Temporary Anchorage Devices

IN ORTHODONTICS

Temporary Anchorage Devices
IN ORTHODONTICS
Ravindra Nanda, BDS, MOS, PhD
UConn Orthodomic Alumni Endowed Chair
Professor and I-lead
Department of Craniofacial Sciences
Chair, Division of Onhodontics
School of Dental Medicine
University of Connecticut I-Iealth Center
Farmington, Connecticut
Flavio Andres Uribe, ODS
Assistant Professor
Division of Orthodontics
Departmem of Craniofacial S<:ienCe$
School of Dental Medicine
University of ConnecliuH Health Center
Farmington, ConnedinJ(
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Contr ibutors
Aim Acar, DDS, PhD
Associate ?rofessor
Department of Orthodontics
Fawlty of Demistry
Marmara University
Istanbul, Turkey
Anka, DOS, MS
Associate Professor
Department of Orthodontics
Nihon University DenIal College
Tokyo, Japan
I lead Orthodontist
Sekido Onhodomic Office
Tama-shL Tokyo, Japan
Peler R. Prof Or Dr
Department of Orthodontics
University of Aachen
Aachen, Germany
Nejat Erw rdi , DDS, PhD
!'rofessor
Depanmem of Onhodomics
Faculty of DentistI)'
Marmara University
Istanbul, Turkey
Ulrike B. Fri tz, Prof Dr
Departmem of Orthodomics
University of Aachen
Aachen. Germany
Peter Goellner, Dr moo dent
Depanmem of Onhodomics
University of Jl.erne
Berne, Switzerland
Private Onhodomic Practi<:c
Bcrne, Switzerland
Brilla A. Jung. Dr med dent
Depanmem of Onhodontics
lohannes Gutenberg-University .\Iainz
Mainz, Germany
Ryuzo Kanomi, DDS, PhD
Private Praaice. Onhodomics
Himeji, Japan
Hiroshi Kawa mura, DDS, DOSc
Professor and Chair
Depanment of Maxillofacial SurgeI)'
Tohoku University
Sendai, Miyagi, Japan
Martin Kunkel, >Tor Dr mcd, Dr med dem
Senior Consuham
Departmem of Oral and Maxillofacial SUl);cry
Johannes CUlenberg-Unj"crsily Mainz
Mainz, Germany
Monen Godtfredscn Laursen, DDS
Clinical Assistant Professor
Oll,anment of Orthodontics
University of Aarhus
Aarhus, Denmark
Certified Specialist in Orthodontics
('rival!' and Community Orthodontic Prod;ce
Aarhus, DenmJrk
Ke.Hoon lee, DDS, PhD
Assistam Professor
Depanmcnt of Onhodonlics
College of DentistI)'
Yonsei University
Seoul, Korea
lames Cheng-Yi Lin, DDS
Clinical Assistant Professor
Depanment of Onhodontics and Pediatric Demistl)'
School of DentistI)'
National Defense Medkal University
Taipei. Taiwan
Al1cnding Orthodontist
Department of Onhodontics and Craniofacial
Demistl)'
Chang Gung Memorial Hospital
Taipei, Taiwan
Dr. lames Lin and Associates' Orthodontic and
Implant Center (privale practice)
Taipei, Taiwan
Eric Jein-Wein Li ou, DDS, MS
Associate Professor
Depanmen! of Onhodontics
Graduate School of Cr;miofacial Medicine
Chang Cung University
Taoyung. Taiwan
Associate Professor and Oirector
Depanment of Onhodontics and Craniofacial
DentistI)'
Chang Gung Memorial Ilospital
Taipei, Taiwan
vii
viII ConlriDulon
Rlne Melsen, Dr Odont, DOS
Profasor
OepJrunent of Onhodo11lks
Univt'nity of AJrhu5
School of Demisuy
A.rhus, Denmark
Kuniaki Miya;imas DOS, MS, PhD
Adjunct ProftSSOr
Department of Orthodontics
5t. University Cellier for AdvJnced DentJI
Edu('dlion
St. Louis. Missouri
Nilgil5al.:a, DDS, DDSc
Clinical Professor
