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Implants in orthodontic treatment

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SEMINAR ON
ORTHODONTIC IMPLANTS
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Implants in orthodontic treatment

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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.for more details please visit
www.indiandentalacademy.com

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.for more details please visit
www.indiandentalacademy.com

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Implants in orthodontic treatment

  1. 1. SEMINAR ON ORTHODONTIC IMPLANTS www.indiandentalacademy.com
  2. 2. CONTENTS  INTRODUCTION  IMPLANT  DIAGNOSIS  OPTIMAL POSITIONING AND PLACEMENT OF IMPLANT  LOADING OF IMPLANTS  FAILURE OF IMPLANTS  CLINICAL APPLICATIONS OF IMPLANTS  SUMMARY AND CONCLUSION  BIBLIOGRAPHY www.indiandentalacademy.com
  3. 3. INTRODUCTIO N www.indiandentalacademy.com
  4. 4. INTRODUCTION • During active treatment, orthodontic anchorage aims to limit the extent of detrimental, unwanted tooth movement. • Tooth borne anchorage is one of the greatest limitations of modern orthodontic treatment. • While extraoral anchorage can be used to supplement tooth borne anchorage and to deliver forces in directions not possible with intraoral forces, extraoral anchorage has severe limitations because it requires excellent patient cooperation. • The advent of osseointegrated implants, due to the pioneering studies of Prof. Branemark has changed this scenario. • The ability of implants to remain stable under occlusal loading has led orthodontists to use them as anchorage units without patient compliance.www.indiandentalacademy.com
  5. 5. IMPLANT  WHAT IS A IMPLANT?  PARTS OF IMPLANT. DIFFERENT HEAD TYPES OF IMPLANT  INDICATIONS AND CONTRAINDICATIONS OF IMPLANTS  ADVANTAGES AND DISADVANTAGES OF IMPLANTS  IMPLANT CRITERIA IMPLANT MATERIAL IMPLANT SIZE IMPLANT SHAPE  HISTORICAL PERSPECTIVE OF IMPLANTS  RECENT ORTHODONTIC IMPLANTS www.indiandentalacademy.com
  6. 6. IMPLANT A graft or insert set firmly or deeply into or onto the alveolar process that may be prepared for its insertion. www.indiandentalacademy.com
  7. 7. DENTAL IMPLANT • A device specially designed to be placed surgically within or on the mandibular or maxillary bone as a means of providing resistance to displacement of a dental prosthesis.  It can be either:  Transgingival (with part of the implant emerging from gingival for direct abutment)  Fully embedded under the gingival (only aiming at the support of a removal prosthesis). www.indiandentalacademy.com
  8. 8. PARTS OF IMPLANT  The commonly used implant screw has 2 parts:  IMPLANT HEAD  It serves as the abutment and in the case of an orthodontic implant, could be the source of attachment for elastics/ coil springs.  IMPLANT BODY  Which is the part embedded inside bone. This may be screw type or a plate type. www.indiandentalacademy.com
  9. 9. IMPLANT HEAD TYPES www.indiandentalacademy.com
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  13. 13. CLASSIFICATION OF IMPLANTS www.indiandentalacademy.com
  14. 14. BASED ON THE LOCATION SUBPERIOSTEAL IMPLANTS • Are implants, which typically lie on top of the jawbone, but underneath the gum tissues. • They usually do not penetrate into the jawbone. • These implants are not anchored inside the bone, but are instead shaped to ride on the residual bony ridge of either the upper or lower jaw. • They are not considered to be osseointegrated implants. INDICATIONS • Used in completely edentulous and partially edentulous upper and lower jaws. • The subperiosteal design used for orthodontic purposes is the “onplant”. www.indiandentalacademy.com
  15. 15. BASED ON THE LOCATION TRANSOSSEOUS IMPLANTS • These implants actually penetrate the entire jaw so that they actually emerge opposite the entry site, usually at the bottom of the chin. • They are not widely used because of the possible damage to the intrabony soft tissue structures like the nerves and vessels as major surgical invasion is involved in this technique. • In the field of orthodontics, these implants have not been used. www.indiandentalacademy.com
  16. 16. BASED ON THE LOCATION ENDOSSEOUS IMPLANTS • These implants are placed directly into the jaw bone. • These are partially submerged and anchored within the bone. • These are most commonly employed types of implants for orthodontic purposes. www.indiandentalacademy.com
