Implants 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 ,or call

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

  1. 1.
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. TEMPORARY ANCHORAGE DEVICES Biocompatible Osseo integration Biological Osseo integration – ankylosed teeth Mechanical retention Dental implant Palatal implant Fixation screws Mini screw Fixation wire Mechanical - Dilacerated teeth
  4. 4.  The Aarhus Anchorage System  IMTEC Mini Ortho Implants  The Spider Screw Anchorage System  Biomechanical considerations  conclusion
  5. 5.   Adult patients have sought orthodontic treatment, often referred by periodontists, restorative dentists, or prosthodontists. The long clinical crowns seen in these patients are the result of super eruption in addition to marginal bone loss, resulting in bite deepening.
  6. 6.   The bone quality in the infrazygomatic crest is generally good and proves sufficient anchorage for the maintenance of a ligature wire during loading. MELSEN and colleagues described the insertion of a surgical wire through the infrazygomatic arch.
  7. 7.   A transmucosal incision, approximately 1 cm long, was made along the superior aspect of the infrazygomatic crest. A horizontal bony canal was drilled through the zygomatic process approximately 1 cm lateral to the alveolar process.
  8. 8.
  9. 9.    A double twisted 0.012-inch stainless steel wire was inserted through the canal. To protect the soft tissues, the twisted part of the wire was covered with a polyethylene tube. Once the incision was closed, the surgical wire was bent and adapted so that the ideal point of force application could be established.
  10. 10.   The replacement of the ligature with a screw seemed a logical progression since it offered better stability and made the surgical placement simpler. COSTA and colleagues described a miniscrew with a head that imitated a bracket.
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  12. 12.   The Aarhus anchorage system is available in either 1.5 or 2mm diameters. To evaluate the load transfer from the miniscrew to the surrounding bone— two different three dimensional finite element models (FEM) were developed.
  13. 13.   The stress levels were higher in the cortical bone than in the underlying trabecular bone. The thickness of the cortical bone determines the overall load transfer and that the density of trabecular bone plays only a minor role.
  14. 14.   Areas suitable for insertion were established by analyzing a series of dry skulls. The areas recommended in the maxilla are the infrazygomatic crest, the alveolar process, the palate, the infranasal spine, and the retromolar area.
  15. 15.  The areas recommended in the mandible are the retromolar area, the alveolar process, and the symphysis.
  16. 16.  A periapical radiograph taken with an acrylic or putty based template serves as a guideline for establishing the exact height and orientation of the miniscrew.
  17. 17. Surgical Placement Procedure
  18. 18.  In the case of thick cortical bone, a 2-3mm incision is made and a pilot hole prepared with a drill 0.3 mm smaller in diameter than the miniscrew. The miniscrew is then manually inserted with a custom screwdriver.
  19. 19. Complications–  Complications related to the use of miniscrews are rare and can be classified into three groups:  Complications During Insertion  Complications During the Loading Period  Complications at Removal
  20. 20. Complications During Insertion:   Initial lack of stability due to inadequate thickness of the cortical bone. Miniscrew insertion in the periodontal ligament or tooth root.
  21. 21. Complications During the Loading Period:   The miniscrew may become loose. The loosening may be caused by either local inflammation or local bone remodeling. Hypertrophy of the mucosa adjacent to a miniscrew may develop.
  22. 22. Complications at Removal:    The miniscrew cannot be removed. If this does occur, then the miniscrew can be removed with a trephine. The miniscrew could fracture on removal.
  23. 23.   The Ortho Implant was recently developed from IMTECs established, Food and Drug Administration (FDA)-approved mini implant system (Sendax Mini Dental Implant). The implant was modified at the head to provide orthodontic force systems the benefit of a hole to which an appliance may be attached.
  24. 24.
  25. 25.   The implants are available in 6, 8, and 10mm lengths. The implant is made from a titanium alloy (Ti-6Al-4V) that research has shown to be 2.5 times stronger than commercially pure titanium.
  26. 26.    Indicated for correction of open/deep bite (intrusion of over erupted teeth). Intrusive molar uprighting Mesiodistal translation along the arch without taxing the anchorage of remaining teeth.
  27. 27.   This mechanotherapy is especially useful in patients with high mandibular plane angles or patients with a clockwise rotational growth tendency. Mini implant anchorage is an asset in the treatment planning of maximum anchorage retraction cases.
  28. 28. Surgical Procedure   Identification of the exact location. When an intra or interradicular application is desired a brass wire separator can be used as a guide.
  29. 29.   The wire is placed between the adjacent teeth. The brass wire is twisted, directed gingivally, and cut so that it terminates at the prescribed placement location. A periapical radiograph is then exposed to verify that the prescribed placement will not interfere with the roots of the teeth.
  30. 30. Ortho Implant placement procedure without flap reflection. (A) Soft tissue punch. (B) Pilot drill. (C) Ortho Implant placement with straight driver.
  31. 31. Surgical Ortho Implant placement with flap reflection. (A) Incision. (B) Pilot drill. (C) Ortho Implant placement with straight driver. (D) Ortho Implant in place.
  32. 32. Orthodontic Mechanics:  When an Ortho Implant is used to address vertical elements of a malocclusion, it should be placed as deep in the vestibule as is reasonably attainable.  For typical anterior openbite closure or molar intrusion, the implants are commonly placed laterally in the alveolus between the 1st and 2nd molar
  33. 33.   The implant can be angled at 10° to 20° to the long axis of the tooth, such angulation permits the deeper vestibular placement of the implant. In a maximum anchorage case, the Implant can be placed laterally in the alveolar ridge mesial to the 1st molar.
