TEMPORARY

ANCHORAGE
DEVICE

By:
Dr. Srivani
Dept of Orthodontics
 Introduction
 Terminology
 Timeline of dental implant dentistry CONTENTS
 Physiology of osseointegration
 Implants structure
 Classification
 Indications
 Contraindications
 Sites of placement
 Surgical placement procedure
 Complications CONTENTS
 Biomechanical consideration
 Clinical applications
 Conclusion
 References
INTRODUCTION
 Definition Of Implant

• Implants are defined as alloplastic device (foreign substance

i.e.metal,ceramic,plastic) which are surgically inserted into or onto the jaw bone -
Boucher

• Implantation is transfer of non-living tissue into biologic system.

• Osseointegration: An intimate structural contact at the implant surface and adjacent

vital bone, devoid of any intervening fibrous tissue - Branemark (1983)
• Gainforth & Higley(1945) first published the use of
subperiostel vitallium implant to retract maxillary canines
in dog

• Linkow (1969) described endosseous blade implants with

perforation for orthodontic anchorage.

• Kawahara( 1975) developed Bioglass coated ceramic

implant for orthodontic anchorage.
• Brane Mark ( 1977) Mentor of Modern Implant Surgery described the high
compatibility and strong anchorage of titanium in human tissue.

• Bromer et al 1977, Hench et al 1973 Introduced various bioactive ceramics such as

glass ceramic.

• Sherman' (1978) placed the first orthodontic implants.

• Creekmore(1983) reported the possibility of skeletal anchorage in orthodontics

• Roberts(1984) used conventional two stage implant in the retromolar region to help
reinforce anchorage successfully closing first molar extraction site in the mandible .

• Turley et al ( 1988) used endo-osseous implants in dogs as anchorage for the

application of variety of orthodontic and orthopaedic forces
• Weherbein and Colleagues (1990’s) developed palatal implants called “Straumnn
orthosystem” which was specially designed for orthodontics anchorage

• Block and Hoffman (1995) introduced the onplant to provide orthodontic anchorage.

• Kanomi (1997) first reported the clinical use of mini implants for orthodontic
anchorage.
 Physiology of Osseointegration

 Temporary Anchorage Devices in Orthodontics,Ravindra Nanda

12
Biology of osseointegration

13
 Temporary Anchorage Devices

• Device that is temporarily fixed to bone for the purpose of enhancing orthodontic
anchorage either by supporting the teeth of the reactive unit or by obviating the need
for the reactive unit altogether, and which is subsequently removed after use.
 Jason B. Cope, Shannon E. Owens
MINISCREWS:

 Less surgical procedure and easy installation.

 Titanium miniscrews are ideal anchorage system

 well accepted by patients and are simple to insert and remove.

 The miniscrew can be loaded immediately

MINIPLATES:

 The Miniplate Implants are comprised of bone plates and fixation screws.

 The plates and screws are made of commercially pure titanium that is
biocompatible and suitable for osseointegration.

 Onplants These are button type implants used in the palatal region. They
serve as anchorage source for expansion as well maxillary protraction.
osseointegration

 Application of Orthodontics Mini- Implants

Jong Suk Lee, Jung Kook Kim; textbook
 Structure of Implants

Implant

Head Body
(Serves as)

Attachment source for

Abutment in prosthetic
elastics & coil springs in
rehabilitation
orthodontic treatment
 Parts of implants

The commonly used implant screw/plate has two parts

a) Implant head

b) Implant body
 Head

• The head must be of sufficient dimension.

• A small diameter and lower profile of the miniscrew head (Lee et al 2009)
24
 Neck

Transmucosal portion that passes through the mucosa.

• It should be smooth and well polished.

• Most miniscrew failure begins with peri-implant

inflammation at this site.
 Screws

 It embeds into cortical and medullary bone to provide retention.

 Cutting edge facilitates insertion.

 Screws are either cylindrical or tapered.