lkpanmfnt of Maxillofacial Surgei)'
Tohoku University
Sendai, Miyagi, Japan
Director
Oepannmu of Oral Surgery
Miyagi Children's
Scndai, Miyagi, lapall
Ravindra Nand;!., 80S, .\IDS, Ph D
UConn Onhodontic Alumni Endowtd Chair
and Head
Departmenl ofCr.mlofil cbl SCiences
Chair, Division of Orthodontics
SChool of Dclltal Medicine
of ConnwiCl.U Jlcahh ('.enter
r.rming\On, Connectiwt
Makolo Nishimura. ODS, DOSe:
PanTiml' lecturer
Division of Oral Dysfunction Sdl'l\CI'
Ikpanml'nt of Onll Ileahh and Dt"'o'elopmcnt Sdrncn
Graduate School of Dcmisty
lohoku University
Scndai,
Orthodomk Faruhy
liAS Orthodonlic Centre
Ichiban..o:ho Dental
Sfndai, Miragi, Japan
li yoSang I'.lfk, DDS, MS, PhD
Prof"sor
of On hod on tics
"rungllQok National University
School o{ DenTistry
Dal'Su, Korca
Clininl Director in the Student Clinic
Depdnml'nt of Onhodonlia
K)'I.Iugpook Uni""nity liosptl .. l
O.legu, I{nru
Yo ungChd "ark, DDS, rhO
Professor alld
Dt>panment of Orthod0!11ics
College of Dentistry
Yonse' lIniwlsilY
Seoul. Korea
A. "orrodi RillO, DDS, Ph D
Praclice
Leiria, Portugal
A. Rohens, DDS, MSD
Privatl" Practice
Onhodontio.
IndialldpoliJ. Indiana
W, Eugene Roben s, DDS, I'h o , DHClMoo)
Jdr.lb,lk Professor and Head
Senion or Orthodontics
lndi.ln.l School of Dentistry
Jndian.lpolis, Indiarm
Aswciatc Professol
Depanmcnt of Ordl and Maxillofadal hnplanwlogy
Unil'l' rsity of Lille JJ
1'3OIhy of Medicine
1'r3l\ce
Junji ... DDS, DOSe:
Visi ting ClinicaJ Ilrofl!SSOr
Dil'ision of Onhodontics
Depannti'nt ofCrdlliofacial &iencl'
S<:hool of Dental
Uni\'enoity of ConnOClirut
Farmington, ConlWClicul
Director
SAS Onhodonlic Centn'
tchiban<ho Dt:ntal Office
Sendai, Miyalli,
Flaviu Andrl'$ Uribe, DDS
Assistant t'rofi'nor
of Orthodontics
Depanmi'r>t of Cr.lniof;x:ial Scil"115
Se:hool of Medicine
of Connl'Clirul Centl'!'
Farmingtun, Connticut
Serdar DDS, Ph D
Asso<'iate [>rofl'5Wr and Chair
Dt:panment of Onhodontics
Ca.ziantep Unl\'cfljity
Faculty of Dl'nti$l/Y
GniJntep, l"ur"ty
Sunil Wadhwa, DDS
Assislalll Professor
Depanlnelll of Craniofacial Sciences
University of Conne<:tiUIl
School of Dental " tedicine
Farmington. Connecticut
Contrlbulors ix
Heiner Wehrbeill. Prof Dr lIIed. Dr mOO dent
Professor and I lead
Depanmen\ of Onhodomics
Johannes GutenbergUniversity Mainz
Mainz. Germany
Preface
I'aliem anchorage preservation, and I<lek
of anchor unih orum present a perplexing problem for
onhodontisl$, mainly because of a lack of effective
devircs. lieadgear, which is used [0 (onuaE anchorage
and requires palient cooperation, is a dcvict that has
bct'n used in onhodomics for a1 leas! 100 ycars. Despite
longeYily in the field. howe ... er, the Us.! of headgeu has
enjoyed only moderate succt'SS. In recent }'i'ars, with Ihe
introduction of temporary anchorage deviCd (TAOs) , a
paradigm shirt has occurred in the overall perspective
toward paliem compliance, prewrVlnioll of anchor.tgl',
and fadliLllion of (realmI'm for V<1rious difficul t maiO(-
dU5ionf. i\s happ"'IIS with cve'Y innovation, th .. learn-
ing ruIW is SIel"p as a result of lack of evidence-based
pl"O$pe(live studies 10 slability. applications. and
long-If.m results.