  17. 17. BASED ON THE CONFIGURATION DESIGN ROOT FORM IMPLANTS • Basic characteristics of this variety of implant are:  Mimics the basic shape of the natural root.  Available in a variety of lengths, widths and designs. INCLUDING :  cylinders (also referred to as “press fit”)  screws (also referred to as “threaded”)  combination of the two. • May be used in any area of the mouth • May replace one or more teeth. www.indiandentalacademy.com
  18. 18. BASED ON THE CONFIGURATION DESIGN BLADE IMPLANTS • Their name is derived from their flat, blade like ( or plate like ) portion, which is the part that gets embedded into the bone. • Available as submergible, two stage and single stage, one piece or two piece devices, and they can be prefabricated or custom made. Basic characteristics:  Shape is wide, flat and comes in various heights and lengths.  Popular for narrow bone that has sufficient height.  May replace one or several teeth.www.indiandentalacademy.com
  19. 19. ACCORDING TO SURFACE STRUCTURE: • Threaded or non-threaded • Porous or non porous DEPENDING ON THEIR REACTION WITH BONE: • Ability of the implant to stimulate bone formation  Bioactive (hydroxyapatite)  Bioinert (Metals) www.indiandentalacademy.com
  20. 20. ACCORDING TO IMPLANT BIOMATERIALS 1. Metals and alloys: • Commercially pure titanium • Ti- Al-Vanadium alloy • Iron Ni-Cr (316L Stainless Steel) 2. Ceramics: • Hydroxyapatite • Alumina and sapphire • Calcium aluminates • Tricalcium phosphates 3. Carbons: • Polycrystalline ( vitreous ) glassy carbon • Carbon silicon 4. Polymers: • Silicone rubber • Polymethylmethacrylate • Polysulfone • Polyethylene • Polytetra fluoroethylene www.indiandentalacademy.com
  21. 21. BASED ON IMPLANT MORPHOLOGY 1. IMPLANT DISC • Onplant 2. SCREW DESIGNS • Mini implant • Aarhus implant • Micro implant • Spider screw • Imtec screw 3. PLATE DESIGNS • Skeletal anchorage system (SAS) • Zygoma anchorage system www.indiandentalacademy.com
  22. 22. • INDICATIONS OF IMPLANTS • CONTRAINDICATIONS OF IMPLANTS • ADVANTAGES OF IMPLANTS • DISADVANTAGES OF IMPLANTS www.indiandentalacademy.com
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  24. 24. DISADVANTAGES OF IMPLANTS 1. Expensive – patient affordability is the primary concern in the use of implants. 2. Cannot be used in medically compromised patients who cannot undergo surgery. 3. It requires of patient co-operation because repeated recall visits for after care is essential. 4. It cannot be universally placed due to the presence of anatomical limitations. 5. Application of implants might be limited by the amount and quality of bone. www.indiandentalacademy.com
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  26. 26. IDEALLY AN IMPLANT USED TO ENHANCE ORTHODONTIC ANCHORAGE SHOULD BE: 1. Small 2. Inexpensive, affordable 3. Biocompatible 4. Easy to place 5. Easily inserted or removed under local anaesthesia 6. Be small enough to locate in multiple sites in the mouth 7. Osseo-integrated in a few days 8. Would be stable to orthodontic loading in all planes of space 9. Routinely resistant to orthodontic forces 10. Able to be immediately loaded 11. Usable with familiar orthodontic mechanics www.indiandentalacademy.com
  27. 27. IMPLANT CRITERIA www.indiandentalacademy.com
  28. 28. IMPLANT MATERIAL PROPERTIES OF IDEAL MATERIAL: 1. Non toxic 2. Biocompatible 3. Posses excellent mechanical properties 4. Provide resistance to stress, strain and corrosion COMMONLY USED MATERIALS CAN BE DIVIDED INTO 3 CATEGORIES: 1. Biotolerant ( stainless steel, chromium cobalt alloy) 2. Bioinert ( titanium, carbon) 3. Bioactive ( hydroxylapatite, ceramic oxidized aluminium) TITANIUM AND ITS ALLOY  Because of titanium’s characteristics: 1. no allergic and immunological reactions 2. no neoplasm formation 3. Osseointegration 4. High corrosion resistance  It is considered an ideal material and is widely used.  Bone grows along the titanium oxide surface, which is formed after contact with air or tissue fluid.  Pure titanium has less fatigue strength than titanium alloys.  A titanium alloy, titanium-6-aluminium-4-vanadium is used to overcome this disadvantage. www.indiandentalacademy.com
