Implants in Orthodontics - A Litterature Rewiev

Transcription

1 Implants in Orthodontics - A Litterature Rewiev Thorir Schiöth University of Berne, Switzerland School of Dental Medicine Department of Orthodontics

2 Implants in Orthodontics Published reports with specific fixtures Dental implants (Braanemark, ITI and etc.) Vitallium bone screw (Creekmore & Eklund 1983) Retromolar implants (Roberts et al. 1990) Flat screw implants (Triaca et al. 1992) Onplants (Block & Hoffman 1995) Palatal implants from Straumann-Orthosystem, Schweiz (Wehrbein et al. 1996,1999 and Fritz et al. 2003) Mini-implants (Kanomi 1997) Zygomatic wires (Melsen et al. 1998) Miniplates (Umemori et al. 1999) Mini-screws (Costa et al and Park, Lee,Kim,Jee 2003) Auto-drive Screw from Osteomed Corp., Dallas, USA (Park, Kyong,Sung 2002) Absoanchor from Dentos inc., Taegu, Korea (Kyong et al. 2003) Spider Screw from HDC Company, Sarcedo, Italy (Maino, BG et al. 2003) Distraktion devices

3 Implants in Orthodontics Brodie et al First of all it should be recognized that there is no such thing as true anchorage available within the mouth. We have at our command only different degrees of resistance. These differences are determined mainly by (1) the form and area of the root surfaces and (2) the nature of the surrounding bone

4 Implants in Orthodontics Ismail et al The use of dental implants has greatly increase over the last three decades, largely as a consequence of their longterm osseo-integration. This has led to increased orthodontic use, with appropriate modifications in the design when required... Implants as a source of absolute anchorage

5 Implants in Orthodontics Absolut Anchorage Ankylosed teeth Osseointegrated dental implants Palatal implants Distraktion devices Miniplates Onplants Zygoma anchorage system Zygomatic wires

6 Miniscrews for orthodontic anchorage Increased Anchorage Mini-implants Mini-screws Micro-implants Arhus-implants Bicortical titanium-screws Spider-screws

7 Implants in Orthodontics Absolut Anchorage Increased Anchorage

8 Miniscrews for orthodontic anchorage Immediate loading (Melsen & Costa 2000) 8mm length conical titanium vanadium Aarhus Screw Screw head with.022 X. 028 bracket 2 perpendicular slots

9 Miniscrews for orthodontic anchorage Immediate loading (Melsen & Costa 2000) 4 adult male monkeys (macaca fascicularis) 2 screws in the mandible in the symphysis area 2 screws in the infrazygomatic crest Screws loaded with Sentalloy springs delivering 25g and 50g of force Springs extended between the screw and the canine Observation period of 1, 2, 3, 4 and 6 months

10 Miniscrews for orthodontic anchorage Immediate loading (Melsen & Costa 2000) 6mm intrabony part and 2mm transmucosal

11 Miniscrews for orthodontic anchorage Immediate loading (Melsen & Costa 2000)

12 Miniscrews for orthodontic anchorage Immediate loading (Melsen & Costa 2000) Beginning of osseointegration following 1 month of loading

13 Miniscrews for orthodontic anchorage Immediate loading (Melsen & Costa 2000) Osseointegration covering a considerable part of the surface

14 Miniscrews for orthodontic anchorage Immediate loading (Melsen & Costa 2000) Time month 1 Infrazygomatic crest Osseointegration (%) 0 SD Mandibular symphysis Osseointegration (%) 0 SD

15 Miniscrews for orthodontic anchorage Immediate loading (Melsen & Costa 2000) Conclusion: effective anchorage for orthodontic displacment of teeth supports the Theory of Immediate Loading

16 Fixture Materials Bioinert: Titanium, Titanium-Vandadium, Hydroxide-Apatite and vitreous Carbon Bioactive: Porcelain (Aluminium oxide Ceramics, Vetroceramic Apatite) Biodegradable: polylactide implants Biotolerant: Stainless steel (Vitallium, Cobalt-Chromium, Nickel-ChromiumVanadium alloys), Gold alloys, Ticonium and etc.

