ANCHORAGEwww.indiandentalacademy.com
In simple terms anchorage in orthodonticsis defined as resistance to unwanted toothmovement.     Angle stated that there w...
Given Angle’s insistence on expansion of archesrather than extraction to deal with crowdingproblems, it is ironic that his...
When anchorage preparation as advocated byTweed was used with standard edgewise appliance thetip, torque and offset bends ...
Graber: defines anchorage as the nature and degreeof resistance to displacement offered by an anatomicalunit when used for...
Horizontally anchorage control means limitingthe mesial movement of the posterior segmentwhile encouraging the distal move...
Sources of Anchorage:(i)extra-oral(ii) intra-oral   Extra-oral anchorage is the anchorage in which one   of the anchorage ...
Classification of anchorage: Acc to Moyers(i)Dep. On manner of force application:•Simple•Stationary•Reciprocal(ii)Dep. On ...
(iii) Dep. on site of anchorage:•Intra oral•Extra oral•Muscular(iv) Dep. on no. of anchor units:•Single / primary•Compound...
1.Natural anchorage         It comes from any resistance afforded within the arch  according to the application of forces ...
Reciprocal / Multiple anchorage :      It involves pitting of two teethor two groups of teeth of equalanchorage value agai...
Stationary Anchorage :      Dental anchorage in which the mannerand application of force tend to displace theanchorage uni...
2. Reinforced Anchorage :•      It involves reinforcing theanchorage or resistance areaeither by adding more resistanceuni...
• This is obtained by  various means  namely:1.Extra oral force to  augment anchorage2.Upper anterior  inclined plane &  S...
3. Prepared Anchorage     Prepared anchorage pre sets the teeth intodisto-axial inclination, greatly increasing theirresis...
Cortical anchorage :      The cortical bone is more resistant to resorptionthan the medullary bone. The cortical anchorag...
Graber has classified anchorage as intramaxillary  anchorage and intermaxillary anchorage.1. Intramaxillary anchorage is t...
SELECTION OF ANCHORAGE:     Since anchorage must be selected to makeproper use of the space created by extraction, amore r...
Minimum        anchorage         mechanics involvedreciprocal forces between posterior teeth and anteriorteeth with no eff...
Moderate anchorage mechanics involve placingan active root thrust or movement on the anchor teeth,causing bodily resistanc...
Maximum        anchorage         mechanics    involvereinforcing the anchor teeth with all means availableand reducing the...
We have a wide array of appliancesavailable to gain and preserve anchorage in allthe three dimensions of space. Theseadjun...
•The extra oral appliances: Various Headgearassemblies,or retractors as some author prefers to callthem, essentially const...
HEAD – GEARHead gears are classified according to the point of origin of force:  •Cervical – Anchorage obtained from nape ...
FORCE AND DURATION OF WEAR :•Most of the authors agree that the amount of forceapplied to maxilla by the headgear should b...
FACE MASK:• It is an extra oral  anchorage source.• It derives anchorage from  facial bones.• Sites of anchorage:   1. Fro...
TRANSPALATAL ARCH•Transpalatal arch is a secondary method of anchorage support inupper posterior segment.It is made by 0.0...
NANCE AND LINGUAL HOLDING ARCHES•The Nance holding arch extends from maxillary molarsto anterior portions of the palatal v...
LIP BUMPER•Lip bumper has been used for molaranchorage, prevention of poor lip habitsand creation of increased space forma...
BAKER’S ANCHORAGE:•It is a type of intermaxillary anchorage.•Class II traction applied between the lowermolars and upper a...
ANCHORAGE PLANNING:• It is of utmost importance in the success of  orthodontic treatment. Therefore it is very much  essen...
CONCLUSION      As orthodontic treatment continues to change andimprove, innovative techniques may find acceptance incerta...
www.indiandentalacademy.com
www.indiandentalacademy.com
Upcoming SlideShare
Loading in …5
×

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

6,449 views

Published on

Welcome to Indian Dental Academy
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

Published in: Education
0 Comments
16 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
6,449
On SlideShare
0
From Embeds
0
Number of Embeds
24
Actions
Shares
0
Downloads
0
Comments
0
Likes
16
Embeds 0
No embeds