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  30. 30. IMPLANT SIZE • Implant fixtures must achieve primary stability and withstand mechanical forces. • The maxillary load is proportional to the total bone implant contact surface. • Factors that determine the contact area are length, diameter, shape and surface design ( rough Vs smooth surface, thread configuration) • The ideal fixture size for orthodontic anchorage remains to be determined. • Various sizes of implants from mini-implants ( 6mm long, 1.2mm in diameter) to standard dental implants (6-15mm long, 3-5mm in dia) are available. • The dimension of implants should be congruent with the bone available at the surgical site and the treatment plan. www.indiandentalacademy.com
  31. 31. IMPLANT SHAPE • The design must limit surgical trauma and allow good primary stability. • It is difficult to identify the “perfect” implant shape. • The most commonly used is cylindrical or cylindrical – conical, with a smooth or threaded surface. • The degree of surface roughness is related to the degree of osseointegration. • The main area of dispute focuses on how an implant gains its support from the surrounding bone. • A screw thread around the implant surface aids loading of surrounding bone in compression. • A smooth cylindrical design increases implant support when shear forces are exerted on the bone. • Both these varieties show a more uniform stress distribution underling loading when compared to other designs. www.indiandentalacademy.com
  32. 32. HISTORICAL PERSPECTIVE • BRANEMARK IMPLANTS • OSSEOINTEGRATION • CREEKMORE IMPLANT SCREWS (1983) • ROBERTS ENDOSSEOUS IMPLANTS (1995) • SUBPERIOSTEAL IMPLANT (ONPLANT) www.indiandentalacademy.com
  33. 33. BRANEMARK IMPLANTS • In 1952, Professor Branemark, Swedish surgeon accidentally discovered that titanium can directly Osseointegrate with the bone when he implanted titanium capsules to study the healing patterns of bone. • Modern implantology has evolved from 1960’s onwards. • In 1960,it was Per Ingvar Branemark, Mentor of Modern Implant Surgery, who introduced the concept of osseo-integration, which led to the widespread use of endosteal implants. • In 1964, he observed a firm anchorage of titanium to bone with no adverse response. • In 1969, Branemark demonstrated that titanium implants were stable over 5 years and osseointegration bone under light microscopic view. • He used 2 stage implants for orthodontic anchorage. • Since, then dental implants have been used to reconstruct human jaws or as abutments for dental prosthesis. • Towards the end of 1980’s a number of clinicians focused on the use of standard dental implants as temporary anchorage for orthodontic tooth movement and then as permanent tooth abutments for tooth replacement. www.indiandentalacademy.com
  34. 34. BRANEMARKS THEORY OF OSSEOINTEGRATION • P.I.Branemark (1982) proposed that implants integrate with bone such that the bone is laid very close to the implant material without an intervening connective tissue. “OSSEOINTEGRATION” can be defined as: • The process and resultant apparent direct connection of the endogenous material surface and the host bone tissues without intervening connective tissue. • Implant should not be loaded must be and left out of function during the healing period for osseous integration to occur. • Osseointegration is a clinically asymptomatic rigid fixation of the implant within bone, during functional loading. • This means that there is stable anchorage of the implant with bone covering its entire surface without an intervening connective tissue. • So, the interface between the tissue and the implant is a strong one, which can withstand occlusal loads. FACTORS AFFECTING OSSEOINTEGRATION: • Occlusal load • Biocompatibility of the material • Implant design • Implant surface • Implant bed ( surgical site) • Surgical technique • Infection www.indiandentalacademy.com
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  36. 36. ADVANTAGES 1. They make it possible to move multiple teeth without loss of anchorage. 2. They can be placed in areas where natural anchorage or conventional orthodontic appliances are impractical, including edentulous spaces in the alveolus of either arch, the palate, zygomatic process, retromolar regions and the ramus. DISADVANTAGES 1. Need for long healing period of 4-6 months, which adds significantly to the treatment time. 2. The bone height required for traditional endosseous implants may also restrict the locations available for implant placement. www.indiandentalacademy.com
