Bone Screws and Plates for Orthodontic Anchorage
The extent to which teeth can be moved with orthodontics is dependent on the available anchorage. When the necessary forces required to move teeth in a particular direction cannot be applied with traditional anchorage techniques (appliances on other teeth), orthodontic practitioners have relied on extraoral anchorage and/or orthognathic surgery to achieve desired results. Unfortunately, headgear use is lengthy, compliance dependent and inappropriate for many patients; orthognathic surgery is expensive and seldomly covered by insurance carriers. For these reasons, there has been an ongoing search for new anchorage techniques.
With the advent of osseointegrated dental implants, dental researchers found that orthodontic forces could be applied to an osseointegrated root form dental implant without implant movement or damage to the implant’s structural integrity. Dental implants, for these reasons, can be ideal orthodontic anchorage sources. If a patient is “fortunate” enough to need dental implants, orthodontics, and the implants will be in an appropriate location to serve as orthodontic anchors, amazing tooth movement can be possible. If the patient does not need tooth replacement, root form implants can often be placed in the retromolar areas or palatal areas to serve as anchorage devices. Following the completion of orthodontic treatment, the implants are then removed, or when possible, the implants are “put to sleep” by allowing soft tissue to cover them. One shortcoming of this technique is that the implant surgery can be extensive and cost prohibitive.
Recently, much research has been directed toward the possibility of using titanium alloy plates and screws, like those used in facial fracture repair, for orthodontic anchorage. Numerous prospective studies have proven that these screws and plates can predictably withstand typical orthodontic forces and that they can be placed with minimally invasive surgical procedures. Typically, screws or plates are placed bilaterally between or apical to tooth roots in appropriate locations for the orthodontic practitioner to use as orthodontic anchorage. These surgical procedures can often be completed with local anesthesia or IV sedation and local anesthesia. This topic is currently popular at orthodontic and oral and maxillofacial surgery continuing education meetings. I have attended several such meetings and the results shown are very impressive. In some cases, results previously thought to be impossible without orthognathic surgery are being
accomplished. Reported complications have been minimal. The success of this research has prompted several companies to market ADA and FDA approved plate and screw kits specifically for these procedures.
I recently placed orthodontic anchorage plates on a patient for the purpose of retracting her maxillary teeth to eliminate overjet. After applying orthodontic forces for only a few months, her orthodontist reports her progress to be very good. This patient had previously been in conventional orthodontic treatment for 2-3 years without success.
Based on results I have seen from the research and my personal experience with this technology, I firmly believe that skeletal anchorage with bone plates and screws will become a standard of care for treating many difficult orthodontic cases. It will definitely become an affordable alternative to orthognathic surgery for correction of some malocclusions.
The Palm Beach Center for Oral Surgery and Dental Implants providing quality care to Delray Beach, Boca Raton, Boynton Beach, and Palm Beach County. 561.900.9080 www.PasqualOMS.com