Anchorage preparation in pae (2)

Anchorage in
Orthodontics
Anchorage in
Orthodontics
www.indiandentalacademy.com

Topics of Discussion
Anchorage.
Classifications of anchorage
Types of anchorage
Anchorage for each stage followed in
Roth
Wick Alexander
MBT
Bioprogressive therapy

Introduction
• Orthodontic tooth movement
Force
Active components???

Introduction
• Active components
Generate forces
In one direction
Equal and opposite force
Newton’s third law of motion

Introduction
• Desired tooth movement is inevitably asso with
an opposing force.
Anchorage units
Anchorage loss
Anchorage management

Definitions
Moyers :
• “ Resistance to displacement.”
• Active elements and resistance elements.
T.M. Graber :
• “The nature and degree of resistance to
displacement offered by an anatomic unit when
used for the purpose of effecting tooth
movement.”

DEFINITIONS :
Proffit :
• “Resistance to unwanted tooth
movement.”
• “Resistance to reaction forces that is
provided (usually) by other teeth, or
(sometimes) by the palate, head or neck
(via extraoral force), or implants in
bone.”

DEFINITIONS :
Nanda :
• “The amount of movement of posterior
teeth (molars, premolars) to close the
extraction space in order to achieve
selected treatment goals.”

Classification – Moyers
Anchorage
Intraoral Extra oral
Cervical
Occipital
Cranial
Facial
Intramaxillary
Intermaxillary
Simple
Stationary
Reciprocal
Single
Compound
Reinforced
Muscular

CLASSIFICATIONS:
Moyers :
• According to the manner of force
application:
1. Simple anchorage :
Resistance to tipping.
2. Stationary anchorage :
Resistance to bodily movement.

CLASSIFICATIONS:
3. Reciprocal anchorage :
Two or more teeth moving in opposite
directions and pitted against each other
by the appliance.

CLASSIFICATIONS:
Moyers :
• According to the jaws involved:
1. Intra maxillary :
Anchorage established in the same jaw.

CLASSIFICATIONS:
2. Inter maxillary :
Anchorage distributed
to both jaws.
Baker’s anchorage (1904)

CLASSIFICATIONS:
Moyers :
• According to the site of anchorage:
1. Intra oral :
Anchorage established within the
mouth.

CLASSIFICATIONS:
2. Extra oral :
Anchorage obtained outside the oral cavity.
a.) Cervical : eg. neck straps
b.) Occipital : eg. Head gears
c.) Cranial : eg. High pull headgears
d.) Facial : eg. Face masks

CLASSIFICATIONS:

CLASSIFICATIONS:
3. Muscular :
Anchorage derived from action of
muscles.
eg. Vestibular shields.

CLASSIFICATIONS:
Moyers :
• According to the number of anchorage
units :
1. Single or primary anchorage:
Anchorage involving only one tooth.
2.Compound anchorage:
Anchorage involving two or more
teeth.

CLASSIFICATIONS:
3. Reinforced anchorage:
Addition of non dental anchorage
sites.
eg. Mucosa, muscle, head, etc.

CLASSIFICATIONS:
Nanda :
• A anchorage : critical / severe
75 % or more of the extraction space is
needed for anterior retraction.
• B anchorage : moderate
Relatively symmetric space closure (50%)
C anchorage : mild / non critical
75% or more of space closure by mesial
movement of posterior teeth

Classification

Classification
• Burstone
• Group A: Postr teeth contribute less than one
quarter to total space closure
• Group B: Postr teeth contribute from one quarter
to one half to total space closure
• Group C: Postr teeth contribute more than one
half to total space closure

Dynamic anchorage: generated by applying
moments or muscular forces. Moments can be
generated through cantilever springs or base
intrusion arches and applied to the anchor teeth.
These create distal tipping forced,which help to
resist anterior displacement of anchor unit Ex : tip
back mechanics, lip bumper.
Types of anchorage

Reinforced anchorage: the
additional resistance to tooth
movement gained when several
teeth are joined together to act as
one large , multirooted tooth.
Prepared anchorage: anchorage
control accomplished by tipping the
teeth roots first, crowns second, to
offer increased resistance to the
later retraction of anterior teeth.