  37. 37. CREEKMORE(1983) • He reported the possibility of skeletal anchorage in orthodontics. • He used vitallium implant screws for anchorage while intruding the upper anterior teeth. • The vitallium screw was inserted just below the anterior nasal spine. After an unloading period of 10 days, an elastic thread was tied from head of the screw to the archwire. • Within one year, 6mm intrusion was achieved. www.indiandentalacademy.com
  38. 38. ROBERTS (1994) • He used conventional two stage implant in retromolar region to help reinforce anchorage successfully closing first molar extraction site in the mandible. • After completion of the orthodontic treatment the implant were removed and histologically analyzed. • They found a high level of osseo integration has been maintained despite the orthodontic loading. DISADVANTAGES OF ENDOSSEOUS IMPLANTS: 1. Complicated appliance design. 2. Bulkiness of the implant and therefore the non-suitability of placement in the interdental areas. 3. Exceptional patient co-operation. 4. Difficulty of selecting proper implant sites in most orthodontic patients. 5. Need to wait for osseointegration before force loading. 6. Invasiveness of surgical procedure. 7. High cost. www.indiandentalacademy.com
  39. 39. SUBPERIOSTEAL IMPLANT ONPLANT ( PALATAL IMPLANTS) • This is a classic example of a subperiosteal implant in orthodontics. • In 1995, a 2 stage hydroxyapatite coated titanium subperiosteal implant ( Onplant, Nobel Biocare, Goteburg, Sweden) was developed by Block and Hoffman. THIS SYSTEM HAS SEVERAL CHARACTERISTICS: 1. Disc shaped 2. 10mm in diameter, 2mm thick 3. Coated with hydroxyapatite on the side against bone and smooth titanium facing soft tissue with a threaded hole where abutments will be placed. DRAWBACKS 1. Primary stability often cannot be achieved by mechanical retention. 2. Placement might be greatly limited by anatomical structures such as torus. 3. Clinical assessment of integration is not easy, except by cephalometry. 4. Further, long term research is needed for future applications. 5. The surgical procedure involved in placement and to uncover the integrated Onplant is complex and traumatic to the patient. www.indiandentalacademy.com
  40. 40. ONPLANT www.indiandentalacademy.com
  41. 41. RECENT ORTHODONTIC IMPLANTS  MINI IMPLANTS  AARHUS IMPLANT  LEONE ORTHODONTIC MINI IMPLANT (OMI)  LIN/LOU ORTHODONTIC MINI ANCHOR SYSTEM (LOMAS)  IMTEC MINI ORTHODONTIC IMPLANT  MICROIMPLANTS  ABSOANCHOR MICRO IMPLANTS (DENTOS)  C-ORTHODONTIC MICROIMPLANT  TOMAS (TEMPORARY ORTHODONTIC MICROANCHORAGE SYSTEM) (DENTAURUM)  MINISCREW ANCHORAGE SYSTEM (MAS)  RMO DUAL TOP ANCHOR MINI ORTHOSCREW SYSTEM  THE SPIDER SCREW FOR SKELETAL ANCHORAGE  MODULAR TRANSITIONAL IMPLANTS (MTI)  BIOS: BIO-RESORBABLE IMPLANT ANCHOR FOR ORTHODONTIC SYSTEMwww.indiandentalacademy.com
  42. 42. MINI IMPLANT • Introduced by Kanomi in 1997. • Conventional dental implants are 3.5- 5.5 mm in diameter and 11-21mm long. • The mini implant is only 1.2mm in diameter and 6mm long, making it much more useful in orthodontic applications. www.indiandentalacademy.com
  43. 43. DISADVANTAGES OF OSSEOINTEGRATED TITANIUM IMPLANTS: 1. Conventional dental implants can only be placed in retromolar and edentulous areas. 2. Are troublesome for patients because of the severity of the surgery, discomfort of initial healing and difficulty of oral hygiene. ADVANTAGES OF MINI IMPLANT: 1. For orthodontic anchorage should be small enough to place in any area of alveolar bone, even apical bone. 2. Surgical procedure should be easy enough for an orthodontist or general dentist to perform and minor enough for rapid healing. 3. Implant should be easily removable after orthodontic traction. 4. Smaller in size, have smooth surfaces and are designed to be loaded shortly after insertion. 5. Oral hygiene is easier to maintain with the ligature wire tied to an attached hook rather than directly to the screw head. 6. Mini implant is too small to cause irreversible damage, and can be removed any time either the orthodontist or the patient desires. 7. Bone healing after removal should be uneventful. 8. Used in variety of applications like molar intrusion, anchorage for molar distalization or in distraction osteogenesis. www.indiandentalacademy.com
