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Anchorage in Orthodontics: a Literature Review

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Anchorage in Orthodontics: a Literature Review Review article Annals and Essences of Dentistry 5368/aedj.2016.8.2.3.2 ANCHORAGE IN ORTHODONTICS: A LITERATURE REVIEW 1 Siva Krishna P 1 Post graduate 2 Prasad Mandava 2 Professor and Head 3 Gowri sankar Singaraju 3 Professor 4 Vivek Reddy Ganugapanta 4 Reader 1-4 Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India. ABSTRACT Abstract : During orthodontic treatment the teeth are exposed to forces and moments, and these acting forces always generate reciprocal forces of the same magnitude but opposite in direction which follows Newton’s third law. To avoid unwanted tooth movements and maintain treatment success, these reciprocal forces must be diverted effectively. In orthodontic treatment, anchorage loss is a potential side effect of orthodontic mechanotherapy and one of the major causes of unsuccessful results. Its cause has been described as a multifactorial response in relation to the extraction site, appliance type, age, crowding, and overjet.Therefore, clinicians throughout the years have made an effort to find biomechanical solutions to control anchorage. The purpose of this article is to review the basics of anchorage and the anchorage planning in different appliance systems. KEYWORDS: Anchorage, Anchor loss, Anchorage planning in different appliance systems. INTRODUCTION Anchorage is the word used in orthodontics to mean and comfortable could make appliance design simplified resistance to displacement. Every orthodontic appliance and more efficient. consists of two elements an active element and a resistance element. The active parts of the orthodontic The present article will focus on anchor saving appliance are concerned with tooth movements. The measures and anchorage concepts in different appliance resistance units provide resistance (anchorage) that systems in orthodontics. makes tooth movements possible. According to Newton’s third law there is equal and opposite reaction to every DEFINITIONS action. Therefore in orthodontics, all anchorage is relative and all resistance is comparative 1. Louis Ottofy defined it as the base against which orthodontic force or reaction of orthodontic force is During orthodontic treatment the teeth are exposed to applied 2. forces and moments, and these acting forces always generate reciprocal forces of the same magnitude but Moyers defined anchorage as Resistance to opposite in direction. To avoid Unwanted Tooth displacement. 1 movements and maintain treatment success, these reciprocal forces must be diverted or resisted. The T.M. Graber 3 defined anchorage as the nature and degree orthodontist must decide where the resistance to the of resistance to displacement offered by an anatomic unit forces is needed to produce the desired tooth Movement when used for the purpose of effecting tooth movement. .Utilization of the resistance of dental units should be the first consideration. If this proves to be inadequate, it must Accordin g to Proffit: Anchorage is Resistance to be supplemented by other anchorage sources, either unwanted tooth movement. Resistance to reaction forces intraoral Extra oral, or both. that is provided (usually) by other teeth, or (sometimes) by the Palate, head or neck (via extra oral force), or implants Skeletal anchorage expand the range of biochemical in bone. 4 possibilities with screws, pins or some readily removable implants anchored to the jaws, so that forces might be Nanda defined anchorage as the amount of movement of applied to produce tooth movement in any direction posterior teeth (molars, premolars) to close the extraction without detrimental reciprocal forces. Orthodontic forces space in order to achieve selected treatment goals.5 might be applied directly to the jaws through skeletal anchorage. Intra-oral skeletal anchor units that are Pullen defined anchorage as selection of adequate and predictably stable, relatively non-interfering, biocompatible properly distributed resistance units for control and Vol. VIII Issue 2 Apr –Jun 2016 7c Review article Annals and Essences of Dentistry direction of force applied to the teeth for dental arch the use of T.P.A., Nance holding arch, lower lingual arch. development or for lesser tooth moment .6 Tissue anchorage such as obtained by lip bumper can be efficiently used to distalize molars. Stoner defined anchorage as source which can resist the reactions of orthodontic forces . According to the jaws involved: CLASSIFICATION OF ANCHORAGE 1. Intra maxillary: Anchorage established in the There are different classifications same jaw. 2. Inter maxillary: Anchorage distributed to both 6 PULLEN CLASSIFICATION : jaws.Baker’s anchorage (1904) Based on Form of Based on source of According to the site of anchorage : attachment resistance 1. Intra oral : Anchorage established within the a. Pivotal a. Intermaxillary mouth. b. Reinforced b. Occipital 2. Extra oral : Anchorage obtained outside the c. Stationary c. Cervical oral cavity a) Cervical : e.g. neck straps MOYERS CLASSIFICATION 1: b) Occipital : e.g. Head gears c) cranial : e.g. high pull headgears According to the manner of force application d) Facial : e.g. face masks a. Simple anchorage : Resistance to tipping. b. Stationary anchorage : Resistance to bodily movement. 