Implants in orthodontics / fixed orthodontic courses

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Implants in orthodontics / fixed orthodontic courses

  1. 1. IMPLANTS IN ORTHODONTICS www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3.  Introduction  Classification of Implants  Materials used for Implants  Osseointegration  Use of Implants in Orthodontics www.indiandentalacademy.com
  4. 4. .  Implants are defined as alloplastic devices which are surgically inserted into or onto the jaw bone-Boucher  Linkow- Father of oral Implantology. www.indiandentalacademy.com
  5. 5. Classification of Implants. Based on their location: Subperiosteal  Transosseous  Endosseous www.indiandentalacademy.com
  6. 6.  Based on their configuration:- Root form Implants (Threaded or non threaded) - Blade/Plate Implants (Porous or nonporous). www.indiandentalacademy.com
  7. 7.  Based on the biologic adaptation at the interface:-Implants which osseointegrate. -Implants which do not osseointegrate.  Based on the loading characteristics :-Nonlatency implants. -Latency implants. www.indiandentalacademy.com
  8. 8.  Based on anchorage requirement:-Direct anchorage. -Indirect anchorage.  According to composition:-Stainless steel -Cobalt-Chromium-Molybdenum (Co-Cr-Mo) -Titanium -Ceramics. www.indiandentalacademy.com
  9. 9.  Stainless steel:-18% Cr & 8% Ni. -subjected to crevice & pitting corrosion.  Cobalt-Chromium-Molybdenum Alloy :-used in fabrication of custom designs such as subperiosteal frames. www.indiandentalacademy.com
  10. 10.  Titanium:-most widely used metal for implants. -Highly reactive & readily oxidises to form oxide. -exist in 3 forms -Alpha -Beta -Alpha-Beta phase (most commonly used). Ti-6Al-4V www.indiandentalacademy.com
  11. 11.  Ceramics:- two types Bioactive-Hydroxyapatite Bioglass- contain oxides of Ca, Na, P & Si.  Miscellaneous:-Vitreous carbon, Vitallium, Tantalum, Platinum, Tungsten, Alumina, Polymers & composites. www.indiandentalacademy.com
  12. 12. Materials used for Implants  In 16 &17th century –Ivory dental implants .  20th century-Metal Implant devices.  1940 &1960’s-CoCrMo subperiosteal & titanium blade implants. www.indiandentalacademy.com
  13. 13.  1970’s-Non metal biomaterials  1982-Branemark Implant. www.indiandentalacademy.com
  14. 14. Biocompatibility of Titanium Implants.  “Passivity”.  Modulus of elasticity . www.indiandentalacademy.com
  15. 15. Biocompatibility of Titanium Implants: Titanium can be considered as composite material.  Chemical process at the Interface: Types of bonding by which biomolecules stick to the Implant surface are -Long range but weak van der waals interaction. -Short range, strong chemical bonding. e.g.:-ionic & covalent bonds. www.indiandentalacademy.com
  16. 16. Chemical process that take place at an Implant-Biotissue interface. www.indiandentalacademy.com
  17. 17. Studies regarding the stability of the Implant materials.  Gainesforth & Higley (1945): -investigated the efficacy of Vitallium screw for orthodontic anchorage. -Screws were inserted into the ramus of 6 dogs and immediately loaded to retract the maxillary cuspids. -Results:-All the screws were lost within 16 to 31 days. www.indiandentalacademy.com
  18. 18.  Sherman(1978):- - Inserted Vitreous carbon implants in 6 dogs & allowed to heal for 70 days before applying a force of 175gms. Results:-After 2wks only two implants were stable.  Smith(1979):- Investigated bioglass- coated aluminum oxide implants that were allowed to heal for 12wks before loading them with 425gms of force for 2-9wks. Results:- All the Implants remained stable except for a slight movement when the force was doubled. www.indiandentalacademy.com
