The progression from using dental implants to microimplants in orthodontics is presented

1. Prepared by:Yaser Yahya Basheer
Supervisedby prof : Maher fouda

2.  What are dental implants?
 History
 Types of dental implants
 Biomaterials for dental implants
 Indications for dental implants
 Orthodontic anchorage

3.  "A dental implant is a biomedical device, which is
usually composed of an inert metal or metallic
alloy, which is placed on or within the osseous
tissues."
Implants are now being used in orthodontics for
the purpose of augmenting anchorage.

4. The history of implants or implant-like
Devices attached to prosthesis can be traced
to ancient civilizations like Egyptians (2000
years), Ancient Chinese (4000 years), lncas
(1500 years), etc. Different materials were
implanted in place of missing teeth; ranging
from teeth taken from slaves, prisoners, or
from animals. In Inca skulls, researchers
found precious stones implanted in the jaws
to replace missing teeth.

5. Stork in 1938, introduced surgical cobalt chromium
molybdenum alloy implant that he used to replace a
left maxillary central incisor and it lasted for 15
years.
In 1946, Stork designed a two-stage screw implant,
which was inserted without a premucosal post and
later after bone healing took place, the crown and
abutment were attached to it.

6. This interface between bone and implant was called
ankylosis and it can be equated with the clinical
term as rigid fixation. Rigid fixation defines the
clinical aspect of this microscopic bone contact with
an implant and in the absence of mobility with a I to
500 gm force applied in a vertical or horizontal
direction. The first submerged implant placed by
Stork lasted for more than 50 years. Bone fused to
titanium was first reported and documented by
Bathe et al in 1940.

7. In 1952, Branemark started extensive experimental
clinical studies on microscopic microcirculation in
bone marrow healing. The 10-year studies regarding
implant placement in the jawbone of the dogs started
in 1960 and in humans these started in 1965 and were
reported in 1977 that led to the term
osseointegration.

8. Osseointegration was defined as "the contact established
between normal and remodeled bone and an implant
Surface Without the interposition of non-bone or
connective tissue,“ or "direct structural and functional
connection between ordered, living bone and the
surface of a load-carrying implant." Osseointegration
can also be defined as a direct interaction of bone to an
implant surface.
As a result, the implant fixture is immobilized in
the bone and lends itself to function as an anchor for
orthodontic anchorage.

9. Dental implants can be subdivided into three major
types based on their mode of attachment to the bone
structure as: endo-osseous, subperiosteal and
transosseous.
endo-osseous subperiosteal transosseous

10. These implants are screwed, tapped or drilled
directly into the bone. They osseointegrate with
the bone.These implants provide better initial
stability /retention. A minimum healing period of
3-4 months is required before they can be loaded.

11. These are available in many designs depending
upon the bone condition and the type of abutment
to be used. Due to the limited amount of space
available , high cost and long waiting period for
them to osseointegrate before loading other
solutions were proposed.

12. a. According to the shape
• Straight/cylinders
• Tapered
• Stepped
b. According to surface finish
• Smooth
• Threaded
• Rough
- Sand blasted
- Acid etched
• Coated
- Titanium plasma sprayed
- Hydroxyapatite
- Aluminium oxide

13. c. Combination
• Straight smooth
• Straight threaded (screw)
• Tapered threaded (screw)
• Stepped-tapered threaded (screw)
• Stepped cylinder
• Combination of root form implants
with different surface coatings and
design
d. According to stages of surgery
• Single stage
• Two stage
e. According to implant abutment
interface design
• Internal
• External

14.  First introduced by Linkow in 1967
 Flat and taper from shoulder towards the base
 Numerous holes for interlocking (retention)
 Cut a groove and tap into the bone
 indicated for thin alveolar ridges

15.  Metallic markers
 Used in orthodontics and growth studies.
A pre-shaped Ramus frame implant. This is the same implant custom-fitted.

16. Mainly used in completely edentulous jaw
conditions:
1. Unilateral
2. Complete

17.  These are used in certain edentulous conditions and
require major surgical procedures.
 1. Staple
 2. Staple pins
 3. Multiple pins

18.  Biodegradable polylactide with a metal
 super-structure.

19.  Bicortical titanium screws (most frequently used
in orthodontics)

20.  There are many biocompatible materials
available today but the main emphasis is on
metals, metal alloys, ceramics, polymers,
composites and carbons.

