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Implants in Orthodontics

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113 views94 pages

Implants in Orthodontics

Uploaded by

Matt Sanoudos
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

IMPLANTS

IN
ORTHODONTICS
 Introduction

 Classification of Implants

 Material used for Implants

 Osseointegration

 Use of Implants in Orthodontics


 Linkow- Father of oral Implantology.

 Implants are defined as alloplastic devices


which are surgically inserted into or onto
the jaw bone-Boucher.
Classification of Implants.
Based on their location:-
 Subperiosteal

 Transosseous

 Endosseous
Classification of Implants
 According to their body geometry:-

-Threaded or Non threaded

-Porous or non porous


Materials used for Implants
 In 16 &17th century –Ivory dental implants .

 20th century-Metal Implant devices.

 1940 &1960’s-CoCrMo subperiosteal &


titanium blade implants.
 1970’s-Non metal biomaterials

 1982-Branemark Implant.
 Stainless steel:-
-18% Cr & 8% Ni
-surface passivation is required
-subjected to crevice & pitting corrosion.

 Cobalt-Chromium-Molybdenum Alloy :-
-used in fabrication of custom designs
such as subperiosteal frames.
 Titanium:-exist in 3 forms
-Alpha
-Beta
-Alpha-Beta phase (most commonly used).
Ti-6Al-4V

 Modulus of elasticity is equal to bone.


 Titanium:-

“Passivity”.

• Metal with surface coatings

Hydroxyapatite Tricalcium phosphate.


 Ceramics:-
Bioglass-contain oxides of Ca, Na, Si.

 Polymers & Composites.

 Other Implant Materials like Gold,


Palladium, Tantalum, Platinum, Zirconium.
OSSEOINTEGRATION.

 Term & concept of Osseointegration


-Branemark.

“An intimate structural contact at the implant


surface and adjacent vital bone devoid of
any intervening fibrous tissue.”
Evolution of the concept of
osseointegration
 Vital microscopic studies of the rabbit fibula-
titanium chambered microscopes.

 Series of experiments:-
-Titanium fixtures for immobilization of autologous
bone grafts.
- Tooth implants studies for healing & anchorage
stability.
 Study done on dogs to find out the load
bearing capacity of implants.

Optical titanium chambers were implanted in


humans-to assess the tissue reactions of
titanium implants.
Biology of osseointegration.

Hematoma

Callus formation
Bone remodeling

Fibrous tissue
Principles of osseointegration
Factors important for reliable bone
anchorage of an Implanted device.

Implant biocompatibility:-
Principles of osseointegration.
 Implant Design:-
 Implant surface:-
 State of the host bed:-
 Surgical technique:-
 Loading condition:-
Use of Implants in Orthodontics

 Growth Studies.

 Anchorage

Orthopaedic Orthodontic
-Space closure
-Maxillary protraction
-Intrusion
-Maxillary expansion -Molar distalization
Growth Studies:-

 Implants are the best


means of reference points
for studying the longitudinal
growth studies.
 Growth Rotations -Bjork &
skeiller .

 Growth of Cleft lip & palate


patients - Shaw

.
ANCHORAGE:-

 Orthopeadic correction-

Two methods for obtaining the Skeletal anchorage:-

 Intentionally Ankylosed teeth.

 Endosseous Implants.
 Maxillary Expansion:-
- Guyman(1980)
Linkow-pioneer in the use of Implants in
Orthodontics.

 Pt’s with one or more missing teeth.


 Loss of teeth during the course of orthodontic
treatment.
 Pt’s with CL-II malocclusion & missing lower
posterior teeth.
 Periodontally compromised teeth.
Anchorage for orthodontic purpose.

Skeletal Anchorage:-
Creekmoore(1983)

-Vitallium bone screw placed below the


anterior nasal spine is used for intrusion of
Upper anteriors.

-6mm of upper incisor intrusion was seen


after one year.
Endosseous Implants for maxillary protraction
-Smalley etal (1988)

• A traction force of 600gm is used and protraction was


done till 8mm of anterior displacement of maxillary
complex occurred.
Use of Endosseous Implant for closure of
extraction site
-Eugene Roberts (1989)
 Endosseous Implants placed in the
retromolar region are used to close
the atrophic extraction site.
Impacted Titanium Post for Anchorage
-Frederic Bousquet etal(1996)
Mini-Implant for Orthodontic Anchorage:-
-Ryuzo Kanomi(1997)

 Mini-Implant is 1.2mm
in diameter and 6mm
in length.
Mini-Implants for space closure.
Mini-Implants for molar intrusion
Skeletal Anchorage system for Open bite correction
-Umemori , Sugawara etal (1999)

• Control of vertical dimension is


very important in correction of
anterior open bite

•‘L’ shaped titanium miniplates are used as a


Source of anchorage for intruding the molars.
 Procedure for miniplate
insertion:-
Onplant & Ortho-Implant.

 Onplant:-Block
&Hoffman.
 It is a flat disk shaped
fixture available in 8 and
10mm in diameter

 It has a HA coated surface


for integration with the
surrounding bone.
Ortho-Implant
- Celenza & Hochman

•Similar to onplant but it is an endosseous Implant.