Mechanical aspect of anchorage
Sliding mechanics
Force is required for 2 purposes
Bone remodeling
Frictional resistance
Controlling and minimizing friction is an imp. Aspect
of anchorage controlwww.indiandentalacademy.com

• Friction ???
• Frictional force
Nature of surface at the interface (rough or smooth,
chemically reactive or passive, modified by
lubricants)
Independent of the apparent area of contact

• Real contact occurs only at a limited number of
small spots: Asperities

• Metal wire in a ceramic bracket
Stick slip phenomenonwww.indiandentalacademy.com

• 2 other factors can affect the resistance to sliding
• Interlocking of surface irregularities
• Extent of plowing
• In clinical practice friction is largely determined
by the shearing component

• Surface quality of the wires
NiTi > βTiβTi > SS Roughness
There is no correlation between surface roughness
and coefficient of friction
β Ti has greatest frictional resistanceβ Ti has greatest frictional resistance

• Surface quality of the wires
• Changes in surface chemistry due to
increased Ti content
• Cold weld effect

• Possible solution to this problem
• Among all, SS/SS couple is most effective for
sliding followed by CoCr/SS, NiTi/SS, βTi/SS
Alteration of the surface of Ti wires

• Surface quality of the brackets
• SS brackets
• Ti brackets
• Ceramic brackets
• Ceramic brackets with metal slots
• Composite brackets
• Polycarbonate plastic brackets

• Flexibility of arch wire and width of the
bracket
Force that pulls the wire into the bracketForce that pulls the wire into the bracket
Self ligating brackets- reduced friction that allowsSelf ligating brackets- reduced friction that allows
more effective sliding- better anchorage controlmore effective sliding- better anchorage control

• Magnitude of friction
Retraction springs
Closing loops

Biologic Aspect Of Anchorage
• Anchorage value
Teeth to be moved
Active components
Anchorage
Extraoral vs intraoral anchorage

Force magnitude
Physiologic force
concept
F/A
• Factors affecting anchorage value
Force magnitude

• Surface area Major determinant
Lower incisor vs molar anchorage
First principle of orthodontic anchoragewww.indiandentalacademy.com

• For a tooth or group of teeth acting as
anchorage unit, pressure within the pdl should
be kept as low as possible
Heavy forces

• Pressure Response Curve for Anchor Teeth (A)
and Teeth to be Moved (M)
• Pressure in the PDL of A is less than the
pressure in the PDL of Mwww.indiandentalacademy.com

• 2nd
factor – pressure distribution
• Single force vs force couple
Second principle of orthodontic anchoragewww.indiandentalacademy.com

• Proffit
Tipping – 50-75 g
Bodily - 100-150 g
Intrusion - 50-75 g
Extrusion - 50-75 g
Rotation - 50-75 g
Uprighting- 75- 125g

• Tooth which is free to tip has a less anchorage
value than a tooth which is restricted in tipping
by the application of a force couple

• 3rd
factor – no. of roots and root morphology
Multirooted > single rootedMultirooted > single rooted
Longer rooted > shorter rootedLonger rooted > shorter rooted
Triangular shaped root > conical or ovoid rootTriangular shaped root > conical or ovoid root
Larger surface area > smaller surface areaLarger surface area > smaller surface area

• 4th
factor – neighboring structures
• Quality of the alveolar bone
• Traumatic extraction
• 2nd
molars inclusion

• Soft tissues
• Fixed app incorporating lip bumper
• Palatal button

ANCHORAGE LOSS:
Anchor loss in all 3 planes of space :
• Sagittal plane:
- Mesial movement of molars,
- Proclination of anteriors

ANCHORAGE LOSS:
• Vertical plane:
- Extrusion of molars,
- Bite deepening due to anterior extrusion

ANCHORAGE LOSS:
• Transverse plane:
- Buccal flaring due to over expanded arch
form and unintentional lingual root torque,
- Lingual dumping of molars,

ANCHORAGE IN
REMOVABLE APPLIANCES:
Early removable appliances:
• Completely tooth borne
• Partly cast,partly wrought wire
• Bimler appliance

ANCHORAGE IN
Early removable appliances:
• Crozat appliance
- Lingual extensions
- Heavy palatal bar
- High labial base wire
- Rest on molar clasp

ANCHORAGE IN
CLASPED REMOVABLE APPLIANCES:
- Active part,
- Clasps,
- Baseplate.
• Baseplate :
- Point of attachment for the active components,
- Distribution of the reactionary forces to the
teeth and tissues.

