Micro screw implant anchorage j c

Journal clubJournal club
World journal of orthodonticsWorld journal of orthodontics
Volume 6,number3,2005Volume 6,number3,2005
www.indiandentalacademy.com

• Microscrew implant anchorageMicroscrew implant anchorage
sliding mecahnicssliding mecahnics
• By Hyo-Sang ParkBy Hyo-Sang Park
• Oh-Won KwonOh-Won Kwon
• Jae-Hyun SungJae-Hyun Sung

IntroductionIntroduction
• The en mass retraction of incisors teethThe en mass retraction of incisors teeth
along with the anchorage control is asalong with the anchorage control is as
one of the important factors forone of the important factors for
successful treatment.successful treatment.
• With the use of skeletal anchorage inWith the use of skeletal anchorage in
orthodontic treatment ,such as dentalorthodontic treatment ,such as dental
implants ,mini implants and mini-orimplants ,mini implants and mini-or
micro implants orthodontist couldmicro implants orthodontist could
expect absolute anchorage for toothexpect absolute anchorage for tooth
movementmovement

Aim of the studyAim of the study
• The utilization of skeletal anchorage inThe utilization of skeletal anchorage in
full –arch treatmentfull –arch treatment
• To test the efficacy of the micro screwTo test the efficacy of the micro screw
implant anchorage (MIA) slidingimplant anchorage (MIA) sliding
mechanics in the bialvelaor protrusionmechanics in the bialvelaor protrusion
treatmenttreatment

Study designStudy design
• A female patient ,22 years of age hadA female patient ,22 years of age had
a lip protrusion .a lip protrusion .
• Intraorally ,class 1 canine and molarIntraorally ,class 1 canine and molar
relationships were evident ,and the overrelationships were evident ,and the over
jet were normal. The patient had a 2jet were normal. The patient had a 2
mm deficiency in the arch length in bothmm deficiency in the arch length in both
arches and 2 mm curve of spee.arches and 2 mm curve of spee.

• The treatment plan called for theThe treatment plan called for the
extraction of the first four premolars andextraction of the first four premolars and
maximum retraction of the maxillarymaximum retraction of the maxillary
anterior teeth with the aid of maxillaryanterior teeth with the aid of maxillary
implants as anchorage .implants as anchorage .
• The mandibular micro screw implantsThe mandibular micro screw implants
were planned for vertical control of thewere planned for vertical control of the
mandibular posterior teeth .mandibular posterior teeth .

Cepahalometric readingsCepahalometric readings

InterventionIntervention
• Absco anchor AX12-108,dentosAbsco anchor AX12-108,dentos
Daegu ,korea is used in the maxillaryDaegu ,korea is used in the maxillary
arch.arch.
• Absco anchor AN12-204,dentos DaeguAbsco anchor AN12-204,dentos Daegu
,korea is used in the mandibular arch.,korea is used in the mandibular arch.

Implant placementImplant placement
• There is barely enough space between theThere is barely enough space between the
maxillary second premolars and the firstmaxillary second premolars and the first
molars for the micro screw placemnetso,molars for the micro screw placemnetso,
implants should be placed at an angle theimplants should be placed at an angle the
bone of 30 -40 degree to the bone surface inbone of 30 -40 degree to the bone surface in
the maxillary arch and 10 -20 degrees in thethe maxillary arch and 10 -20 degrees in the
mandibular archmandibular arch

• Andreasen and kristerson stated thatAndreasen and kristerson stated that
less than 4 mm of periodontal damageless than 4 mm of periodontal damage
can be recovered with out analysis .can be recovered with out analysis .
The root damage which might beThe root damage which might be
caused from contact of micro screwcaused from contact of micro screw
implant to the root would be less than 1implant to the root would be less than 1
mm because of small diameter (1.2)mm because of small diameter (1.2)
mm of the micro screw.mm of the micro screw.

Maxillary archMaxillary arch

• Partial caninePartial canine
retractionretraction

• En massEn mass
retraction of 6retraction of 6
teeth usingteeth using
0.016x0.0220.016x0.022
arch wire .150arch wire .150
g of force ong of force on
each sideeach side

Mandibular archMandibular arch
• Microscrew implant isMicroscrew implant is
placed abetween theplaced abetween the
first and secondfirst and second
molars .molars .