  34. 34. Removal Procedure:
  35. 35.    Complications predominately lie in the potential for iatrogenic placement and poor soft tissue response. Soft tissue has the potential to grow over an exposed implant head—placement of healing cap. Placing the implant into an adjacent tooth root.
  36. 36.
  37. 37.   The Spider Screw (HDC Company, Sarcedo, Italy) is used as a noncooperation based anchorage system. It is a self-tapping, commercially pure titanium miniscrew.
  38. 38.   Used in clinical situations involving mutilated dentitions, poor cooperation, or extraction cases requiring maximum anchorage. This system is available in either 1.5 or 2mm diameters. The 1.5mm diameter screw comes in 6, 8, or10mm lengths, while the 2mm diameter screw comes in 7, 9, or 11mm lengths.
  39. 39.  Available in three different transmucosal designs to accommodate the soft tissues
  41. 41. Sites of choice include the :       Maxillary tuberosity The mandibular retromolar area Edentulous areas Interdental sites The palatal vault and The alveolar processes above the root apices in the anterior region.
  42. 42. Surgical Procedure:  The surgical armamentarium includes a low speed contra angle hand piece, a bur with a depth stop, and a hand screwdriver.  A site locator can be fabricated from resin and orthodontic wire and utilized to determine the insertion position of the screw in the bone.
  43. 43.  Long cone radiographs are taken to visualize the site locator relative to the delicate anatomical structures.
  44. 44.
  45. 45. Orthodontic Mechanics:   Miniscrew anchorage can be direct or indirect. There is a tendency for buccal inclination of the clinical crowns as intrusion is attempted. Control can be achieved by torquing archwires or with transpalatal bars.
  46. 46. Torque possibilities with Spider Screw. (A) Buccal tipping during intrusion. (B) Pure intrusion using buccal and lingual screws.
  47. 47. Complications:  Inflammation of the peri-implant tissues, especially in areas of frenum tissue or muscle tissue.  These problems can be controlled with proper oral hygiene and topical application of a 0.2% chlorhexidine rinse.
  48. 48. Factors influencing the stability of the titanium screw:    Screw diameter The second is peri-implant soft tissue inflammation The third is bone quality. MIYAKAWA S, et al: AJO DO124:373-378, 2003
  49. 49.   The use of miniscrews for anchorage reinforcement produces somewhat different mechanics. The force used during retraction is not reciprocal, either the entire arch or the anterior segment will rotate around the center of rotation.
  50. 50.
  51. 51.   In cases of severe protrusion, where absolute anchorage is required in both arches, these mechanics can produce posterior open bite and deep overbite. The use of precurved archwires will result in an even stronger intrusive force on the posterior segment.
  52. 52.   One approach is to lengthen the archwire hook and raise the miniscrew insertion point to redirect the vector of retraction force, so that it passes through the center of resistance of the anterior segment. This is located between the lateral incisor and canine roots, 6.76mm above the cervical area, or at the level of the root tip.
  53. 53.
  54. 54.   MELSEN and colleagues recommended that the archwire hook extend 10mm from the main archwire, but anatomical limitations usually make this impractical. Elastomeric chain or coil springs positioned above the bracket level may impinge on the soft tissue because of archwire curvature.
  55. 55.   It is difficult to place the miniscrew high enough. Insertion in the mobile mucosa increases the risk of inflammation around the miniscrew and may lead to failure
  56. 56.  Light ‘L’ inter-maxillary elastics, worn only at night, can prevent posterior open bite
  57. 57.   In patients with gummy smiles or other factors favoring intrusion of an entire arch, more vertical retraction forces can be used to prevent occlusal plane rotation. Occlusally directed archwire hooks should be placed posterior to the canines.
  58. 58.
  59. 59.  Occlusal plane rotation due to forces of occlusion can be prevented by bonding anterior biteplanes to the lingual surfaces of the anterior teeth at the beginning of retraction.
  60. 60.
  61. 61.  In a patient with a gummy smile or over erupted upper incisors, additional miniscrews can be placed in the upper anterior region to produce a vector of force that counteracts occlusal plane rotation and preserves anterior torque.
  62. 62.   Mini-implant TADs are an excellent adjunct to provide stable, bone based anchorage for the application of orthodontic biomechanical force systems. Many different orthodontic mechanics can incorporate the stable Implant as anchorage in treating a given malocclusion.
  63. 63.   In many cases, the successful outcome of the treatment depends on treatment planning. In any mechanics, anchorage should be planned and taken care of from the first day of treatment.
  64. 64.    Applications of Orthodontic Mini-Implants— Jong Suk Lee, Jung Kim, Chel Park & Vanarsdall Temporary Anchorage Devices in Orthodontics: A Paradigm Shift-Jason B. Cope Intraoral Hard and Soft Tissue Depths for Temporary Anchorage Devices- Antonio Costa, Giulio Pasta, And Giovanni Bergamaschi
  65. 65.    Miniscrew Implants: The Aarhus Anchorage System-Birte Melsen and Carlalberta Verna Miniscrew Implants: IMTEC Mini Ortho Implants-Robert Herman and Jason B. Cope Miniscrew Implants: The Spider Screw Anchorage System-B. Giuliano Maino, Paola Mura, and John Bednar [SEMINARS IN ORTHODONTICS]
  66. 66.  MIYAKAWA S, et al: Factors associated with the stability of titanium screws placed in the posterior region for orthodontic anchorage. AJO DO124:373-378, 2003  Biomechanical considerations in treatment with miniscrew anchorageMIN-HO JUNG, TAE-WOO KIM JCO FEB. 2008
  67. 67. Leader in continuing dental education