ANCHORAGE IN
• To ensure adequate anchorage from base plates:
- Extension as far as possible, also for stability,
- Close fit to the tissues,
- Contouring along the lingual gum margins,
- Adequate bulk of acrylic.
- Eg. Schwartz expansion plate

ANCHORAGE IN
• Wire components:
- Labial bow:
Prevents proclination of incisors
Stationary anchorage.
• Intermaxillary anchorage:
- Elastics
• Headgears

ANCHORAGE IN
REMOVABLE FUNCTIONAL
APPLIANCES:
• Reactionary forces:
- Sagittal
- Vertical
- Transverse

ANCHORAGE IN
APPLIANCES:
• Tooth borne appliances:
- Sved bite plane:
stationary anchorage

ANCHORAGE IN
APPLIANCES:
• Tooth borne appliances:
Activator, bionator,
twin block

ANCHORAGE IN
REMOVABLE FUNCTIONAL APPLIANCES:
• Anchorage obtained by:
- capping of incisal margins of lower incisors
- proper fit of cusps
of teeth into the acrylic
- deciduous molars
used as anchor teeth

ANCHORAGE IN
REMOVABLE FUNCTIONAL APPLIANCES:
- edentulous areas after loss of deciduous molars
- noses in upper
and lower interdental spaces
- labial bow prevents
anterior flaring and posterior
displacement of appliance

ANCHORAGE IN
APPLIANCES:
• Tissue borne appliances:
- Vestibular screen, Frankel’s function
regulator
• Anchorage by acrylic extending into
vestibule
• Headgears

ANCHORAGE IN
APPLIANCES:
• Tissue borne appliances:
- Vestibular screen

ANCHORAGE IN FIXED
APPLIANCES:
BEGG TECHNIQUE:
• 1950s by Dr. Begg in Australia
• Use of vertical slot
• Use of light forces for tipping teeth
• Use of optimal forces, so that extra oral
forces are not required
• No anchorage preparation necessary

ANCHORAGE IN FIXED
APPLIANCES:
Storey and Smith’s experiment on differential forces:
1954
• Series of animal experiments
• Bodily applied force will slow the rate of tooth
movement through a bone compared with a
tipping force
• Optimal force concept by Storey:
“ There is an optimum range of force which
produces maximum amount of tooth movement
through bone, and with forces above or below
this range there is reduced tooth movement.”www.indiandentalacademy.com

ANCHORAGE IN FIXED
APPLIANCES:
• Experiment using cuspid retraction spring:
• Free crown tipping retraction of cuspid
and bodily movement anchorage
resistance by molar and bicuspid

ANCHORAGE IN FIXED
APPLIANCES:
• Optimal force range for moving canines
distally: 150-200 gm.
• Further increase of force reduced the
canine movement till it approached zero
• Movement of molar unit occurred with
force values of 300-500 gm.
• Therefore, use of light differential forces
in Begg technique

ANCHORAGE IN FIXED
APPLIANCES:
Differences between conventional Begg and refined
Begg:
• Use of Special grade wire in conventional Begg
as opposed to P and P+ and Supreme
• Use of lighter elastic forces in refined Begg
• Use of extraoral anchorage and other
reinforcements
• Use of lighter auxiliaries and springs ( 0.009,
0.010, 0.012 as opposed to 0.014 and 0.016)

Conventional Begg
• Differential force concept
• 1st
premolar extraction
• 8 teeth extraction
Begg was applying the principles of differential forces

Conventional Begg
• Storey and Smith (1952)
• Statistical evidence confirmed
the results of Begg’s clinical
experience
• Edgewise app and springs

Conventional Begg
• Tooth with a greater root surface area
needs greater force to be moved
canine: molar = 3:8www.indiandentalacademy.com

Conventional Begg

Conventional Begg
• Reason for different rates of movement of
canines
• Storey and Smith presented the concept of
undermining resorption
• Sandstedt (1904)
• Schwarz (1932)

Conventional Begg
Teeth subjected to very high forces
Resorption of tooth investing tissues
Teeth are loosened within the sockets

Conventional Begg
Use of differential forces
Reduction of anterior overbite
Use of anchor bends
Light wires
Heavy wires

