The level anchorage system-Dr.Terrel Root

1. THE LEVEL ANCHORAGE SYSTEM
Dr.Pooja Kale
II MDS

2. Am J Orthod,1981

3. • Terrell L. Root -1981 - combination of straight
wire appliance and anchorage preparation.
• Aim – quantify the anchorage requirement.
018 edgewise slot.
• Orderly manipulation of need and availability
of anchorage.

4. • The level anchorage is a blending of the new
and the old.

5. • The new consists of highly
resilient,smooth,deformation resistant arch
wires such as NITI in combination with
accurate preadjusted brackets and cast tubes
that automatically provide
tip,torque,height,offset,inset nd rotational
control.

6. • The old consists of time-honored precepts
that state that humans have changed slowly.
• Generalized orthodontic goals of proper
FUNCTION,TOOTH STABILITY AND PLEASING
ESTHETICS ARE UNIVERSALLY ACCEPTED.

7. • Function, stability, and esthetics: these terms
encompass the primary clinical goals of
orthodontic treatment.

8. • The philosophy is that function is adequate when
the jaws close in hinge relation and the teeth
occlude in centric occlusion;
• when the mandible slides forward from centric
occlusion into protrusion, the anterior teeth
function and the posterior teeth disocclude.
• when the mandible moves into lateral excursion,
the canines function while the posterior teeth
disclude.

9. • Stability is attained when, after completion of
treatment, the teeth remain in their new
position.
• Esthetic requirements (which are
uncompromisingly subjective) are met when
the teeth and facial profile are “pleasing to
the eye of the beholder. ”

10. The level anchorage will provide
• A highly predictable relationship between the goal and
the result.
• A documented,easily calculated diagnostic system that
establishes a definitive step-by-step treatment plan.
• Reduction of the need for the patient co-operation.
• Elimination of most tongue thrust problems.
• Reduction of chair time to a minimum when one is
treating to an ideal goal.

11. • Increase in mandibular growth when needed even in
adults.
• Achievement of maximum facial esthetic potential.
• Adaptability to any orthodontist’s treatment goals for
patient of any age.
• The latest fully preadjusted appliance system
engineered to meet the requirements of orthodontic
treatment
• Improvement of level of confidence of patient and
orthodontist and their interrelationship.

12. BOUNDARIES OF DENTURE
• Correction of the malocclusion must take
place within critical anatomic limits.
• The point B is the anterior boundary for the
lower anterior roots.
• If lower anterior roots are moved lingually, B
point follows.

13. • The lower arch width depends on the original
lower canine width,which,provided that the
canines are not blocked out labially or
lingually.
• If canine crowns are tipped labially in an
attempt to expand, the musculature will tip
them back to their original width after the
appliance is removed.

14. • Cortical bone determines the root structure boundary
for the lower premolars and molars.
• Musculature determines how upright their crowns can
be.
The ascending ramus,as viewed in cephalmetric
radiograph is the posterior bounday of the mandible.
Arch length in this area increases through
1.5mm/side/year[ 16yrs for girls and 18yrs for boys]

15. • The point A is the anterior border for the
maxillary anterior roots.
• The lingual cortical bone is the lingual boundary
for the upper anterior root structure.
• The buccal boundary for maxillary premolars and
molars is based on proper function with the
mandibular teeth.
• Midpalatal suture widening provides some
expansion of the maxillary arch.

16. • . The maxillary tuberosity is the posterior
boundary of the maxilla.
• This area increases in lenght about 1.5mm
per year per side to age 16 for girls and 18 for
boys.

17. • The position of lower anterior teeth is very
importan to the diagnosis, esthetics and
stability of the orthodontic case.
• Labial musculature determines the lower an-
terior crown position.
• "Upright" lower anterior teeth seem to be in
their most stable position

18. • From the level-anchorage viewpoint "upright”
is described as being 3mm to 5 mm infront of
the line NB at an angulation of 17 to
23degrees to NB
• Due to tongue thrusting habit, these are
protruded, once corrected lip musculature tips
these teeth back into a more upright position.

19. • In cases like large ANB angle,the lips are held
forward by the protrusive maxilla and lower
anteriors are usually tipped forward trying to
get into functional occlusion.
• .

20. • Ideal anchorage goals for
the denture base angle
ANB ranges from 0 to 4
degrees
• LI will be very stable
when they range btn
3mm to NB at 17.5° for an
ANB of 0° to a more
protrusive 5mm to NB at
22.5° for an ANB of 4
degrees.

21. Anchorage
• Anchorage is an integral part of the LEVEL
ANCHORAGE SYSTEM.
• Types
• TOOTH ANCHORAGE
• ANCHORAGE SAVERS

22. • TOOTH ANCHORAGE[ Resistant to movement and
distance to move]
• One can increase the resistance to movement by so
changing the axial inclination of anchor teeth that
when pulled against they do not move as easily as they
did before their inclination was changed.
• Intrusion and bodily movement are relatively difficult.
• Thus distoaxial inclination increased the anchorage
preparation.

23. • Distance to move: By extraction
• Class III elastics that tip the lower buccal
crowns distally also increases the distance to
move.

24. • ANCHORAGE SAVERS
• These are orthodontic adjuncitve procedures
and phenomena that reduce thr amount of
tooth anchorage necessary to correct the
malocclusion
• Eg: Headgear,TPA,postponement of
extraction,lip bumpers.

25. The appliance
• The level anchorage appliance is a completely
new,fully preadjusted appliance for automatic
correction of tip,torque,offset,inset,height and
rotations.

