Anchorage (orthodontics)

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Temporary Anchorage Device Implant orthodontic anchor model.jpg
Temporary Anchorage Device

Anchorage a medical term in orthodontics is defined as a way of resisting movement of a tooth or number of teeth by using different techniques. Anchorage is an important consideration in the field of orthodontics as this is a concept that is used frequently when correcting malocclusions. Unplanned or unwanted tooth movement can have dire consequences in a treatment plan, and therefore using anchorage stop a certain tooth movement becomes important. [1] Anchorage can be used from many different sources such as teeth, bone, implants or extra-orally. [2] [3]

Contents

Certain factors related to the anatomy of teeth can affect the anchorage that may be used. Multi-rooted, longer-rooted, triangular shaped root teeth usually provide more anchorage than the single-rooted, short-rooted and ovoid rooted teeth.

History

One of the earliest uses of anchorage came from Henry Albert Baker for his use of the intermaxillary anchorage or Baker's Anchorage. This type of anchorage involves using elastics from one jaw to the other, in the form of either Class 2 elastics (moving upper teeth back) where lower molar teeth serve as anchors, or Class 3 elastics (moving lower teeth back) where upper molars serve as anchors. Intramaxillary anchorage is also used in the form of E-chain, when elastics are used from the back molar teeth to the front teeth in the same jaw to move teeth back of the mouth.

Classification based on site

Orthodontic headgear will usually consist of three major components:

Full combination orthodontic headgear with headcap, fitting straps, facebow and elastics Full orthodontic headgear with headcap and fitting straps.jpg
Full combination orthodontic headgear with headcap, fitting straps, facebow and elastics

Classification based on number of teeth

Robert Moyers defined the classification of anchorage in the number of units. [4]

Classification based on space closure

Ravindra Nanda and Charles J. Burstone described three types of anchorages that are based on the need during a treatment where space closure is needed. [5] In some orthodontic cases, teeth have to be removed in order to either relieve dental crowding or reduce a large overjet or overbite. Therefore, the space created after removing teeth is usually closed during an orthodontic treatment. A space can be closed by either moving back teeth forward or front teeth backward.

Group A Anchorage

This type is considered critical anchorage, which involves 75% movement of anterior teeth and 25% posterior teeth into the space created by extraction. Thus the expectation in this type of anchorage is to bring front teeth back.

Group B Anchorage

This type of anchorage is considered moderate, which involves 50% movement of both anterior and posterior teeth into the extraction space. The expectation in this type of anchorage is to see posterior teeth moving forward equally as compared to anterior teeth moving backwards.

Group C Anchorage

This type of anchorage is considered non-critical, which involves posterior teeth moving forward 75% of the time and front teeth moving backwards 25% of the time into the extraction space. Greater movement of back teeth is seen in this case.

Absolute Anchorage

This type of anchorage is needed in a treatment when there is 0% movement of posterior teeth forward and 100% movement of anterior teeth backwards. This type of anchorage is usually produced by using mini-implants or temporary anchorage devices.

Classification based on implant

Orthodontic mini-implants can be used for the purpose of anchorage in an orthodontic treatment. The implants can be used to provide either direct or indirect anchorage. [6]

Direct Anchorage

In this type of setup, orthodontic force is applied directly from the implant to one or multiple teeth. In this type of anchorage, the location of the implant plays a very important role due to different force vectors being affected.

Indirect Anchorage

In this type of setup, an implant is used to stabilize one or multiple teeth into a unit. An orthodontic force is then used against this unit to move single or multiple teeth. In this setup, the location of the implant is not as important as long as the implant is stable.

Classification based on bone

Cortical Anchorage

Cortical bone is known to resorb slower than the medullary bone. Therefore, cortical anchorage is used in orthodontics to allow for slower movement of teeth, especially molars in the posterior dentition. [7] A clinician may produce a movement which allows the buccal roots of the permanent molars to move buccally (outside), eventually contacting the cortical bone. It is claimed that by using cortical bone against posterior teeth, mesial movement of posterior teeth can be prevented which helps in anchoring the posterior teeth in the back of the jaw.

