ANCHORAGE
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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy....
DEFINITION
• Site of delivery from which an orthodontic
force is exerted.
• Nature and degree of resistance to displacemen...
ANATOMICAL UNITS USED FOR
ANCHORAGE
• Teeth
• Alveolar bone
• Palate
• Lips
• Implants
• Head
• Neck
• Forehead
• Chin
www...
Types of Anchorage
1. Simple anchorage
2. Stationery anchorage
3. Reciprocal anchorage
4. Intraoral anchorage
a) Intra max...
6. Reinforced/ Augmented / Multiple
anchorage
a) Intra oral
b) Extraoral
c) Intermaxillary
d) Muscle anchorage
e) Cortical...
Factors affecting anchorage
1. Teeth – Embeded in alveolar bone.
Anchorage value depends upon-
A) Form of roots
a) Round r...
• Maxillary molars have tripod arrangement of
roots.
Palatal root – Large round. Resists extrusion.
Buccal roots – Small. ...
www.indiandentalacademy.com
C) Root length -
Longer the root, greater is it’s resistance
to movement. e.g. canines.
D) Inclination of roots –
Distal i...
F) Shape and size of crown of tooth -
Tooth with carious or fractured crown is
poor abutment tooth.
2) Direction of force ...
3) Direction of force relative to the axis of
tooth -
Tooth resists intrusive movement the
most.
4) Type of force - Bodily...
Optimum force -
1 mm. Per month tooth movement.
Lightest force which produces
maximum response.
No discomfort to the patie...
6) Good intercuspation
Good cuspal occlusion gives better
anchorage value.
7) Proximal contiguity –
Contiguous teeth are b...
9) Age of patient – Anchorage value of
toothdiminishes with age.
10) Individual tissue response –
This varies with patient...
Asperities
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Effects of Friction
Increased force requirements
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Force – Anchorage relation
www.indiandentalacademy.com
Simple Anchorage
• In this type of anchorage the anchor teeth are
subjected to tipping force.
• Greater number of teeth ar...
Finger spring
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Z spring
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Canine retractors
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Expansion screw
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Stationery anchorage
• Anchor teeth are subjected to reaction force which
will move them bodily.
• Anchor teeth are not pe...
Examples of stationery anchorage
1) Fitted labial bow. Splinting effect.
2) Incisor capping of acrylic in
Activator, Swed ...
Fitted Labial Bow
Splinting effect
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Incisor capping of acrylic
Activator Swed Plate
Splinting effectwww.indiandentalacademy.com
Begg’s Anchor bends
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Breaking arch
Uprighting spring
www.indiandentalacademy.com
Intra-oral Anchorage
• The anchorage sources are situated within
the oral cavity.
• It can be simple, stationery, reciproc...
Intra maxillary anchorage
• Anchorage source is within the same jaw.
• Sites in other jaw, or extraoral sites not utilized...
Closing loops
Retraction
Horizontal elastics
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Trans Palatal Arch
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Nance Appliance
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Hilger’s Pendulum Appliance
www.indiandentalacademy.com
Microimplants
www.indiandentalacademy.com
Intermaxillary Anchorage
• Anchor units in one jaw are used to effect
tooth movement in the other jaw.
• Tooth movement in...
Examples
(i) Functional Appliances.
e.g. Activator, Bionator, Twin block etc.
By harnessing muscle force -
• Upper dental ...
Activator
www.indiandentalacademy.com
Intermaxillary Elastics
• Cl-II, Cl-III elastics.
This is called as Baker’s Anchorage.
• Cross Bite elastics (Criss-cross ...
Cross Elastics
Cl-II Elastics
www.indiandentalacademy.com
www.indiandentalacademy.com
Reciprocal Anchorage
• Two teeth or two groups of teeth move to
an equal amount and in opposite direction.
• Both these gr...
Midline diastema
closure
Expansion
Cross elasticswww.indiandentalacademy.com
EXTRA ORAL ANCHORAGE
• Anchorage is derived from sites outside the
mouth.
e.g. Head,neck forehead,chin.
(i) Occipital anch...
Indications
• Extraoral anchorage is usually employed
for -
(i) Correction of basal maxillomandibular
jaw relationship i.e...
Head gear force
• The force is delivered through a face bow
or J hook which is attached to headcap or
neckstrap or hook on...
Outer bow
Inner bow
F
Face bow
High Pull H.G.
Cervical Pull H.G. Combination Pull H.G. Reverse Pull H.G.
www.indiandentala...
High Pull Head Gear
• Restricts anterior growth of maxilla.
