A SIMPLE AND EFFECTIVE TECHNIQUE FOR AUGMENTING MOLAR ANCHORAGE

 

Introduction

Anchorage as defined by Graber1 is “the nature and degree of resistance to displacement offered by an anatomic unit for the purpose of effecting tooth movement”. One of the major concerns of our speciality is to provide adequate anchorage for selective movement of individual tooth or a group of teeth 2, 3, 4. Attaining maximum or absolute anchorage has always been an arduous goal for the practicing orthodontist often resulting in a condition, dreaded by most, called ‘anchorage loss’.

A number of methods/ appliances have been used in orthodontics to conserve anchorage. Some of these commonly used appliances are:

 

1) TRANSPALATAL ARCH: It is usually used for transverse and vertical anchorage control and usually used as a secondary source of anchorage and not as a primary one5, 6.

2) HEADGEAR: It provides adequate anchorage in all three planes but demands high level of patient cooperation7, 8.

3) NANCE BUTTON: It requires laboratory procedures 9.

4) SECOND MOLAR BANDING: It is a time consuming procedure and not favourable for patients with vertical growth pattern, often difficult when second molar are not completely erupted

5) FACE MASK: It demands patient cooperation.

6) MICRO SCREWS AND DENTAL DISTRACTION: These are invasive procedures and need extensive armamentarium and not cost efficient10, 11, 12.

The above mentioned modalities for reinforcing anchorage demand patient cooperation, require laboratory procedure, are invasive or are insufficient in providing anchorage especially in sagittal direction.

In our department we have incepted a simple, yet efficient technique of reinforcing anchorage in sagittal direction by bonding lingual buttons to the second molar of the maxillary and mandibular arch and then reinforcing anchorage by ligating both molars with active lace backs( Figure-1 and Figure -2).

   Figure 1  
  Figure 2

                                                                                              

 

 

Procedure:

1)  The buccal surface of second molar in the maxillary arch and mandibular arch is properly brushed with pumice and water along with all the usual precautions taken during bonding. (.i.e. keeping the field dry , applying etchant, washing the tooth surface properly, drying  the field again, applying primer and adhesive to the mesh of lingual button, and finally curing it with light cure) .

 

2)  The lingual button is then bonded on to the buccal surface of second molars in all the four quadrants.

 

3)  Active lace backs are tied from lingual buttons of the second molars to the molar tube of the first molar in all four quadrants using ligature wires (010 inches).

 

Discussion

Newer methods of conserving anchorage10, 11, 12  (micro implants, dental distraction) are invasive, whereas banding second molar is a time consuming procedure and cannot be performed with the same efficacy on malformed teeth. Sometimes accessibility also possesses a few problems. This newly incepted technique is simple in application and saves precious chair side time. The precaution has to be taken to reactivate the lace back every visit owing to linear distortion of ligature wire( elongation due to tensile loading) .The other advantages are:

 

1) No additional laboratory procedure.

2) Provides adequate anchorage in sagittal direction.

3) An effective method of obtaining anchorage in periodontally compromised cases because banding these teeth might further worsen the periodontal status.

4) Can be used effectively in vertically growing patients.

5) Economically beneficial.

6) No special armamentarium required.

 

In certain cases the buccal surface of maxillary second molar is not accessible in those cases the lingual button or beggs bracket with bracket being rotated 90° for easier insertion of ligature wire can be bonded on the palatal surfaces of the second molar.

 

Conclusion

 

Orthodontists have sought many solutions to augment anchorage. The technique presented in this article is simple, easy to apply, effective and provides adequate anchorage in the sagittal direction and anchorage can be used immediately after bonding.

 

References:

1.      Graber TM: Orthodontics: Principles and Practice. WB Saunders , 1998

2.      Hixon EH, Atikan H, Callow GE, Mc Donald HE, Tacy RJ. Optimum force, differential force and anchorage. Am J Orthod; 1969:55:5:437-456.

3.      Thompson WJ. Combination anchorage technique (CAT)-An update of current mechanics. Am J Orthod.1988; 93: 363-379.

4.      Geron S, Shpack N, Kandos S, Davidovitch M, Vardimon AD. Anchorage loss- a multifactorial response. Angle Orthod.2003; 73:730-737.

5.      Moyers RE. Handbook of orthodontics for the student and general practitioner. 2nd Ed. Chicago, III: Year Book Medical; 1963:261-262.

6.      Voytek B, Richard LC, Scott JH, David HK. Stress related molar responses to the transpalatal arch: a finite element analysis. Am J Orthod Dentofac Orthop. 1997; 112:512-518.

7.      Mc Laughlin RP, Bennet JC. Anchorage control; during levelling and aligning with a preadjusted edgewise appliance system. J Clin. Orthod. 1991; 25:687-696.

8.      Renfroe E W. The factor of stabilization in anchorage .Am J Orthod 1956; 42:86-97.

9.      Bondemark L, Kurol J. Distalization of first and 2nd molars simultaneously with repelling magnets. Eur J Orthod 1992; 14:264-272.

10. Carano A, Velo S, Incovati C, Poggio P. Mini-screw-anchorage-system(MAS) in the maxillary alveolar bone. J Ind Orthod Soc.2004; 37; 74-88.

11. Iseri H, Kisnisci R, Tuz H, Altug A. Dentoalveolar Distraction Osteogenesis for rapid orthodontic canine retraction. J Oral Maxillofac Surg 2002; 60:389-94.  

12. Iseri H, Bzeizi N, Kisnisci R. Rapid canine retraction using Dentoalveolar distraction Osteogenesis (Abstract). Eur J Orthod 2001; 23:453.

 

 

 

 

Contributing authors:
Dr. K. Nagaraj, Final year postgraduate student, Department of orthodontics and dentofacial orthopaedics, K.L.E.S Institute of dental sciences, Belgaum.
Dr. Sumit Yadav, (corresponding author) Final year postgraduate student, Department of orthodontics and dentofacial orthopaedics, K.L.E.S Institute of dental sciences, Belgaum.
Dr. Madhur Upadhyay, Final year postgraduate student, Department of orthodontics and dentofacial orthopaedics, K.L.E.S Institute of dental sciences, Belgaum.
Dr. Sameer Patil, Professor Department of orthodontics and dentofacial orthopaedics, K.L.E.S Institute of dental sciences, Belgaum.
Dr.K.M.Keluskar, Professor and head Department of orthodontics and dentofacial orthopaedics, K.L.E.S Institute of dental sciences, Belgaum.