No one person can claim to bt! an expert in the appli-
cation ofTADs, since the technique is youn!! lcsults
are short term. For this reason, I invi tl'd clinicians
who have been instrumental in pioneering this tech-
nique to participate in the of this book. They
haw helped nle to compile a book that b clear and
concise in describing some of the basic prindplt:$
involved in the applkation of TAOs for differen1 types
of mal occJu5ioru. TIle book is not dt:$ignl'd to be an
exhaustive compendium of every application of 1"ADs
that has been reported. Instead, the primary emphasi s
is on the detaill'd description of m .. thods that have
been shown to be successful and have the potential to
become mainstream in clinical orthodonti cs. The tcrt
will app;:JI to both academics and clinicians, since
equal importance has ben given to both thcoletical
and practical aSpc<:ls. Each chapter covel"$ il$ topics in
great delllit and is accompanied by exteru;ve illustra
tions and Il"ferenct:$.
ORGANIZAnON
Part I, 6iologial Perspettive, addresses the use of
endosseous rnini.screws and the biOlogical rnponse
to TAOs. Chapter I leviews the historical p.."rspE"Clivf of
implant development relative 10 the current (oncepts
of bone physiology, surgery, healing. a nd integration. It
i$ written to help clinidans develop a Kientilk perspec-
(or the effective use of miniKI"eWS. Chapter 2 looks
at bone biology and the factors that predict stabi lit)'
behi nd mhanicaliy retained ,lI1d 05scous integrated
orthodontic TAI>$.
II , Diagnosis Treatment Planning. looks
at thl'$l' aspCCI5 for orthodontic rasa that require
skeletal anchorage Chapter J reviews idea) sites for
the placement of mini-implants and how to apply orth
odontic fo" ... using threedimensional finite
models (3D I'F.M) . Chapter 4 provides a unique
spective of I{. ] system, since the chapter author
designed the I{ I System. Chapter 5 det,llls what factol"!i
should be addressed when deciding to usc skeletal
anchorage, including the indications (or when skeletal
anchorage should be used the possible and
advi'T"So.' dftcts.
Ill , "i"mechanlcs Consi der.ltions, offers prag.
matic discussions r<gardillg the appl ication of sound
biomechankal prindpll!$ involved in mOOng le-eth with
the help of skeletal Chapter 6 addresses
the fundamenlal biomechanial principles of minl_
screwdriven orthodontia and explains the practial
appl ication of these principles. Chapter 7 reviews
different dinial Kcnari05 in which skeletal anchorage
may provide an advantage to conventional trcatment
mechanics.
I'an IV, Anchorage Device Systems and Clinical
Applications, exl,lores the different types of anchoTa!,'"
device systems and the "clinical applications" oflhese
systems, with an emphasis on practical applications and
avoidance of common mistakes and pitfalls. Chapter 8
addresses the applianCC$. mechanics. and
strategies for orthognathic like orthodontics in Class I
and II dentoalveolar protrusion, dass 1II delltoal\'oolar
protrusion. anterior open bite. and Class II mandibular
mrognathism. Chapter9 details the management of the
occlusal plane using TAOs and looks at the dimensions
of occlusal plane in space and force application and
dC','ices. Chapter 10 reviews the treatment limitations
Ihat corne with missing teeth, tooth movement using
TAOs, and Wllgenital teeth. Chapter II
addresses various methods for bone anchorage, includ
ing microimplams, rl!$()rbable screws, bracket head-
type microimplants, and noninvasive miniplatl'S.
Chapter 12 prOOdn information on mini or micro
screw implanli . Chapltt 13 detai ls the and
disad\Olntagt' of using titanium miCtO$O"ev."S, as well as
screw design, implant insertion, typical implant sit ts.
complications. and (ailure rates. Chapter 14 looks at the
U!K' of conve ntional dent.ll implants versus TAOs for
orthodont ic anchorage.
Part V, Skeletal Anchorage, condudes the book by
looking specifically m the different aspects of skeletal
an(horage. Chapter 15 th ... features of or-
thodontic miniplatcs and Krews, indications (or
anchorage systems (SAS) treatment. timing of treat
ment positioni ng of miniplall'S, orthodontic mechan-
ics ofSAS, and procedures for implantation and
removal of miniptatl'$. Chaplet" 16 detdil$ ,he cJinial
U!K' of different onhodomk implants 10 correct diffemtt
mdlocdusions. 111e tre3tmetlt methods Pll':5ented in this
chapttt are wmpared with the conventional method
and the benefil$ of the implant method are c!.tri fied.
