Implant Introduce New Era in Orthodontic Treatment discusses the use of temporary anchorage devices (TADs) like mini-screw implants in orthodontic treatment. It provides background on dental implants and defines TADs. The document discusses the parts, materials, insertion technique, applications, advantages and limitations of TADs. It describes appropriate sites for TAD placement and risks. The document concludes that TADs have become increasingly popular due to their easy use, versatile designs and ability to allow immediate loading, facilitating treatment for difficult cases.

1. Implant Introduce New Era
In Orthodontic Treatment

2. DR. Mir Abu Naim
Asst. Professor & Head
Department Of Orthodontics
Udayan Dental College, Rajshahi

3. What Is Implant?
• Birth control method

4. Dental implant
• A dental implant (also known as an
endosseous implant or fixture) is a
surgical component that interfaces
with the bone of the jaw or skull to
support a dental prosthesis such as
a crown, bridge, denture, facial
prosthesis or to act as an
orthodontic anchor.

5. Orthodontic Implant
• Also known as:
Mini-screw
Temporary Anchorage
Device Or TAD.

6. TAD
• A temporary anchorage device
(TAD) is a device that is temporarily
fixed to bone for the purpose of
enhancing orthodontic anchorage
and is subsequently removed after
use.

7. TAD Classification
• TADs can grouped as:
Endosseous implant
Surgical Implant
Mini-Screw
Implants

8. Size & Shape
• Conical (Cylindrical)
• a) Miniscrew Implants
• b) Palatal Implants
• c) Prosthodontic
Implants
• Mini plate Implants
• Disc Implants
(Onplants)
Implant Bone
Contact
• Osteointegrated
• Non-
osteointegrated
Application
• Orthodontic
purposes.
(Orthodontic
Implants) or TAD
• Prosthodontic and
orthodontic
purposes.

9. Historical prespective
• 1945 - Gainsforth and Higley - concept
of skeletal anchorage using vitallium
implants
• 1969 - Branemark - concept of
osseointegration using titanium
implants
• 1990’s – Commercially available
miniscrew implants
• 1997 – Kanomi – K1 system of
osseointegrated miniscrews

11. Materials
• The materials commonly used for
implants can be divided into 4 categories:
– Biotolerant - stainless steel, chromium-
cobalt alloy.
– Bioinert - titanium, carbon
– Bioactive - vitroceramic apatite
hydroxide & ceramic oxidized
aluminium.
– Bioresorbable - Polylactide

12. Parts Of TAD
•Head
•Neck
•Screw
The
parts
include:

13. Or Screw

14. Indication for use of TAD
Absolute anchorage
In case of missing teeth it give anchorage and manage the
space correctly
Difficult tooth movement can possible
Adjunctive orthodontic treatment in adult
Attaching Orthopaedic forces.

15. Difficult movement that can
possible with TAD
Anterior or posterior intrusion
Molar Distalization
En-mass retraction
Molar upright
And others.

16. Lets see how can we use
implant

17. Advantages and Uses of TADs
Patients with hypodontia
Asymmetric tooth movements
Treatment of occlusal cant
Alternative to Orthognathic surgery
Retreatment cases
Cases of poor patient compliance

18. Envelope Of Discrepancy

19. Things to Consider before Placing a MI
• Patient related factors
– General factors
• Smoking
• Age
• Infective endocarditis
• Diabetes mellitus
• Bone diseases and use of medicines
– Local factors
• Oral hygiene
• Quality bone
• Tooth roots and other vital structures

20. Biological Basis of Miniscrew Implant
Anchorage
Hounsfield Classification of Bone Density
• D1: Dense compact bone
• D2: Dense to thick porous compact bone on the outside and
coarse trabecular bone on the inside
• D3: Porous compact and fine trabecular bone
• D4: Fine trabecular bone
• D5: Immature, non-mineralized bone
D1 D2 D3 D4

21. Selection of a MI System
– Pitch – tight vs. loose
– Length – 6 – 14 mm
– Diameter – 1.2 – 2.3 mm
– Shape – Conical, cylindrical, mixed
– Tip – Thread forming vs. thread cutting
– Surface – Smooth or roughened

23. Insertion Technique
• Rinse with a 0.12% chlorhexidine solution
• Apply a topical anesthetic gel
• Determine the site by placing a probe parallel
to the long axis of the teeth or a radiograph
• Pinpoint mark is made at the planned area
with explorer
• Miniscrew is mounted on driver and secured
on cortical bone
• Clockwise roations at less than 1/4 rotation
per second
• Detach driver from screw by pulling in the axis
of the screw

24. Pictures

25. Biomechanical Consideration
using MI
• Loading Time - Immediate
• Loading Technique - Direct vs
Indirect
• Loading Force - 300-400gm

26. Thread design
• Self Drilling:
 It does not require a pilot hole.
 It has either a sharp or a tapered
apex to allow placement or a notch
in the tip to drill through the cortex.
• Self tapping:
 These screws are unable to create
their own thread as the advance in
the bone

27. Contraindication for implant therapy:
 Absolutecontraindication:
Bleeding Disorders
Bone Metabolism Disorders
Immuno-compromised
Diabetes Mellitus
Anti-coagulant treatment
Pregnancy
Xerostomia
Titanium allergy

28. • When other conventional methods of
anchorage are adequate.
• Poor Oral hygiene
• Smoking
• Local Bone pathology
• Inadequate bone depth and quality
• Local factors like bone amount and local
infection
Relative contraindications:

29. Limitations:
• Patients younger than 12 years who have not yet
completed skeletal growth should have palatal
Miniscrew placed away from the midline suture
in the paramedian region.
• Thin cortical bone limits the use of mini implants
because Miniscrew implants are mechanically
retained, loosening of screw can develop as a
result of thin cortical bone, if thinner than 0.5
mm and also if density of trabecular bone is low.

30. • Clinician's skill.
• Ethical issues: Enthusiastic use of an invasive
and costly procedure like Miniscrew
anchorage in all patient is not recommended.
There must be a definite indication and
should have low risk- benefit ratio.

31. Site of orthodontic implant
placement
• In maxilla:
• Maxillary tuberosity
• Infrazygomatic crest area
• Buccally between maxillary 1st and 2nd
molar
• Buccally between maxillary canine and 1st
pre-molar
• Labially between the maxillary incisors
• Palatally between the maxillary 2nd pre-
molar and 1st molar
• Mid palatal area

32. Site of orthodontic implant
placement
• In mandible:
• Retromolar region
• Bucally between mandibular 1st and 2nd
molar
• bucally between the maxillary 1st molar
and 2nd pre-molar.
• Bucally between mandibular pre-molars
and canine.
• Facially in the symphyseal region.

33. Risk And Complication
Trauma to the
periodontal
ligament or the
dental root
Potential
complication of
root injury
Miniscrew
slippage
Nerve involvement
Air subcutaneous
emphysema
Nasal and
maxillary sinus
perforation
Miniscrew
bending, fracture
and torsional
stress

34. Complication During Removable
Fracture of
implant
Partial
osseointegration

35. Orthodontic VS Prosthodontic
implant
Prosthodontic implant
• Site of placement is alveolar
process of jaw and zygomatic
process of maxilla
• Flap surgery and bone
preparation needed
• Not use until skeletal growth
completed
• Loading after osseointegration
• Pain and swelling may persist a
week
• Diameter-2.9 to 6 mm, length-
6-18 mm
Orthodontic implant
• Every structure where enough
cortical bone present
• Only perforation of mucosa
needed
• There in no age
contraindication
• Immediate loading
• Minimum patient discomfort
• Diameter-1.2 to 2.3 mm,
length- 6-14 mm

36. CHARACTER CONVENTIONAL IMPLANTS
Anchorage Teeth and extraoral bony
structures
Implants
Stability Not stable Stable
Number of Anchor
Teeth
Maximum number
teeth must be included
For direct anchorage teeth are
not necessary, minimal
number of teeth are needed
for indirect force on implant
anchorage
Treatment Efficiency Applying force on teeth, part of
it
is wasted, due to periodontal
amortization
More efficient as force is
transmitted directly to the
implant
Duration Prolonged Shortened
Patient's
cooperation
Obligatory Minimal
Acceptability Most of treatment devices
restrict
patients motion, don't meet
esthetical requirements
Discomfort for patient is
minimal

37. Conclusion
Miniscrew implants have become
increasingly popular over the last few years.
Easy use, versatile designs and immediate
loading remains their top merits. Their use may
reduce the number of surgical and extraction
cases and greatly facilitate the treatment of
patient with low compliance, borderline surgical
needs and those requiring retreatment.