Idea of cortical bone anchorage is intensively used in Bioprogressive Therapy of Robert M. Ricketts who recommended using the cortical bone to slow the movement of the molar teeth in high anchorage cases. [8]

Related Research Articles

<span class="mw-page-title-main">Orthodontics</span> Correctional branch of dentistry

Orthodontics is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns. It may also address the modification of facial growth, known as dentofacial orthopedics.

<span class="mw-page-title-main">Dental braces</span> Form of orthodontics

Dental braces are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, gaps, deep bites, cross bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.

<span class="mw-page-title-main">Orthodontic headgear</span> Orthodontic device used to correct bite

Orthodontic headgear is a type of orthodontic appliance typically attached to the patient's head with a strap or number of straps around the patient's head or neck. From this, a force is transferred to the mouth/jaw(s) of the subject.

<span class="mw-page-title-main">Malocclusion</span> Misalignment between upper and lower teeth as the jaws close

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855–1930), the "father of modern orthodontics", popularised it. The word derives from mal- 'incorrect' and occlusion 'the manner in which opposing teeth meet'.

<span class="mw-page-title-main">Palatal expansion</span> Orthodontics device to widen the upper jaw

A palatal expander is a device in the field of orthodontics which is used to widen the upper jaw (maxilla) so that the bottom and upper teeth will fit together better. This is a common orthodontic procedure. The use of an expander is most common in children and adolescents 8–18 years of age. It can also be used in adults, although expansion is more uncomfortable and takes longer in adults. A patient who would rather not wait several months for the end result achieved by a palatal expander may be able to opt for a surgical separation of the maxilla. Use of a palatal expander is most often followed by braces to then straighten the teeth.

A dental emergency is an issue involving the teeth and supporting tissues that are of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source. Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency.

Orthodontic technology is a specialty of dental technology that is concerned with the design and fabrication of dental appliances for the treatment of malocclusions, which may be a result of tooth irregularity, disproportionate jaw relationships, or both.

Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

<span class="mw-page-title-main">Overjet</span> Extent of horizontal overlap of the top and bottom front teeth (incisors)

In dentistry, overjet is the extent of horizontal (anterior-posterior) overlap of the maxillary central incisors over the mandibular central incisors. In class II malocclusion the overjet is increased as the maxillary central incisors are protruded.

<span class="mw-page-title-main">Crossbite</span> Left-right misalignment of upper and lower teeth

In dentistry, crossbite is a form of malocclusion where a tooth has a more buccal or lingual position than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.

Lingual braces are one of the many types of the fixed orthodontic treatment appliances available to patients needing orthodontics. They involve attaching the orthodontic brackets on the inner sides of the teeth. The main advantage of lingual braces is their near invisibility compared to the standard braces, which are attached on the buccal (cheek) sides of the tooth. Lingual braces were invented by Craven Kurz in 1976.

Scissor bite is a type of bite seen in some mammals such as dogs and humans. This type of bite involves outward positioning of the upper posterior teeth and inward positioning of the lower posterior teeth. The reason for this happening is an expanded upper arch and constricted lower arch.

A lip bumper is a dental appliance used in orthodontics, for various purposes to correct a dentition by preventing the pressure from the soft tissue. Lip bumpers are usually used in orthodontic treatment where the patient has a crowded maxillary or mandibular teeth in an arch.

Elastics are rubber bands frequently used in the field of orthodontics to correct different types of malocclusions. The elastic wear is prescribed by an orthodontist or a dentist in an orthodontic treatment. The longevity of the elastic wear may vary from two weeks to several months. The elastic wear can be worn from 12 to 23 hours a day, either during the night or throughout the day depending on the requirements for each malocclusion. The many different types of elastics may produce different forces on teeth. Therefore, using elastics with specific forces is critical in achieving a good orthodontic occlusion.

Activator Appliance is an Orthodontics appliance that was developed by Viggo Andresen in 1908. This was one of the first functional appliances that was developed to correct functional jaw in the early 1900s. Activator appliance became the universal appliance that was used widely throughout Europe in the earlier part of the 20th century.