3. Muscular: Anchorage derived from action of c. Reciprocal anchorage : Two or more teeth muscles. e.g. Vestibular shields. moving in opposite directions and pitted against each other by the appliance. According to the number of anchorage units: Simple Anchorage: 1. Single or primary anchorage Anchorage involving only one tooth. Dental anchorage in which the manner and application of 2. Compound anchorage : force tends to displace or change axial inclination of the Anchorage involving two or more teeth. tooth or teeth that form the anchorage unit in the plane of 3. Reinforced anchorage : space in which the force is being applied. In other words Addition of non-dental anchorage Sites. resistance of anchorage unit to tipping is utilized to move e.g. Mucosa, muscle, head, etc. another tooth or teeth. 7 Nanda classified anchorage as Stationary anchorage: 1. A anchorage: critical / severe Dental anchorage in which the manner and application of 75% or more of the extraction space is needed force tend to displace the anchorage unit bodily in the for anterior retraction. plane of space in which the force is being applied is 2. B anchorage: moderate termed stationary anchorage (Graber). Relatively symmetric space closure (50%) 3. C anchorage: mild / non critical Reciprocal Anchorage: 75% or more of space closure by mesial movement of posterior teeth It involves pitting of two teeth or two groups of teeth of equal anchorage value against each other to produce 8 reciprocal tooth movement eg: closing diastema, two MARCOTTE’S CLASSIFICATION (1990) :. central incisors are pitted against each other. Group A Anchorage : Also refers to maximum posterior Reinforced anchorage: anchorage. 75% or more space required for anterior retraction. The biomechanical paradigm is to increase It involves reinforcing the anchorage or resistance area posterior M/F ratio (beta M/F ratio) relative to the anterior either by adding more resistance units or by the use of M/F ratio (Alfa M/F ratio). various adjuncts. A simple way of reinforcing anchorage is to band the second molars. Various other ways include, Vol. VIII Issue 4 Jan –Mar 2016 8c Review article Annals and Essences of Dentistry Group B Anchorage : Simplest form of space closure. to anchor unit by patient wearing extra oral appliance The requirement includes equal translation of the anterior (head gear) placing backward force against the upper and posterior segments into the extraction space. Equal arch.Use of skeletal anchorage systems. and opposite moments and forces are indicated. Group C Anchorage : Also refers to maximum anterior 2. SUBDIVISION OF DESIRED TOOTH MOVEMENT anchorage. 75% of space closure achieved through mesial movement of posterior teeth. The biomechanical A common way to improve anchorage control is to pit paradigm is to increase anterior M/F ratio (i.e. Alfa M/F the resistance of a group of teeth against the movement of ratio) relative to posterior M/F ratio (i.e. beta M/F ratio) a single tooth rather than dividing the arch into or less equal segments e.g. to reduce strain on posterior GIANELLY AND GOLDMAN (1971) 9: anchorage – retraction of canine individually. 1. Maximum Anchorage 3. TIPPING /UPRIGHTING 11 2. ModerateAnchorage 3. Minimum Anchorage Another possible strategy for Anchorage control is to tip the teeth and then upright them rather than moving SOURCES OF ANCHORAGE 10 them bodily. INTRAORAL SOURCES 4. FRICTION AND ANCHORAGE CONTROL STRATEGIES 12 I.ALVEOLAR BONE In a typical extraction case it is desired to close the II.TEETH extraction space 60% by retraction of anterior teeth and 40% by forward movement of posterior segments. This Roots form, Size of the roots, Number of roots, Position of can be obtained by 3 approaches: tooth, Axial inclination of the teeth, Root formation., • One step space closure with a frictionless Contact points and Intercuspation are the factors which appliance. decide anchor value of a tooth . • Two step procedure by sliding the canine, then III.BASAL BONE retracting the incisors.( tweed technique ) • Two step closure by tipping the anterior segment Certain areas of the basal bones like the hard with some friction and then up righting the tipped palate and the lingual surfaces of the mandible in the teeth. anterior regions can be used to augment the anchorage 13 5. CORTICAL ANCHORAGE
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