  44. 44. AARHUS IMPLANT • The increasing desire for early loading of implants used for orthodontic anchorage led Melsen to develop to Aarhus implant in 1999. • Due to its small dimension ( 6mm length) this titanium anchorage screw can be located in multiple sites, including between the roots of teeth. • It allows osseo-integration to occur even in the presence of immediate orthodontic loading, providing the orthodontic forces (25-50g from sentalloy springs ) pass through the screw. • The strain that develops in the bone surrounding the loaded screw leads to a local environment in which increased bone formation results. • Due to the size of the screw it can be used in a number of different locations and can be easily removed when no longer required. www.indiandentalacademy.com
  45. 45. ORTHODONTIC MINI IMPLANT (OMI) LEONE • The diameter of the threaded portion varies from 1mm to 2mm. • Non drilling ( self tapping ) screws which require pilot holes to be drilled before they are inserted. ADVANTAGES: • Ease of insertion between the roots without the risk of root contact. DISADVANTAGES: 1. Potential for fracture, which is closely related to the diameter of screw. 2. As bone density increases, the resistance created by the stress surrounding the screw becomes more important in removal than in insertion of the screw. At removal, the stress is concentrated in the neck of the screw, which may lead to fracture. www.indiandentalacademy.com
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  47. 47. LIN/LOU ORTHODONTIC MINI ANCHOR SYSTEM (LOMAS) • These are self tapping and self drilling screws. • The apex of the screw is extremely fine and sharp, so that pilot drilling is unnecessary in most cases. • Transmucosal portion of the neck should be smooth. • Screws are available with different neck lengths for various implants sites. ADVANTAGES: 1. Easier handling 2. Immediate bearing of heavier orthodontic forces 3. More sizes are different applications than other bone screws. www.indiandentalacademy.com
  48. 48. IMTEC MINI ORTHODONTIC IMPLANT • These are apex tapered mini implant which is used to provide increased anchorage stabilization for attachment of orthodontic appliances. • These are available in lengths of 6mm, 9mm and 12mm. A tapering, conical design was preferred over a straight screw. • They are made of titanium alloy with a core diameter of 0.7mm. • It does not normally require an injection, flap or even a pilot hole. A topic a anesthetic is used to replace the typical local anesthetic, and the use of a small tissue punch removes the mucosa, thereby eliminating the need for an incision or flap. • The implants auto advancing thread design enable osseo compression to occur around the screw as it is being embedded deeper into the bone. Advantages: 1. These head designs allow for good oral hygiene and stability. 2. Can be placed quickly and efficiently with little or no discomfort to the patient. 3. Ease of insertion 4. Requires minimally invasive office procedure requires only a topical anesthetic is most cases. 5. Immediately loadable as there is no trauma to the site. Complications: 1. Breakage and damage to adjacent tooth roots. www.indiandentalacademy.com
  49. 49. MICRO IMPLANTS DISADVANTAGES OF ORTHODONTIC MINISCREWS 1. Heads of many designs of orthodontic miniscrews tend to cause gingival irritation and inflammation. 2. The design of the screw heads also made it difficult to connect coil springs and other elastomers to these ordinary bone screws. ADVANTAGES OF MICROIMPLANTS: 1. Inexpensive 2. Small in diameter (1.2mm) 3. Come in several lengths 4. Inserted in any desired location including interradicular space 5. Can be loaded immediately 6. Can withstand typical orthodontic forces of 200-300 gms for the entire length of treatment 7. Do not need osseointegration 8. Unlike restorative implants and can easily be removed by the orthodontist. www.indiandentalacademy.com
  50. 50. ABSOANCHOR MICRO IMPLANTS (DENTOS) • Developed by Hee Moon Kyung in 2003 • It is a narrow titanium microimplant, that has a button shaped head with a hole for ligatures and elastomers. • Its small diameter allows its insertion into many areas of the maxilla and mandible such as between the roots of adjacent teeth. • An orthodontic microimplant should be longer and wider than the previously available surgical screws. • This helps to compensate for the generation of larger moments by the orthodontic microimplant head. www.indiandentalacademy.com