• Restricts vertical growth of maxilla.
• Restricts eruption o...
Cervical Pull Head Gear
• Restricts anterior growth of maxilla.
• Causes distal tipping of maxillary molars.
• Causes extr...
Combination Pull H.G.
• Causes distal bodily movement of maxillary
molars.
• No rotation of maxilla/ palatal plane.
• No r...
Face mask/Reverse pull H.G.
• Indicated in skeletal class III cases with
deficient maxilla.
• Takes support from forehead ...
Position/ Length of outer bow
Vertical position of outer bow –
High, straight, low.
Length of outer bow –
Short, medium, l...
Reinforced/Augmented/Multiple
Anchorage
• When simple anchorage is insufficient to
withstand reaction force, the anchorage...
Types of reinforced anchorage
(1) Tooth and Tissue borne anchorage –
Palatal or lingual removable appliances.
(2) Intra ar...
(3) Inter maxillary anchorage –
Cl-II, Cl-III elastics (Baker’s anchorage).
Diagonal, cross bite elastics.
Functional appl...
Inclined plane
60 degree to occlusal plane.
Guides lower jaw forward.
Exerts backward force on the
maxillary appliance.
ww...
Lip bumper Denholtz appliance
Frankel Appliance Screening effectwww.indiandentalacademy.com
(4) Cortical anchorage -
Roots placed against cortical bone.
Cortical bone is compact, resistant to
resorption.
e.g. Ricke...
www.indiandentalacademy.com
Gradation of anchorage
(1) Maximum anchorage (critical) –
Anchor teeth should not move.
Anchorage is reinforced.
Frictionl...
60 : 40 space closure
60 % retraction of anterior teeth.
40 % forward movement of posterior teeth.
(1) One step space clos...
Signs of anchor loss
(1) Mesial movement or lingual rolling
of molars.
(2) Space closure without sufficient
retraction of ...
Methods/Strategies to control anchorage
(1) Include as many teeth as possible in the
anchorage unit. Ratio of PDL area –
2...
(7) Movement by tipping followed by
uprighting of teeth.
(8) Two step space closure –
Retraction of canines first followed...
Prepared anchorage
www.indiandentalacademy.com
60 : 40 space closure Tipping of anterior teeth
against
Bodily movement of posterior
teeth.
www.indiandentalacademy.com
Canine retraction
Incisor retraction
Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentala...
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Anchorage1 (2)/certified fixed orthodontic courses by Indian dental academy /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Anchorage1 (2)/certified fixed orthodontic courses by Indian dental academy /certified fixed orthodontic courses by Indian dental academy

  1. 1. ANCHORAGE www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. DEFINITION • Site of delivery from which an orthodontic force is exerted. • Nature and degree of resistance to displacement offered by an anatomic unit when used for the purpose of effecting tooth movement. • Newton’s third law of motion Action Reaction • Anchorage is resistance to unwanted displacement of teeth to the reaction force. www.indiandentalacademy.com
  3. 3. ANATOMICAL UNITS USED FOR ANCHORAGE • Teeth • Alveolar bone • Palate • Lips • Implants • Head • Neck • Forehead • Chin www.indiandentalacademy.com
  4. 4. Types of Anchorage 1. Simple anchorage 2. Stationery anchorage 3. Reciprocal anchorage 4. Intraoral anchorage a) Intra maxillary anchorage b) Inter maxillary anchorage 5. Extraoral anchorage a) Occipital b) Cervical c) Parietal d) Frontal e) Genial www.indiandentalacademy.com
  5. 5. 6. Reinforced/ Augmented / Multiple anchorage a) Intra oral b) Extraoral c) Intermaxillary d) Muscle anchorage e) Cortical anchorage f) Absolute anchorage (Implants) www.indiandentalacademy.com
  6. 6. Factors affecting anchorage 1. Teeth – Embeded in alveolar bone. Anchorage value depends upon- A) Form of roots a) Round roots – 50% PDL fibres resist force/ displacement in any direction. b) Flat roots – 50% PDL fibres resist force in M-D direction. e.g. mandibular incisors, buccal roots of maxillary molars. c) Triangular roots – 2/3rd of fibres resist force/ displacement e.g. maxillary canines and central incisors. www.indiandentalacademy.com
  7. 7. • Maxillary molars have tripod arrangement of roots. Palatal root – Large round. Resists extrusion. Buccal roots – Small. Resist intrusion. B) Size and number of roots. ( root surface area) Multirooted tooth is more resistant to displacement than a single rooted tooth. Anchorage value of any tooth is proportional to it’s root surface area. www.indiandentalacademy.com