,I
Chapler 17 the analomic .. 1 in
PJlalal implam placement. evalualion of
bone height aI Ihe implJnI Sill', prt'pannion oflhl' surgi-
cal lemplate for posi tioning the implant, Ihe surgical
nll'thod, "",a lu.llion of lhe impl'lIl1 pl" c.emem method,
and voHious orthodontic mcchanio used wi th p,llat,ll
implallls. Chaplcr 18 looks at a.unmotl ly used 5kelclal
ort hodonti c anchot:lge deviO"S and discusses their dini-
{";I i uSt' and polemial benefits. Sp<.'Cifi{";llly, the chaplet"
focuw:s on the USt' of implants for orthodontic
t'UUllerll l.lsks.
CONTRIBUTORS
Thl'" amhOTs who ha,coontributed to this book are dini-
("lll>' 3aivl': many of them are engJgt.-d in ciini{";ll and
labomlory reS<'arch ill bone biology, tooth moveml'"lll ,
dinical onhodunllcs. and biomechanics.
mos, of the argurnents pUI forw ... d in this textbook are
based on currenl research finding:;. I lowever, wrn-n con_
dusillC evidence W;t$ nOI available, we presented 3 con-
S<'nsus founded on 3 significant dCPlh of Cl<perien(f ,rnd
J\'ailable scielllific d(ua.
NOTE FROM THE EDITOR
I was fonun,lIe to work with 3 group of 3U1hol'!l who
are among the mOst prominent in the field of ortho-
dontia. We hope Ihal ourdfor15 will St'IVC as a stimulus
for further in incll:.tsingly impott3nt
of clinical onhodomia and also provide the much
neled impetus loward gt'nual acceptabililY ofTADs in
day-Io-day onhodontics.
Acknowledgments
lowe a heanfelt thanks 10 my contribUlOrs. Without
their cooperation, this effor! could not have come to
fruition. They are innovators. scientists. and super clini-
cians in the trucst sense, and they haw helped 10 pioncrT
a new way 10 address the correction of malocdusions_ I
hope they will appreciate the final result and will forget
about my constant pleas to meet deadlines,
Flavio Uribe deserves special Te<ogllilion for helping
me prepare this book during every slage of its develop-
melll. I am very fonunate 10 have a colleague like him,
who in his own righl is a thoughtful clinician and a
prolific wriler. A special thanks to Sunil Wadhwa for his
advice and comments. which were easy to incorporate
in development of the book
I also express my gratitude both 10 Caby Hrkko, who
during her residency did exhaustive literature resear(h
that was instmmental in helping me decide on potemial
contributors. and Madhur Upadhyay. who help<.'<1 me
in the fin al stages of preparing the manUKript, espe-
cially with proofreading o(various chapters.
A book like this is nOI possible without the cn(Our
ageme1l1 o( the publisher. I express my sincere thanks
to Senior Editor John Dolan (or laking up this project
and me at every step, and my deep 10
Counney Sprehe. my developmental editor, (or being
the driving fOf((' for Ihis book (,om day one.