  51. 51. ABSOANCHOR MICRO IMPLANTS (DENTOS) www.indiandentalacademy.com
  52. 52. ABSOANCHOR MICRO IMPLANTS (DENTOS) • It comes in diameters from 1.2mm to 1.6mm for different tasks and sites. • Even the smaller 1.2mm and 1.3mm microimplants can withstand as much as 450 gm of force, whereas most orthodontic applications need forces of less than 300gms. • The tapered type of microimplant offers a tighter initial fit than the cylindrical does, making the first choice for orthodontic use a 1.2mm or 1.3mm tapered microimplant. • 1.4-1.6mm microimplant can be used when there is enough space between the roots and greater force is needed. • In the mandible, the buccal surfaces and retromolar areas offer adequate thickness and quality of cortical bone for placement of 1.2-1.3mm dia. Micro implants 4-5mm in length. • The cortical surfaces of the maxillary buccal areas are thinner and less compact than those of the mandible and require longer microimplants generally 6-8 mm for a 1.2-1.3 mm diameter. • At least 6mm of the microimplant should penetrate into the bone, which usually requires a length of 10-12mm for 1.2-1.3mm diameter microimplants placed in the interdental spaces. The midline areas contain high quality cortical bone, but also osseous sutures, so that a microimplant placed in the suture area should be a litter thicker than usual. • Successful microimplantation depends on several factors: – Clinicians skill – Patients physical condition – Site selection and fit – Oral hygiene www.indiandentalacademy.com
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  56. 56. C-ORTHODONTIC MICROIMPLANT • Developed by Kyu Rhim Chung IMPLANT DESIGN:- • It is a unique titanium device that provides absolute orthodontic anchorage mainly from osseointegration. IT HAS 2 COMPONENTS: 1. A screw that measures 1.8mm in diameter and 8.5mm, 9.5mm or 10.5mm in length. The entire surface, except for the upper 2mm is sandblasted, large grit and acid etched for optimal osseointegration. 2. A head that measures 2.5mm in diameter and 5.35mm, 6.35mm or 7.35mm in height. It contains a 0.8mm diameter hole located 1mm, 2mm or 3mm from the top of the screw. • The entire C implant is virtually the same size as a conventional miniscrew. The 2 component system keeps the neck area from fracturing during implantation and removal, and the long span between the head and the screw body prevents gingival irritation during orthodontic retraction.www.indiandentalacademy.com
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  58. 58. C-ORTHODONTIC MICROIMPLANT ADVANTAGES: 1. It is based on the design of conventional osseointegrated implants but like microimplant systems, can be used in many orthodontic situations that require immediate loading. 2. The threaded design allows better mechanical retention and transfer of compressive forces. 3. It minimizes micromotion of the implant and improves initial stability, the principle requirement for immediate loading. 4. Small size, two part design, efficiency and low cost of the C implant makes it applicable in various types of cases. 5. The groove in the screw head allows the patient to easily attach intermaxillary elastics, so that the clinician can control the direction of force without using soldered extensions or hooks. 6. Can be used in patients with compromising systemic diseases such as diabetes, osteoporosis, osteopenia, hyperparathyroidism, smokers, and in patients with radiation therapy in the oral cavity. 7. They can be immediately loaded. Applied forces can range from 50-200gms depending on the quality of bone and orthodontic tooth movement desired. www.indiandentalacademy.com
  59. 59. TOMAS (TEMPORARY ORTHODONTIC MICROANCHORAGE SYSTEM) (DENTAURUM) ADVANTAGES 1. It avoids the disadvantages created by conventional pins such as labor intensive and unusual handling, poor hygiene and gingivitis. 2. After the quick and easy application of the toman pin, the head in the customary bracket design, work as a temporary anchor allowing for various orthodontic tooth alignments. www.indiandentalacademy.com