Conventional Begg
Strang (1954) – Treatment problems, their
origin and elimination
Edgewise app
Closing extraction space requires more force
Use of head gears - recommended

Conventional Begg
Space closure
Premolars bypassed
Extra oral anchorage is not requiredwww.indiandentalacademy.com

Conventional Begg
• Means of preventing anchorage failure
Use of thin round steel wires
Anchor bends
Stationary anchorage
Premolars not bracketed
Light torquing forces in 3rd
stage
Use of reverse torquing auxillaries

ANCHORAGE IN FIXED
APPIANCES:
• Historical perspective
• Edgewise: Angle, Tweed, Andrews, Ricketts,
Alexander, Roth, Burstone, Bennett and
Mclaughlin
• Methods to reinforce anchorage
• Begg: conventional and refined
• Tipedge
• Studies in anchorage
• Newer methods in anchorage conservation

ANCHORAGE IN FIXED
APPIANCES:
HISTORICAL PERSPECTIVE:
ANGLE;
E arch :
- tipping tooth movements
- first to utilise stationary
anchorage of 1st
permanent
molars with clamp bands

ANCHORAGE IN FIXED
APPIANCES:
• Long clamp band: crown tipping resistance
of posterior teeth pitted against crown
tipping resistance of cuspid.
- simple anchorage vs. simple anchorage

ANCHORAGE IN FIXED
APPIANCES:
• Pin and tube appliance: root control by
pins soldered to labial archwire
• Ribbon arch appliance: size of archwire
itself did not provide anchorage of
posterior teeth

ANCHORAGE IN FIXED
APPIANCES:
• Edgewise appliance:
0.022” slot
Utilised by Tweed

• Tweed’s anchorage preparation
• Tweed Merrifield appliance
• Level Anchorage System
• Vari Simplex Discipline
• Rickett’s Bioprogressive Therapy
• MBT appliance

Tweed’s anchorage preparation
• Tipping the posterior segment
distally
• Lower posterior segment

When teeth are tipped distally as they are in
anchorage preparation, osteoid tissue appears to
be laid down adjacent to the mesial surface of the
tooth being moved distally.”
- Kaare Reitan
Such conclusions do not make the necessity of
anchorage preparation obselete

• Clinical orthodontist who routinely create
excellent facial changes are those who
recognize the importance of and prepare
anchorage in their practice

• Concept
• Upright the mesially inclined lower posterior
segment
• Terminal molar to be tipped distally
• Angle formed between the class II elastic and
long axis of terminal molar
Mandible will be much more stable and will resist
forward displacement

• After anchorage preparation, if movement does
occur
• Anchorage not prepared
Slow mesial bodily movement
Uprooting and elevation of the molars

• Tweed classified anchorage preparation
First degree
Second degree
Third degree

• First degree / minimal anchorage preparation
ANB 0º- 4º,ANB 0º- 4º, facial esthetics are goodfacial esthetics are good
Mandibular terminal molars must beMandibular terminal molars must be uprighteduprighted
Direction of intermaxillary elastic pullDirection of intermaxillary elastic pull
shouldshould not exceed 90ºnot exceed 90º
Discrepancy < 10 mm

• Second degree
ANB exceeds 4.5ANB exceeds 4.5 Class II
Mandibular second molars should always be bandedMandibular second molars should always be banded
Must be tipped distally so that their distal marginalMust be tipped distally so that their distal marginal
ridges are at gum levelridges are at gum level
Direction of pull of Intermaxillary elastics shouldDirection of pull of Intermaxillary elastics should
always be > 90ºalways be > 90º

• Third Degree or Total Anchorage Preparation
ANB does not exceed 5ºANB does not exceed 5º
Discrepancy – 14 -20 mm
AllAll posterior teeth (second premolar to terminal molars)posterior teeth (second premolar to terminal molars)
areare tipped distallytipped distally
Distal marginal ridges of terminal molars areDistal marginal ridges of terminal molars are belowbelow
gum levelgum level

• Severe cases – anchorage prepared in both the arches
• How to tip lower posterior segment ???
Sliding jigwww.indiandentalacademy.com

Lower anchorage preparation completed
Lower canines and incisors retracted
Upper extractions
Class II elastics – distal tipping of upper
posterior segmentwww.indiandentalacademy.com