  19. 19.  Gray(1983):-Tested the bioglass implants & vitallium implants which were placed in femur of rabbits. After 28 days healing period, loads of 60,120,&180gms were applied. Results:-No movement of the implants occurred. Eugene Roberts(1984):Inserted pure titanium screws shaped implants into the femurs of rabbits & after a healing period of 6-12wks, the paired implants were loaded with 100gms of force for 12 wks. Results:-Histologically increase in the bone mass in the area of loaded implant was seen. www.indiandentalacademy.com
  20. 20.  Eugene Roberts(1988):Examined histologic sections of dog mandibles containing rigid titanium screws to compare the findings of bright field & polarized light microscopic illumination to microradiographs of mineralized sections. Results:-10% direct bone contact is sufficient to resist the implant movement.  Linder-Aronson(1990):-tested the effectiveness of Branemark implants in monkeys. www.indiandentalacademy.com
  21. 21. OSSEOINTEGRATION.  Term & concept of Osseointegration -Branemark. “An intimate structural contact at the implant surface and adjacent vital bone devoid of any intervening fibrous tissue.” www.indiandentalacademy.com
  22. 22. Evolution of the concept of osseointegration  Vital microscopic studies of the rabbit fibulatitanium chambered microscopes.  Series of experiments:-Titanium fixtures for immobilization of autologous bone grafts. - Tooth implants studies for healing & anchorage stability. www.indiandentalacademy.com
  23. 23.  Study done on dogs to find out the load bearing capacity of implants.  Optical titanium chambers were implanted in humans-to assess the tissue reactions of titanium implants. www.indiandentalacademy.com
  24. 24. Biology of osseointegration. Hematoma Callus formation www.indiandentalacademy.com
  25. 25. Bone remodeling Fibrous tissue www.indiandentalacademy.com
  26. 26. Principles of osseointegration Factors important for reliable bone anchorage of an Implanted device:Implant biocompatibility:- www.indiandentalacademy.com
  27. 27. Principles of osseointegration.  Implant Design:- www.indiandentalacademy.com
  28. 28.  Implant surface:- www.indiandentalacademy.com
  29. 29.  State of the host bed:- www.indiandentalacademy.com
  30. 30.  Surgical technique:- www.indiandentalacademy.com
  31. 31.  Loading condition:- www.indiandentalacademy.com
  32. 32. Use of Implants in Orthodontics  Growth Studies  Anchorage Orthopaedic -Expansion -Protraction Orthodontic -Intrusion -Space closure -Molar Distalization. www.indiandentalacademy.com
  33. 33. Growth Studies:-  Implants are the best means of reference points for studying the longitudinal growth studies. www.indiandentalacademy.com
  34. 34.  Growth Rotations -Bjork & skeiller .  Growth of Cleft lip & palate patients - Shaw . www.indiandentalacademy.com
  35. 35. ANCHORAGE: Orthopeadic correction- Two methods for obtaining the Skeletal anchorage: Intentionally Ankylosed teeth.  Endosseous Implants. www.indiandentalacademy.com
  36. 36.  Maxillary Expansion:- - Guyman(1980) -Ankylosed teeth acted as abutments for palatal expansion in rhesus monkeys. -Transmit the laterally directed forces across the midpalatal suture. www.indiandentalacademy.com
  37. 37. • After 8wk healing period 1-2 pound force was applied to the ankylosed teeth. • Palatal widening was seen due to skeletal expansion that was periodically assessed during 13, 21, & 23 wks. www.indiandentalacademy.com
  38. 38. Frontonasal suture expansion using titanium screws. -Kiumars Movassaghi et al(1995) Pure titanium craniofacial plates were contoured into ‘L’ shape with a 90 degree angle at the midpoint. Plates were placed on either sides of the suture. A distraction force of 55gms was activated across the sutures. www.indiandentalacademy.com