  60. 60. TOMAS PIN • The tomas pin is designed for insertion in the upper or lower jaw. • Temporary anchorage can be achieved during orthodontic treatment with the aid of intraosseous anchorage of the tomas pin ( mini screw). • The tomas pin is made from titanium grade 5. • The head of the tomas pin can be used with various orthodontic appliances, according to each indication, to achieve the required tooth movement or as a support. • It is available in two lengths, 8 and 10mm. • The head of the tomas-pin contains a 22 cross slot which has the same function as a bracket slot. • This unique cross slot enables the clinician to work with the pin head in the same manner as with a conventional bracket slot. • The collar in the epithelial region of the pin is mechanically polished in order to achieve an optimal adaptation to the gingival and to prevent irritation. • The integrated self-tapping thread construction allows the very time consuming thread cutting stage of operation to be avoided and therefore saves time. www.indiandentalacademy.com
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  62. 62. TOMAS (TEMPORARY ORTHODONTIC MICROANCHORAGE SYSTEM) (DENTAURUM) REASONS FOR PREMATURE LOOSENING OF THE TOMAS PIN 1. Poor hygiene before, during and after insertion especially when parts of the tomas pin are contaminated which are directly in contact with the tissues. 2. Drilling speed is too high during pilot drilling ( max 1500 rpm, optimal 800 rpm ) or during mechanical insertion of the tomas pin ( max. 25 rpm). 3. Torque is too high during insertion ( max. 20 Ncm) 4. Unfavorable positioning of the tomas pin ( outside the region of attached gingival, too close to the frenum). 5. Patient has tampered with or played with the head of the tomas pin due to possible habits. 6. Peri implantitis due to soft tissue irritation.www.indiandentalacademy.com
  63. 63. MINISCREW ANCHORAGE SYSTEM MINISCREW DESIGN:- • The conical screws used in the Miniscrew Anchorage System ( MAS), made of grade 5 titanium. ARE AVAILABLE IN THREE SIZES:  Type A has a diameter of 1.3mm at the top of the neck and 1.1mm at the tip  Type B is 1.5mm in diameter at the neck and 1.3mm at the tip. Both types are 11mm long  Type C, which is 9mm long, has a diameter of 1.5mm at the neck and 1.3mm at the tip. • The screw head consists of two fused spheres (the upper 2.2mm in diameter, the lower 2mm), with an internal hexagon for insertion of the placement screwdriver. • A .6mm horizontal slot a the junction of the two spheres allows for the attachment of elastics, chains, coil springs, ligature wires, or auxiliary hooks. • MAS screws can resist a force much greater than that of any orthodontic application. www.indiandentalacademy.com
  64. 64. MINISCREW ANCHORAGE SYSTEM ADVANTAGES OF MINISCREWS OVER OTHER FORMS OF ANCHORAGE INCLUDE: 1. Optimal use of traction forces, regardless of the number or positions of the teeth. 2. Applicability at any stage of development, including interceptive therapy. 3. Shorter treatment time with no need to prepare dental anchorage. 4. Independence of patient cooperation 5. Patient comfort 6. Low cost COMPLICATIONS COMMON TO ALL IMPLANTS 1. Damage to anatomic structures such as nerves, vessels, and roots 2. Loss of screw during placement or loading 3. Breakage of a screw within the bone during insertion or removal 4. Inflammation around implant sites. 5. Breakage may be more likely with screws or small diameter. THE MAS OFFERS SEVERAL ADVANTAGES: 1. Increased selection of insertion sites 2. Ease of insertion and removal 3. Ability to withstand immediate loading 4. Applicability in growing patients 5. Low cost www.indiandentalacademy.com
  65. 65. RMO DUAL TOP ANCHOR MINI ORTHOSCREW SYSTEM • Are manufactured from a high quality corrosion resistant titanium alloy ( Ti-6AL-4V). • They are available in 2 types that differ in head design. • These designs make the mini orthoscrew extremely versatile to use with all orthodontic appliance such as wires, springs, metals ligatures, elastic chain and modules. FIRST TYPE (UPPER BUTTON HEAD) • The size of the upper button is smaller than the lower head to allow easy attachment of an auxiliary device. • A collar provides gingival protection. SECOND TYPE ( LOWER HEXAGONAL HEAD) • It has a crosshead design for attachment of wires and auxillary devices. • The screws are self tapping and self drilling.www.indiandentalacademy.com