Tweed Merrifield appliance

• Attachments
022 edgewise slot
Permits variety of archwire use

• Highlighting points – Anchorage preparation
Sequential banding and bonding
Sequential tooth movement
Sequential anchorage preparation
Directional force system

• Sequential banding and bonding
Less traumatic
Longer interbracket span
Heavy wires

• Sequential tooth movement
Enmasse retraction
Placing all bends at a time
Not followed

• Sequential anchorage preparation
10 – 2 anchorage system10 – 2 anchorage system
High pull head gear
Vertical spurs soldered
Distal to Mb. Lateral incisor

Distal tip achieved
Read out
15º

Distal tip achieved
Before tipping premolars
Read out to be performed

• During the course of treatment, various hooks
are soldered

Directional force system
Defined as controlled forces which place the
teeth in most harmonious relation with their
environment

Favorable Unfavorablewww.indiandentalacademy.com

ANCHORAGE IN FIXED
APPIANCES:
THE STRAIGHT WIRE APPLIANCE:
• Dr. Lawrence Andrews , mid 70s
• Preadjusted bracket system
• Extra torque added to incisor brackets to prevent
bite deepening
• Anti-tip and anti-rotation features in canine,
premolar and molar brackets: extraction and non-
extraction series
• Same force levels and treatment mechanics as
previous systems

Level anchorage system
• Terrell L. Root
• Aim – quantify the anchorage requirement
• 018 edgewise slot
• Mandibular molars – 2 choices of distal crown tip

• Anchorage – Resistance to movement
Distance to move
Anchorage savers
Those orthodontic adjunctive procedures that
reduce the amount of tooth anchorage necessary
to correct the malocclusion

• High pull headgear to maxillary 1st
molars 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 www.indiandentalacademy.com

Vari-simplex discipline-Alexander
• Vari – variety of bracket used
• Simplex – KISS principle
fewer archwire changes
• Treatment philosophy – Tweeds fundamentals
1. Anchorage preparation
2. Positioning Mb incisors over basal bone
3. Orthopedic alteration using head gear

• Key objective
Non extraction therapy as far as possible
Interproximal enamel reduction
Control of Mb incisor position with –ve torque

• Bracket selection
Twin brackets
Lang brackets
Lewis brackets

• Anchorage considerations
Gain in the arch length
Promotes leveling
0° angulation in Mb 2nd
molar–
Need not to be uprighted excessively
Tip values

• -5°of labial root torque
Holds the Mb incisors to their original position
Major change

• Head gears / Retractors
Retractors’ ( Dr. Fred Schudy)
Cervical, combination or high pull depending on
growth pattern and control needed

• Other intra oral appliances to control
anchorage:

• Other intra oral appliances to control
anchorage:
Mandibular lingual arch: sagittal and
transverse control
Lip bumper:
- Uprighting of mandibular first molars
- distal force on lower molars
- muscular anchoragewww.indiandentalacademy.com

Rickett’s Bioprogressive Therapy
• Muscular anchorage
• Cortical anchorage
Nance buttonNance button
Quad helixQuad helix
Headgears: cervical, combination andHeadgears: cervical, combination and
high pullhigh pull www.indiandentalacademy.com

ANCHORAGE IN FIXED
APPLIANCES:
BURSTONE’S SEGMENTAL ARCH
TECHNIQUE:
• Arch divided into 1 anterior and 2 posterior
segments, treated as separate units
• Frictionless mechanics using TMA springs; low
load deflection rate
• Differential space closure: anterior retraction or
posterior protraction or both should be possible
• Proper moment to force ratios

ANCHORAGE IN FIXED
APPLIANCES:
Anterior retraction: group A arches: (AJO 1982)
• Buccal stabilizing segment with a transpalatal
arch in maxilla and lingual arch in mandible:
posterior anchorage unit
• Anterior segment
• Two tooth concept:
large distance b/w canine
and molar;
low load- deflection rateswww.indiandentalacademy.com

ANCHORAGE IN FIXED
APPLIANCES:
• En masse controlled tipping followed by en
masse root movement
• TMA 0.018 loop welded to 00.017 by 0.025
base arch
• - magnitude of moment
on molar increases due
to additional wire
in the loop
- low load deflection ratewww.indiandentalacademy.com

ANCHORAGE IN FIXED
APPLIANCES:
• Heavy base arch withstands the higher
moments without permanent deformation
• Spring is positioned mesially
• Posterior tipping of buccal segments along
with TPA and consolidation of posterior
teeth : anchorage reinforcement

