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Micro implant anchorage in orthodontics /certified fixed orthodontic courses by Indian dental academy
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Micro implant anchorage in orthodontics /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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  • 1. MICRO IMPLANT ANCHORAGE IN ORTHODONTICS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. INTRODUCTION Oral implantology has recently become the object of growing attention. Successful long term Osseo integration,has greatly increased the use of dental implants over the last 3 decades. Other than replacing missing teeth,implants can also be used to enhance orthodontic treatment -as a source of absolute anchorage, -for orthopedic anchorage, -as abutments for restorations, -in osteogenic distraction. www.indiandentalacademy.com
  • 3. During active treatment,orthodontic anchorage aims to limit the extent of detrimental,unwanted tooth movement. The ability of Osseo integrated implants to remain stable under occlusal loading has led orthodontists to use them as anchorage units without patient compliance www.indiandentalacademy.com
  • 4. History The earliest implantation in the sense of reimplantation, Date back to pre-Christian times . In 18th and 19th centuries artificial materials were used as implant materials but were proved to be failures and were abandoned. Endosseous implants became a major influence within the oral implant Surgery due to the work of Branemark who achieved constant Long term success rates with oral endosseous implants. In the early 1930s the introduction of stainless metals and the development of a cobalt-chromium-molybdenum alloy (vitallium) gave new impulses to implant surgery. www.indiandentalacademy.com
  • 5. Dahl(1945),first published the use of subperiosteal vitallium implants to effect tooth movements in dogs Linkow (1966),described endosseous blade implants with perforations for orthodontic anchorage. Kawahara etal(1975), developed ,Bioglass-coated ceramic implants for orthodontic anchorage Various bioactive ceramics such as glass ceramics(Bromer etal 1977,Hench etal 1973),tricalcium phosphate ceramics (Luhr and Riess,1984) and hydroxy appetite ceramics (Hajek and Newesely,1963; Jarcho etal, 1977) www.indiandentalacademy.com
  • 6. Branemark (1969,1977) the mentor of modern implant surgery ,described the high compatibility and strong anchorage of titanium in human tissue and coined the term “Osseointegration” Creekmore (1983) reported the possibility of skeletal anchorage in orthodontics Higuchi and James (1991) used titanium fixtures For intraoral anchorage to facilitate orthodontic tooth movement. Costa etal (1998) used miniscrews for orthodontic anchorage Ume mori etal (1999) used SAS for open bite correction. www.indiandentalacademy.com
  • 7. CLASSIFICATION Based on their position: -subperiosteal, -transosseous, -endosseous Based on material of construction: -titanium,ideal material -gold alloys, -vitallium, -cobalt-chromium, -vitreous carbon, -aluminium oxide ceramics www.indiandentalacademy.com
  • 8. Based on their design: -screw type -cylindrical type -blade type -onplant www.indiandentalacademy.com
  • 9. Indications for implant therapy. motivated,cooperative,good oral hygiene growth of alveolar process should be completed www.indiandentalacademy.com
  • 10. Contraindications for implant therapy Absolute contraindications: -severe systemic disorders; osteoporosis, -psychiatric disease,e.g.pyschoses,dysmorphobia. -alcoholics,drug abusers Relative contraindications: -insufficient volume of bone, -poor bone quality, -pts undergoing radiation treatment, -insulin-dependent diabetes, -heavy smokers www.indiandentalacademy.com
  • 11. TITANIUM AS AN IDEAL IMPLANT MATERIAL Titanium is a reactive metal -forms an oxide layer on contact with air, water or any electrolyte,which protects it from chemical attack including aggressive body fluids Titanium is inert in tissue – i.e.,no ions are released which are reactive with the body tissues www.indiandentalacademy.com
  • 12. Titanium possesses good mechanical properties  -tensile strength=st.steel -tough and malleable,makes it insensitive toshock loading and will yield on heavy loads -corrosion resistant Titanium is a bioactive material -bone grows into rough surface of the metal and bonds with metal leading to osseointegration www.indiandentalacademy.com
  • 13. Uses of implant-based anchorage • Retracting and realigning anterior teeth with no Posterio support • Closing edentulous spaces in first molar extraction sites • Mid-line correction when missing posterior teeth, • Intruding/extruding teeth, • Protraction or retraction of one arch • Stabilization of teeth with reduced bone support • Orthopaedic traction www.indiandentalacademy.com
  • 14. Measurement of alveolar bone height www.indiandentalacademy.com