  8. 8. www.indiandentalacademy.com
  9. 9. C) Root length - Longer the root, greater is it’s resistance to movement. e.g. canines. D) Inclination of roots – Distal inclination of roots resists distal movement. E) Position of tooth in the dental arch – Mandibular second molar offers maximum resistance to mesial movement as it is located between the mylohyoid ridge and external oblique ridge. www.indiandentalacademy.com
  10. 10. F) Shape and size of crown of tooth - Tooth with carious or fractured crown is poor abutment tooth. 2) Direction of force relative to direction of growth - General direction of growth is forward, outward and occlusally. Force in opposite direction encounters maximum resistance. www.indiandentalacademy.com
  11. 11. 3) Direction of force relative to the axis of tooth - Tooth resists intrusive movement the most. 4) Type of force - Bodily movement encounters more resistance than tipping. 5) Amount of force – Capillary blood pressure is 20-26 gms./cms. High force – Compression of PDL. Undermining resorption. Delayed tooth movement. Light force – Frontal resorption. Rapid movement. Less strain on anchor teeth. www.indiandentalacademy.com
  12. 12. Optimum force - 1 mm. Per month tooth movement. Lightest force which produces maximum response. No discomfort to the patient. Located at the beginning of the plateau of the force-movement graph. www.indiandentalacademy.com
  13. 13. 6) Good intercuspation Good cuspal occlusion gives better anchorage value. 7) Proximal contiguity – Contiguous teeth are better ancors than single, isolated teeth. 8) Associated muscle function – Alfred Rogers harnessed muscle force to effect tooth movement and to conserve the anchorage. www.indiandentalacademy.com
  14. 14. 9) Age of patient – Anchorage value of toothdiminishes with age. 10) Individual tissue response – This varies with patients. 11) Friction at wire bracket interface – NiTi wires have rough surface. Surface elevations (asperities) increase friction. Stick-slip phenomenon occurs. Titanium cold welds with S.S. Highr coefficient of friction. NiTi has 50% and Beta Ti has 80% Titanium. Friction of wires is reduced by surface implantation with N2,C ions.www.indiandentalacademy.com
  15. 15. Asperities www.indiandentalacademy.com
  16. 16. Effects of Friction Increased force requirements www.indiandentalacademy.com
  17. 17. Force – Anchorage relation www.indiandentalacademy.com
  18. 18. Simple Anchorage • In this type of anchorage the anchor teeth are subjected to tipping force. • Greater number of teeth are used to move less number of teeth within the same dental arch. • Hnce it is Intraoral and Intramaxillary type of anchorage. • Examples :- (a) Removable aplliances using active components like Labial bow, Finger spring, Z spring, Expansion screw etc. • Simple anchorage has lesser anchorage value than stationery anchorage as tooth can be easily tipped but bodily movement requires complex mechanics.www.indiandentalacademy.com
  19. 19. Finger spring www.indiandentalacademy.com
  20. 20. Z spring www.indiandentalacademy.com
  21. 21. Canine retractors www.indiandentalacademy.com
  22. 22. Expansion screw www.indiandentalacademy.com
  23. 23. Stationery anchorage • Anchor teeth are subjected to reaction force which will move them bodily. • Anchor teeth are not permitted to tip. • Anchor tooth must move bodily. Other teeth tip. • Tooth offers greater resistance to bodily movement than tipping as force is distributed throught the length of clinical root. www.indiandentalacademy.com
  24. 24. Examples of stationery anchorage 1) Fitted labial bow. Splinting effect. 2) Incisor capping of acrylic in Activator, Swed plate. Splinting effect. 3) Anchor bend mesial to molar tube of Begg Technique. 4) Breaking arch of Begg Technique using (a) Uprighting springs on canines. (b) Torquing auxiliary on incisors. www.indiandentalacademy.com
  25. 25. Fitted Labial Bow Splinting effect www.indiandentalacademy.com
  26. 26. Incisor capping of acrylic Activator Swed Plate Splinting effectwww.indiandentalacademy.com
  27. 27. Begg’s Anchor bends www.indiandentalacademy.com
  28. 28. Breaking arch Uprighting spring www.indiandentalacademy.com
