Anchorage in orthodontics-1 /certified fixed orthodontic courses by Indian dental academy


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  • Anchorage in orthodontics-1 /certified fixed orthodontic courses by Indian dental academy

    1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education
    2. 2. Extra oral anchorage H E A D G E A R S
    3. 3. 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
    4. 4. Extra oral anchorage Mild cases Cases with severe crowding and overjet Severe cases – additional space is required even after extraction
    5. 5. Extra oral anchorage Application of EOF Face bow
    6. 6. Extra oral anchorage Stops – inner bow
    7. 7. Extra oral anchorage J hook head gear
    8. 8. Extra oral anchorage Directional control Effects of EOF depends on Duration Direction Magnitude 1 ounce – 28.35 gms
    9. 9. Extra oral anchorage Types of head gears
    10. 10. Extra oral anchorage Basic concept for types of head gears
    11. 11. Extra oral anchorage Relationship to the occlusal plane Low pull High pull Medium pull
    12. 12. Extra oral anchorage Low pull head gear Extrusion of the molars
    13. 13. Extra oral anchorage undesirable
    14. 14. Extra oral anchorage High pull head gear
    15. 15. Extra oral anchorage Intrusion of the molars undesirable
    16. 16. Extra oral anchorage Medium pull head gear
    17. 17. Extra oral anchorage  Protraction head gear
    18. 18. Extra oral anchorage Orthopedic effects Restrict forward and downward movement 350-450 gms/each side – 14hrs/day
    19. 19. Extra oral anchorage
    20. 20. Extra oral anchorage Practical aspects Good fitting bands Inner bow – passive Should not contact any teeth Ant. Segment – between the lips Expansion – distalization
    21. 21. Extra oral anchorage Mandibular arch Use of class III intermaxillary traction with head gear
    22. 22. 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
    23. 23. Mechanical aspect of anchorage Friction ??? Frictional force Nature of surface at the interface (rough or smooth, chemically reactive or passive, modified by lubricants) Independent of the apparent area of contact
    24. 24. Mechanical aspect of anchorage Real contact occurs only at a limited number of small spots: Asperities
    25. 25. Mechanical aspect of anchorage Metal wire in a ceramic bracket Stick slip phenomenon
    26. 26. 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
    27. 27. Mechanical aspect of anchorage Surface quality of the wires NiTi > βTi > SS Roughness There is no correlation between surface roughness and coefficient of friction β Ti has greatest frictional resistance
    28. 28. Mechanical aspect of anchorage Surface quality of the wires Changes in surface chemistry due to increased Ti content Cold weld effect
    29. 29. Mechanical aspect of anchorage Possible solution to this problem Alteration of the surface of Ti wires Among all, SS/SS couple is most effective for sliding followed by CoCr/SS, NiTi/SS, βTi/SS
    30. 30. Mechanical aspect of anchorage Surface quality of the brackets SS brackets Ti brackets Ceramic brackets Ceramic brackets with metal slots Composite brackets Polycarbonate plastic brackets
    31. 31. Mechanical aspect of anchorage Flexibility of arch wire and width of the bracket Force that pulls the wire into the bracket Self ligating brackets- reduced friction that allows more effective sliding- better anchorage control
    32. 32. Mechanical aspect of anchorage Magnitude of friction Retraction springs Closing loops
    33. 33. Conventional Begg Differential force concept 1st premolar extraction 8 teeth extraction Begg was applying the principles of differential forces
    34. 34. Conventional Begg Storey and Smith (1952) Statistical evidence confirmed the results of Begg’s clinical experience Edgewise app and springs
    35. 35. Conventional Begg Storey and Smith (1952) Tooth with a greater root surface area needs greater force to be moved canine: molar = 3:8
    36. 36. Conventional Begg
    37. 37. Conventional Begg Reason for different rates of movement of canines Storey and Smith presented the concept of undermining resorption Sandstedt (1904) Schwarz (1932)
    38. 38. Conventional Begg Storey and Smith (1952) Teeth subjected to very high forces Resorption of tooth investing tissues Teeth are loosened within the sockets