ANCHORAGE IN FIXED
APPLIANCES:
Group B arches:
• M/F ratio needed = 10:1 for translation
• Spring placed centrally b/w the two tubes
for same rate of change in M/F in both
alpha and beta moments

ANCHORAGE IN FIXED
APPLIANCES:
Group C arches:
• Loop is positioned at 1/3 rd interbracket distance
from the molar tube
or
• Symmetrically placed spring with Cl II or Cl III
elastics
• Side effects: flaring of anteriors, vertical
extrusion of anteriors
• Can be eliminated by using headgear to upper
arch

ANCHORAGE IN FIXED
APPLIANCES:
• Staggers and Germane (1991)
• Placement of gable bend near the beta
moment to increase the M/F ratio
• Kuhlberg and Burstone (1997)
• Use of a loop with symmetric angulation
but asymmetric placement

ANCHORAGE IN FIXED
APPLIANCES:
ROTH’S TECHNIQUE:
• .022 slot
• Double key hole loops used b/w lateral
and canine, and canine and premolar
- control canine rotation during extraction
space closure

ANCHORAGE IN FIXED
APPLIANCES:
Things that tend to slip posterior anchorage forward:
• Use of resilient wires and continuous wires to
level a deep curve of Spee
• Rapid bracket alignment with very resilient
wires
• Attempts to upright distally inclined canines
• Attempts at moving maxillary incisor roots
lingually
• Attempts at expansion with a labial arch wire
• Using a reciprocal force system to retract
extremely proclined anteriorswww.indiandentalacademy.com

ANCHORAGE IN FIXED
APPLIANCES:
Ways to avoid anchor loss:
• Leveling with small flexible wire
• Retraction of lower anteriors using a facebow
• Band second molars in the beginning of
treatment
• Use of utility arch to level curve of Spee
• Use of multiple short Cl II or Cl III elastics for
intra-arch adjustment: do not extrude molars and
do not change cant of occlusal plane

ANCHORAGE IN FIXED
APPLIANCES:
• Use of mandibular
lingual arch with finger
springs to widen premolar areas
• Transpalatal bar:
intrusion of molars and
rotational control

ANCHORAGE IN FIXED
APPLIANCES:
• Critical anchorage cases: Asher facebow
used to retract anteriors

ANCHORAGE IN FIXED
APPLIANCES:
INVERSE ANCHORAGE TECHNIQUE:
Jose Carriere- 1991
• Mandible is a preferred point of reference for diagnosis
and treatment planning, while maxilla is better suited to
adapting orthodontic correction
• - maxilla is anatomically a more stable reference than
mandible
- functionally mandible is the center of convergence of
force vectors, while maxilla is less influenced by forces

ANCHORAGE IN FIXED
APPLIANCES:
- histological difference between maxilla
and mandible ; maxilla has more plasticity
of response
• Treatment starts from the distal segments
and moves towards the mesial part
sectionally ( distomesial sequence)

ANCHORAGE IN FIXED
APPLIANCES:
• Inverse anchorage equation:
C - Dc/2 – R1 = 0 where,
• C= horizontal distance b/w the vertical line
passing through the cusp tip of the upper canine
and the vertical line passing through the posterior
end of the distal ridge of the lower canine
• Dc= arch length discrepancy of the mandibular
arch, measured from distal of both lower canines
• R1= amount in mm which the anterior limit of the
lower incisors should be moved in the ceph for the
correction of a casewww.indiandentalacademy.com

ANCHORAGE IN FIXED
APPLIANCES:
Stages:
• Maxillary stage:
treatment started in the maxilla with
posterior leveling, canine retraction,
anterior leveling and anterior retraction
• Mandibular stage:
same sequence

• Class II Div 1

• Other anchorage reinforcements used:
- lingual arch, labial arch and transpalatal
arch
- extraoral anchorage with Cl III elastics

ANCHORAGE IN FIXED
APPLIANCES:
DIFFERENTIAL STRAIGHT ARCH
TECHNIQUE: TIP-EDGE
• Peter Kesling
• 0.022 by 0.028 slot size with increase to 0.028
• Vertical slot for placement of auxiliaries
• Finishing possible with rectangular wires

