bone) prevent free sliding Prevention  Patients should be instructed to visit orthodontist if they feel discomfort or Can not engage elastics
  64. 64. Anchorage bends engaging buccal tube  Once entered in molar tube free sliding is prevented due to three point contact Prevention  Check the situation every visit  If necessary remove the arch wire, st. it and, make new anchor bend mesially
  65. 65. Ligating premolar too tightly to arch wire  Arch wire can not slide distally Prevention  Ligate the arch wire lightly so that arch is free to slide
  66. 66. Insufficient anchorage bend in first arch wire when first applied  Good rule to follow to incorporate enough AB to cause the ant. section to lie against the floor of mucobuccal fold when distal ends of arch wire is threaded into molar tubes.
  67. 67. Prevention Not to estimate the amount of bend in number of degrees, because  Inclination of molar and buccal tube  Length of arch wire must be taken into account
  68. 68. Distorted anchorage bend  Seen in negligent pt. mesial to lower molar tube, esp. when lower 2nd premolars are not present Prevention  Examine the arch wire closely  If distorted ,remove from mouth, eliminate the distortion
  69. 69. Too much anchorage bend  May cause distortion of arch wire  May cause arch wire to rotate in molar tubes rotate the molars  failing to depress molars
  70. 70. Improper toe in  Results in loss of control of anchor teeth & failure to reduce ant. Deep bite.  Proper amount of toe in or toe out is determined by placing the arch wire in molar tubes & in anterior brackets  The wire should pass st. forward and occlusally as it leaves the tube from the action of anchorage bend.
  71. 71. Arch wire too soft  Arch wire material must have higher resiliency that is compatible with freedom from likelihood of # of arch wire while they are being worn  Other wise Rx time will increase  more anchorage loss
  72. 72. Overactivated expansion loops or improperly bent arch wires  Cause rapid initial labial tipping and spacing of ant. Teeth  More force time spend to recover original lab.ling. inclination of ant. Teeth  Loss of anchorage
  73. 73. Bend – over free end of lock pin impinging on arch wire  A lock pin tail striking the wire distal to caninedoes more harm than the same in C.I Prevention  Use short lock pin or cut the lock pin tail off flush with the side of bracket  Bend all pins tail to mesial.
  74. 74. Wrong type of bracket  Do not edge wise bracket  May allow ample tipping labiolingually but it restricts mesiodistal tipping and causes loss of anchorage
  75. 75. Arch wire rolling in buccal tube  Avoid too much anchorage bend and/or too much toe in bend
  76. 76. Improper arch wire form  Arch wire should keep all teeth in the cancellous through of alveolar bone  Arch wire must be bilaterally similar in form or should be so shaped as to eliminate any asymmetry of arch
  77. 77. Upper and lower arch wire forms not coordinated  Teeth will assume faulty relationship  Ant. or pos. cross bite  cuspal interference  prolonged Rx time
  78. 78. Internal diameter of buccal tube too small or large  Best internal diameter 0.036” for 0.016” wire  if less free sliding will reduced  if more  molar control lessen, depression force on ant. Lessen
  79. 79. length  Length 0.20” – 0.25” ,  shorter tube  lessens molar control & force of anchor bend,  longer tube  more control, reduces the distance of arch wire between mesial end of molar tube and premolar bracket operational difficulties during stage 3.
  80. 80. Retaining looped arch wire longer than necessary  Danger of loops moving into such positions that they press against labial surface of ant. teeth  Not transmit tooth depressing force as accurately as an arch wire without loop  Cuspid will depress more than incisors
  81. 81. Binding of doubled-back arch wire in flat oval tube  Binding will occur by having the legs too far apart  May be due to too large a radius where the arch wire returned on itself, or too long a vertical section extending from the hook that is wound around the arch.  Legs of double back are not ll.
  82. 82. Curving arch wires between expansion loops  Make the arch wire st. between the loops  If need to modify the form make bends in the loops  When engaged, loops become distorted  rotations of the sections of archwire  If curved three point contact  inhibit free lab.ling. tipping
  83. 83. Thumb or finger sucking, lip sucking,tongue thrusting and abnormal sleeping habits  Retard or prevent treatment progress  Cause loss of anchorage Prevention  Habit breaking measures
  84. 84. Improper ligature tie at canine  do not pass ligature ties on canines over the incisal of brackets  prevents free tipping  It should pass directly distally across the labial surface of canine
  85. 85. Anchorage bend too far mesially  Ideal location at the mesial of anchor molar  It may become restricted by ligature tie on bicuspid, preventing free distal sliding  Arch wire will be projected towards the occlusal plane and be deformed by occlusal forces.
  86. 86. prevention  Anchorage curves instead of bends  Gently curved anchor bend can be initially placed so far mesially in the arch wire that it is unnecessary to remove the arch wire from mouth in order to make a new bend farther.
  87. 87. Using 0.014” instead of0.016” wire  0.014” exerts insufficient force from its anchorage bend to prevent the anchor molars from being tipped mesially.  Ant. Deep bite will also not open
  88. 88. Loosening of anchor molar bend  Pull the affected molar forward  Anterior teeth are not depressed
  89. 89. Conclusion  Place adequate anchorage bends in both arch mesial to molar tubes  Use of arch wires, rubber elastics which exert tooth moving forces of low value.  Not to move any teeth bodily other than anchor molars in stage I
  90. 90. Thank you Leader in continuing dental education