21.  Titanium
 Tantalum
 Alloys of titanjum/aluminium/van~dium
 Cobalt/chromium/molybdenum
 Chromium/iron/nickel
 Titanium and its alloys are most widely used.

22.  Aluminium oxide (aluminium and sapphire)
ceramics
 Carbon
 Carbon silicon compounds.

23.  Polymethylmethacrylate
 Silicon rubber
 Polyethylene
 Polylactide

24. 1.Edentulous mandible
2. Edentulous maxilla
3. Frontal region upper jaw
4. Partially edentulous jaws (one or two missing
teeth)
• Kennedy's class II and III
5. Single tooth implantation
6. Extraoral implantation, (epithesis)
7. Immediate implantation
• Trauma (bone situation is to be considered)
• Periodontal problems
• Periapical pathology, and resorption of roots
• Agenetic elements, (by birth missing teeth)
• Caries
8. Orthodontic anchorage

25. 1. Medical
• Temporal (flu, pregnancy, etc.)
• (Auto) immune diseases
• Terminal illness
• Inability to restore with prosthesis
• Use of corticosteroids
• Radiotherapy of the head, (tumoricidal
radiation of implant site)
• Severe Diabetes mellitus
• Psychological problems (unrealistic patient
expectation)

26. 2. Dental
• Anatomy-nerves (too close), sinus, etc.
• Local pathology-cyst, roots stumps,
gum problems, etc.
• Microbiology-bacterial sensitive.
• Bad Oral hygiene
•Lack of operator expertise
• Motivation
• Non cooperative patient

27. 3. General
• Finance
• Touring job (unable to keep
appointments)
• Attitude
• Spastic patient

28. With the advent of prosthetic implants and their
predictable results, the orthodontists saw an
opportunity to use them for the purpose of anchorage.
Routinely used dental implants are unsuitable for use
as orthodontic anchorage units as their size precludes their
use, unless edentulous regions exist in the mouth.

29. Initially routine dental implants of relatively lesser
diameter 3.5-4.5 mm and varying lengths (10-16mm)
were used in orthodontics. They were of the self
tapping variety with the threads having a sandblasted
or acid-etch surface finish. The polished trans-mucosal
neck was either 2.5 or 4.5 mm long. Because of their
size they were generally placed in the palate or in the
retromolar region.

30. Following their success, implants were especially
designed for anchorage in orthodontics .
They are smaller in diameter generally 0.9-1.6 mm in
diameter and ranged from 6-12 mm in length. The
implant head has a hole and / or a groove to accept
an orthodontic wire or other orthodontic accessories.
Commercially available mini-implants(A) TOMAS
Dentaurum (Germany), (B) Bredent (Germany) (C) Dentos(Korea)

31. They can be of the self-tapping or the self-drilling
variety . Decrease in size has also led to
their being placed rather easily in other sites like in
the interdental region, between the molars . Their
small size has led to them being called-"mini-implants,
micro-implants, mini-screws or mini-pins".
Mini-implant placed at an angle
between 15 and 16
Horizontally inserted mini-implant in
the mandible

32. • Direct method
To place mini-implant directly without an Incision
Indicated in placements over 'attached gingiva'
In majority of the cases
More predictable results
• Indirect Method
Placements over 'unattached gingiva'
Will require a vertical incision of 2 to 5 mm in
length.
Relatively less commonly used
The implant will be covered by the gingival tissue.

33. • Self Tapping and
• Self Drilling
Self Tapping
• Pre-Drilling with a suitable drill 0.2 mm
less than that of the mini implant to be
implanted
Self-Drilling
• No need to pre-drill
• Just use a round bur or a small 2 to 4 mm
drill to get a 'purchase point', especially
when angulating the implant

34. Step I -isolate the region and
apply surface anesthct!c (15%
Lidocanine)
Step Il-anesthetize using
infiltration 0.2 ml anesthetic
Step III-mark the exact location
using the periodontal probe.