  39. 39. Increase in growth about 6mm was seen across the frontonasal suture. www.indiandentalacademy.com
  40. 40. Sutural expansion using rigidly integrated endosseous implants. Andrew Parr et al(1996) Evaluated the use of endosseous implants in the midface region,2 flanged titanium implants were placed on either side of the midnasal suture of rabbits. Divided into two groups: one group-1N & other group-3N force was applied. . www.indiandentalacademy.com
  41. 41.  An open coil spring has been compressed between the abutments to provide the expansion load.  Distance between the implants increased significantly in the loaded groups & higher in the 3N group. www.indiandentalacademy.com
  42. 42. Endosseous Implants for maxillary protraction -Smalley etal (1988) Tantalum markers were placed in the cranial base, mandible, zygomatico Temporal , zygomaticomaxillary, frontomaxillary, premaxillomaxillary Sutures. www.indiandentalacademy.com
  43. 43. •A traction force of 600gm is used and protraction was done till 8mm of anterior displacement of maxillary complex occurred. www.indiandentalacademy.com
  44. 44. Implants for Intrusion Skeletal Anchorage :-Creekmore(1983) -Vitallium bone screw placed below the anterior nasal spine is used for intrusion of Upper anteriors. -6mm of upper incisor intrusion was seen after one year. www.indiandentalacademy.com
  45. 45. Implants for space closure.  Implanto-Orthodontics-Linkow.(1970).  Implant was used to replace the missing tooth.  Upper arch was consolidated using a fixed appliance & in lower arch only premolar and molar were banded and connected by o.o4o rigid Elastic wire. www.indiandentalacademy.com
  46. 46. Use of Endosseous Implant for closure of extraction-Eugene Roberts (1989) site  Endosseous Implants placed in the retromolar region are used to close the atrophic extraction site. Pontic www.indiandentalacademy.com
  47. 47. www.indiandentalacademy.com
  48. 48. Buccal view after mesial translation of 2nd & 3rd molars. www.indiandentalacademy.com
  49. 49. Diagnostic models,2.5yrs Of post retention. www.indiandentalacademy.com
  50. 50. Onplant & Ortho-Implant.  Onplant:-Block &Hoffman.(1995)  It is a flat disk shaped fixture available in 8 and 10mm in diameter  It has a HA coated surface for integration with the surrounding bone. www.indiandentalacademy.com
  51. 51. Animal studies: In the dog, the onplant has been exposed & connected to the contra lateral 2nd premolar with a stainless steel spring activated to deliver 110z of force . 5months later tooth moved towards the onplant by 8mm from its original position. www.indiandentalacademy.com
  52. 52. An expansion device soldered to a traspalatal bar & secured to the expansion device to control molar distalization. The 2nd molars were bodily distalized 6mm in 11 months. www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. www.indiandentalacademy.com
  55. 55. Ortho-Implant - Celenza & Hochman •Similar to onplant but it is an endosseous Implant. •Its surface is sandblasted and etched to increase the adhesion to the surrounding bone www.indiandentalacademy.com
  56. 56. www.indiandentalacademy.com
  57. 57. Uses of Onplant & Ortho-Implant  Space closure.  Molar distalization. www.indiandentalacademy.com
  58. 58. Palatal Bone Support for placement of an Orthodontic Implant is sufficient enough without causing any damage to the Nasal floor. -Heinrich et al (1999) www.indiandentalacademy.com
  59. 59. Impacted Titanium Post for Anchorage -Frederic Bousquet etal(1996) •35-yr old female before treatment, showing anterior crowding. www.indiandentalacademy.com