ANCHORAGE IN FIXED
APPLIANCES:
ANCHORAGE IN FIXED FUNCTIONAL
APPLIANCES:
• Herbst appliance:
partial anchorage: maxilla:
first permanent molars and first premolars are
banded and connected with a lingual or buccal
sectional wire
mandible: first premolars are banded and
connected with a lingual sectional wire touching
anterior teeth

ANCHORAGE IN FIXED
APPLIANCES:
Partial anchorage

ANCHORAGE IN FIXED
APPLIANCES:
- Total anchorage: maxilla:
labial arch wire attached to brackets on
premolars, canines and incisors
Mandible: lingual sectional arch wire
extended to permanent first molars
• Bands are replaced by cast splints

ANCHORAGE IN FIXED
APPLIANCES:
Total anchorage

ANCHORAGE IN FIXED
APPLIANCES:
Jasper jumper:

ANCHORAGE IN FIXED
APPLIANCES:
Jasper jumper:
• Preparation of anchorage:
- full size arch wires cinched back at the
ends; inclusion of second molars
- anterior lingual crown torque in lower
wire
- TPA and lingual arch

ANCHORAGE IN FIXED
APPLIANCES:
Jasper jumper:
• Expansion of molar area

IMPLANTS :
• Boucher: Implants are alloplastic devices which
are surgically inserted into or onto jaw bone.
• Anchorage source:
Orthopedic anchorage:
- maxillary expansion
- headgear like effects
Dental anchorage:
- space closure
- intrusion ( anterior and posterior)
- distalization www.indiandentalacademy.com

IMPLANTS :
• Implant designs for orthodontic usage:
- onplant
- mini-implant
- impacted titanium post
- skeletal anchorage system

IMPLANTS :
Why implants?
Limitations of fixed orthodontic therapy:
• Headgear compliance and safety
• Reactive forces from dental anchors

IMPLANTS:
Implants for orthopedic anchorage:
• Maxillary protraction:
- Smalley (1988)
- insertion of titanium
implants into maxilla,
zygoma, orbital and occipital
bones of monkeys
-12-16mm widening of sutures
with 5-7mm increase in overjet

IMPLANTS:
• Implants for skeletal expansion:
-Guyman (1980) intentionally ankylosed maxillary
permanent lateral incisors of monkeys
No movement of
laterals during expansion

IMPLANTS:
• Parr, Roberts, et al (1997):
Midnasal expansion using endosseous titanium
screws; Rabbit study
Stability of implants seen for 1N and 3N loading

IMPLANTS :
Implants for intrusion of teeth:
• Creekmore ( 1983)
Vitallium implant for
anchorage while intruding
upper anterior teeth
6mm intrusion with
25degrees torque

IMPLANTS :
• Southard (1995)
Comparison of intrusion
potential of titanium
implants and that of teeth
Titanium implants placed
in extracted 4th
premolar
area of dogs
Intrusive force = 60gms

IMPLANTS :
Implants for space closure:
• Linkow ( 1970): implanto-orthodontics

IMPLANTS :

IMPLANTS :
Implants for space closure:
• Eugene Roberts: use of retromolar implants
for anchorage
Size of implant: 3.8mm width and 6.9mm
length
0.019 x 0.025 TMA wire from premolar to
retromolar implant to prevent distal
movement of premolar

IMPLANTS :
Other implant designs:
• Onplant: Block and Hoffman (1995)
“an absolute anchorage device”
Titanium disc- coated with hydroxyapatite on
one side and threaded hole on the other
Inserted subperiosteally

IMPLANTS :
• Impacted titanium posts:
Bousquet and Mauran (1996)
Post impacted between upper
right first molar and second
premolar extraction space on
labial surface of alveolar process
Perpendicular to bone surface

• Molar connected to
implant with 0.040 ss
wire

IMPLANTS :
• Mini-implant:
Ryuzo Kanomi ( 1997)
Small titanium screws 1.2mm diameter and
6mm length
Initially used for incisor intrusion
6mm intrusion of mandibular incisors

Incisor intrusion:

Incisor intrusion
Cuspid retraction
Molar intrusion

IMPLANTS :
• Skeletal anchorage system (SAS):
Sugawara and Umemori (1999)
Titanium miniplates
Placement in key ridge for upper molar and ramus
for lower molar intrusion
Uses:
- molar intrusion
- Molar intrusion and distalisation
- Incisor intrusion
- Molar protraction
- Molar extrusionwww.indiandentalacademy.com

