ANCHORAGE

Convener: Dr. J.N. Sharma Department of Orthodontics

Presenter: Sushmita Shrestha Roll no:275

CONTENTS
Definition Relationship of tooth movement to force Sources of anchorage Classification Types of anchorage Anchorage planning Recent Advancements

Definition
According to Proffit: anchorage is resistance to unwanted tooth movement The dentist or orthodontist always constructs an appliance to produce certain desired tooth movements. For every (desired) action there is an equal and opposite reaction. Inevitably, reaction forces can move other teeth as well if the appliance contacts them. Anchorage, then, is the resistance to reaction forces that is provided (usually) by other teeth, (sometimes) by the palate, head or neck (via external force) and less frequently by anchors screwed to the jaws.

Relationship of tooth movement to force

An obvious strategy for anchorage control would be to concentrate the force needed to produce tooth movement where it was desired, and then to dissipate the reaction force over as many other teeth as possible, keeping the pressure in the PDL of anchor teeth as low as possible. A threshold, below which pressure would produce no reaction, could provide perfect anchorage control.

Sources of anchorage
Anchorage during orthodontic therapy may be obtained from: -Intra oral sources -Extra oral sources -Both

Intra oral sources

Teeth Alveolar bone Basal bone Musculature

Teeth:
Whenever some teeth are moved orthodontically, the remaining teeth of the oral cavity can act as anchorage or resistance unit. The anchorage potential of a teeth depend on factors such as -Root form -Size and no of roots -Root length -Inclination of teeth -Ankylosed teeth

Alveolar bone:
The alveolar bone that surrounds a tooth offers resistance to tooth movement only up to a certain amount of force.. When the force exceeds a certain limit, the alveolar bone permits tooth movement by bone remodeling.

Basal bone: The areas which provide intra oral anchorage are: -Hard palate -lingual surface of mandible in the region of the roots.

Musculature:
Dental anchorage may be increased by making use of hypertonic labial musculature . As in the case of a lip bumper

Extra oral sources

Cranium(occipital or parietal anchorage) Head gear along with a face bow can be used to restrict maxillary growth or to move the dentition or maxillary bone distally. Back of the neck(cervical anchorage) e.g. cervical head gear

Classification
According to the manner of force application: -Simple anchorage -Stationary anchorage -Reciprocal anchorage According to jaws involves: -Intramaxillary -Intermaxillary

 According to site of anchorage: -Intra oral -Extra oral cervical ,occipital ,cranial , facial According to no of anchorage units: -Single or primary anchorage -Compound anchorage -Multiple reinforced anchorage

Types of anchorage
Simple anchorage Stationary anchorage Reciprocal anchorage Intra oral anchorage Extra oral anchorage Intra maxillary anchorage Inter maxillary anchorage Multiple or reinforced anchorage

Simple anchorage
Dental anchorage in which the manner and application of force that tends to displace or change the axial inclination of the tooth or teeth that form the anchorage unit in the plane of space in which the force is being applied..

Stationary Anchorage
Dental anchorage in which the manner and application of force tend to displace the anchorage unit bodily in the plane of space in which the force is being applied. eg. retraction of central incisors using first molars as anchorage unit.

Reciprocal Anchorage
Anchorage in which one or more dental units is utilized to move one or more opposing dental units. eg. correction of posterior cross bite by the use of through the bite elastics.

Intraoral Anchorage
It is the one in which all the resistance units along with the teeth to be moved are situated within the oral cavity.

Extraoral Anchorage
It is the one in which one of anchorage units is situated outside the oral cavity. It is used in the correction of maxillomandibular jaw malrelationships.

Combination head gear

Intramaxillary Anchorage
In this the resistance units are all situated in the same jaw. It may be reciprocal, stationary or of simple type

Intermaxillary Anchorage
In this type of anchorage the unit situated in one jaw is used to effect tooth movement in the other jaw. Most intermaxillary anchorage is in form of elastic traction. It is a form of multiple anchorage.

