Feature Micro Implants in Orthodontics
By A. Korrodi Ritto, DDS, PhD
everal temporary osseous anchor systems have been
S introduced into the market as orthodontic anchorage
during recent years.
Implant orthodontics is in rapid expansion and devel-
oping in eastern Asian countries and will become an indis-
pensable modality in modern orthodontic therapy within
the next ten years.
Success or failure of the traditional edgewise treatment
depends on careful consideration to anchorage for tooth
movement. The use of implant anchorage simplifies ortho-
dontic treatment by sparing us the need for patient compli-
ance and the complexity of treatment.
Among different type of anchor implants, the bone
screws seemed to be more popular and widely accepted by
orthodontists, because they offer several advantages over
the other systems: smaller fixture, easier surgical procedures
and less trauma, lower cost and risk, more clinical indica-
Mesialization of lower molars (Figures 1-8)
Figure 1. First lower molars extracted. Figure 2. Lateral view.
Figure 5. Stabilization. Figure 6. Decay on lower first
molars.
The big advantage of the mini-implants as anchorage
for lower molars mesialization is that the lower front teeth
don’t change their position. With conventional anchorage, it
is a hard work to control the lower incisors torque, and
sometimes we spend more 6 months to correct this prob-
lem. Also due to reverse curve arches and heavy arches,
root resorption happen.
22
tions and more implant sites. Among the problems we can
describe are loosening, break and failure rate.
Following are photos highlighting many solutions for
orthodontic purposes with mini implants.
1—Mesialization of lower molars (fig 1-8)
2—Canine retraction (fig 9-11)
3—Upper incisor retraction (fig 12-16)
4—Lower Incisor intrusion (fig 17-18)
5—Upper molar intrusion (fig 19-20)
6—Close the bite (fig 21)
7—Premolar retraction (fig. 22- 27)
8—Upper molar mesialization (fig 28-31)
In this article we describe many solutions for orthodon-
tic purposes with mini implants.
Figure 3. Implant with traction. Figure 4. Molar is advanced.
Figure 7. Pre-orthodontics. Figure 8. Molars have been
advanced.
It is also very easy to control root parallelism during
mesialization, if we use a segmented arch with the point of
the coil spring fixation near to the center of resistance.
In this case, the #37 moved to the #36 position with a
good parallelism, however, on the other side, a conventional
technique was used and it takes more time and more diffi-
culties to get the same result.
IJO • VOL. 15 • NO. 3 • FALL 2004
Canine retraction (Figures 9-11, 11a)

Figure 9. Implant with traction. Figure 10. Canine retracted. Figure 11. Elastic for finishing. Figure 11a.
The canine distalization can be done in different ways, depending on the conditions. It is possible to use a spring coil, or
an elastomeric ligature, as well as different high of the mini-implant or the fixation system to the canine. If it is important to
get a root parallelism, it is better to attach the coil to a segmented wire, which passes through the vertical slot of the bracket.

Upper incisor retraction (Figures 12-16)

Figure 12. Traction in place.
Figure 13. Frontal view.
Figure 14. Retraction with looped
wire from the implant.
Upper canine retraction
can be done with crimpable
or weld clasps to the straight
wire in lingual or vestibular
fixed technique, or attached
directly to the loops or even
to a segmented retrusion
arch.

Lower incisor intrusion (Figures 17-18,

18a, 18b)

Figure 15. Retraction from the Figure 16. Finishing the case.
palatal implants.

Upper molar intrusion (Figures 19-20)

Upper
molar intru-
sion is one of Figure 17. Intrusion of laterals and Figure 18. Intrusion done.
the most diffi- cuspids.
cult move-
ments to
achieve with
conventional
orthodontics,
particularly
when there is
no tooth dis-
tal to the Figure 18a. Figure 18b.
Figure 19. Location of Figure 20. Traction in
molar. This implants. place.
problem caus- Lower incisor intrusion can be done with spring coils
es many difficulties when we need to mesialize lower molars, or elastomeric ligatures to the mini-implant placed
and a premature contact is present. Here, the orthodontist can between the roots of the incisors. On the upper arch, the
also prepare the space necessary for a prosthesis or implant. mini-implant can also be placed near to the nasal spine.
With only one implant in the palatal area, and an
implant on the vestibular area or even the fixed appliance we
achieve nice results.
IJO • VOL. 15 • NO. 3 • FALL 2004 23
Case 6. Bite closure (Figure 21)
Skeletal anchorage in
one jaw is important to close
the bite, or used for Class II
or Class III elastics, without
unwanted dental move-
ments.

Figure 21. Anchorage to close a lat-

eral open bite.

Premolar retraction (Figures 22-27)

Figure 22. Initial bite. Figure 23. Traction in place. Figure 24. Distalizing the 2nd pre- Figure 25. Distalizing the 1st
molar. premolar.

With mini-implants it is now very easy to distalize pre-

molars, or any other teeth, using spring coils attached to it.
However it is imperative to decide the correct site of place-
ment no avoid a root contact with the mini-implant during
the distalization.

Figure 26. Distalizing the canine. Figure 27. Need to distalize upper
incisors.

Upper molar mesialization (Figures 28-31)

Figure 28. Initial bite. Figure 29. Implant with Figure 30. Traction done. Figure 31. Case finishing.
traction.
Like the distalization, the molars mesialization is also A. Korrodi Ritto, DDS, PhD, the inventor of
possible to achieve with the mini-implants, to close extrac- the Ritto Appliance, received his dental
tions spaces, or in cases of missing lateral incisors where degree, orthodontic training and PhD in
we want to move all the teeth forward. orthodontics from the Oporto Dentistry
University. He is invited professor in the
department of orthodontics, and in exclusive
practice in Leiria, Portugal. Dr. Ritto can be
contacted at ritto@mail.telepac.pt or at
http://www.ritto-appliance.com.
A. Korrodi Ritto, DDS,
PhD
24 IJO • VOL. 15 • NO. 3 • FALL 2004