No notes for slide

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

  1. 1. ANCHORAGEwww.indiandentalacademy.com
  2. 2. In simple terms anchorage in orthodonticsis defined as resistance to unwanted toothmovement. Angle stated that there were many means forobtaining anchorage, including the tooth themselvesand sources external to the teeth. He classifiedanchorage as simple , stationary, reciprocal, intermaxillary and occipital. www.indiandentalacademy.com
  3. 3. Given Angle’s insistence on expansion of archesrather than extraction to deal with crowdingproblems, it is ironic that his edgewise appliancefinally provided the control for root positionnecessary for successful extraction treatment. One of Angle’s last student, Charles Tweed,adapted the edgewise appliance for extractiontreatment. Tweed placed tip back bends in thelower arch to vary the amount of distoaxialinclination of the lower posterior teeth. Theamount of distal tip varied depending on theseverity of malocclusion. www.indiandentalacademy.com
  4. 4. When anchorage preparation as advocated byTweed was used with standard edgewise appliance thetip, torque and offset bends had to be placed in eachedgewise arch. The bends were then duplicated orincreased in the successive arches as the caseprogressed. Reed Holdaway in 1952 described pre-angulation of the edgewise appliance in mandibularbuccal segments as a method of setting up posterioranchorage units into tipped back or anchorageprepared positions. www.indiandentalacademy.com
  5. 5. Graber: defines anchorage as the nature and degreeof resistance to displacement offered by an anatomicalunit when used for purpose of effecting tooth movement.Bennett and McLaughlin: emphasized the needto consider anchorage in all the three planes of spacei.e., horizontal, vertical and lateral (transverse).White & Gardiner: it is the site of delivery fromwhich a force is exerted. www.indiandentalacademy.com
  6. 6. Horizontally anchorage control means limitingthe mesial movement of the posterior segmentwhile encouraging the distal movement of anteriorsegment. Vertically, anchorage control involves thelimitation of vertical skeletal and dentaldevelopment in the posterior segment andlimitation or vertical eruption of, or even intrusionof anterior segments. In transverse plane It comprises of themaintenance of expansion procedures, primarily inupper arch, and the avoidance of tipping or www.indiandentalacademy.comextrusion of posterior teeth during expansion.
  7. 7. Sources of Anchorage:(i)extra-oral(ii) intra-oral Extra-oral anchorage is the anchorage in which one of the anchorage unit is situated outside the oral cavity . Extra-oral anchorage can be further classified as :  Cervical  Cranial o Occipital o parietal  Facial eg. Delaire Facemask Intra-oral anchorage : It is the anchorage in which the resistance units are all situated within thewww.indiandentalacademy.com oral cavity e.g., teeth, palate, muscular forces, inclined planes of teeth.
  8. 8. Classification of anchorage: Acc to Moyers(i)Dep. On manner of force application:•Simple•Stationary•Reciprocal(ii)Dep. On jaws involved:•Intermaxillary•Intramaxillary www.indiandentalacademy.com
  9. 9. (iii) Dep. on site of anchorage:•Intra oral•Extra oral•Muscular(iv) Dep. on no. of anchor units:•Single / primary•Compound•Multiple/ reinforced www.indiandentalacademy.com
  10. 10. 1.Natural anchorage It comes from any resistance afforded within the arch according to the application of forces between any given teeth or group of teeth.Simple Anchorage :• Dental anchorage in which the manner and application of force tends to displace or change axial inclination of the tooth or teeth that form the anchorage unit in the plane of space in which the force is being applied.• In other words resistance of anchorage unit to tipping is utilized to move another tooth or teeth.Compound Anchorage :• Here anchorage www.indiandentalacademy.com is provided by more than one tooth with greater support is used to move teeth with lesser support.
  11. 11. Reciprocal / Multiple anchorage : It involves pitting of two teethor two groups of teeth of equalanchorage value against each otherto produce reciprocal toothmovement.• Eg: closing of diastemas: twocentral incisors are pitted against eachother. www.indiandentalacademy.com
  12. 12. Stationary Anchorage : Dental anchorage in which the mannerand application of force tend to displace theanchorage unit bodily in the plane of space inwhich the force is being applied is termedstationary anchorage (Graber). www.indiandentalacademy.com