  29. 29. Intra-oral Anchorage • The anchorage sources are situated within the oral cavity. • It can be simple, stationery, reciprocal or reinforced. • It can be of two types – (I) Intra maxillary anchorage. (II) Intermaxillary anchorage. www.indiandentalacademy.com
  30. 30. Intra maxillary anchorage • Anchorage source is within the same jaw. • Sites in other jaw, or extraoral sites not utilized. Examples - (i) Removable appliances like Z spring, Finger spring, Expansion plates. (ii) Retraction of anterior teeth with horizontal (Cl-I) elastics, closing loop arch wires. (iii) Nance button - Nance holding arch, Hilger’s Pendulum appliance. (iv) Lip bumper. (v) Trans palatal arch (TPA). (vii) Micro implants. (MIA or Absolute anchorage) www.indiandentalacademy.com
  31. 31. Closing loops Retraction Horizontal elastics www.indiandentalacademy.com
  32. 32. Trans Palatal Arch www.indiandentalacademy.com
  33. 33. Nance Appliance www.indiandentalacademy.com
  34. 34. Hilger’s Pendulum Appliance www.indiandentalacademy.com
  35. 35. Microimplants www.indiandentalacademy.com
  36. 36. Intermaxillary Anchorage • Anchor units in one jaw are used to effect tooth movement in the other jaw. • Tooth movement in the two arches may not be equal. • Hence it is not truly reciprocal. • It is Intraoral and Reinforced. www.indiandentalacademy.com
  37. 37. Examples (i) Functional Appliances. e.g. Activator, Bionator, Twin block etc. By harnessing muscle force - • Upper dental arch is distalized. • Lower dental arch is mesialized. • This helps to correct Cl-II, Cl-III malocclusion. www.indiandentalacademy.com
  38. 38. Activator www.indiandentalacademy.com
  39. 39. Intermaxillary Elastics • Cl-II, Cl-III elastics. This is called as Baker’s Anchorage. • Cross Bite elastics (Criss-cross elastics). • Diagonal elastics. www.indiandentalacademy.com
  40. 40. Cross Elastics Cl-II Elastics www.indiandentalacademy.com
  41. 41. www.indiandentalacademy.com
  42. 42. Reciprocal Anchorage • Two teeth or two groups of teeth move to an equal amount and in opposite direction. • Both these groups should have same resistance value. If not the movement will not be equal. Examples - (i) Correction of midline diastema (ii) Bilateral symmetrical expansion. (iii) Correction of posterior cross bite. www.indiandentalacademy.com
  43. 43. Midline diastema closure Expansion Cross elasticswww.indiandentalacademy.com
  44. 44. EXTRA ORAL ANCHORAGE • Anchorage is derived from sites outside the mouth. e.g. Head,neck forehead,chin. (i) Occipital anchorage – High pull H.G. (ii) Cervical anchorage – Low pull H.G. (iii) Cranial/ Parietal anchorage – Vertical pull H.G. (iv) Forehead/Frontal anchorage – Reverse pull H.G. (v) Chin – Reverse pull H.G. www.indiandentalacademy.com
  45. 45. Indications • Extraoral anchorage is usually employed for - (i) Correction of basal maxillomandibular jaw relationship i.e.Growth modification in skeletal Cl-II, Cl-III cases. (ii) To prevent mesial movement of posterior teeth to preserve anchorage during retraction of anterior teeth. www.indiandentalacademy.com
  46. 46. Head gear force • The force is delivered through a face bow or J hook which is attached to headcap or neckstrap or hook on the bar of RPHG. • Face bow consists of outer bow and inner bow joined in center. • Inner bow is inserted in the H.G. tube attached to the SS band on 6/6 or in arch wire hook or in the removable appliance. • Outer bow is connected to headcap or neckstrap. • Extra oral elastics deliver the force. www.indiandentalacademy.com
  47. 47. Outer bow Inner bow F Face bow High Pull H.G. Cervical Pull H.G. Combination Pull H.G. Reverse Pull H.G. www.indiandentalacademy.com
  48. 48. High Pull Head Gear • Restricts anterior growth of maxilla. • Restricts vertical growth of maxilla. • Restricts eruption of maxillary molars. • Causes distal movement of maxillary molars. • Prevents mesial movement of maxillary molars (reinforces anchorage). www.indiandentalacademy.com
  49. 49. Cervical Pull Head Gear • Restricts anterior growth of maxilla. • Causes distal tipping of maxillary molars. • Causes extrusion of maxillary molars. • Prevents mesial movement of maxillary molars( reinforses anchorage). www.indiandentalacademy.com
  50. 50. Combination Pull H.G. • Causes distal bodily movement of maxillary molars. • No rotation of maxilla/ palatal plane. • No rotation of occlusal plane. Vertical Pull H.G. • Exerts vertical pull. • Used for true intrusion of maxillary incisors. • Chin cup treatment with vertical treatment. www.indiandentalacademy.com