Ravindra Nanda
lI iii
Contents
Part I
Chapter I
Chapter 2
Part II
Chapter 3
Chapter 4
Chapter 5
Part III
Chapler 6
Chapter 7
Part IV
BIOLOGICAL PERSPECTIVE
EndO$seot)s Mlniscrews: Historical, Vascular. aM Imegration Perspectives, 3
W. Eugene ROOms and Jeffery A. Roben$
Biological Response to OrthodOntiC Temporary Anchorage Devices. 14
Sunil WadhwII ""d Ramndm Nand"
DIAGNOSIS AND TREATMENT PLANNING
Radiographic EvalUiltion of Bone Sites for Mini-lmplant Placement 25
Kuniaki Mi,'ajima
Miniature Osseorntegrated Implants for Orthodontics Anchorage, 49
Ryuw Kanllm; and IV. Euge"e Rolwm
FaclOr'> in the Decision to Use Sl:eletal Anchorage, 73
/line Mei5ell and Monell Godtfrl'dsen tauf$I!r1
BIOMECHANICS CONSIDERATIONS
Biomecnanical Principles in Mmi5Crew-Dr1ven OrthodOntio. 93
Young-Chel ['ark all(/ Kee/oon I.e
Skeletal Anchorage Based on BiorTle<hanics. 145
I'I,w;o A"dre, Uribe lind Nail/itt
ANCHORAGE DEVICE SYSTEMS AND CLINICAL APPLICATIONS
Chapter 8 Appliances, Mechanics, and Treatment Strategies Toward Orthognathic-Like Treatment Results, 167
Eric Jein-lVein Liou mul I"mes Cheng-Yi Un
Chapter 9 Controlled Occlusal Plane Changes Using Temporary Anchorage Devices, 198
Gcorge Alibi
Chapter TO Man<!gement of Missing Teeth Using Temporary Allchorage Devices. 223
George Ali bi
Chapter 1 I Skeletal AnchO(age: Different Approaches. 238
A. Ko.,-odi Rino
Chapter 12 Clinical Application of Microimpjants, 260
H)'o-Snng I'ark
Chapter 13 Clinical Suitability of Titanium Mrcroscrews fO( Oithodontic Anchorage, 287
Ulrike B. fritz ami PCler R. Diedrich
Chapter 14 Treaunem Planning With Endosseous Implants fO( Orthodontic Anchorage and ProsthodontiC
RestO(atiom, 295
1'1"'10 Amlre5 Uribe Ilml R"r'indra Nan/iii
Part V SKELETAL ANCHORAGE
Chapter 1 5 Skeletal Anchorage System Using Orthodontic Miniplates, 317
Junji $uga",ara, MakOID Nishimura, /-lirwhi Nagruaka, ",,,I Hiroshi Ka",amura
Chapter 16 Bone Anchorage: a New Concept in OrthodontICS, 342
Nejat rverdi mid Serdar OJ",,m<'Z
Chapter 17 Palatal Anchorage. 374
Nejlll En-erdi ""d Ahu A(<lr
Chapter 18 Sl:eietal Anchorage in OrthodOntiCS USing Palatal Implants. 392
Heiner lVehrbein, Brilra A. lung, Martin Kunkel, ami Peler GOellner
PART I
BIOLOGICAL PERSPECTIVE
"
CHAPTER 1
Endosseous Miniscrews: Historical, Vascular,
and Integration Perspectives
W. Eugene I?obens and Jeffery A. I?oberts
T he explosive development of temporary anchorage
devices (TAUs) presents a professional dilemma for
onhodomists. Ahhough a large body of evidence sup-
pons oSSRoimegmrl'd anchorage, mOSt miniscrew and
microscrew systems currently are HOI d .. for
osseous integrution (osscointegration) and were mar
keted with liu le or no fundamcnwl scientific verifica-
lion. Clinical applications have superseded the scientific
rationale for their effective use. In the :lbscnce of ade-
quate (evidence-based) research, dinicians must rely
on a limited number of b<lsi(. 5(ience studies, supple-
mented by scientific interpolation of fundamental data
derived from investigations of other Iypes of endosS<'-
OllS implants. Historically, the ClilTent surge in mini
screws resembles the initial devdopmem of denwl
implants. At present the only reliable for dis
criminaling among miniscrew sy5lemli is using Ihe fun
damental prillciplcs of bone biology, osscoimegratioll,
and TIle "state "n" is "clinician,
beware:
' ,'his chapter reviews the historical perspective of
implam deve!opmem W omenl concepts of
bone physiology, surgery. healing. and imcgration. nle
purpose is \0 help clinicians develop a sciemific peTSPff'
ti,'C for effcctive use of Bone physiologk.l1
principles arc imponam in selecting 3 device and devel.
oping a realistic perspective for using it crfectively to
treat specific malocclusions, No single system is optimal
for all clinical applications. n'e anchorage .. :ds of
each patient are unique bt>eause of the nature of the
malocdusion, the hosl response to the inv,\siwdevice( s),
and the biomechanical approaches favored by the
cl inician,
DEFINITION AND DESIGN
The TADs (Ompose a broad array of implants used
to suppon onhodontic treaune1l1, As presently defined.
all TADs are invasive devices and are b-e5t resented for
problems that cannOI be effectively managed with
convemional mechanics (Figure \-1, A) . 11Ie anchorage
componem may be a biocompatible wire allached 10
the en,tosseous base of an implant for pros
thetic use. Funhermore, a nonfunctional osseoime-
grated implant may serve as an abutment for surgically
assisted. rapid palatal (I' igure \ . 1. 8) . I'h..,
products with the longest clinical histOJY of efficacy are
originally designed for pros
thetic purposes. ''
Most current mini5Cl'eW5 are titanium (1i) or tita-
nium aHoy and are manufadured with a smooth.
machined surface that is nOI designed 10 osscoilllegratc.