  60. 60. Titanium post Titanium post & head of Mechanical impactor. www.indiandentalacademy.com
  61. 61. Post impacted in interdental septum between 1st molar & extraction site. Rigid .040 wire connecting 1st molar tube to post. www.indiandentalacademy.com
  62. 62. www.indiandentalacademy.com
  63. 63. Upper right posterior segment after 2 months of retraction showing distal movement of Premolar & no mesial movement of molar. www.indiandentalacademy.com
  64. 64. Cast models after 18 months of treatment. www.indiandentalacademy.com
  65. 65. Mini-Implant for Orthodontic Anchorage:-Ryuzo Kanomi(1997)  Mini-Implant is 1.2mm in diameter and 6mm in length. www.indiandentalacademy.com
  66. 66. After raising of mucoperiosteal flap and denuding of bone, 2mm of round bur is used. Pilot drill used to enter bone same Distance as the length of mini-implant. Mini-Implant inserted with accompanying screw driver. www.indiandentalacademy.com
  67. 67. Mucosal punch used to remove soft-tissue Surrounding head of mini-implant. Two hole titanium bone plate attached to head of mini-implant and tied to bracket with ligature wire. www.indiandentalacademy.com
  68. 68. Patient at start of incisor intrusion. www.indiandentalacademy.com
  69. 69. Mini-Implants for space closure. www.indiandentalacademy.com
  70. 70. Mini-Implants for molar intrusion www.indiandentalacademy.com
  71. 71. Skeletal Anchorage system for Open bite correction -Umemori , Sugawara etal (1999) • Control of vertical dimension is very important in correction of anterior open bite •‘L’ shaped titanium miniplates are used as a Source of anchorage for intruding the molars. www.indiandentalacademy.com
  72. 72.  Procedure for miniplate insertion:- www.indiandentalacademy.com
  73. 73. www.indiandentalacademy.com
  74. 74. Pretreatment facial photographs Pretreatment intraoral photographs www.indiandentalacademy.com
  75. 75. Post treatment intraoral photographs www.indiandentalacademy.com
  76. 76. ‘Y’ Titanium miniplate for intrusion & distalization of maxillary molars. (key ridge) Straight titanium miniplate for Intrusion of maxillary incisors. (anterior ridge of piriform opening). www.indiandentalacademy.com
  77. 77. Intrusion of maxillary anterior teeth using SAS Before treatment Intrusion of maxillary anteriors After treatment www.indiandentalacademy.com
  78. 78. Microimplant (Absoanchor) Kyung, Park et al Recent among the implants – Microimplant. To overcome disadvantages of conventional Osseointegrated implants like -size, procedure of insertion, cost, & bulkiness. Diameter is 1.2mm but available in different sizes. www.indiandentalacademy.com
  79. 79. www.indiandentalacademy.com
  80. 80. Usually 4-5mm length of implant with 1.2-1.3mm diameter will provide adequate retention, but in maxilla a microimplant of 6-8mm is used. Microimplant insertion:- www.indiandentalacademy.com
  81. 81. Periapical radiograph to see the root approximation. • NiTi coil spring applied to maxillary buccal & lingual and mandibular buccal microimplants. www.indiandentalacademy.com
  82. 82. Micro Implant -Park et al  Dimension of micro implant are 1.2mm in diameter & 6mm in length. 28yr old female with CL-I bialveolar protrusion before treatment. www.indiandentalacademy.com
  83. 83. Placed in the buccal alveolar bone between 2nd premolar &1st molar in the upper arch & between 1st molar & 2nd molar in the lower arch. Placement of maxillary microscrew. Mandibular microscrew. www.indiandentalacademy.com
  84. 84. Initial maxillary canine retraction force applied with tieback between micro-implant & canine. After 2 months of treatment, maxillary anterior retraction force applied with nickel titanium coil spring. www.indiandentalacademy.com