  51. 51. Face mask/Reverse pull H.G. • Indicated in skeletal class III cases with deficient maxilla. • Takes support from forehead pad and chin cup. • Protraction force to maxilla through the extra oral elastics. • Direction of force - Forward, downward, inward. • Amount of force – 12 Ounce per side. 1 Ounce = 28.33 grams. • Examples – Delaire, Petit, Hickham face masks. www.indiandentalacademy.com
  52. 52. Position/ Length of outer bow Vertical position of outer bow – High, straight, low. Length of outer bow – Short, medium, long. www.indiandentalacademy.com
  53. 53. Reinforced/Augmented/Multiple Anchorage • When simple anchorage is insufficient to withstand reaction force, the anchorage is reinforced/augmented by various methods. • Particularly in maximum/critical anchorage cases www.indiandentalacademy.com
  54. 54. Types of reinforced anchorage (1) Tooth and Tissue borne anchorage – Palatal or lingual removable appliances. (2) Intra arch(intra maxillary) anchorage – (i) Nance holding arch. (ii) Anterior inclined plane. (iii) Trans palatal arch(TPA). (iv) Implants. Titanium screws - 9,10.12 mm length. 1-1.2 mm width. Non osseointegrated. www.indiandentalacademy.com
  55. 55. (3) Inter maxillary anchorage – Cl-II, Cl-III elastics (Baker’s anchorage). Diagonal, cross bite elastics. Functional appliances. Inclined plane. (4) Muscle anchorage – Lip bumper. Mayne appliance. Denholtz muscle anchorage appliance. Oral screens. Frankel’s appliance. www.indiandentalacademy.com
  56. 56. Inclined plane 60 degree to occlusal plane. Guides lower jaw forward. Exerts backward force on the maxillary appliance. www.indiandentalacademy.com
  57. 57. Lip bumper Denholtz appliance Frankel Appliance Screening effectwww.indiandentalacademy.com
  58. 58. (4) Cortical anchorage - Roots placed against cortical bone. Cortical bone is compact, resistant to resorption. e.g. Rickett’s Bioprogressive appliance. Disadvantages – Root resorption. www.indiandentalacademy.com
  59. 59. www.indiandentalacademy.com
  60. 60. Gradation of anchorage (1) Maximum anchorage (critical) – Anchor teeth should not move. Anchorage is reinforced. Frictionless mechanics is prefered for space closure. (2) Minimum anchorage – Some movement of anchor teeth is permitted. (3) Moderate anchorage – Intermediate.www.indiandentalacademy.com
  61. 61. 60 : 40 space closure 60 % retraction of anterior teeth. 40 % forward movement of posterior teeth. (1) One step space closure with a frictionless mechanics. (2) Two step space closure with sliding mechanics. Retraction of canines first followed by retraction of incisors. (3) Distal tipping followed by uprighting of the anterior teeth. www.indiandentalacademy.com
  62. 62. Signs of anchor loss (1) Mesial movement or lingual rolling of molars. (2) Space closure without sufficient retraction of anterior teeth. (3) Proclination of anterior teeth. (4) Increase in overjet. (5) Spacing of teeth. (6) Extrusion/ distal tipping of molars. (7) Unwanted change in molar relationship. (8) Appearance of cross bite. www.indiandentalacademy.com
  63. 63. Methods/Strategies to control anchorage (1) Include as many teeth as possible in the anchorage unit. Ratio of PDL area – 2:1 without friction 4:1 when there is friction. (2) Move minimum teeth at a time. (3) Use light forces. (4) Use differential forces(Begg technique). (5) Frictionless mechanics for space closure. (6) Subdivision of desired forces – Use of sectional arches for intrusion,retraction.www.indiandentalacademy.com
  64. 64. (7) Movement by tipping followed by uprighting of teeth. (8) Two step space closure – Retraction of canines first followed by retraction of incisors. Divide and conquor ( Tweed, Alexander). (9) Anchorage preparation – Distal tipping of posterior teeth in Tweed’s technique. (10) Reinforcement of anchorage. www.indiandentalacademy.com
  65. 65. Prepared anchorage www.indiandentalacademy.com
  66. 66. 60 : 40 space closure Tipping of anterior teeth against Bodily movement of posterior teeth. www.indiandentalacademy.com
  67. 67. Canine retraction Incisor retraction Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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