Tackling an

iatrogenic
problem!!

INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Introduction
All modern mechanics have a double scale of
ladder ascendant & descendant , ascending from
experiment to the invention of causes &
descending from causes to the invention of new
experiments
Anchorage plays a very vital role in
orthodontics. Loss of anchorage can take place
during
Aligning, leveling and retraction stages.
www.indiandentalacademy.
com
Reasons for anchor loss
during aligning



Lower molars normally drift mesially to
occupy the lee-way space after shedding of
lower primary second molars which can be
restricted by timely placement of lingual
arch.
Anchorage requirement in upper arch is
greater compared to lower arch
Improper positioning of brackets.
www.indiandentalacademy.
com
Reasons for anchor loss
during retraction
iatrogenic
factors
incorrect
alpha &
beta bends

excessive forces
used during
retraction.


posterior segments
are not consolidated
during retraction.

Improper
positioning
of loop
Improper bracket
positioning
www.indiandentalacademy.
com
When in doubt use
a wire applying
lighter forces
Anchorage
reinforcement

Use light
Continuous
force
During
aligning.
www.indiandentalacademy.
com
How to control anchorage
during leveling ?
Using light continuous forces
Maintain the direction of force
Rein force anchorage
Proper bracket positioning.
www.indiandentalacademy.
com
Anchorage control during
retraction
retraction
individual
enmasse
Walking of
canine
Rein force
anchorage
www.indiandentalacademy.
com
Anchorage
reinforcement
EO
high
cervi
cal
straight
com
bi
IO
TPA
Nance button
Class II elastics
Lingual arch
www.indiandentalacademy.
com

Anchor loss
occurs by mesial
tipping of molars

Hence distalize
molars

Extra oral
Intra oral
www.indiandentalacademy.
com

Extra oral

High pull

Cervical pull
Combi pull
distalizing effect
on molars and
premolars
www.indiandentalacademy.
com
Intra oral
Inter maxillary

Intra maxillary

Absolute
anchorage


www.indiandentalacademy.
com
IO non compliance
appliances
Intermaxillary
Elastics
Modular appliance
Intra maxillary
Modified nance arch with NiTi coils
distalising bow
Absolute
anchorage
Palatal
implants www.indiandentalacademy.
com
Modular appliance is made up of 0.016
x0.0 22 rectangular SS / TMA wire

Modular appliance consists of an omega
loop touching the mesial aspect of buccal
tube and there is an upward curve in the
mesial part of the canine bracket, which
ends in a hook on the upper or gingival
part.

www.indiandentalacademy.
com
The gingival part of the hook is
helicoidally recurred with the end inward
to avoid erosion of the vestibular mucosa.
Tip back bend of 45 degrees is given
distal to omega loop .
The wire should be cinched distal to the
molar buccal tube
The buccal segment should be contoured
to prevent tissue impingement.

www.indiandentalacademy.
com
APPLIANCE DESIGN
omega
loop
hook to
engage
elastics
tip back bend of 45
degrees
www.indiandentalacademy.
com
Class II elastics ( preferably blue
or green ) applying 100 150 gm
force are used from the hook mesial
to canine and to the lower molar
hook.

The modular sectional arch blocks
the segment between the canine and
the upper first molar in one unit ,
which it moves in distal direction.

www.indiandentalacademy.
com
BIOMECHANICS
Based on cantilever mechanism


Mechanics
of spring
elastics

www.indiandentalacademy.
com
These mechanics can
effectively tip back an upper
molar and rotate the molar
mesial out.
Distal end of omega loop acts
as a stop and applies the
tipping force on upper molar.
www.indiandentalacademy.
com
A light class II elastic is
placed from lower arch
Class II elastic is effective ,
not only because of its distal
force but because a very large
moment is produced tipping
the molar distally.
www.indiandentalacademy.
com
Class II elastics can flare the lower
arch, increase the vertical and steepen
the occlusal plane.
Hence elastics are used for a short period
of time.
Because the molars tip back rapidly, only
a short period of class II elastic wear
is required leading to negligible side
effects

www.indiandentalacademy.
com
www.indiandentalacademy.
com
www.indiandentalacademy.
com
Pre - treatment
www.indiandentalacademy.
com
www.indiandentalacademy.
com
www.indiandentalacademy.
com
Pre - treatment
www.indiandentalacademy.
com
www.indiandentalacademy.
com
Upper 5s
lower 4s
www.indiandentalacademy.
com
www.indiandentalacademy.
com
Post surgical
www.indiandentalacademy.
com
www.indiandentalacademy.
com
www.indiandentalacademy.
com
Case - 3
www.indiandentalacademy.
com
Case - 3
www.indiandentalacademy.
com
www.indiandentalacademy.
com
www.indiandentalacademy.
com

Modular
appliance

Less time
consuming
www.indiandentalacademy.
com
advantages
fixed into the
auxiliary tube


Distalisation is brought
about in short duration
of time..



versatile
Unilateral or bilateral
Class II
www.indiandentalacademy.
com
Conclusion
If anchor loss is noticed
early and timely
intervention of modular
appliance is made, it saves
a lot of drudgery.
www.indiandentalacademy.
com
Acknowledgement
Dr. E. MUNIRATNAM NAIDU,
Principal,
Vice principal,
PROF&HEAD OF DEPARTMENT,
ORTHODONTICS.

STAFF MEMBERS & P.G. STUDENTS
Department Of orthodontics
MEENAKSHI AMMAL DENTAL
COLLEGE.

www.indiandentalacademy.
com


www.indiandentalacademy.
com