  85. 85. Mandibular micro-implants between 1st & 2nd molars. Force applied with elastic thread between microscrews & mandibular archwire. www.indiandentalacademy.com
  86. 86. Mechanism of bodily retraction of anterior segment, with force applied against microimplant passing near center of resistance of six anterior teeth. Mandibular microimplant uprights & intrudes the molars. www.indiandentalacademy.com
  87. 87. . Patient after 18 months of treatment www.indiandentalacademy.com
  88. 88. Superimposition of pre & post- treatment cephalometric tracings. www.indiandentalacademy.com
  89. 89. Micro-Implant for anchorage in Lingual orthodontics 19yr old female with skeletal CL-II malocclusion before treatment. www.indiandentalacademy.com
  90. 90. Palatal microscrew should be implanted into the alveolar bone at 30-40 degree between 1st & 2nd molar to avoid root damage. www.indiandentalacademy.com
  91. 91. Lingual Sliding mechanics using nickel titanium coil springs to microimplants. www.indiandentalacademy.com
  92. 92. Patient after 16 months of treatment. www.indiandentalacademy.com
  93. 93. Superimpositions of cephalometric tracings before & after treatment. www.indiandentalacademy.com
  94. 94. 28yr old female CL-II patient with lip protrusion & gummy smile before treatment. www.indiandentalacademy.com
  95. 95. Insertion site measured from guide bar on bite-wing x-ray Stab incision for flap reflection Drilling through cortical bone only. Microimplant insertion. www.indiandentalacademy.com
  96. 96. Maxillary .017x.o25 ss closing loop archwire & .016x.016ss overlay intrusion archwire used to retract anterior teeth upward & backward. www.indiandentalacademy.com
  97. 97. Schematic of retraction wire. www.indiandentalacademy.com
  98. 98. Improvement in profile & gummy smile after treatment. www.indiandentalacademy.com
  99. 99. Use of Osseointegrated Implants in unilateral cleft lip & palate pts. Hiroaki et al (1999)  Unilateral cleft pts who needed maxillary lateral bony defect in the alveolar region restricts orthodontic accomplishment.  Late secondary bone grafting to the cleft region followed by the insertion of the Osseointegrated implants provides good retention to the maxillary arch. www.indiandentalacademy.com
  100. 100. Bibliography.     Implants in dentistry-Hobkirk. Block & Kent- Oral Implantology. Science of dental materials- Skinner. Orthodontic principles & practice-Graber & Vanarsdall. www.indiandentalacademy.com
  101. 101.  Bone responses to orthodontic forces on vitreous carbon dental implants –Alan Sherman AJO:JULY 78.  Bone dynamics associated with the controlled loading of bioglass coated aluminum oxide endosteal implants-John Smith AJO:DEC 79.  Ankylosed teeth as abutments for palatal expansion in rhesus monkeys. Guyman et al AJO :sep 83.  Osseous adaptation to continuous loading of rigid endosseous implants. AJO :AUG 84.  Osseointegrated titanium implants for maxillofacial protraction-Smalley et al AJO:OCT 88. www.indiandentalacademy.com
  102. 102.  Implant-Orthodontics-Linkow JCO MAY 70.  Possibility of skeletal anchorage- Creekmore JCO APR 83.  Absolute anchorage device-Hoffman & block AJO MAR 95.  Rigid implant anchorage to close a mandibular first molar extraction site –Roberts et al JCO:DEC 94.  Osseointegration and its experimental background.J.Prosth. dent sep 83.  Biocompatibility of titanium implants –kasemo. J.Prosth.dent jun 83.  Endosseous implants as anchorage to protract molars and close an atrophic extraction site.-Roberts, Marshall AO sep www.indiandentalacademy.com 89.