    39. 39. Conventional Begg Use of differential forces Reduction of anterior overbite Use of anchor bends Light wires Heavy wires
    40. 40. Conventional Begg Use of differential forces  Strang (1954) – Treatment problems, their origin and elimination  Edgewise app  Closing extraction space requires more force  Use of head gears - recommended
    41. 41. Conventional Begg Use of differential forces Space closure Premolars bypassed Extra oral anchorage is not required
    42. 42. Conventional Begg Means of preventing anchorage failure Use of thin round steel wires Anchor bends Stationary anchorage Premolars not bracketed Light torquing forces in 3rd stage Use of reverse torquing auxillaries
    43. 43. Refined Begg ( Dr. V P Jayade ) Differential force concept was misunderstood Excessive retraction Prevented in refined begg by applying efficient brakes along with heavy differential forces
    44. 44. Refined Begg ( Dr. V P Jayade ) Perfect example of stationary anchorage Saggital Vertical transverse
    45. 45. Refined Begg ( Dr. V P Jayade ) Stage I
    46. 46. Refined Begg ( Dr. V P Jayade ) Active components in stage I Light or ultra light class II elastics Lower class I elastics
    47. 47. Refined Begg ( Dr. V P Jayade ) Active components in stage I Upper palatal elastics / elastics from power arm (Jyotindra Kumar)
    48. 48. Refined Begg ( Dr. V P Jayade ) Active components in stage I Upper Class I are seldom used Uneven class I ,class II for midline correction
    49. 49. Refined Begg ( Dr. V P Jayade ) Anchorage considerations in stage I Palatal elastics or elastics from power arm Upper molars to be supported with TPA
    50. 50. Refined Begg ( Dr. V P Jayade ) Anchorage considerations in stage I Conserving lower molar anchorage Stiffer wires Light or ultra light elastics Molar stops
    51. 51. Refined Begg ( Dr. V P Jayade ) Anchorage considerations in stage I High angle cases Light anchor bends Light elastics TPA – away from the palate High pull head gear
    52. 52. Refined Begg ( Dr. V P Jayade ) Anchorage considerations in stage I Transverse plane Stiffer arch wires Expansion in arch wires TPA Sufficiently expanded face bow or lip bumper
    53. 53. Refined Begg ( Dr. V P Jayade ) Stage II – easiest Objectives Maintain all the corrections of stage I Closure of extraction spaces Controlled tipping of anteriors Protraction of posteriors Correction of molar relation Correction of premolar crossbites and rotation
    54. 54. Refined Begg ( Dr. V P Jayade ) Stage II Archwires used Reduction in the anchor bend
    55. 55. Refined Begg ( Dr. V P Jayade ) Braking mechanics Reversal of anchorage Def – the brakes reverses the anchorage site from posterior to anterior segment by permitting only bodily movement of the anterior teeth, instead of allowing them freedom to tip Braking springs/ T pins Torquing components
    56. 56. Refined Begg ( Dr. V P Jayade ) Braking springs
    57. 57. Refined Begg ( Dr. V P Jayade ) Angulated T pins
    58. 58. Refined Begg ( Dr. V P Jayade ) Combination wires Material Ant. Seg – rectangular (022 x 018) Post. Seg – round 018
    59. 59. Refined Begg ( Dr. V P Jayade ) Torquing auxiliaries 2 spur or 4 spur MAA – 010 / 011 Strong base wires
    60. 60. Refined Begg ( Dr. V P Jayade ) Active components in stage II
    61. 61. Refined Begg ( Dr. V P Jayade ) Active components in stage II
    62. 62. Refined Begg ( Dr. V P Jayade ) Active components in stage II
    63. 63. Refined Begg ( Dr. V P Jayade ) Stage III – most complicated and anchorage consuming Objectives of stage III Maintain all the corrections Distal root uprighting auxilliary Palatal root torquing auxilliary
    64. 64. Refined Begg ( Dr. V P Jayade ) Stage III - objectives To achieve desired root movements Monitor anchorage in all 3 planes To correct the position of 2nd molars To monitor undesirable effects
    65. 65. Refined Begg ( Dr. V P Jayade ) Stage III Reciprocal mesial crown moving forces Upper arch Lower arch
    66. 66. Refined Begg ( Dr. V P Jayade ) How to overcome stage III problems??? Proper diagnosis and treatment planning Using efficient brakes Controlled tipping of incisors Use of heavy base arch wires Lighter auxiliaries and uprighting springs Light cl II elastics Reinforcement of anchorage Contraction and toe in built into the wires
    67. 67.