• Partial caninePartial canine
retractionretraction
• En mass retractionEn mass retraction
of the 6 anteriorof the 6 anterior
teeth usingteeth using
0.019X0.0250.019X0.025

• Application of anApplication of an
intrusion force tointrusion force to
upright and intrudeupright and intrude
the mandibularthe mandibular
molars by ligatingmolars by ligating
an elastic threadan elastic thread
from microscrewfrom microscrew
implant to theimplant to the
mandibular archmandibular arch
wirewire

ResultsResults
• The treatment was completed after 18The treatment was completed after 18
months .TShe patient had a wellmonths .TShe patient had a well
balanced face and a good dental interbalanced face and a good dental inter
digitations with class 1 canine anddigitations with class 1 canine and
molar relationships.molar relationships.

• The maxillary anteriors were retractedThe maxillary anteriors were retracted
with a 6 mm distal movement and a 2mwith a 6 mm distal movement and a 2m
m intrusion. The posterior werem intrusion. The posterior were
retracted by 2.5 mm distally.retracted by 2.5 mm distally.
• The mandibular posterior teethThe mandibular posterior teeth
maintained their vertical position andmaintained their vertical position and
showed mesial root movement andshowed mesial root movement and
anterior teeth were uprightanterior teeth were upright

• The facial profile was improved withThe facial profile was improved with
retraction in the upper lip (1.8mm)andretraction in the upper lip (1.8mm)and
lower lips by (5 mm)lower lips by (5 mm)

DiscussionDiscussion
• The methods controlling the mode ofThe methods controlling the mode of
the anterior tooth retraction arethe anterior tooth retraction are
• The occlusogingival position of microThe occlusogingival position of micro
screw implantscrew implant
• The height of anterior hooksThe height of anterior hooks
• And amount of torqueing curve given onAnd amount of torqueing curve given on
the arch wirethe arch wire

• The upward and backward retractionThe upward and backward retraction
force passes near the center offorce passes near the center of
resistance of anterior teeth with aresistance of anterior teeth with a
torquing curve in the arch wiretorquing curve in the arch wire

• The micro implants should be placesThe micro implants should be places
approximately 4 mm gingival to arch inapproximately 4 mm gingival to arch in
non extraction cases and 8- 10 gingivalnon extraction cases and 8- 10 gingival
in extraction cases.in extraction cases.
• The closer the implant to arch wire theThe closer the implant to arch wire the
greater will be the lingual tipping ofgreater will be the lingual tipping of
anterior teeth .anterior teeth .

• Moving the canines distally prior to theMoving the canines distally prior to the
anterior tooth retraction generates aanterior tooth retraction generates a
clock wise moment and induces lingualclock wise moment and induces lingual
tipping of the four teethtipping of the four teeth

• The intrusive force on the mandibularThe intrusive force on the mandibular
posterior teeth creates a counterposterior teeth creates a counter
clockwise momentclockwise moment

• The anterior movement of theThe anterior movement of the
mandibular molars ,while maintainingmandibular molars ,while maintaining
their upright position can close thetheir upright position can close the
mandibular planemandibular plane

• The micro screw implant can reduce the needThe micro screw implant can reduce the need
for inter maxillary elastics as well as extra oralfor inter maxillary elastics as well as extra oral
appliance .appliance .
• In addition this technique is less dependentIn addition this technique is less dependent
up on patient co operation .up on patient co operation .
• The class II elastics cause lingual tipping andThe class II elastics cause lingual tipping and
extrusion of the maxillary anterior teeth andextrusion of the maxillary anterior teeth and
extrusion and mesial tipping of mandibularextrusion and mesial tipping of mandibular
posterior teeth .posterior teeth .
• Which lead to opening of the mandibularWhich lead to opening of the mandibular
plane angleplane angle

ConclusionConclusion
• Micro screw implants provideMicro screw implants provide
anchorage for the retraction of 6anchorage for the retraction of 6
anterior teeth with out anchorage loss.anterior teeth with out anchorage loss.
• The combination of micro screwThe combination of micro screw
implants with sliding mechanics bringsimplants with sliding mechanics brings
many advantages ,such as reducedmany advantages ,such as reduced
treatment time ,early profile changestreatment time ,early profile changes
,simplified treatment mechanics and the,simplified treatment mechanics and the
elimination of inter arch mechanicselimination of inter arch mechanics

Micro screw implant anchorage j c

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Micro screw implant anchorage j c