IMPLANTS IN ORTHODONTICS
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Introduction Classification of Implants Material used for Implants Osseointegration Use of Implants in Orthodontics
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 Linkow- Father of oral Implantology.
 Implants are defined as alloplastic devices which are surgically inserted into or onto the jaw bone-Boucher.
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Classification of Implants. Based on their location: Subperiosteal
Transosseous
Endosseous
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Classification of Implants  According to their body geometry:-
-Threaded or Non threaded
-Porous or non porous
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Materials used for Implants In 16 &17th century –Ivory dental implants . 20th century-Metal Implant devices. 1940 &1960’s-CoCrMo subperiosteal & titanium blade implants.
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1970’s-Non metal biomaterials
1982-Branemark Implant.
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 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. www.indiandentalacademy.com
 Titanium:-exist in 3 forms -Alpha -Beta -Alpha-Beta phase (most commonly used). Ti-6Al-4V  Modulus of elasticity is equal to bone.
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Titanium:“Passivity”. •
Metal with surface coatings Hydroxyapatite
Tricalcium phosphate.
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Ceramics:Bioglass-contain oxides of Ca, Na, Si. Polymers & Composites. Other Implant Materials like Gold, Palladium, Tantalum, Platinum, Zirconium. www.indiandentalacademy.com
OSSEOINTEGRATION. Term & concept of Osseointegration -Branemark. “An intimate structural contact at the implant surface and adjacent vital bone devoid of any intervening fibrous tissue.” www.indiandentalacademy.com
Evolution of the concept of osseointegration  Vital microscopic studies of the rabbit fibulatitanium chambered microscopes.  Series of experiments:-Titanium fixtures for immobilization of autologous bone grafts. - Tooth implants studies for healing & anchorage stability. www.indiandentalacademy.com
 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.
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Biology of osseointegration. Hematoma
Callus formation
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Bone remodeling
Fibrous tissue
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Principles of osseointegration Factors important for reliable bone anchorage of an Implanted device. Implant biocompatibility:-
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Principles of osseointegration.  Implant Design:-
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Implant surface:-
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 State of the host bed:-
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 Surgical technique:-
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 Loading condition:-
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Use of Implants in Orthodontics ďƒ˜
Growth Studies.
ďƒ˜
Anchorage Orthodontic
Orthopaedic -Maxillary protraction
-Maxillary expansion
-Space closure
-Intrusion -Molar distalization
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Growth Studies: Implants are the best means of reference points for studying the longitudinal growth studies.
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Growth Rotations -Bjork & skeiller .
Growth of Cleft lip & palate patients - Shaw
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ANCHORAGE:
Orthopeadic correction-
Two methods for obtaining the Skeletal anchorage:
Intentionally Ankylosed teeth.
Endosseous Implants.
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 Maxillary Expansion:-
- Guyman(1980)
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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.
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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.
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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. www.indiandentalacademy.com
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.
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Impacted Titanium Post for Anchorage -Frederic Bousquet etal(1996)
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Mini-Implant for Orthodontic Anchorage:-Ryuzo Kanomi(1997)
 Mini-Implant is 1.2mm in diameter and 6mm in length.
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Mini-Implants for space closure.
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Mini-Implants for molar intrusion
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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.
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 Procedure for miniplate insertion:-
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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.
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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
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Micro Implant  Dimension of micro implant are 1.2mm in diameter & 6mm in length.
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Micro-Implant for anchorage in Lingual orthodontics
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MAGNETS IN ORTHODONTICS
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Introduction Types of magnetic materials Properties of magnets Application of magnets in orthodontics. www.indiandentalacademy.com
In 1953, magnets were first used for denture retention by BEHRAN & EGAN.
Use of magnets in orthodontic- BLECHMAN & SMILEY.
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PROPERTIES OF MAGNETS
 Flux Density
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In dentistry, ferromagnetic materials with static field are used. Magnetocrystalline Anisotropy. Coercivity.
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 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)
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 High force to volume ratio.
 Maximal force at shorter distances.
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No interruption of magnetic force lines by intermediate media. No friction in attractive force configuration.
No energy loss.
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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
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 SAMARIUM-COBALT (SmCo5&Sm2Co17) MAGNETS:-
-high resistance to demagnetization.
-corrosion resistance.
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 Advantages:-Continuous force is exerted. - Eliminates the patient co-operation. -No friction.  Disadvantages:-Tarnish &corrosion products are cytotoxic. -Cost factor
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 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. www.indiandentalacademy.com
APPLICATIONS OF MAGNETIC APPLIANCES 1. 2. 3. 4. 5. 6.
Tooth intrusion Expansion Tooth Impaction Space closure Molar distalization Magnetic Edgewise brackets
7. 8.
Functional Appliances. Retainers.
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 Tooth Intrusion:Active Vertical Corrector-Dellinger(1986) -Samarium cobalt magnets in the repelling mode are used.
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 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.
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EXPANSION:-Vardimon et al(1987) demonstrated palatal expansion using two types of magnetic devices in Macaca fascicularis monkeys. -Tooth borne appliance
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 Tissue borne appliance (attached directly to palate by endosseous pins).
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 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.
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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
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3 magnet configuration to enhance CL-II mechanics
3 magnet configuration used to simultaneously move all 4 canines distally www.indiandentalacademy.com
CL-II mechanics using magnetic force system in CL-II extraction case.
Repulsive CL-II mechanics in CL-II Nonextraction cases.
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 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.
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 Magnetic Edgewise Brackets:-Kawata(1987) -Samarium cobalt magnet with an edgewise bracket (o.018slot) .
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 Functional Orthopaedic Magnetic Appliances:Vardimon(1989) -for correction of CL-II&CL-III malocclusion.
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 Magnetic Twin Block:Clark(1996) -Samarium cobalt magnets were embedded in the inclined surface of the twin block in attractive mode.
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 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
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MAD-II FOR CORRECTION OF CL-II,DIVISION 1 MALOCCLUSION.
Deep Bite
open Bite
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 MAD III
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 MAD - IV
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MAD IV(a)
MAD IV( b)
MAD IV( c)
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 Treatment of CL-II bimax with magnetsDarendelier&Joho(199 2) -Autonomous fixed magnetic appliance.
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 Propellant Unilateral Magnetic Appliance (PUMA) - Chate(1995) Magnets are use to stimulate costo-chondral bone graft in Hemi facial microsomia.
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 Retainers:-Springate & Sandler(1991) -micro magnets made of neodymium iron boron magnets as a fixed retainer in a patient with persistent diastema.
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 Bibiliography:-
-Dentofacial Orthopedics with functional appliances-T.M Graber, Rakosi,Petrovic. -
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