 Screws are designed as:

a. Self drilling
b. Self tapping types
 Screw size and diameter

Size ranges in –
 Length : 4-12 mm
 Diameter : 1.2- 2.7 mm
 Thread design

Self Drilling:
 It does not require a pilot hole.
 It has either a sharp or a tapered apex to allow placement or a notch in the tip to drill
through the cortex.

Self Tapping:
 These screws are unable to create their own thread as the advance in the bone
 Two designs are available that are-
 Thread cutting
 Thread forming
 Classification of materials

Biotolerant Stainless steel

Cobalt chromium alloy

Bioinert Titanium
Carbon

Bioactive Hydroxyapatite
Ceramic oxidized aluminium

Resorbable Polylactic acid

Polyglycolic acid

 Application of orthodontic miniimplants Jong Suk Lee Jung kook kim Robert vanarasdall
 Development of microimplants
 Initially screw were used 1.2 mm in diameter and 5-10 mm in length.

Drawback: Lack of superstructure on the head to attach elastics.

Now ,hooks,button or bracket on head which minimizes
inflammation.
Ligature wire was tied on neck and bent
Hook caused persistant inflammation
into hook
Design of new mini – implant
  Characteristics of an ideal anchorage device include
SMALL AFFORDABLE

BIOCOMPATIBLE EASY TO PLACE

ROUTINELY RESISTANT TO
EASY TO REMOVE ORTHODONTIC FORCES

USABLE WITH FAMILIAR ABLE TO LOAD

ORTHODONTIC MECHANICS IMMEDIATELY

 Temporary Anchorage Devices in Orthodontics: Clinical Experimentation or Evidence-Based? Dr.

Jason Cope
 Factors Affecting Success of Mini-Implants- A Review: Dr. Nagarathna KN:
The Orthodontic Cyber Journal, Feb 2012

1. Length: 

2. Diameter:
3. Miniscrew head

4. The Trans-gingival Collar:

 A review of biomarkers in peri-miniscrew implant crevicular fluid (PMICF) Kaur et al; 
Progress in orthodontics 2017(18):42-50
 Factors affecting Primary Stability

• Primary stability is the mechanical

interlocking with the cortical bone when
the mini implant is placed.

1. Bone quality
2. Implant design:

a. Length and diameter: Mizrahi E 2007, Mini-implants

of 1.4–1.9 mm diameter and 5–8 mm length had the
highest success rate

b. Pitch & flutes: Brinley CL et al 2009 analyzed that

higher placement torque and pullout strength shown for
the 0.75 pitch when compared with 1.0 mm and 1.25
mm pitch
c. Self drilling and Self tapping: Chen Y et al in
2008, stated that success rates were higher in the self-
drilling group (93%) than in self-tapping group (86%).

3. Material of the screw: Papadopoulos MA et al

(2011) reported success rates of 87.7% for both
Titanium alloy and Stainless steel. The Stainless steel
provides greater mechanical characteristics.
4. Based on the placement site: Martinelli FL et al in 2010 stated that the molars were
favorable sites for skeletal anchorage. Placing anchorage in anterior sites requires even
more careful planning,

5. Angle of insertion: Park HS et al 2006 Ajodo, suggested that insertion angle of 30°–
40° in maxilla and 10°–20° in the mandible
 Secondary Stability

• Secondary stability occurs due to remodelling of bone.

Factors affecting secondary stability:

• Oral hygiene/ Periodontal health

• Mucosal type
• Onset of loading
• Smoking
 Immediate Loading and Delayed Loading

• Nakagaki et al 2014, observed that the bone mineralization of the compression region
of cortical bone surrounding immediately loaded miniscrews was significantly higher
than that of the tension region.

• Chaddad et al (2008 Angle orthod), Elevating a flap for insertion was reported to

reduce success rate and resulted in failure of immediate loaded implants and showed
screw emergence at the oral mucosa  e.g., palate, retromolar area.
 Methods of measuring the stability

1. Invasive technique

 Histological
 Cutting torque resistance analysis
 Pullout test

2. Non-invasive technique

 Radiographs
 Tapping test/ Percussion test
 Periotest/ Impact hammer method
 Resonance frequency analysis
 Finite element analysis
 Bone density and MISCH classification

Dense cortical bone.