17 Titanium in Medicine Material Science, Surface Science, Engineering, Biological Responses and Medical Applications Editors Donald M. Brunette, University of British Columbia, Vancouver, Canada Pentti Tengvall, Linköping University, Linköping, Sweden Marcus Textor, Swiss Federal Institute of Technology, Zürich, Switzerland Peter Thomsen, Göteborg University, Göteborg, Sweden Textor et. al (

18 Fixture Materials -Titanium Textor et. al ( Titanium is a higly reactive metal. In fact, titanium is so reactive that it forms oxides (or nitrides) when exposed to almost any oxygen- (or nitrogen-) containing species. Titanium is used in ultrahigh vacuum equipment as a very efficient reactive pump, irreversible reacting with almost all type of species present as gases in vacuum systems, exept noble gases.

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20 Fixture Materials Titanium Titaniumoxide Contamination Surface Scientist

21 Implant Shape Cylindrical Onplants Plates

22 Implant Shape Onplants (Block & Hoffman 1995)

23 Implant Shape Onplants (Block & Hoffman 1995) Titanium alloy disk, coated with hydroxylapatite on one surface

24 Implant Shape Onplants (Block & Hoffman 1995) Healing screw Transgingival abutment designed to receive a inch wire

25 Implant Shape Onplants (Block & Hoffman 1995)

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27 Implant Shape Miniplates (Umemori et al. 1999) L-shaped miniplate Fixed by bone screws (length 5mm or 7mm)

28 Implant Shape Miniplates (Umemori et al. 1999) Surgical Technique

29 Implant Shape Miniplates (Umemori et al. 1999) Advantages No preparation to obtain a location for implantation Stable rigid anchorage Immediate loading Simplified treatment mechanics Shorthening orthodontic treatment time

30 Implant Shape Miniplates

31 Implant Sizes Dental Implants: 3-4 mm in diameter, 6-10 mm in length Mini-Implants (Kanomi) 1.2 mm in diameter, 6 mm long

32 Anatomical Sites Subperiosteal Transosseous Endoosseous Combinations?

33 Anatomical Sites Palate Retromolar area Chin-Symphysis Alveolar bone (Premolar, Molar area) Zygomatic arch Anterior nasal spine Vestibular

34 Anatomical Sites Miniscrews (Costa et al. 1998) Location for miniscrews in the maxilla Midpalatal suture and below anterior nasal spine Infrazygomatic ridge

35 Anatomical Sites Miniscrews (Costa et al. 1998) Location for miniscrews in the mandible Retromolar region

36 Anatomical Sites Miniscrews (Costa et al. 1998) Location for miniscrews in the mandible Alveolar process Symphysis

37 Biomechanics, Forces, and Time of Loading Substantial differences of Orthodontic-* and Prosthetic-**Forces. * Discontinuous, mostly vertikal measured in kilograms **Continous, mostly horizontal g

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39 Healing time Dental implants 3-6 Month Palatal implants weeks 2X6mm Mini-screws 4 weeks Immediate Loading?

40 Implants in Orthodontics Published reports with specific fixtures Dental implants (Braanemark, ITI and etc.) Vitallium bone screw (Creekmore & Eklund 1983) Retromolar implants (Roberts et al. 1990) Flat screw implants (Triaca et al. 1992) Onplants (Block & Hoffman 1995) Palatal implants from Straumann-Orthosystem, Schweiz (Wehrbein et al. 1996,1999 and Fritz et al. 2003) Mini-implants (Kanomi 1997) Zygomatic wires (Melsen et al. 1998) Miniplates (Umemori et al. 1999) Mini-screws (Costa et al and Park, Lee,Kim,Jee 2003) Auto-drive Screw from Osteomed Corp., Dallas, USA (Park, Kyong,Sung 2002) Absoanchor from Dentos inc., Taegu, Korea (Kyong et al. 2003) Spider Screw from HDC Company, Sarcedo, Italy (Maino, BG et al. 2003) Distraktion devices

41 Implants in Orthodontics 1. Dental implants

42 Implants in Orthodontics 1. Dental implants-disadvantages Limited in range of application by their relatively large size Difficulty of selecting proper implant sites Need to wait for osseointegration (~3 months) Invasiveness of the surgical procedure High costs (~ Fr ), especially when not used as a part of post treatment reconstruction

43 Implants in Orthodontics 3. Retromolar Implants (Roberts et al. 1990) Endosseous base: 6.90 mm length, 3.85 mm Cover screw and Transcutaneous screw

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45 Implants in Orthodontics 4. Flat screw implants (Triaca et al. 1992) 1992

46 Implants in Orthodontics 4. Flat screw implants (Triaca et al. 1992)

47 Implants in Orthodontics 6. Palatal implants (Wehrbein et al. 1996,1999 and Fritz et al. 2003)

48 Implants in Orthodontics 6. Palatal implants (Wehrbein et al. 1996,1999 and Fritz et al. 2003) Directly bonded Connected with sectionals