    68. 68. Tweed’s anchorage preparation Tweed Merrifield appliance Level Anchorage System Vari Simplex Discipline Rickett’s Bioprogressive Therapy MBT appliance
    69. 69. Tweed’s anchorage preparation Tipping the posterior segment distally Lower posterior segment
    70. 70. Tweed’s anchorage preparation When teeth are tipped distally as they are in anchorage preparation, osteoid tissue appears to be laid down adjacent to the mesial surface of the tooth being moved distally.” - Kaare Reitan Such conclusions do not make the necessity of anchorage preparation obselete
    71. 71. Tweed’s anchorage preparation Clinical orthodontist who routinely create excellent facial changes are those who recognize the importance of and prepare anchorage in their practice
    72. 72. Tweed’s anchorage preparation Concept Upright the mesially inclined lower posterior segment Terminal molar to be tipped distally Angle formed between the class II elastic and long axis of terminal molar Mandible will be much more stable and will resist forward displacement
    73. 73. Tweed’s anchorage preparation After anchorage preparation, if movement does occur Slow mesial bodily movement Anchorage not prepared Uprooting and elevation of the molars
    74. 74. Tweed’s anchorage preparation Tweed classified anchorage preparation First degree Second degree Third degree
    75. 75. Tweed’s anchorage preparation First degree / minimal anchorage preparation ANB 0º- 4º, facial esthetics are good Discrepancy < 10 mm Mandibular terminal molars must be uprighted Direction of intermaxillary elastic pull should not exceed 90º
    76. 76. Tweed’s anchorage preparation Second degree ANB exceeds 4.5 Class II Mandibular second molars should always be banded Must be tipped distally so that their distal marginal ridges are at gum level Direction of pull of intermaxillary elastics should always be > 90º
    77. 77. Tweed’s anchorage preparation Third Degree or Total Anchorage Preparation ANB does not exceed 5º Discrepancy – 14 -20 mm All posterior teeth (second premolar to terminal molars) are tipped distally Distal marginal ridges of terminal molars are below gum level
    78. 78. Tweed’s anchorage preparation Severe cases – anchorage prepared in both the arches How to tip lower posterior segment ??? Sliding jig
    79. 79. Tweed’s anchorage preparation Lower anchorage preparation completed Lower canines and incisors retracted Upper extractions Class II elastics – distal tipping of upper posterior segment
    80. 80. Tweed Merrifield appliance
    81. 81. Tweed Merrifield appliance Attachments 022 edgewise slot Permits variety of archwire use
    82. 82. Tweed Merrifield appliance Highlighting points – Anchorage preparation Sequential banding and bonding Sequential tooth movement Sequential anchorage preparation Directional force system
    83. 83. Tweed Merrifield appliance Sequential banding and bonding Less traumatic Longer interbracket span Heavy wires
    84. 84. Tweed Merrifield appliance Sequential tooth movement Enmasse retraction Placing all bends at a time Not followed
    85. 85. Tweed Merrifield appliance Sequential anchorage preparation High pull head gear Vertical spurs soldered Distal to Mb. Lateral incisor 10 – 2 anchorage system
    86. 86. Tweed Merrifield appliance Sequential anchorage preparation Distal tip achieved Read out 15º
    87. 87. Tweed Merrifield appliance Sequential anchorage preparation Before tipping premolars Read out to be performed Distal tip achieved
    88. 88. Tweed Merrifield appliance During the course of treatment, various hooks are soldered
    89. 89. Tweed Merrifield appliance Directional force system Defined as controlled forces which place the teeth in most harmonious relation with their environment
    90. 90. Tweed Merrifield appliance Favorable Unfavorable
    91. 91. Level anchorage system Terrell L. Root Aim – quantify the anchorage requirement 018 edgewise slot Mandibular molars – 2 choices of distal crown tip
    92. 92. Level anchorage system Anchorage – Resistance to movement Distance to move Anchorage savers Those orthodontic adjunctive procedures that reduce the amount of tooth anchorage necessary to correct the malocclusion
    93. 93. Level anchorage system High pull headgear to maxillary 1st molars or J hook headgear to anteriors: reduction in ANB by 1 degree every 6 months Palatal bar: decreases vertical descent due to tongue pressure. Delaying upper first premolar extraction by one year: reduces mandibular anchorage space by 1mm Class III elastics worn 24 hrs: flatten the curve of Spee and upright buccal segments at the rate of 1mm / month