26. • Eg: Mandibular 2nd
premolar bracket
should measure 5mm
below the occlusal
surface of the tooth.
• This system helps
maintain marginal ridge
integrity as anchorage

27. • There are 2 choices of
distal crown tip for the
mandibular buccal
teeth Regular and
Major.
The choice depends on
the severity of the
malocclusion.

28. ➢ The severity of the malocclusion is quantified as a
function of seven clinical variables:
1. Depth of curve of Spee.
2. Lower arch discrepancy: crowding or spacing.
3. Space needed to upright lower anteriors.
4. Anchorage needed to retract lower canines.
5. Anchorage needed to correct A-N-B
6. Additional anchorage needed if mandibular plane angle is high,
additional anchorage available if mandibular plane angle is low.
7. Anchorage needed to retract upper anteriors in extraction cases

29. ➢ How much lower arch length is required to correct these
seven variables-
1.Depth of the curve of spee-It takes 1 mm of arch length to
level 1 mm of curve.
2.Lower arch discrepancy- it takes 1 mm of arch length to
correct each millimeter of crowding.
3.Space to upright the lower anteriors- Subtract the goal
position of the lower anteriors from their original position
and multiply by two (both sides).
29

30. • 4.Lower buccal anchorage to retract the canines-
The canines: must be retracted a total of the anterior
discrepancy plus the space needed to upright the lower
anteriors, Add those two values and divide by 6 to
determine how far the lower buccal segments come
forward during canine retraction.
• 5.For retracting six anterior teeth in first premolar
extraction case 3mm of space is needed in lower arch.
In second premolar extraction case,retracting 8 teeth
needs 4mm space

31. 6. Additional anchorage -. If Frankfort mandibular plane
angle is higher by 8 than average then the case will take 1mm
of additional anchorage. If the FMPA is lower by 80 than
average 1mm of anchorage is available.
➢ High pull headgear to maxillary 1stmolars 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.

32. Analysis chart and treatment plan
• The difficulty of the orthodontic case is
directly related to how much change the
orthodontist intends to achieve.

33. • The problem is recorded on a chevron
representing lateral cephalogram landmarks
and arrow pointing to the goals

34.  The depth of the curve of spee is recorded above the arrow.
 The amount of crowding/spacing in the lower arch is recorded below the
arrow
 The position of LI teeth in angulation and mm to NB is recorded on the
chevron line
 The position of UI teeth in angulation and mm to NA is recorded on the
chevron line
 Effective SNA,SNB and ANB are recorded above and below the chevron.
 The FMA is recorded on the chevron line representing the FH.
 The SN mandibular angle is recorded on the chevron line representing the
lower border of the mandible

35. The ideal goal
• When the original ANB is low or tends towards
class III maloocclusion,the 0 degree ANB goal
is chosen.
• When the original ANB is 7 to 10,the 4 degree
ANB goal is chosen.

36. Charting the anchorage problem
Direction A: Add 1 to 6
According to summary of extraction
suggestion, if the total is greater than
12,extraction of all first premolars.
Direction B: Record extraction values.
Direction C: Line 5,7,8
Direction D: Subtract total [ + and -]
If the value remains negative..use class
III elastics [+1} and headgear {+1}.

38. Treatment steps for extraction and
non-extraction

39. CASE REPORT

40. THE MAXILLARY TEETH WERE BANDED AND A
0.017*0.025 NITI ARCH WIRE WAS TIED,FOLLOWED BY
0.018*0.025 SS TO STABILIZE THE TEETH

41. CLASS III ELASTICS WERE
WORN TO A LOWER 0.018
ROUND NITI ARCH
FOLLOWED BY
0.017*0.025NITI 0.018*0.025 SS WIRE PLACED
TO COMPLETE LEVELING OF THE
BUCCAL SEGMENTS

42. THE CANINES WERE RETRACTED ON 0.015*0.025 NITI WITH OPEN COIL SPRING
AND WIRHGABLE BENDS AT THE EXTRACTION SITE

43. THE LOWER ANTERIORS
WERE BANDED AND TIPPED
UPRIGHT, AND THE ANTERIOR
SPACES WERE CLOSED
0.018*0.025 SS ANCHORAGE
ARCH WITH VERTICAL LOOPS
PLACED IN THE EXTRACTION SITE
AND 1ST UPPER PREMOLARS
WERE EXTRACTED.

44. THE UPPER ANTERIORS
WERE RETRACTED ON A
0.017*0.025 NITI WIRE
WITH PUSH COIL SPRING.
THEN ARCH WAS
REPLACED WITH A
0.017*0.024 SS VERTICAL
LOOP ARCH AND A HIGH
PULL J HOOK
TREATMENT WAS FINISHED
ON IDEAL 0.017*0.024SS U/L
ARCH WIRES

46. THE TONGUE THRUST AND INCORRECT
TONGUE POSTURE
• The level anchorage
system indicatesmthe
use of lingual spurs in
the lower anterior area
to immediately correct
the habit.

47. Treatment variables and their control
• Patient variables are harder to control
• But incorrect tongue posture and finger sucking
habits are eliminated by the use of tongue spurs.
• Patient cooperation with wearing headgear
seems to be improved when the exact length of
the time the appliance must be worn is known.

49. SUMMARY
• The level Anchorage System uses new
materials such as NITI wire and new
completely preadjusted applainces to aid in
the ease of treatment and help eliminate
variables.