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ORTHODONTIC TREATMENT WITH USE OF IMPLANT ANCHORS
The above graphic depicts a problem that has perplexed both patients and dentists over the years: A missing lower molar with a space in front of it. The problem has been that when orthodontic forces are used to move the molar forward, often the anchorage on the teeth in front of the molar forces them backward, resulting in loss of control of the direction of tooth movement. In the above graphic, a small implant has been placed behind the last molar and a titanium wire attached to brackets on the smaller teeth in front of the larger molars. The implant will provide indirect anchorage of these smaller teeth so that as the molars are gradually pulled forward, the forces that normally would move the smaller teeth backward are now directed toward and absorbed by the implant. These forces are small enough that the implant does not have to achieve integration to the bone prior to being loaded. Orthodontics can therefore commence as soon as soft tissue healing of the implant is complete.
The above graphic depicts the cross-section of the implant in the jaw bone. Over the course of treatment, the implant will become intimately integrated with the bone. At the end of treatment, it is usually removed with a special device called a trephine bur, which fits around the implant and spirals down in a clockwise motion, separating it from the surrounding bone. The bone will fill in the space and tissue healing over the site is very rapid.
The above x-ray depicts a case where both the patient and the dentist want to close a space in front of a lower molar on the right side of the jaw. It shows the implant in place with the titanium wire attached with brackets to the forward teeth (bicuspids). There is also a wire placed on the tongue side from the molar to the bicuspids to control the movement in a sideways direction as the molar slowly moves forward. The initial movement of the molar will occur fairly rapidly approaching 0.5mm per month and then begins to slow as denser cortical bone is encountered. Sheets of cortical bone will move out in front of the molar, as it moves forward, maintaining the boney envelope of the teeth.
The above x-ray depicts the final outcome of the case with the
space closed and the bicuspids in their normal alignment. The bite or
occlusion is now correct and the patient looks, feels and chews
better. Many orthodontic cases that could not be managed properly
prior to dental implants, are now being routinely treated in a timely
fashion. The future of modern orthodontics is now! The following case, graphics and x-rays were provided by Dr. Eugene
Roberts who is currently Director of the Division of Orthodontics,
Indiana University School of Dentistry and is also the Chairman of the
Department of Oral Facial Development. This case has been reprinted
with the permission of the Journal of the Indiana Dental Association. |
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