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  67. 67. RMO DUAL TOP ANCHOR MINI ORTHOSCREW SYSTEM ADVANTAGES 1. Improve treatment capabilities 2. Reduce treatment time. 3. Provide enhanced anchorage 4. Patient anatomy no longer limits treatment. 5. Gain anchorage in locations previously difficult or impossible without surgery, invasive procedures or cumbersome appliances, making treatment more comfortable and acceptable to patients. 6. The titanium biocompatible, self tapping, self drilling mini orthoscrew are simply placed and removed by the orthodontist chairside. www.indiandentalacademy.com
  68. 68. THE SPIDER SCREW FOR SKELETAL ANCHORAGE • The spider screw is a self tapping miniscrew available in three lengths – 7mm, 9mm, and 11mm in size • The screw head has an internal 0.21” X 0.25” slot, an external slot of the same dimension and an 0.25” round vertical slot. • It come in three heights to fit soft tissues of different thickness:  REGULAR with thicker head and an intermediate-length collar.  LOW PROFILE with a thinner head and a longer collar  LOW PROFILE FLAT with the same thin head and a shorter collar. • All three type are small enough to avoid soft tissue irritation, but wide enough for orthodontic loading. • The biocompatibility of titanium ensures patient tolerance, and the spider screw smooth self tapping surface permits easy removal at the completion of treatment. www.indiandentalacademy.com
  69. 69. www.indiandentalacademy.com
  70. 70. THE SPIDER SCREW FOR SKELETAL ANCHORAGE ADVANTAGES 1. Spider Screws can be used to support different types of orthodontic mechanics, especially in case with incomplete arches or limited cooperation. 2. In ease of application and small size also permit their use in patients with intact dentitions when anchorage recovery is necessary during treatment. 3. It can be easily removed with a manual a screw driver without local anesthetic. 4. Once the screw is inserted especially in sites with poor bone quality it must be loaded immediately to promote mechanical stability. Because miniscrews rely on mechanical retention rather than osseointegration for their anchorage, the orthodontic force should be perpendicular to the direction of screw placement. 5. Applied forces can range from 50gm to 200gm, depending on the quality of the bone and the orthodontic movement desired. www.indiandentalacademy.com
  71. 71. MODULAR TRANSITIONAL IMPLANTS • The MTI, 1.8mm in diameter is available is lengths of 14mm, 17mm and 21mm. • It was designed to support a temporary fixed prosthesis during the healing phase associated with placement of permanent implants, and to be removed when the permanent implants are restored. www.indiandentalacademy.com
  72. 72. MODULAR TRANSITIONAL IMPLANTS IMPLANT FAILURES • MTIs are unprotected from rotational forces and are problematic. • After causing soreness for the patient, these implants became mobile PURPOSE OF MTI • Small implants can be combined over wide edentulous spaces to serve both as orthodontic anchors and retention for temporary fixed prosthetic restorations. ADVANTAGES 1. To use implant-supported orthodontic anchorage in treatment of preprosthetic patients. 2. Small size, relatively low cost, ease of placement, ability to be loaded immediately and adaptability to routine orthodontic mechanics. www.indiandentalacademy.com
  73. 73. BIOS: BIO-RESORBABLE IMPLANT ANCHOR FOR ORTHODONTIC SYSTEM • Bioresorbable implant anchor for orthodontics system (BIOS) implant is designed to provide orthodontic anchoring functions in patients and then be resorbed without a foreign body reaction or signs of clinical inflammation. • An implant consist of biodegradable polylactide with a metal superstructure. PURPOSE • A stable positioned implant which could assume a stationary anchorage function for an adequate period but could then be readily, removed or preferably resorbed within the tissues. www.indiandentalacademy.com
  74. 74. BIOS: BIO-RESORBABLE IMPLANT ANCHOR FOR ORTHODONTIC SYSTEM • Implants made of biodegradable polylactide alpha-polyester and adapted to the respective range of indications are used as anchorage in the osseous jaw. • They should retain the required stability for a period of 9-12 months and are then degraded, with no trace of residual material and without a significant foreign-body. • The loading capacity of the bios implant was found to be adequate for clinical application in orthodontics. www.indiandentalacademy.com

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