D1 Anterior mandible
Buccal shelf area
midpalatal region

Porous cortical bone

D2 with coarsefrm
trabeculae
Regions D 1 to D3
Anterior maxilla
are adequate for TAD
Midpalatal region
Posteriorinsertion.
mandible
TADS can be placed in
Porous
D1 to D3cortical bone
regions with 70-
D3 with fine trabeculae
90percent success.
posterior maxilla
Posterior mandible

Fine trabeculae bone

D4 Tuberosity region  Misch CE. Contemporary implant dentistry. 2nd
ed.
 Classification of TAD’s
Subperiosteal
1. Based on the Location: Transosseous

Endosseous

2. Based on the Configuration Design

Root form implants

Screw designs Blade/Plate Implants

Dentos absoanchor Aarhus implant Spider screw, OMAS Skeletal Graz implant- Zygoma
implant system system, Leone mini- anchorage supported anchorage
implant. system (SAS) system system.
 
Depending upon the area of implantation

Subperiosteal
Endosteal
Transosseous
ii) Depending on shape

Screw type
Disc type
Blade type
3. According to the Composition

Stainless Cobalt- Titanium Ceramic Miscellaneous

steel chromium- implants vitreous carbon &
molybdenum(Co composites
-Cr-Mo)

Alpha Beta Alpha-Beta phase Ti-6Al-4V

4. According to the Surface Structure

Threaded or Nonthreaded Porous or Nonporous

 Role of Mini-implants in Orthodontics, International Journal of Oral Implantology and Clinical

Research, Sep-Dec 2011
 Classification of Implants for Orthodontic Anchorage

1. According to the shape and size:

I) Conical (Cylindrical)

a) Miniscrew Implants
b) Palatal Implants
c) Prosthodontic Implants

II) Mini plate Implants

III) Disc Implants (Onplants)

2. According to Implant bone contact:

I) Osteointegrated
II) Non-osteointegrated

3. According to the application:

I) Used only for orthodontic purposes. (Orthodontic Implants) or TAD (temporary

anchorage devices)

II) Used for prosthodontic and orthodontic purposes

 Temporary anchorage devices in orthodontics, Gowri sankar.Singaraju, Annals and

Essences of Dentistry , July – September 2009
 Temporary anchorage devices in orthodontics, Gowri sankar.Singaraju, Annals and
Essences of Dentistry , July – September 2009
 Temporary anchorage devices in orthodontics, Gowri sankar.Singaraju, Annals and
Essences of Dentistry , July – September 2009
 Indications for placement of implants
 Maximum anchorage cases

 Patient with several missing teeth making it difficult to engage posterior units

 Intrusion of anterior and posterior segments and distalization

 Where asymmetrical tooth movement is needed

 To treat borderline cases with non extraction method

 When patient is not willing to undergo orthognathic surgery

 Contraindication for Implant Therapy

Absolute Contraindications

 Bleeding Disorders
 Bone Metabolism Disorders
 Immuno-compromised
 Diabetes Mellitus
 Anti-coagulant treatment
 Pregnancy
 Xerostomia
 Titanium allergy
Relative Contraindications
 Insufficient volume of bone
 Poor bone quality
 Patients undergoing radiation therapy
 Insulin dependent diabetes
 Heavy smokers.

57
SAFE ZONES

58
‘‘Safe Zones’’: A Guide for Miniscrew Positioning in the Maxillary and Mandibular
Arch, Paola Maria Poggioa; Cristina Incorvatib; Stefano Velob; Aldo Carano†b (Angle
Orthod 2006;76:191–197.)

 In green are the zones with a

mesiodistal measure over 3.1 mm.