•Its surface is sandblasted and etched to


increase the adhesion to the surrounding bone
Micro Implant

 Dimension of micro implant


are 1.2mm in diameter &
6mm in length.
Micro-Implant for anchorage
in Lingual orthodontics
MAGNETS

IN

ORTHODONTICS
 Introduction

 Types of magnetic materials

 Properties of magnets

 Application of magnets in orthodontics.


 In 1953, magnets were first used for denture
retention by BEHRAN & EGAN.

 Use of magnets in orthodontic- BLECHMAN &


SMILEY.
PROPERTIES OF MAGNETS

 Flux Density
 In dentistry, ferromagnetic materials with
static field are used.

 Magnetocrystalline Anisotropy.

 Coercivity.
 Coulombs law:-This law states that force between
two magnetic poles is directly proportional to
magnitude & inversely proportional to square of the
distance between them.

 Curie point:-Pierre Curie(1859-1906)


 High force to volume ratio.

 Maximal force at shorter distances.


 No interruption of magnetic
force lines by intermediate
media.

 No friction in attractive force


configuration.

 No energy loss.
TYPES OF MAGNETIC MATERIALS

 Platinum-cobalt(Pt-co)
 Aluminium-Nickel-Cobalt(Al-Ni-Co)
 Ferrite
 Chromium-cobalt-Iron
 Samarium Cobalt(SmCo)
 Neodymium-Iron-Boron(Nd2Fe B)
14
 SAMARIUM-COBALT (SmCo5&Sm2Co17)
MAGNETS:-

-high resistance to demagnetization.

-corrosion resistance.
 Advantages:-
-Continuous force is exerted.
- Eliminates the patient co-operation.
-No friction.

 Disadvantages:-
-Tarnish &corrosion products are cytotoxic.
-Cost factor
 Biological effect of magnetic forces:-

Aronson:-thinning of epithelium under


attracting & repelling magnets.

McDonald - proliferative activity of fibroblasts


in presence of static magnetic field

Lars Bondemark & Kurol studied changes in


human dental pulp and gingival tissue.
APPLICATIONS OF MAGNETIC
APPLIANCES
1. Tooth intrusion
2. Expansion
3. Tooth Impaction
4. Space closure
5. Molar distalization
6. Magnetic Edgewise brackets
7. Functional Appliances.
8. Retainers.
 Tooth Intrusion:-

Active Vertical Corrector-Dellinger(1986)


-Samarium cobalt magnets in the repelling mode
are used.
 Fixed Magnetic Appliance:-
-introduced by VARUN KALRA & CHARLES BURSTONE.
Appliance consists of an upper &lower acrylic splints with
samarium cobalt magnets in stainless steel casting
embedded in a repelling mode.
 EXPANSION:-Vardimon et al(1987) demonstrated
palatal expansion using two types of magnetic devices in
Macaca fascicularis monkeys.

-Tooth borne appliance


 Tissue borne appliance (attached directly to
palate by endosseous pins).
 Tooth Impaction:- Vardimon,Graber,Drescher
-Neodymium Iron Boron magnets can be used to
assist eruption of an impacted canine.

 Mancini(1996)-force levels are sufficient enough to


induce the cellular &biochemical changes are required to
produce orthodontic tooth movement.
space closure
-simple tooth movement without archwires :-Muller(1984)
-Complex Intra &Interarch Mechanics:-Blechman(1985)

CL-II mechanics with a magnetic force


system in a CL-I extraction case
3 magnet configuration to enhance
CL-II mechanics

3 magnet configuration
used to simultaneously
move all 4 canines distally
CL-II mechanics using magnetic force
system in CL-II extraction case.

Repulsive CL-II mechanics in CL-II


Nonextraction cases.
 Molar Distalization.
-Gianelly et al(1989):-repelling magnets in conjuntion with a
modified Nance appliance was used.
-Bondemark & Kurol:-repelling samarium cobalt magnets were
used for distalization.
 Magnetic Edgewise Brackets:-Kawata(1987)
-Samarium cobalt magnet with an edgewise bracket
(o.018slot) .
 Functional Orthopaedic Magnetic Appliances:-
Vardimon(1989)
-for correction of CL-II&CL-III malocclusion.
 Magnetic Twin Block:-
Clark(1996)
-Samarium cobalt magnets
were embedded in the
inclined surface of the twin
block in attractive mode.
 Magnetic Activator Device(MAD):-
-Darendilier (1993) developed this magnetically active
functional appliance.
MAD I-mandibular deviations
MAD II-CLII malocclusion
MADIII-CLIII malocclusion
MADIV-skeletal open bite correction.

MAD-II
MAD-II FOR CORRECTION OF CL-II,DIVISION 1
MALOCCLUSION.

Deep Bite

open Bite
 MAD III
 MAD - IV
MAD IV(a)

MAD IV( b)

MAD IV( c)
 Treatment of CL-II
bimax with magnets-

Darendelier&Joho(199
2)
-Autonomous fixed
magnetic appliance.
 Propellant Unilateral Magnetic Appliance (PUMA)
- Chate(1995)

Magnets are use to stimulate costo-chondral bone


graft in Hemi facial microsomia.
 Retainers:-Springate &
Sandler(1991)

-micro magnets made of


neodymium iron boron
magnets as a fixed
retainer in a patient with
persistent diastema.
 Bibiliography:-
-Dentofacial Orthopedics with functional appliances-T.M Graber,
Rakosi,Petrovic.
-

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