Multiple Anchorage
It is also known as reinforced anchorage. Here more than one type of resistance unit is utilized. Eg. removable tooth and tissue born and extra oral appliances to augment dental units.

Cortical Anchorage

Factors Affecting Anchorage:

It is of utmost importance in the success of orthodontic treatment. Prior to initiation of the treatment it is essential to assess the anchorage demand of each case so that appropriate treatment modalities can be executed.

 The anchorage requirement depends on a number of factors:

1. Number of teeth being moved: the greater the number of teeth the greater the anchorage demand. 2. Type of teeth being moved: the movement of slender anterior teeth offers less strain on the anchorage than the robust multirooted teeth.

3. Type of tooth movement: Whenever bodily movement is required there is greater strain on anchorage in contrast to tipping tooth movement. 4. Duration of tooth movement: treatment of a prolonged duration places an undue strain on the anchorage.

Anchorage loss:
Inspite of precaution taken in planning anchorage,a certain amount of unwanted movement of anchor teeth invariably occurs during orthodontic treatment. Such unwanted movements of anchor teeth is called anchorage loss

Planning of anchorage:
Based on the anchorage loss that is permissible, the anchorage demand of an extraction case can be of three types: 1. Maximum anchorage cases: -The cases where anchorage demand is very high. -Not more than 1/4th of the extraction space should be lost by forward movement of the anchor teeth. Eg. Class 1 Bimaxillary protrusion Class 2 div 1 (maxilla) Class 3 (mandible)

 Moderate anchorage cases: Here the anchor teeth can be permitted to move forward into 1/4th to of the extraction space.

 Minimum anchorage cases: Anchorage demand is very low. More than half the extraction space can be lost by the mesial movement of anchor teeth. Eg.Class 2 div 1(mandible) Class 3 (maxilla)

Recent Advancements

Implant anchorage
If structures other than the teeth could be made to serve as anchorage, it would be possible to produce tooth movement or growth modification without unwanted side effects. With the development of successful bone implant techniques, the potential existed for what could be described as absolute anchorage, with no tooth movement except what was desired.

 Implants could be used as anchorage for orthodontic tooth movement, and that they made it possible to do things that were previously impossible, for example, intrusion of maxillary posterior teeth in the treatment of anterior open bite.

 A number of options for absolute anchorage exist at present. The principal ones are: -Titanium screws that penetrate through the gingiva into alveolar bone. -Bone anchors placed beneath the soft tissue, usually in the zygomatic buttress area of the maxilla

Temporary Implant anchorage

Temporary skeletal anchorage is derived from implants, miniplates attached with screws to basal bone of the maxilla or mandible, or just a screw with a channel for attaching a spring that is placed into the alveolar process. This approach makes it possible to accomplish tooth movement, especially in adults, that was very difficult or impossible previously. With skeletal anchorage there is no concern about moving teeth that were not intended to be moved, but the amount of force to teeth that are to be moved still must be determined with the amount of friction in mind

Applications of skeletal anchorage...

1. Intrusion of posterior teeth to close an anterior open bite 2. Distal movement of maxillary molars (and the entire maxillary arch if needed) 3. Retraction and intrusion of protruding upper incisors 4. Positioning individual teeth when no other satisfactory anchorage is available (usually because other teeth have been lost to dental disease)

Patient and Doctor Perceptions of Skeletal Anchorage

How difficult is it for patients to tolerate skeletal anchorage, and how difficult is it for doctors to place and use it?? The results of a recent collaborative study at the University of North Carolina (UNC) and the Universit Catholique de Louvain (UCL) indicate a high success rate, positive patient and doctor reactions to skeletal anchorage, and suggest that problems with using the anchors are surprisingly small.
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Conclusion:
Anchorage is a very important aspect of orthodontic treatment which should be of concern for the success of the treatment. Proper planning of anchorage at the time of start of treatment will give desired outcome and thus patient satisfaction

References:
Text book of Profitt. Orthodontics Principles and Practice T.M. Graber Orthodontics (S.I. Bhalaji) www.google.com

THANK YOU!!!