ANCHORAGE IN FIXED
APPLIANCES:
Zygoma ligatures: Melsen et al JCO ’98
• Anchorage for intrusion and retraction of maxillary
incisors in partially edentulous patients
• Horizontal bony canal drilled 1cm lateral to alveolar
process with entrance and exit holes in superior
portion of infrazygomatic crest
• Double twisted 0.012 ligature wire inserted through
the canal

ANCHORAGE IN FIXED
APPLIANCES:

ANCHORAGE IN FIXED
APPLIANCES:
Methods of anchorage conservation:
Transpalatal arch:
• Introduced by Goshgarian
• 0.036 SS wire
• Anchorage reinforcement
• Other uses: distalization,
rotation, torque, expansion
or contraction, vertical control

ANCHORAGE IN FIXED
APPLIANCES:
• Burstone : ( JCO ’88-’89)
use of 0.032 by 0.032 SS or TMA in
transpalatal arches depending on the
passive or active

ANCHORAGE IN FIXED
APPLIANCES:
Lip bumper:
• Alters equilibrium b/w cheeks, lips and
tongue
• Transmits forces from perioral muscles to
the lower molars
• Can be used for distalization of molars
• Attachment of Cl III elastics

ANCHORAGE IN FIXED
APPLIANCES:
Lingual arch:
Introduced by Hotz
0.036 SS wire
Loops mesial to the lower molars
Prevents mesial migration of molars
Can be used for gaining arch length
Springs soldered to lingual arches
for premolar movements

Anchorage control in MBT
• 2nd
principle of orthodontic anchorage
• Anchorage loss – maximum in the first stage
• Def – Tooth movement needed to achieve passive
engagement of steel 19 x 25 wire of suitable arch
form into a correctly placed 022 preadjusted
bracket system

• Major reason for anchorage loss ???
• Anchorage control
Mesial tip built into the bracket system
The maneuvers used to restrict undesirable changesThe maneuvers used to restrict undesirable changes
during the opening phase of treatment, so thatduring the opening phase of treatment, so that
leveling and aligning is achieved without keyleveling and aligning is achieved without key
features of the malocclusion becoming worse.’features of the malocclusion becoming worse.’

• 1st
step in anchorage control
Recognize the anchorage needs of the case
Diagnosis and treatment planning stage

• Eg – class II div 1
• Goal is set for incisor position - PIP
Class IIIwww.indiandentalacademy.com

• Mistakes in tooth leveling and aligning during
early years
Roller coaster effect

• Roller coaster effect has been eliminated from the
present day practice
Reduced tip in bracket system
Light arch wire forces
Use of lacebacks instead of elastic forces

• Lacebacks for A/P canine control
Restrict canine crown from tipping forward

• Lacebacks for A/P canine control
Robinson – 57 PM extn cases

Restrict canine crown from tipping forward
Distalizing canines without causing unwanted
tipping

Continued till rectangular SS wire stage
Discontinued if space appears betn lateral &
canine

• Bendbacks for A/P incisor control

• Bendbacks for A/P incisor control
Bend is placed 1-2 mm
distal to molar tubewww.indiandentalacademy.com

• A/P anchorage control of
lower molars – the lingual
arch
• Class III elastics & headgear

• A/P anchorage support & control for upper molars –
 The upper molars move mesially more easily
than lower molars
 Upp ant segment has larger teeth than low ant
 Upp ant brackets have more tip built
 Upp incisors require more torque control &
bodily movement
 More Class II type malocclusions than Class III

• A/P anchorage support & control for upper molars –
Head gears TPA

• Vertical anchorage control of incisors

• Vertical control of canines

• Vertical control of molars in high angle cases
Palatal bar
Upp 2nd molars not initially banded
Headgear – high pullwww.indiandentalacademy.com

• Anchorage control in Transverse plane
Intercanine width
Molar crossbites

Conclusion:
• In many cases , the successful
outcome of the treatment depends on
treatment planning.
• In PAE, anchorage should be planned
and taken care of from the first day of
treatment.

Anchorage preparation in pae (2)

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (15)

Similar to Anchorage preparation in pae (2)

Similar to Anchorage preparation in pae (2) (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Anchorage preparation in pae (2)