  103. 103.  Frontonasal suture expansion in rabbits using titanium screws.-Movassaghi et al J. of oral max. surg 95.  Sutural expansion in using endosseous implants –Rabbit study-Parr AO may 96.  Use of impacted titanium post for orthodontic anchorage – Bousquet et al JCO AUG 96.  Mini-Implant-Ryuzo kanomi. JCO 97.  Skeletal Anchorage System-Sugawara JCO DEC 99. www.indiandentalacademy.com
  104. 104.  Micro-Implant anchorage for treatment of skeletal class-I Bialveolar protrusion-Hyo-Sang Park.2001 JUL JCO. www.indiandentalacademy.com
  105. 105. MAGNETS IN ORTHODONTICS www.indiandentalacademy.com
  106. 106.  Introduction  Types of magnetic materials  Properties of magnets  Application of magnets in orthodontics. www.indiandentalacademy.com
  107. 107.  In 1953, magnets were first used for denture retention by BEHRAN & EGAN.  Use of magnets in orthodontic- BLECHMAN & SMILEY. www.indiandentalacademy.com
  108. 108. PROPERTIES OF MAGNETS  Flux Density www.indiandentalacademy.com
  109. 109.  In dentistry, ferromagnetic materials with static field are used.  Magnetocrystalline Anisotropy.  Coercivity. www.indiandentalacademy.com
  110. 110.  Coulombs law:-This law states that force between two magnetic poles is directly proportional to magnitude & inversely proportional to square of the distance between them.  Curie point:-Pierre Curie(1859-1906) www.indiandentalacademy.com
  111. 111.  High force to volume ratio.  Maximal force at shorter distances. www.indiandentalacademy.com
  112. 112.  No interruption of magnetic force lines by intermediate media.  No energy loss. www.indiandentalacademy.com
  113. 113. TYPES OF MAGNETIC MATERIALS       Platinum-cobalt (Pt-co) Aluminium-Nickel-Cobalt(Al-Ni-Co) Ferrite Chromium-cobalt-Iron Samarium Cobalt(SmCo) Neodymium-Iron-Boron(Nd2Fe B) 14 www.indiandentalacademy.com
  114. 114.  Advantages:-Continuous force is exerted. - Eliminates the patient co-operation. -No friction.  Disadvantages:-Tarnish & corrosion products are cytotoxic. -Cost factor. www.indiandentalacademy.com
  115. 115.  Biological effect of magnetic forces:- Aronson:-thinning of epithelium under attracting & repelling magnets. McDonald - proliferative activity of fibroblasts in presence of static magnetic field Lars Bondemark & Kurol studied changes in human dental pulp and gingival tissue. www.indiandentalacademy.com
  116. 116. Clinical Applications of Magnets. Orthopaedic - Expansion -Growth modulation Orthodontic -Tooth Intrusion -Space closure -Molar Distalization. -Retainer. www.indiandentalacademy.com
  117. 117.  EXPANSION:-Vardimon et al(1987) demonstrated palatal expansion using two types of magnetic devices in Macaca fascicularis monkeys. -Tooth borne appliance www.indiandentalacademy.com
  118. 118.  Tissue borne appliance (attached directly to palate by endosseous pins). www.indiandentalacademy.com
  119. 119. Change in the Inter incisal relationship Maxillary Protraction was related to A-P activity of the premaxillary suture (primarily) & the transverse palatine suture (secondarily). www.indiandentalacademy.com
  120. 120. Transverse change as measured from before and after treatment models. Intercanine change vs. Intermolar change www.indiandentalacademy.com
  121. 121.  Functional Orthopaedic Magnetic Appliances:Vardimon(1989) -for correction of CL-II www.indiandentalacademy.com
  122. 122. www.indiandentalacademy.com
  123. 123. 4 types of functional magnetic system:- www.indiandentalacademy.com
  124. 124. www.indiandentalacademy.com
  125. 125.  Magnetic Twin Block:Clark(1996) -Samarium cobalt magnets were embedded in the inclined surface of the twin block in attractive mode. www.indiandentalacademy.com
  126. 126.  Magnetic Activator Device(MAD):-Darendilier (1993) developed this magnetically active functional appliance. -MAD I-mandibular deviations -MAD II-CLII malocclusion -MADIII-CLIII malocclusion -MADIV-skeletal open bite correction. www.indiandentalacademy.com