  13. 13. 2. Reinforced Anchorage :• It involves reinforcing theanchorage or resistance areaeither by adding more resistanceunits or by the use of variousadjuncts.• A simple way of reinforcinganchorage is to band the secondmolars.• Various other waysinclude, the use of T.P.A., Nanceholding arch, lower lingual arch.• Tissue anchorage such asobtained by lip bumper can be www.indiandentalacademy.comefficiently used to distalize molars.
  14. 14. • This is obtained by various means namely:1.Extra oral force to augment anchorage2.Upper anterior inclined plane & SWED APPLIANCE3.Trans palatal arch www.indiandentalacademy.com
  15. 15. 3. Prepared Anchorage Prepared anchorage pre sets the teeth intodisto-axial inclination, greatly increasing theirresistance to displacement. This method is veryeffective for controlling anchorage, especiallywhen anchorage is critical.4. Active root thrust : This concept was put forward by Dr. CalvinCase in 1908. It involves building bodilyresistance into the anchor area through the useof extensions fixed to the bands of the molarteeth. www.indiandentalacademy.com
  16. 16. Cortical anchorage : The cortical bone is more resistant to resorptionthan the medullary bone. The cortical anchorageconcept makes use of this. Rickett’s advocated torquing the roots of buccalteeth outwards against the cortical plate as a way toinhibit their mesial movement. Torquing movements are limited by facial andlingual cortical plates. If a root is persistently forcedagainst the cortical plate, tooth movement is greatlyslowed, root resorption is likely and eventual penetrationof cortical bone may sometimes occur. www.indiandentalacademy.com
  17. 17. Graber has classified anchorage as intramaxillary anchorage and intermaxillary anchorage.1. Intramaxillary anchorage is the anchorage is which the resistance units are all situated with in the same jaw. If appliances are placed only in maxillary or mandibular arch they are considered, intra maxillary resistance units.2. Intermaxillary anchorage is anchorage in which the units situated in one jaw are used to effect tooth movement in the other jaw. Also called BAKER’S www.indiandentalacademy.com anchorage.
  18. 18. SELECTION OF ANCHORAGE: Since anchorage must be selected to makeproper use of the space created by extraction, amore rational approach of classifying anchoragewould be the one which guides the operator tomake use of the available space. Accordingly anchorage in mandibular archcan be put into three classes:DEPENDING ON ANCHOR LOSS EXPECTED: •minimum, •moderate and •maximum anchorage. www.indiandentalacademy.com
  19. 19. Minimum anchorage mechanics involvedreciprocal forces between posterior teeth and anteriorteeth with no effort to maintain a moment on theanchor area. Minimum anchorage mechanics are selectedwhen the mandibular posterior teeth may be permittedto migrate mesially into half or more of the extractionsite. www.indiandentalacademy.com
  20. 20. Moderate anchorage mechanics involve placingan active root thrust or movement on the anchor teeth,causing bodily resistance in this area. Moderate anchorage mechanics are selectedwhen the mandibular posterior teeth may be permittedto move forward into one fourth to one half of theextraction site. www.indiandentalacademy.com
  21. 21. Maximum anchorage mechanics involvereinforcing the anchor teeth with all means availableand reducing the workload required of the anchor areaby developing forces outside the mandibular arch foras much of the desired tooth movement possible. Maxillary anchorage mechanics are selectedwhen the mandibular posterior teeth may be permittedto move forward into no more than one fourth of theextraction site. www.indiandentalacademy.com
  22. 22. We have a wide array of appliancesavailable to gain and preserve anchorage in allthe three dimensions of space. Theseadjuncts available are broadly classified into:• extraoral and• intra-oral appliances www.indiandentalacademy.com
  23. 23. •The extra oral appliances: Various Headgearassemblies,or retractors as some author prefers to callthem, essentially constitute this group. Moyers addsthe face mask to this group.•The intra oral adjuncts can be grouped according tothe plane of space in which they act. The transpalatalarch acts in all the three dimensions. Whereas lacebacks, Nance/lingual holding arches, lip bumper act inanteroposterior direction.•Head gear and face mask give adequate control invertical plane. Where as T.P.A. and quad helix help topreserve the expansion in transverse plane. www.indiandentalacademy.com