  • 15. Tissue response following implant placement Stage I;Woven callus (0-2wks) -bridging callus forms within a few millimeters from the margin of implantation site, -stability of the approximating segments is important for efficient bridging callus formation Stage II;Lamellar compaction (2-6wks) -is the period of lamellar compaction, -callus matures and achieves sufficient strength for loading. www.indiandentalacademy.com
  • 16. Stage III;Interface healing (2-6wks) -begins at the same time callus is completing lamellar compaction, -callus starts to resorb and remodeling of devitalized interface begins. Stage IV;Maturation (6-18wks) -bone matures by a series of modeling and remodeling process -callus completes resorption(modeling) www.indiandentalacademy.com
  • 17. Long term maintenance Repetitive loading results in microscopic cracks Which if accumulates lead to structural failure. Osteoclasts resorbs oldest and most weakened Bone which maintains structural integrity. This remodeling of the interface and supporting bone helps in long term maintenance of rigid osseous fixation. www.indiandentalacademy.com
  • 18. MINI-IMPLANTS Conventional-3.5-5.5mm dia, 11-21mm length Small in size;1.2mm dia,6mm length www.indiandentalacademy.com
  • 19. mini-implant for cuspid retraction For molar intrusion www.indiandentalacademy.com
  • 20. For molar distalization For anterior intrusion www.indiandentalacademy.com
  • 21. Steps in placement of mini implant (Osseointegrated) 1.Reflection of mucoperiosteal Flap and denuding of bone 2.Pilot drill used to enter same Distance as length of mini-implant www.indiandentalacademy.com
  • 22. 3.Mini implant inserted 4.Implant site sutured www.indiandentalacademy.com
  • 23. 5.Gingival tissue exposed Over head of mini implant 6.Soft tissue surrounding head Of mini-implant www.indiandentalacademy.com
  • 24. 7.titanium bone plate attached to head of mini-implant www.indiandentalacademy.com
  • 25. NON OSSEOINTEGRATED MINI IMPLANTS: (Spider screw) Advantages:  small in size,  inexpensive,  simple to place and remove,  immediately loadable,  well tolerated by patients, www.indiandentalacademy.com
  • 26. spider screw -is a self-tapping titanium mini screw -available in three lengths-7mm,9mm,& 11mm. -screw head has an internal slot of .021”x.025” external slot of.021”x.025” round vertical slot of .025” www.indiandentalacademy.com
  • 27. Available in three forms Regular-thicker head & intermediate length collar Low profile-thin head & long collar Low profile flat-thin head & shorter collar www.indiandentalacademy.com
  • 28. Site for placement: should have enough bone depth to accommodate the screw & 2-3mm of bone width to protect adjacent dental roots and anatomical structures typical insertion areas -maxillary tuberosity -retromolar areas -edentulous ridges -interradicular septi -palate -anterior alveolar process www.indiandentalacademy.com
  • 29. Determination of screw placement site: Acrylic surgical index www.indiandentalacademy.com
  • 30. SURGICAL PROCEDURE Osseous site preparation with 1.5mm pilot drill Spider screw insertion with low speed Contra-angle(30rpm) www.indiandentalacademy.com
  • 31. Screw removal Immediately after removal Seven days later www.indiandentalacademy.com
  • 32. Case Report Extrusion of maxillary molars-pre Rx www.indiandentalacademy.com
  • 33. Intrusion of premolar & molars using coil springs & elastics to spider screw www.indiandentalacademy.com
  • 34. Post-Rx –after intrusion of molars www.indiandentalacademy.com
  • 35. Treatment planning phase • problem list & patient desires • initial evaluation 1. 2. 3. 4. 5. chief complaint medical/dental history review intra/extra oral examination evaluation of existing prosthesis diagnostic impressions/articulated casts 6. radiographs (panoramic and periapical, CT scan or tomography – as indicated) www.indiandentalacademy.com 7. photographs
  • 36.  Problem list & treatment considerations www.indiandentalacademy.com
  • 37. TEETH – NUMBER & EXISTING CONDITION INCLUDING: prognosis of remaining teeth size, shape & diameter of existing dentition tooth & root angulations & proximity mesiodistal width of edentulous space **Need: minimum of 6-7mm between teeth to facilitate implant placement (based on 3mm fixture) > 1.5mm between implant and natural teeth 7mm from center of implant – to center of implant for edentulous area **If more than 10mm mesiodistal space – then single tooth implant not recommended www.indiandentalacademy.com
  • 38. bone support – quality & quantity (Lekholm & Zarb classification) quality: best is thick compact cortical bone w/ core of dense trabecular cancellous bone best region is mandibular symphysis; poorest in posterior regions quantity: required for implant placement: 6mm buccal-lingual width w/ sufficient tissue volume 8mm interradicular bone width 10mm alveolar bone above inferior alveolar (IAN) canal or below maxillary sinus **If inadequate bone support, may need ridge or site augmentation: ramus or chin graft (autograft) DFDBA (allograft) Bio-Oss(xenograft) **implants should be placed at a minimum of 2mm from the inferior alveolar (IAN) canal or below the maxillary sinus           www.indiandentalacademy.com
  • 39. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com