49 Implants in Orthodontics 7. Mini-Implants (Kanomi 1997) 1.2X6mm Mini-Implant-Surgical Procedure

50 Implants in Orthodontics 7. Mini-Implants (Kanomi 1997) Surgical Procedure

53 Implants in Orthodontics 7. Mini-Implants (Kanomi 1997) Placement of mini-implants for cuspid retraction

54 Implants in Orthodontics 7. Mini-Implants (Kanomi 1997) Placement of mini-implants for molar intrusion Figure 14

55 Implants in Orthodontics 8. Zygomatic Wires (Melsen et al. 1998) Inexpensive and simple method of anchorage for intrusion and retraction of maxillary incisors

56 Implants in Orthodontics 8. Zygomatic Wires (Melsen et al. 1998). Loading results in displacement of the wire within and finally outside the bone. Slight local irritation at the site of mucosa perforation

57 Implants in Orthodontics 10. Miniscrews (Costa et al. 1998) 2 different caps Head itself has 2 perpendicular grooves (0.022x0.028) Cap with a square 0.036inch tube

58 Implants in Orthodontics 10. Miniscrews (Costa et al. 1998) Titanium miniscrew 2-mm diameter, 9-mm length Penetration into the bone varies from 5 to 7 mm Extra bony part (intramucosal and extramucosal) thus vary from 2 and 4 mm

59 Implants in Orthodontics 10. Miniscrews (Costa et al. 1998) Inserted directly through the mucosa without any flap A hole with a diameter of 1.5mm was drilled Miniscrew was inserted manually Miniscrews were removed under local anestesia

60 Implants in Orthodontics 10. Miniscrews (Costa et al. 1998) Advantages: Easy to insert and remove Can be performed by an orthodontist Immediate loading Shortening treatment time

61 Implants in Orthodontics 10. Miniscrews (Costa et al. 1998) Disadvantages: Loosening of the miniscrew Local irritation Contact with nerves and roots Perforation of the sinus when placed in the infrazygomatic region

62 Implants in Orthodontics 13. Spider Screw (Maino et al. 2003) Self-tapping 7mm, 9mm or 11mm titanium miniscrew. Three heights to fit soft tissues of different thickness

63 Implants in Orthodontics 13. Spider Screw (Maino et al. 2003) 0.021x0.025 internal and external slot round vertical slot

64 Implants in Orthodontics 13. Spider Screw (Maino et al. 2003) Typical insertion areas: Maxillary tuberosity Retromolar areas Edentulous ridges Interradicular septi The palate Anterior alveolar process above the apices

65 Implants in Orthodontics 13. Spider Screw (Maino et al. 2003) Surgical Procedure: Minimal intraradicular distance: mm Surgical Index recommended when risk of damaging adajent structures Position determined radiographically using the long-cone parallel technique.

66 Implants in Orthodontics 13. Spider Screw (Maino et al. 2003) Surgical Procedure: A water cooled 1,5mm pilot drill with a stop corresponding to the length of the Spider Screw is used to perforate the soft tissue and cortical bone Miniscrews rely on mechanical retention rather than osseoingegration

67 Deguchi et al To analyze histomorphometric bone-implant interface and establish adequate healing period: 97% overall success rate (failures only during healing period) Once an implant was rigidly fixed within supporting bone, orthodontic loads were not threat to its osseous integration Implants with as little as 5% bone contact at the bone-implant interface successfully resisted orthodontic force 3-week healing period sufficient in dogs relates to about 4-5 weeks of healing in humans Critical healing time shorter

68 Schnelle et al A Radiographic Evaluation of the Availability of Bone for Placement of Minscrews primarily in the maxillary (mesial to first molar) and mandibular (mesial and distal to first molar) posterior regions. At most locations adequate bone for placement was located more than half way down the root length, which typically would be covered by movable mucosa Inability to place miniscrews in attached gingiva may necessitate design modifications to decrease soft tissue

69 Advantage of miniscrews Inexpensive (costs?) Inserted in any desired location, including intraradicular space Less traumatic surgery Immediate loading Withstand typical orthodontic forces of g NO osseointegration needed

70 Disadvantage of miniscrews Only mechanical retention Only sliding mechanics Risk of infection Proximity to nerves and roots Detrimental effect of shearing forces