Molar distalization is a process in the field of Orthodontics which is used to move molar teeth, especially permanent first molars, distally (backwards) in an arch. This procedure is often used in treatment of patients who have Class 2 malocclusion. The cause is often the result of loss of E space in an arch due to early loss of primary molar teeth and mesial (forward) migration of the molar teeth. Sometimes molars are distalized to make space for other impacted teeth, such as premolars or canines, in the mouth.

ACCO or Acrylic Cervical Occipital Anchorage is an appliance in field of orthodontics which is used for distalization of maxillary molars. This appliance is a removable type of appliance which was developed by Herbert I. Margolis. This appliance is intended to be worn 24 hours a day except during meals. It is one of the few removable appliances made for distalization of molars and thus require patient compliance for the treatment to be successful.

Intrusion is a movement in the field of orthodontics where a tooth is moved partially into the bone. Intrusion is done in orthodontics to correct an anterior deep bite or in some cases intrusion of the over-erupted posterior teeth with no opposing tooth. Intrusion can be done in many ways and consists of many different types. Intrusion, in orthodontic history, was initially defined as problematic in early 1900s and was known to cause periodontal effects such as root resorption and recession. However, in mid 1950s successful intrusion with light continuous forces was demonstrated. Charles J. Burstone defined intrusion to be "the apical movement of the geometric center of the root (centroid) in respect to the occlusal plane or plane based on the long axis of tooth".

Open bite is a type of orthodontic malocclusion which has been estimated to occur in 0.6% of the people in the United States. This type of malocclusion has no vertical overlap or contact between the anterior incisors. The term "open bite" was coined by Carevelli in 1842 as a distinct classification of malocclusion. Different authors have described the open bite in a variety of ways. Some authors have suggested that open bite often arises when overbite is less than the usual amount. Additionally, others have contended that open bite is identified by end-on incisal relationships. Lastly, some researchers have stated that a lack of incisal contact must be present to diagnose an open bite.

References

  1. aa (1994-01-01). By Ravindra Nanda – Temporary Anchorage Devices in Orthodontics (23379th ed.). Elsevier Health Sciences.
  2. Prezzano, Wilbur J. (1951-09-01). "Anchorage and the mandibular arch". American Journal of Orthodontics. 37 (9): 688–697. doi:10.1016/0002-9416(51)90180-7. PMID   14868756.
  3. Rachala, Madhukar Reddy (2011-12-12). Microimplants in Orthodontics: Temporary Anchorage Device. S.l.: LAP LAMBERT Academic Publishing. ISBN   9783847312062.
  4. Roberts-Harry, D.; Sandy, J. (2004-03-13). "Orthodontics. Part 9: Anchorage control and distal movement". British Dental Journal. 196 (5): 255–263. doi:10.1038/sj.bdj.4811031. ISSN   0007-0610. PMID   15017408. S2CID   36848924.
  5. Nanda, Ravindra (2005-04-12). Biomechanics and Esthetic Strategies in Clinical Orthodontics. Elsevier Health Sciences. ISBN   978-1455726110.
  6. Wehrbein, Heiner; Göllner, Peter (2007-11-01). "Skeletal anchorage in orthodontics--basics and clinical application". Journal of Orofacial Orthopedics. 68 (6): 443–461. doi:10.1007/s00056-007-0725-y. ISSN   1434-5293. PMID   18034286. S2CID   39899842.
  7. "The effectiveness of cortical anchorage in patients treated with Class II elastics: Gary Pulsipher Department of Orthodontics, University of Illinois, 1991". American Journal of Orthodontics and Dentofacial Orthopedics. 102 (1): 97. 1992-07-01. doi:10.1016/S0889-5406(05)80990-4.
  8. Urias, Dayse; Mustafa, Fatima Ibrahim Abdel (2009-07-15). "Anchorage Control in Bioprogressive vs Straight-wire Treatment". The Angle Orthodontist. 75 (6): 987–92. PMID   16448242.