35. Step lV-using the tissue punch
expose the bone
-exposed bone would cause the
bleeding point to be visible
Step V-under copious irrigation
make pilot hole (using a round bur
or drill-2 to 4 mm in length) through
the cortical bone (optional but
preferable)

36. Step VI-using the edaptor/screw
driver provided screw the mini implant
into the bone, or use an
implant' physio-dispenser.
-mini-implant after placement.
Surgical procedure for removal of
mini-implant .Since the mini-implant
does not osseo-intigrate the mini-implant
can be easily unscrewed using the screw
driver provided. It leaves small
bleeding point which heels without
any medication or suturing required

37. • SAS systems, Sendai Japan
• OMAS Systems, Taipei Taiwan, Lomas-Mondial,
Germany
• ORLUS Systems, Yonsei University, Seoul, Korea
• Mia Systems, Kyungpook University, Daedu,
Korea
• TOMAS, Dentaurum, Germany
Tomas from Dentaurum

38. •Orthodontic implants are now gaining in
popularity for their ability to provide anchorage in
difficult conditions . The "mini-implants"
have the advantage of being practically immovable
when used for the purpose of exerting tooth moving
forces. This ability of providing absolute anchorage
helps in achieving difficult movements like molar
 distalization, enmass retraction , etc routinely.
Distalization of the maxillary posterior segment using a mini-Implant

39. Enmass retraction in a critical anchorage case

40. Segmental treatment used to align an impacted maxillary canine
This in turn is responsible for the increased acceptance of
orthodontic treatment by adults and other esthetically
conscious patients, as segmental treatment becomes possible .
They are capable of providing excellent anchorage for a
relatively minor increase in the cost of orthodontic treatment,
also decreasing treatment time.

41. Segmental treatment used to
Intrude the mandibular incisors.

42. Implants have been used to distalize maxillary and
mandibular molars and groups of teeth, and to obtain
tipping, uprighting, intrusion, extrusion and transfer of
anchorage to other parts of the mouth. The implants
and the new bicortical titanium screws are so
convenient to place that the line of action of the
orthodontic force can be made to coincide with the
level of the center of resistance of the teeth to be moved
resulting in a favorable translatory tooth movement.
Enmass retraction of maxillary and mandibular Incisors with the point of application of
force closer to the center of resistance of the teeth to be retracted.

43. The implant assisted orthodontic treatment
helps to minimize anchorage loss and decrease the
overall duration of treatment, as these can be loaded
immediately. Headgears and other extra-oral means of
anchorage are eliminated.
Most importantly, orthodontic treatment is now possible in
cases where multiple teeth are missing or the other
anchorage units are compromised. Also, treatment is
no longer dependent on patient cooperation.
Implant placed in the edentulous region to retract the remaining teeth in
the arch.

44. There are few contraindications to the use of
miniscrews but it is advised to be cautious in their
use especially when treating young individuals
below the age of 14 years, because young patients
have more spongy bone which at times doesn't allow
the primary stability to be achieved at the time of
initial placement.

45. a, General contra-indications:
The microimplant must not be used if the patient has-
1. History of immune deficiency,
2. History of steroid therapy (in the past 6 months),
3. Bleeding or clotting disorders,
4. Uncontrolled endocrine disease,
5. Bone disease,
6. Rheumatic ailments,
7. Cirrhosis of the liver, or any other acute disease.
b. Local contra-indications:
1, The osteomyelitis of the jaws,
2. Receives radiation therapy in the head and neck region,
3. Has receding gingtval disease or
4. Unsatisfactory oral hygiene.

46. Mini-screws can be placed at various sites to either
provide direct or indirect anchorage. Direct
anchorage potential is said to be used when the
forces are afflicted directly from the screw head
eg. E-chains used to retract teeth. Indirect
anchorage is said to exist when the mini -screw is
used to immobilize or augment tile anchorage
potential of the molars .
Direct anchorage to
mesialize the molar Indirect anchorage

47. Various Sites of implants
• Maxilla
- infrazygomatic crest area.
- Maxillary tuberosity area
- Intra radicular between the roots both
buccally and
palatally
- Mid palatine area

48. • Mandible
- Retro molar area
- Intra radicular area
- Mandibular
symphysis
• Others
- Edentulous areas

49. Orthodontic anchorage
 Used for retraction of anterior teeth,
 Uprighting of molars.
 Mesiodistal tooth movement,
 Open bite correction (archived by intruding posterior
teeth: skeletal anchorage)
 Distalization of 1st and 2nd molars
 Intrusion of teeth
 Compromised anchorage in periodontally involved
teeth where anchorage is a problem/congenital
anomalies and developmental defects of jaws which
may result in inadequate anchorage.
 Replacement of missing teeth after the completion of
orthodontic treatment (should be done only after
completion of craniofacial growth).

50. Mini-screws are likely to revolutionize the way
orthodontic treatment is planned and executed
with anchorage planning having become
simplified and treatment time decreasing, more
and more patients are likely to become
motivated to seek orthodontic treatment.

52. THANks