Clinical Use of Skeletal Anchorage System For Orthodontic Treatment

1
Clinical Use of Skeletal Anchorage System For
Orthodontic Treatment

??? ?? ??
2
Introduction

• Maximum Anchorage
• Skeletal Anchorage

3
Maximum Anchorage

• Intraoral device
• Unstable inefficient
• Extraoral device
• Depends on the patients cooperation

4
Skeletal Anchorage

• Ankylosis
• Implant
• Onplant ( Palatal implant )
• Miniscrew
• Miniplate

5
History

• Gainsforth and Higley (1945) Orthopedic
  anchorage by placing metallic screws and wires in
  the dog ramus
• Smith(1977), Sherman(1978) Forces were applied
  from implant to implant to test their stability
  under such loading with endosseous implants

6
History

• Costa(1998) Miniscrews as orthodontic anchorage
• ? ?? (2000) Micro-implant anchorage? ???
  sliding mechanics
• ? ?? ?(2000) ??? ?????? titanium miniscrew?
  ????(2)

7
The Characteristics of SAS

• Elimination of compliance-dependent intraoral
  and extraoral anchorage aids
• Relatively predictable outcomes
• Favorable esthetics
• Reduction of orthodontic appliances

8
Miniscrew

• Advantage
• Convenience of insertion removal with
  self-tapping
• Medication is useless
• Early loading of orthodontic force
• Disadvantage
• Loosening
• Infection
• Injury to adjacent anatomical structures

9
Miniscrew

• Placement
• Maxilla Anterior nasal spine
• Midpalatal suture
• Infrazygomatic ridge
• Mandible Retromolar region
• Symphysis
• Edentulous area of the
  alveolar process

10
Miniscrew surgical procedure
11
Miniplate

• Advantage
• Wide range of placement
• Disadvantage
• Surgical procedure is more difficult
  
• Periodontal problem
• Cost

12
Miniplate surgical procedure
13
Material Method
14
Patients

• Period 2000. 2 2001. 9
• Patient Age 12 35 yrs
• Patient number 47 ( M/16 , F/31 )

15
Materials

• Screw Osteomed co. Autoscrew
• 1.6/2.0mm(D), 8.0mm(L)
• Plate Surgical titanium miniplate

16
Indication

• Canine retraction
• Anterior teeth retraction
• Intrusion
• Molar distal movement

17
Canine retraction
18
Anterior teeth retraction
19
Intrusion
20
Molar distal movement
21
Failure

• Indication
• Loosening
• Position
• Infection

22
Cause of failure

• Poor position 4/95 (4)
• Loosening 18/95 (19)

23
Failure of screw vs plate

• Screw 15/70 (21)
• Plate 7/25 (28)
• Total 22/95 (23)

24
Failure of Mx vs Mn

• Maxilla 12/50 (24)
• Mandible 10/45 (22)
• Total 22/95 (23)

25
Loosening
26
Clinical consideration in successful SAS

• Placement
• Design
• Oral hygiene management
• Prevention of damage to adjacent anatomic
  structure

27
Conclusion

• SAS presented absolute anchorage value
• But screw loosening is a major problem