By definition. TAOs are temporary devices; no long (;>ITn
functiona l or esthetic role is planned. Thus. most TADs
are removed a(ter orthodontic treatment Howe\'er.
some osscointegrated TADs may be covered with saft
tissue ( put 10 sleep") or retained for sustained I)ros
thetic funnion (see Fi gure I-I. B) . At present, Ihe mOSI
common TADs include miniscrews. microsocws, min
iature implallts (miniimplants). pal'lml implants.
modified bone plates. and retromolar implants, as well
functionally loaded prosthetic implanlS. In addition,
a TAD may be a temporary prosthetic component (e.g ..
bracket allae,hed 10 gold crown) that is removed after
treatment (Fib'\lre 1-2). '111erefore. TADs can range from
nonintegrated miniscrews 10 implant$upponed pros-
theses (ISPs) wilh lemporary onhodontic altlchments.
BACKGROUND
At the Bone Research Laboratory at the UniveJ1'iily of
Padlic in San Francisco, the authors performed a series
of experiments 10 develop onhodontic anchorage
devices.' .. Titanium miniscrt'ws. 2 mm in diameter
with an acidel(hed surface, were tested in rabbils. dogs.
and monkeys from 1980 to 1988. "I'h .. de"ices were very
predictable when pla(ed in exlraoral sites such as rab
bit femur a nd nasal but the intraoral use of
Ihe miniscrews in dogs and monkeys was less success-
ful (failure ratc. - 25%50%). Failure was defined as
3
4 PART I BioIogic .. 1 P.-nplive
Figure I-I
A. a.", III. nuJocdusion in 4J-Y" .()Id WOmdn compliuted by
in ... lin-depe-ndml di.loon n,dlilU' , .... d end-51 nul d; ... ... II. I.di .t'lfOmolu Impl.nI
(TAD) was used 10 and I1l(lW 1M [hird molu maially to .as an arn.umem for 3
6nd pro:Olhn,s; it will 1M' rt'ITIO'-U fkQ,,, ... P.l,iml', tw.llh onhogrmhi<"
5Uf8I'f}' .. -u rIOI a vi.ble option. The rompromi ... trl"ltmtnl in dlt arch wal pfr-
prostlletic alignmemlo opm oown tht l1'flh md IIw Idl segment maially.
The riglll implam In lubefosiry region wn " Icmpordf)'
device (TAD), but il w,1I ft'tainw 10 5<:"'" "s a posterior abutment for a removable pania)
denmfr.
mobililY or exfolialion of Jhe filnure. Similar
10 current reports. "" there were 5ignificMlI anatomical
limitations rd3tive to where min;screws could be- plaud.
Funhennore. sofl ti$SlU' irritalion of cheek. tongue. and
alveolar mUC0$3 was a significant problem. The biome-
chanical possibilities "ere wmpromised bec:ause of a
lack of resistan-. panicularly when immedi-
ately loaded. Unlt5s m;niscrews are os5tOimcgrated, Ihe
m,t reliable mechanics are for the line of force to pass
through the implam, nOI ideal for treaUnenl of mot
malocclusions, The use of lever am,s 10 improve Ihe line
of force may result in unfavor.lblc on the
implant.
It Is impomnt to nOll' that the limitalions of Ihe
miniscrews tested more than 20yearsago in authors'
laboratory are simi lar to Ihe omenl predictabil ity for
these devicts."" ThUs. it is apparent that Ihe biological
efficaq of miniscrews is lagging rapid increasc in
their dinical usc. This s<:.mario is 10 initial
d('\elopmem of denial implanl$ befOTe Ihe well-
documenled introduction of "osseoinlegralion" in Ihe
early 19805. "
The 2 mm, acidet(hed Ti minis<:rt..'W$ developed in
Ihe alllhors' laboralory were never used in patients
bause the intraoral animal data were considered inad_
equale 10 secure institutional review board (tRill
for a clinicallrial. Because of the long history
of clinical without any serious complicatioru
(e.g., osteomyelitis. neoplasms), siandard 8ranemark
(Swedish) prosthetic fu:lura adapted for orth-
odontic These relatively large implants (3.75
x 7 mm) could not be- placed in the alveolar ridge if
space closure and arch consolidation were objectl\le$
of Iftatment (S Fig. \.]). I'or malldibular anchorage.