 In blue are the zones with a

mesiodistal measure between 2.9 and
3.1 mm.
 Poggio PM, Incorvati C, Velo S, Carano A. ‘‘Safe Zones’’: A Guide for Miniscrew
Positioning in the Maxillary and Mandibular Arch. Angle Orthod 2006;76:191–197

60
 Am J Orthod Dentofacial Orthop. 2005 Jun;127(6):713-22. Dental implants
for orthodontic anchorage. Huang LH, Shotwell JL, Wang HL

Safety distance = Diameter1.2

of the implant + 2  .PDL
375
space
+ Minimum distance between
1.5
implant and tooth, i.e 1.5 mm

4.95 mm.
 Insertion Angle

• Angled insertion either to the long tooth axis or the occlusal plane has been
suggested to increase bone-to-implant contact and reduce anatomic structures
injury risk.

• Angled insertion to the long tooth axis of 30°–40° in the maxilla and 10°–
20° in the mandible has been suggested.

 Park HS, Jeong SH, Kwon OW. Factors affecting the clinical success of screw
implants used as orthodontic anchorage. Am J Orthod Dentofacial Orthop
2006;130:18-25

63
• Angulation to the occlusal plane was suggested to be 30°–45° for the posterior
maxilla and mandible 

• whereas approximately 90° for the anterior maxilla and posterior edentulous maxilla

• Steeper angulation (<30°) increases miniscrew slippage risk.

 Lim SA, Cha JY, Hwang CJ. Insertion torque of orthodontic miniscrews
according to changes in shape, diameter and length. Angle Orthod 2008;78:234-
40

64
Anatomic Regions of
Implant Placement &
Clinical Applications
 SITES OF PLACEMENT:

MAXILLA MANDIBLE

 Infrazygomatic crest area.  Retromolar Area.

 Tuberosity area.  Between 1st and 2nd molars
 Between 1st and 2nd molars buccally. buccally.
 Mid palatal Area.  Between 1st molar and 2nd premolar
 Between 1st molar and 2nd premolar buccally.
buccally.  Between canine and premolar
 Between canine and premolar buccally. buccally.
 Between incisors facially.
 Selection of Microimplant Sites and Sizes

• Microimplants with diameters ranging from 1.2 to 1.6 mm are small enough to be
placed anywhere in the mouth.

• Microimplant lengths of more than 6 mm in the maxilla, and 5 mm in the mandible

are recommended.

 Role of Mini-implants in Orthodontics, International Journal of Oral Implantology and

Clinical Research, Sep-Dec 2011
 Uses of orthodontic mini-implants
 Used for retraction of anterior teeth ,

 Uprighting of molars,

 Open bite correction.

 Deep bite correction

 Molar mesialization

 Molar distalization
 Maxilla

 Infrazygomatic Crest Area:

Recommended micro-implant size:
Diameters of 1.3 and 1.4mm and a length Place your screenshot here
of 5 to 6 mm.
 Maxillary Tuberosity Area:
Recommended micro-implant size:
Diameters of 1.3 and 1.5 mm
Length of 7 to 8 mm.

70
 Between the Maxillary First Molar and Second
Premolar Buccally:

Recommended micro-implant size: Place your screenshot here

Diameters of 1.2 and 1.3 mm

Length of 7 to 8 mm.
 Between the Incisors Facially

Recommended micro-implant size:

Diameters of 1.3 and 1.6 mm and a
Length of 6 to 7 mm.
 Between the Maxillary First Molar and
Second Premolar Palatally:

Recommended microimplant size:

Diameters of 1.3 and 1.6 mm and a Length
of 10 to 12 mm. Place your screenshot here
 Mid-Palatal Area

Recommended microimplant size:

Diameters of 1.5 and 1.8 mm
Length of 5 to 6 mm.

74
 Between the maxillary 1st molar and 2nd molars
bucally

Recommended microimplants :
Diameter of 1.2 and 3mm
Length of 7-8mm
 Between canine and premolar
buccally

Recommended microimplants
Diameter of 1.2 and 1.3mm
Length of 7-8mm
 Mandible

 Retromolar Area

Recommended micro-implant size:

Diameters of 1.4 and 1.6 mm and a length of
5 to 10 mm.
 Between the Mandibular First Molar and
Second Premolar Bucally

Recommended micro-implant size:

Diameters of 1.3 and 1.6 mm
Length of 5 to 7 mm.

78
 Between mandibular first and second molar
buccally

Recommended microimplants:
Diameter of 1.2-1.4mm
Length of 5-7mm
 Mandibular Symphysis Facially
Recommended micro-implant size:
Diameters of 1.3 and 1.4 mm and a length of
5 to 6 mm. Place your screenshot here
 Cleaning and Sterilization
1. Conventional cleaning

2. Ultrasonic cleaning

3. Rinsing and drying

4. Sterilization

 Microimplant (AbsoAnchor system)catalogue_ Korean 9th ed jan 2014

5. Step by step sterilization procedures including Microimplants using the kit case
6. Microimplant installation procedures into driver

7. Sterilized Package - No need sterilization

Surgical procedure
for implant
placement
 Surgical Procedures

A. One-Step Self Drilling (Drill-Free) Method (Attached Gingival Area)

B. Two-Step Self Drilling (Drill-Free) Method (Attached Gingival Area)

C. Self-Tapping (Pre-Drilling) Method (Attached Gingival Area)

D. Self-Tapping (Pre-Drilling) Method (Movable Mucosal Area)

 Standardized procedures

1. Preoperative examination stage

2. Marking stage

3. Perforating stage

4. Guiding stage

5. Finishing stage
 Application of orthodontic miniimplants textbook; Jong Suk Lee Jung kook kim Robert
vanarasdall
 1) Preoperative examination stage

 Insertion site is selected according to the anatomic conditions and biomechanical

requirements

 Confirmation should be done by both clinical and radiographic examinations.

 Administration of LA.
 Infiltration Topical

Mucosal
patch
 2. Marking stage

 Periodontal probe is used to mark horizontal

and vertical reference lines on the gingiva
 A brass wire used to determine proper anteroposterior and vertical
placement of a microimplant
Surgical stents for accurate miniscrew insertion. Richard R J Cousley, David J
Parberry,J Clin Orthod. 2006 Jul;40(7):412-7; quiz 419

Plaster separating media is applied over it and it is

pressure formed using a thermoforming baseplate.

Drill
Miniimplant
a hole
XMark
inanalogue
RAYthe
the
iscast,
planned
used is
5mminserted
to location
deep,manually
determineatwith
the
the prescribed
using the
Guide
Abutment
cylinder
if fitted
is placed
over over
the analogue
abutment
insertion site,
pen on
angulations,
place screwdriver
working cast.
of insertionand inclination
 Micro-implant Positioning Guide , Hemanth, Sudhanshu Verma, Technique Clinic
2012
 Orthodontic Micro-Implants- Technology and Clinical Applicaions,
Georgeta Zegan,Romanian Journal of Oral Rehabilitation, April 2009

3) Perforating stage

CORTICAL BONE

IMPLANT ORLUS SURGICAL DRILL

4) Guiding stage

Engaged screw is inserted at a planned angle

Rotation of the screw with minimal vertical

force
Palm grip is recommended for
Pen grip is not recommended
Perforating and guiding stage
5) Finishing stage
Implant inserted to the planned depth

Head exposed to an adequate extent

 Finishing solely with rotational force is crucial to maximize contact with the cortical
bone
For the finishing stage, it is better to use the finger grip because rotation
should be applied very cautiously. The handle should be grasped gently with only 3
fingers.
10
0
Post operative instructions
 Emergency situations
MARKED MOBILITY MEANS A FAILURE

IF EXTRUDED REIMPLANTATION REQUIRED

SWELLING DRAINAGE OF PUS

CONTINUOUS PAIN
Removal
 Risks & Complications
 Miniscrew slippage

 Nerve involvement

 Trauma to the periodontal ligament or the dental root during insertion can lead
to ankylosis.

 Air subcutaneous emphysema

 Nasal and maxillary sinus perforation

 Miniscrew bending and fracture during insertion

 Aphthous ulceration due to tissue irritation

 Soft tissue inflammation, infection and peri-implantitis

 Miniscrew fracture during removal.

