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Clinical Use of Skeletal Anchorage System For Orthodontic Treatment

Clinical Use of Skeletal Anchorage System For Orthodontic Treatment. 길병원 치과 센터. Introduction. Maximum Anchorage Skeletal Anchorage. Maximum Anchorage. Intraoral device : Unstable & inefficient Extraoral device : Depends on the patient’s cooperation. Skeletal Anchorage. Ankylosis

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Clinical Use of Skeletal Anchorage System For Orthodontic Treatment

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  1. Clinical Use of Skeletal Anchorage System For Orthodontic Treatment 길병원 치과 센터

  2. Introduction • Maximum Anchorage • Skeletal Anchorage

  3. Maximum Anchorage • Intraoral device : Unstable & inefficient • Extraoral device : Depends on the patient’s cooperation

  4. Skeletal Anchorage • Ankylosis • Implant • Onplant ( Palatal implant ) • Miniscrew • Miniplate

  5. History • Gainsforth and Higley (1945) : Orthopedic anchorage by placing metallic screws and wires in the dog ramus • Smith(1977), Sherman(1978) : Forces were applied from implant to implant to test their stability under such loading with endosseous implants

  6. History • Costa(1998) : Miniscrews as orthodontic anchorage • 박 효상 (2000) : Micro-implant anchorage를 이용한 sliding mechanics • 정 규림 등(2000) : 구강내 고정원으로서 titanium miniscrew의 이용증례(2)

  7. The Characteristics of SAS • Elimination of compliance-dependent intraoral and extraoral anchorage aids • Relatively predictable outcomes • Favorable esthetics • Reduction of orthodontic appliances

  8. Miniscrew Advantage • Convenience of insertion & removal with self-tapping • Medication is useless • Early loading of orthodontic force Disadvantage • Loosening • Infection • Injury to adjacent anatomical structures

  9. Miniscrew Placement • Maxilla : Anterior nasal spine Midpalatal suture Infrazygomatic ridge • Mandible : Retromolar region Symphysis Edentulous area of the alveolar process

  10. Miniscrew surgical procedure

  11. Miniplate • Advantage : Wide range of placement • Disadvantage : Surgical procedure is more difficult Periodontal problem Cost

  12. Miniplate surgical procedure

  13. Material & Method

  14. Patients • Period : 2000. 2 ~ 2001. 9 • Patient Age : 12 ~ 35 yrs • Patient number : 47 ( M/16 , F/31 )

  15. Materials • Screw : Osteomed co. Autoscrew 1.6/2.0mm(D), 8.0mm(L) • Plate : Surgical titanium miniplate

  16. Indication • Canine retraction • Anterior teeth retraction • Intrusion • Molar distal movement

  17. Canine retraction

  18. Anterior teeth retraction

  19. Intrusion

  20. Molar distal movement

  21. Failure • Indication • Loosening • Position • Infection

  22. Cause of failure • Poor position : 4/95 (4%) • Loosening : 18/95 (19%)

  23. Failure of screw vs plate • Screw : 15/70 (21%) • Plate : 7/25 (28%) • Total : 22/95 (23%)

  24. Failure of Mx vs Mn • Maxilla : 12/50 (24%) • Mandible : 10/45 (22%) • Total : 22/95 (23%)

  25. Pre-loading loosening Screw 5/70 (7%) Mx. 1/35 (3%) Mn. 4/35(11%) Plate 1/25 (4%) Mx. 1/15 (7%) Mn. 0/10 (0%) Post-loading loosening Screw 6/70 (9%) Mx. 5/35 (14%) Mn. 1/35 (3%) Plate 6/25 (24%) Mx. 4/15 (27%) Mn. 2/10 (20%) Loosening

  26. Clinical consideration in successful SAS • Placement • Design • Oral hygiene management • Prevention of damage to adjacent anatomic structure

  27. Conclusion • SAS presented absolute anchorage value • But screw loosening is a major problem

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