    94. 94. Level anchorage system
    95. 95. Level anchorage system
    96. 96. Vari-simplex discipline-Alexander Vari – variety of bracket used Simplex – KISS principle fewer archwire changes 1. 2. 3. Treatment philosophy – Tweeds fundamentals Anchorage preparation Positioning Mb incisors over basal bone Orthopedic alteration using head gear
    97. 97. Vari-simplex discipline-Alexander Key objective Non extraction therapy as far as possible Interproximal enamel reduction Control of Mb incisor position with –ve torque
    98. 98. Vari-simplex discipline-Alexander Bracket selection Twin brackets Lang brackets Lewis brackets
    99. 99. Vari-simplex discipline-Alexander Anchorage considerations Tip values Gain in the arch length Promotes leveling 0° angulation in Mb 2nd molar– Need not to be uprighted excessively
    100. 100. Vari-simplex discipline-Alexander -5°of labial root torque Holds the Mb incisors to their original position Major change
    101. 101. Vari-simplex discipline-Alexander Head gears / Retractors Retractors’ ( Dr. Fred Schudy) Cervical, combination or high pull depending on growth pattern and control needed
    102. 102. Vari-simplex discipline-Alexander Other intra oral appliances to control anchorage:
    103. 103. Vari-simplex discipline-Alexander Other intra oral appliances to control anchorage: Mandibular lingual arch: sagittal and transverse control Lip bumper: - uprighting of mandibular first molars - distal force on lower molars - muscular anchorage
    104. 104. Rickett’s Bioprogressive Therapy Muscular anchorage Cortical anchorage Nance button Quad helix Headgears: cervical, combination and high pull
    105. 105. Anchorage control in MBT 2nd principle of orthodontic anchorage Anchorage loss – maximum in the first stage Def – Tooth movement needed to achieve passive engagement of steel 19 x 25 wire of suitable arch form into a correctly placed 022 preadjusted bracket system
    106. 106. Anchorage control in MBT Major reason for anchorage loss ??? Mesial tip built into the bracket system Anchorage control The maneuvers used to restrict undesirable changes during the opening phase of treatment, so that leveling and aligning is achieved without key features of the malocclusion becoming worse.’
    107. 107. Anchorage control in MBT 1st step in anchorage control Recognize the anchorage needs of the case Diagnosis and treatment planning stage
    108. 108. Anchorage control in MBT Eg – class II div 1 Goal is set for incisor position - PIP Class III
    109. 109. Anchorage control in MBT Mistakes in tooth leveling and aligning during early years Roller coaster effect
    110. 110. Anchorage control in MBT Roller coaster effect has been eliminated from the present day practice Reduced tip in bracket system Light arch wire forces Use of lacebacks instead of elastic forces
    111. 111. Anchorage control in MBT Lacebacks for A/P canine control Restrict canine crown from tipping forward
    112. 112. Anchorage control in MBT Lacebacks for A/P canine control Robinson – 57 PM extn cases
    113. 113. Anchorage control in MBT Restrict canine crown from tipping forward Distalizing canines without causing unwanted tipping
    114. 114. Anchorage control in MBT Continued till rectangular SS wire stage Discontinued if space appears betn lateral & canine
    115. 115. Anchorage control in MBT Bendbacks for A/P incisor control
    116. 116. Anchorage control in MBT Bendbacks for A/P incisor control Bend is placed 1-2 mm distal to molar tube
    117. 117. Anchorage control in MBT A/P anchorage control of lower molars – the lingual arch Class III elastics & headgear
    118. 118. Anchorage control in MBT A/P anchorage support & control for upper molars –  The upper molars move mesially more easily than lower molars  Upp ant segment has larger teeth than low ant  Upp ant brackets have more tip built  Upp incisors require more torque control & bodily movement  More Class II type malocclusions than Class III
    119. 119. Anchorage control in MBT A/P anchorage support & control for upper molars – Head gears TPA
    120. 120. Anchorage control in MBT Vertical anchorage control of incisors
    121. 121. Anchorage control in MBT Vertical control of canines
    122. 122. Anchorage control in MBT Vertical control of molars in high angle cases Palatal bar Upp 2nd molars not initially banded Headgear – high pull
    123. 123. Anchorage control in MBT Anchorage control in Transverse plane Intercanine width Molar crossbites
    124. 124. Thank you Leader in continuing dental education