Mini-implants in Orthodontics: A Review

Transcription

1 Annals of Dental Research (2013) Vol 3(1): 6-10 HATAM Publishers: All Rights Reserved Annals of Dental Research Review Mini-implants in Orthodontics: A Review Singla Suchinder a, Kalra JPS a, Bansal Parul a, Bhatia Pankaj a, Goyal Amit a a Department of Orthodontics, Guru Nanak Dev Dental College, Sunam, Punjab, India Correspondence to Dr. Suchinder Singla Department of Orthodontics, Guru Nanak Dev Dental College, Sunam, Punjab, India suchindersingla@yahoo.in Article Info Received: 13 May 2013 Revised: 25 June 2013 Accepted: 01 July 2013 Abstract Clinicians continue to need anchorage that displays a high resistance to displacement.according to Newton's Third Law, there is a reaction for every action, control of which isdifficult to achieve intraorally. Earlier, orthodontists used extraoral traction to reinforceintraoral anchorage. Nevertheless, patients seldom used headgears 24 hours a day- 7days a week, hence this source of anchorage was often compromised.development of thesimple, stable, and easy-to-use orthodontic mini-implantrepresents a critical turning point in the search for effortlesscontrol of orthodontic anchorage.of course, many problems remain unresolved. Giventhe relatively short (10-year) history of the use of miniimplantsin orthodontic treatment, long-term data is necessarily limited. This review presents the complete history of orthodontic mini implants along with the pros and cons and the different clinical situations in which they can be used. Annals of Dental Research (2013) 3 (1): 6-10 Keywords: Implants, orthodontics, anchorage Copyright: 2013 Singla et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 6

2 Mini-implants Singla et al Introduction Sometimes in orthodontics the Mandible Retro molar area dictum divide and rule has to be Intra radicular area followed; be it the separate movement of crown and root of a particular tooth or movement of one particular tooth or few teeth at a time. This is usually done to avoid the unwanted mesial migration of the posterior teeth into the available space (Anchor Loss).Temporary anchorage devices provide an answer to this. This article will provide an insight into the temporary anchorage devices used in orthodontics. Classification : 1. According to shape Straight/cylinders Tapered Stepped 2. According to site Maxilla Infrazygomatic crest area Maxillary tuberosity area Intra radicular between the roots both buccally and palatally Mid palatine area Mandibular symphysis Others Edentulous areas 3. According to material METALS AND METAL ALLOYS Titanium Tantalum Alloys of titanium/ aluminium/vanadium Cobalt/chromium/molybdenum Chromium/iron/nickel Titanium and its alloys are most widely used. CERAMICS AND CARBONS Aluminium oxide (aluminium and sapphire) ceramics Carbon Carbon silicon compounds. POLYMERS AND COMPOSITES Polymethylmethacrylate Silicon rubber Polyethylene Polylactide 7

3 Singla et al Mini-implants Uses: a) Used for retraction of anterior teeth, b) Uprighting of molars. c) Mesiodistal tooth movement, d) Open bite correction (archived by intruding posterior teeth: skeletal anchorage) e) Distalization of 1st and 2nd molars f) Intrusion of teeth g) Compromised anchorage in periodontally involved teeth where anchorage is a problem/congenital anomalies and developmental defects of jaws which may result in inadequate anchorage. h) Replacement of missing teeth after the completion of orthodontic treatment (should be done only after completion of craniofacial growth) Surgical procedure: Direct method To place mini-implant directly without an Incision Indicated in placements over In majority of the cases More predictable results Indirect Method Placements over 'unattached gingiva' Will require a vertical incision of 2 to 5 mm in length. Relatively less commonly used The implant will be covered by the gingival tissue Micro-implant Driving Methods Self Tapping - Pre-Drilling with a suitable drill 0.2 mm less than that of the mini implant to be implanted Self Drilling - No need to pre-drill Just use a round bur or a small 2 to 4 mm drill to get a 'purchase point', especially when angulating the implant Surgical Procedure for Self Drilling Step I-isolate the region and apply surface anesthetic (15% Lidocanine) Step II-anesthetize using infiltration 0.2 ml anesthetic Step III-mark the exact location using the periodontal probe. 'attached gingiva' 8

4 Mini-implants Singla et al Step lv-using the tissue punch expose the bone -exposed bone would cause the bleeding point to be visible Step V-under copious irrigation make pilot hole (using a round bur or drill-2 to 4 mm in length) through the cortical bone (optional but preferable) Step VI-using the adaptor/screw driver provided screw the mini- implant into the bone, or use an implant physio-dispenser. Surgical procedure for removal of mini-implant Since the mini-implant does not osseointegrate the mini-implant can be easily unscrewed using the screw driver provided. It leaves small bleeding point which heels without any medication or suturing required. Contraindications: 1. Medical Temporal (flu, pregnancy, etc.) (Auto) immune diseases Terminal illness Inability to restore with prosthesis Use of corticosteroids Radiotherapy of the head, (tumoricidal radiation of implant site) Severe Diabetes mellitus Psychological problems (unrealistic patient expectation) 2. Dental Anatomy-nerves (too close), sinus, etc. Local pathology-cyst, roots stumps, gum problems, etc. Microbiology-bacterial sensitive. Bad oral hygiene Lack of operator expertise Motivation Non cooperative patient 3. General Finance Touring job (unable to keep appointments) Attitude Spastic patient Conclusion: As is said that the only thing constant in this world is CHANGE and orthodontics is no exception. Temporary anchorage devices have made the treatment more efficient and made the treatment outcome more predictable in this fast moving world. 9

5 Singla et al Mini-implants References 1. Gainsforth BL, Higley LB.A study of orthodontic anchorage possibility in basal bone. Am J Orthod 1945; 31: Citation : Singla Suchinder, Kalra JPS, Bansal Parul, Bhatia Pankaj, Goyal Amit. Mini-implants in Orthodontics: a review. Annals of Dental Research 2013; 3 (1): Umemori M, Sugawara J, Nagasaka H,Kawamura H. Skeletal anchorage system for open-bite correction. Am J OrthodDentofacial Orthop1999; 115: Roberts, WE, Nelson, CL, Goodacre CJ.Rigid implant anchorage to close amandibular first molar extraction site. J ClinOrthod 1994; 28: Creekmore TD, Eklund MK.The possibility of skeletal anchorage.j ClinOrthod 1983; 17: Kanomi R.Mini implant for orthodontic anchorage.j ClinOrthod 1997; 31: Bae SM, Park H.S, Kyung HM, Kwon OW, Sung JH.Clinical Application of Micro-Implant Anchorage.J ClinOrthod 2002; 36: Kyung HM, Park HS, Bae SM, Sung JH, Kim IB.Development of orthodontic microimplants for intraoral anchorage. J ClinOrthod 2003; 37: