Skeletal Anchorage in Orthodontics – Basics and Clinical Application

Abstract

This review article describes the basics and clinical applications of skeletal anchorage in orthodontics, namely: areas of indication, anchorage devices, insertion areas, indications, potential complications, and their use in growing patients. The areas for skeletal anchorage include orthodontic-prosthetic anchorage, orthodontic anchorage, and skeletal anchorage in orthopedic therapy procedures. The anchorage devices currently available are: prosthetic implants, mini screws, palatal implants, onplants, bone anchors, zygoma wires and skeletally-supported distractors. The insertion areas described so far (according to therapeutic procedure and bone supply available) include edentulous jaw sections, the interdental septum, infra-apical and supra-apical areas, the palate (median, paramedian, lateral), the retromolar area, and the zygomatic bone. Force systems are applied (direct or indirect anchorage) according to surgical and orthodontic or orthopedic requirements. Skeletal anchorage devices should be selected according to the following criteria. Is the anchorage task unifunctional or multifunctional? How many anchorage devices are required for the therapy in question? What is the success rate of the various anchorage devices; what are the applicable biomechanics and soft tissue or hard tissue conditions in the insertion area? The success rates for miniscrews are currently between 80% and 90%, and over 90% for palatal implants. The potential of skeletal anchorage is broadening the current orthodontic treatment spectrum, guaranteeing the practitioner absolute control of anchorage by avoiding the unpredictable reactions of periodontal anchorage, leading to a reduction in unwanted side effects.

Orthodontic space closure after first molar extraction without skeletal anchorage

“…B. die Gesichtsmaske nach Delaire-Verdon [17] oder intraorale maximale Verankerungen durch Implantate oder Schrauben zur Verfügung. Diese Formen der skelettalen Verankerung können je nach Knochenangebot als Minischrauben in die interradikulären Septen des bezahnten Alveolarfortsatzes oder als Gaumenimplantat im anterioren Palatinum inseriert werden [24,25].…”

“…by employing extraoral anterior anchorage via a Delaire-Verdon orthopedic mask [17] or intraoral maximum anchorage using implants or screws. These forms of skeletal anchorage can, depending on the bone quality, be fixed using miniscrews in the interradicular septum of the alveolar process or as an anterior palate implant [24,25].…”

Stability comparison between commercially available mini-implants and a novel design: Part 1

“…1 Despite the tremendous success of mini-implants in facilitating treatment outcomes, however, the stability of mini-implants remains an important issue that needs to be resolved because failure rates are widely variable and could be as high as 25%. 2,3 As the potential uses of mini-implants have broadened, recent studies have focused on examining factors contributing to failure and evaluating stability.…”

Long-term Effects of Traumatic Injuries to Incisors and Periodontal Tissues during Childhood

“…Kahl-Nieke [29] favorisiert den orthodontischen Lü-ckenschluss im Wechselgebiss bei Platzmangel, Protrusion der oberen Schneidezähne, nach distal geneigten Kronen der Nachbarzähne, konvexem Profil und vertikalem Wachstumstyp sowie Anlage aller Zähne. Allerdings ist zu beachten, dass in heutiger Zeit durch skelettale Verankerung die Nebenwirkungen (Mittellinienverschiebung, Abflachung des Zahnbogens, konkaver Profilverlauf oder Einengung des Zungenraums) konventioneller intraoraler Apparaturen vermieden werden können [56].…”

“…KahlNieke [29] favors orthodontic space closure in the mixed dentition where there is dental crowding, protrusion of the upper incisors, distal crown inclination of adjacent teeth, a convex profile and vertical growth pattern, as well as primordia of all the teeth. It is worth noting however that the sideeffects of conventional intraoral appliances (midline displacement, flattening of the dental arch, concave profile or space deficit for the tongue) can be avoided nowadays by skeletal anchorage [56].…”