  127. 127. MAD-II MAD II is used for correction of CL-II malocclusion. It consists of upper& lower removable appliance , carrying magnets in both buccal segments. www.indiandentalacademy.com
  128. 128. A 30 degree inclination of the occlusal surface of the magnet to the basal surface produces an oblique force vector to correct a CL-II malocclusion. www.indiandentalacademy.com
  129. 129. Mechanical retention of the appliance against the magnetic forces is by clasps on the posterior teeth & in the anterior area by adding small amount of composite on the labial surface so that the labial bow rests on it. www.indiandentalacademy.com
  130. 130. • A 10yr old pt with a skeletal & dental CL-II Div 1 malocclusion. Overjet-6mm & Overbite-3mm. www.indiandentalacademy.com
  131. 131. After 4 months of night time wear www.indiandentalacademy.com
  132. 132. MAD-II FOR CORRECTION OF CL-II,DIVISION 1 MALOCCLUSION. Deep Bite open Bite www.indiandentalacademy.com
  133. 133. MAD II appliance with transverse screw & two sagittal screws incorporated in lingual side of the lower appliance to permit the sagittal reactivation. www.indiandentalacademy.com
  134. 134. Early CL-III treatment with Magnetic appliance. Patient before treatment. www.indiandentalacademy.com
  135. 135. Combined MED & MAD III appliance  MAD III Bonded upper plate ,with two midpalatal Samarium cobalt magnets. Removable lower plate with buccal magnets. www.indiandentalacademy.com
  136. 136. www.indiandentalacademy.com
  137. 137. Patient after 14 months of treatment. www.indiandentalacademy.com
  138. 138.  MAD - IV Magnetic activator device IV uses anterior attracting & posterior repelling magnets. www.indiandentalacademy.com
  139. 139. •MAD IV consists of removable upper & lower plates each of which contains three cylindrical neodymium magnets coated with stainless steel. www.indiandentalacademy.com
  140. 140. MAD IV(a) MAD IV( b) MAD IV( c) www.indiandentalacademy.com
  141. 141.  Tooth Intrusion:Active Vertical Corrector-Dellinger(1986) -Samarium cobalt magnets in the repelling mode are used. www.indiandentalacademy.com
  142. 142. www.indiandentalacademy.com
  143. 143. Pre-Treatment www.indiandentalacademy.com Post-Treatment
  144. 144.  Fixed Magnetic Appliance:-introduced by VARUN KALRA & CHARLES BURSTONE. Appliance consists of an upper &lower acrylic splints with samarium cobalt magnets in stainless steel casting embedded in a repelling mode. www.indiandentalacademy.com
  145. 145. Results:-Length of the mandibular condyle increased significantly in the treated group. -the entire upper and lower arches intruded during the treatment. www.indiandentalacademy.com
  146. 146.  Tooth Impaction:- Vardimon,Graber,Drescher -Neodymium Iron Boron magnets can be used to assist eruption of an impacted canine. www.indiandentalacademy.com
  147. 147. Vertical &Horizontal magnetic brackets were designed with the magnetic axis magnetized parallel and perpendicular to the base of the edge wise bracket. •Vertical type –Impacted canines & incisors . •Horizontal type –Impacted premolars &molars. www.indiandentalacademy.com
  148. 148. Surgical procedure:Palatal approach was used to expose the maxillary canine. Vertical magnetic bracket bonded on the palatal crown surface of the impacted canine. www.indiandentalacademy.com
  149. 149. • A spacer of 2.5mm is positioned between the magnetic bracket & loose intraoral magnet. •Fixation of the intraoral magnet to the Hawley type retainer with self curing acrylic followed by removal of spacer , to apply an attraction force of 0.3N. www.indiandentalacademy.com
  150. 150. •Treatment progression of the magnetic attraction after 3 months. • Fixed appliance treatment stage. www.indiandentalacademy.com
  151. 151. An attractive solution to unerupted tooth. -Sandler(1991) www.indiandentalacademy.com
  152. 152. •Upper left canine erupting through the mucosa. •Larger magnet repositioned to allow further movement. •Sufficient eruption to allow attachment to be placed. www.indiandentalacademy.com