Causes of Orthodontic Mini- Implant failure and ways to avoid them

Host Factors:
Optimize site selection
1.Thick cortical bone
2.Good soft tissue
condition Maintenance Factor
Avoid Overload
Implant Factors:
Operator Factors: Ensure Design for enhanced
proper manipulation stability
1. Avoid vibration 1. Maximize cortical bone
2. Minimize surgical support
trauma 2. Minimize surgical
3. Standardize procedures trauma
3. Use biocompatible
material
Insertion Torque

10
7
• The rotational axis of the torque tester was rotated clockwise at a speed of 3
rotations per minute, and the torque values were recorded every 0.1 second
using a computer program (QuickDataAcq, SDK Developer, London, UK).

10
8
 Surface
Roughness of
Miniscrews

10
9
 Surface Roughness of Miniscrews

To increase surface roughness:

 Lasers
 Machined surface
 Acid etched surface
 Resorbable blasting media (RBM)
 Coatings of hydroxyapatite powder
 RBM+ Machined (Hybrid)
 Anodized surface

 Influence of surface treatment on the insertion pattern of self-drilling orthodontic mini-

implants

11
0
SEM image of orthodontic mini implants (× 10). A, Machined surface; B, acid etched
surface; C, RBM surface; D, hybrid surface. The surface difference between C and D
is observed. SEM, Scanning electron microscope; RBM, resorbable blasting media.

11
1
Recycling of Mini-
Implants

11
2
 Effects of recycling on the biomechanical characteristics of retrieved orthodontic
miniscrews; Soon-Dong Yuna,Sung-Hwan Choia,Jung-Yul ChaKorean J Orthod
2017;47(4):238-247]

11
3
Recent Advances
In TADS
SUMMARY
 CONCLUSION

• Implants have revolutionized the field of anchorage in orthodontics.

• The presently available implant systems are bound to change and evolve into more
patient friendly and operator convenient designs.

• So by choosing a proper selection mini implant insertion site, angle, length and
diameter we can get good results in orthodontic treatment
REFERENCES
• Seminars in Orthodontics Volume 11, Issue 1 , Pages 47-56, March 2005 Minibone
plates: The skeletal anchorage system

• Seminars in Orthodontics Volume 11, Issue 1 , Pages 40-46, March 2005 miniscrew
implants: The Spider Screw anchorage system

• Temporary Anchorage Devices in Orthodontics,Ravindra Nanda

• Application of orthodontic miniimplants Jong Suk Lee Jung kook kim Robert
vanarasdall
• Temporary Anchorage Devices in Orthodontics: Clinical Experimentation or
Evidence-Based? Dr. Jason Cope
• A review of biomarkers in peri-miniscrew implant crevicular fluid (PMICF) Kaur et
al; Progress in orthodontics 2017(18):42-50
• Role of Mini-implants in Orthodontics, International Journal of Oral Implantology
and Clinical Research, Sep-Dec 2011
• Misch CE. Contemporary implant dentistry. 2nd ed
• Temporary anchorage devices in orthodontics, Gowri sankar.Singaraju, Annals and
Essences of Dentistry , July – September 2009
• Safe Zones’’: A Guide for Miniscrew Positioning in the Maxillary and Mandibular
Arch, Paola Maria Poggioa; Cristina Incorvatib; Stefano Velob; Aldo Carano†b
(Angle Orthod 2006;76:191–197.)
• Micro-implant Positioning Guide , Hemanth, Sudhanshu Verma, Technique Clinic
2012
• Orthodontic Micro-Implants- Technology and Clinical Applicaions, Georgeta
Zegan,Romanian Journal of Oral Rehabilitation, April 2009
• Surgical stents for accurate miniscrew insertion. Richard R J Cousley, David J
Parberry,J Clin Orthod. 2006 Jul;40(7):412-7; quiz 419
•
It's not how far you fall but how high you bounce
that really matters.“ ~ Zig Ziglar.

THANK
YOU!