Ihe retromolar area was selected as the optimal si ll'.
Indirect anchorage evolved as the mosl effectiw mecha.
nism for mOSI applications. ' To a lesser exlent, the
luberosity region oflhe m<lJCilia has served as OS5COI.IS
si ll' for anchorage implanu (S Ag. 1-1 . B) A prospec
tive clinical trial of implanl denlonstrnied
that mseointegraled anchorage is a highly reliable clini
cal procedure."
The machine tools and methods fot manufacturing
11 and Ti alloy screws h,we improved dramJtically in
Ihe past 20 years, as illuSlraled by Ihe functional designs
of supramucosal heads for mJny mini..:rew syslems. AI
present. the major problem with TADs is the inabili ty
10 achieve osseoimegr.Jlion routindy with mOSI current
devices. To our knowledge. the osseointegrated 1(-1
SYSlem (S Chapter 4) developed by 0,- Ryuw Kanami
is Ihe only OMrointegraled miniscrew for orthodontic
i1pplicalion. ... As m;niscrew tf'chnology matures. other
osseoimegraled systems will likely (-"'Ol>"t.
PERSPEcnVES
Dental impla1l1 has progressed from non
imegraled screws (19405)' 10 osseointegraled devkts
(1972 10 presenl). The firsl documemed UM: of osseo;n
legraled unhodontic anchorage apparently in a
patient trEated from 1912 to 1975 by Dr. Tom Iionon
(Columbus, Gwrgia) and Dr. lIilt Tatum (Opelika,
Alabama). Dr. Iionon corrected a buccal cr055b;lc
(scissorsbi te) with a bite plate and crOS$-claslics
anchored by an ossrotntegrated 11 blade implant.
cmtommade and plaud by Dr. Hilt Tatum, a pioneer
in the field of implant dentiSlry. In addilion 10
ing the firsl osseointegrated implall\ fat orthodontic
E"dosseous M,,,,u,ews: Historical. VaKu'ar. arid I"trq,atio" Perspectives 5
Il'lapse ofClus II. Division I malocclusion in 47Y"'arold brach),<<'Phalic woman. A
malocclusion w.s (feat<"d 35 yean earlier wilh o."",ion of (OUf fin. pll'molaf$.
A. T",atment fequiml SJ)KG 10 replaa mandibulu p",molUll with implants.
8. Onhooomic brackn ... ..,re att.KhW to the wu for the crowIl1 brio", inVGtirt3
and ClS,ing in gold. C. TIlt crowns "'Ith allachl brackeu sen>ed :as TAOs for kwling and
finMirt3 the mandibul.r ,"th. O. Afte. uea,men, 'he gold crowns mvonnl and the
brackm rem<ro-ed a .10 .... , The crowns we", poli,t.ro and reuined :as tM
proslhesu.
anchorage. Dr. Tatum was the developer of the maxil
lary sinus bone graft procedure" and other
dental implant innOvations''"
TIlt: field of dental implamology originally embraced
what was actually all osseointegratioll "fai lure" (fibrous
implant interface) with the semiphysiologkal tl'nn
"pseudoperiodomium.""'''' Ilowever. subsequent
research demonstrated that Ihl' fibrous interfa<e W<I$
aaually ava(\llar scar lissu; funhermore. mobile
implanl$ wilh a "pseudoperiodomium" had a high
failure ratf'. TItanium bladf' or alloy
(Vitallium) blade dental implants have had many
years of (un(lio'131 Most favorable repons
involve blades ,hal achieved ossrointegrntion despite
being immediately loaded!'" The mOS! reliable
dental implant devices currently in use are osseoin(e
grated systems. based directly or indirectly on the
biological concept introduced by Brlnemark and
his (oliegul'S.'L" developmenlal progression
likely will repeal ilself with Il!$pea to miniscrew$
because osseoimegralion is a mature technology wilh
high reliability. Extension of the biolhnology of