  153. 153. Detailing with fixed Appliance. Post -treatment Mancini(1996)-force levels are sufficient enough to induce the cellular & biochemical changes required to produce orthodontic tooth movement. www.indiandentalacademy.com
  154. 154. space closure:-Complex Intra & Interarch Mechanics:-Blechman(1985) CL-II mechanics with a magnetic force system in a CL-I extraction case www.indiandentalacademy.com
  155. 155. 3 magnet configuration to enhance CL-II mechanics 3 magnet configuration used to simultaneously move all 4 canines distally www.indiandentalacademy.com
  156. 156. Intramaxillary magnetic force to move Canine distally. www.indiandentalacademy.com
  157. 157. Upper canine retraction Pre-treatment. Lower canine retraction www.indiandentalacademy.com Post-treatment
  158. 158.  Molar Distalization:-Gianelly et al(1989):-repelling magnets in conjunction with a modified Nance appliance was used. Lateral view of magnets in position. www.indiandentalacademy.com
  159. 159. -A 11yr/F with a CL-II DIV I malocclusion in the late mixed dentition period. -Nance appliance was seated on the second deciduous molar. Results:-Molar movement in distal direction-3.2mm Deciduous molar movement in mesial direction-0.6mm www.indiandentalacademy.com
  160. 160. Molar distalization with repelling magnets -Takami etal(1991) The Molar distalization system uses two opposing magnets for each maxillary quadrant. . • Nance appliance is placed to reinforce the anchorage. • Constant magnetic force of 80z is applied. • Magnets are reactivated for every 2wks www.indiandentalacademy.com
  161. 161. Case from the present study before & after rapid molar distalization. www.indiandentalacademy.com
  162. 162. Repelling magnets vs. superelastic Ni-Ti coils. Bondemark & Kurol (1992).  In simultaneous distal movement of maxillary first & second molars -Mean distal movement for supercoils is 3.2mm. -for magnets is 2.2mm. www.indiandentalacademy.com
  163. 163.  Magnetic Edgewise Brackets:-Kawata(1987) -Samarium cobalt magnet with an edgewise bracket (o.018slot) . www.indiandentalacademy.com
  164. 164. Clinical application of magnetic brackets in crowded dental arch. Cast models before & after treatment. www.indiandentalacademy.com
  165. 165. Autonomous fixed magnetic appliance. -Darendeliler & Joho  Treatment of CL-II bimaxillary protrusion with magnets:. A13yr old female patient before treatment www.indiandentalacademy.com
  166. 166. •Ideal arch form using Bonwill-Hawleys method. •Calculation of mesial & distal magnet cuts needed to create proper arch form. •Upper & lower magnetic arches before coating. www.indiandentalacademy.com
  167. 167. Lower magnets temporarily affixed to cast for Indirect bonding. www.indiandentalacademy.com
  168. 168. Magnetic arches in place. www.indiandentalacademy.com
  169. 169. Additional magnet bonded to close median diastema Patient after 6 months of treatment with AFA www.indiandentalacademy.com
  170. 170.  Propellant Unilateral Magnetic Appliance (PUMA) - Chate(1995)  Magnets are use to stimulate costo-chondral bone graft in Hemi facial microsomia. www.indiandentalacademy.com
  171. 171.  Retainers:-Springate & Sandler(1991) -micro magnets made of neodymium iron boron magnets as a fixed retainer in a patient with persistent diastema. www.indiandentalacademy.com
  172. 172.  Bibliography:- -Dentofacial Orthopedics with functional appliances-T.M Graber, Rakosi,Petrovic. -Magnetic force systems in orthodontics-Blechman AJO 78. -Rare earth magnets and Impaction-Vardimon AJO 91. -Use of magnets to move the molars distally-Gainelly AJO 89. -Magnetic vs Mechanical expansion with different thresholds and points of force application. Vardimon.AJO 87. -Effects of fixed magnetic appliance on the dentofacial complex. Kalra.AJO 89. -A new orthodontic force system of magnetic brackets. Kawata AJO 87. -An open bite correction with MAD IV. JCO 95. Darendeliler. www.indiandentalacademy.com
  173. 173. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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