  24. 24. HEAD – GEARHead gears are classified according to the point of origin of force: •Cervical – Anchorage obtained from nape of the neck •Occipital / Straight pull – anchorage obtained from back of the head. The line of traction is parallel to occlusal plane. •Parietal / High pull – Anchorage obtained from upper part of the head and always above the center of resistance of tooth. •Combi pull – The line of traction is between high pull and straight pull. Another variable in the headgear is the outer bowof the facebow:The outer bow can belong, medium or short. www.indiandentalacademy.com
  25. 25. FORCE AND DURATION OF WEAR :•Most of the authors agree that the amount of forceapplied to maxilla by the headgear should be between400 – 800 gm (Graber, King, Blucher, Moore, Rickets,Wieslander, Sodensky, Ringberg, Borton, Pfieffer andGroberty ).•Light continuous forces seem to produce more dentalchanges than skeletal . Whereas heavy force andintermittent wear is found to produce more skeletalchange.•According to Marcotte force values of 200 gms per sidein mixed dentition and 500 gms per side in permanentdentition for 18-20 hrs / day suggested.•Graber advocates force application of more than 400 www.indiandentalacademy.comgms for 10-12 hrs / day.
  26. 26. FACE MASK:• It is an extra oral anchorage source.• It derives anchorage from facial bones.• Sites of anchorage: 1. From skull 2. From chin 3. From skull & chin• Force applied: approx. 1 pound (450 gms) per side. www.indiandentalacademy.com
  27. 27. TRANSPALATAL ARCH•Transpalatal arch is a secondary method of anchorage support inupper posterior segment.It is made by 0.045” or 0.051” stainless steel round wirewhen it is soldered to the molar bands with loop placedin the middle of palate so that wire is placed 2 mm fromthe roof of palate.•If the TPA is placed 6-8 mm down from palate it caninduce molar intrusion due to tongue pressure. It can beused to expand maxillary molar width as well as stabilizeagainst occipital pull head gear. After cross bitecorrection, it will maintain molar position againstundesirable sidewww.indiandentalacademy.com used in the effects of utility archesmaxillary arch.
  28. 28. NANCE AND LINGUAL HOLDING ARCHES•The Nance holding arch extends from maxillary molarsto anterior portions of the palatal vault. It is a fixedappliance. An acrylic button, but half inch or less indiameter, is attached to the palate. This button mustcreate light seal with the palate to prevent the creation offood trap.•It is important to position the acrylic button against thevertical component of the palatal vault.•The stabilizing lingual arch for the lower lie behind andbelow the lower incisors, so that it doesnt interfere withtheir retraction. The lower lingual arch is conveniently www.indiandentalacademy.cominserted from distal than from the mesial of molar tube.
  29. 29. LIP BUMPER•Lip bumper has been used for molaranchorage, prevention of poor lip habitsand creation of increased space formandibular arch.The appliance hasstainless steel wire of 0.045” that spansthe facial surface of mandibular archwithout contacting teeth and is insertedinto tubes attached to the mandibularmolars. Anteriorly the wire is coveredwith plastic tubing or a shield made ofacrylic that holds the lower lip away fromthe mandibular incisors. Forces frommentalis muscle are transmitted to www.indiandentalacademy.commandibular molars, enabling them tomove to an upright and distal position.
  30. 30. BAKER’S ANCHORAGE:•It is a type of intermaxillary anchorage.•Class II traction applied between the lowermolars and upper anteriors as well as Class IIItraction applied between upper molars and loweranteriors are referred to as BAKER’SANCHORAGE. www.indiandentalacademy.com
  31. 31. ANCHORAGE PLANNING:• It is of utmost importance in the success of orthodontic treatment. Therefore it is very much essential to carefully assess the anchorage demands of the individual case and select the most appropriate treatment plan.It depends on the following factors:1. NUMBER OF TEETH TO BE MOVED:2. TYPE OF TEETH BEING MOVED3. TYPE OF TOOTH MOVEMENT www.indiandentalacademy.com4. DURATION OF THE TREATMENT
  32. 32. CONCLUSION As orthodontic treatment continues to change andimprove, innovative techniques may find acceptance incertain types of cases. Magnetic forces or electricstimulation may possibly show the path to an improvedmechanotherapy. But by and large, the basic concept ofarch wires placed in brackets to move teeth will remainthe most efficient method. Fundamental principles of anchorage laid down byTweed have remained unchanged and will continue toremain so. The list of adjuncts available may increase.The objective in selection of treatment mechanics is tohave a bag a tricks’ that is large enough to treat most ofthe conditions, but not so large as to be unmanageable www.indiandentalacademy.comto incorporate into one’s practice routine.
  33. 33. www.indiandentalacademy.com
  34. 34. www.indiandentalacademy.com

×