MAHATMA GANDHI DENTAL

COLLEGE
AND HOSPITAL

DEPARTMENT OF
ORTHODONTICS AND
DENTOFACIAL
ORTHOPAEDICS

ANCHORAGE

Guided by-

Submitted by-

Dr.MRIDULA TREHAN(MDS)

ANKITA GUPTA

H.O.D

BDS FINAL YEAR

DEPARTMENT OF ORTHODONTICS

BATCH 2008-09

AND DENTOFACIAL ORTHOPAEDICS

CONTENTSIntroduction-General principles of tooth

movement
Anchorage
Sources of anchorage-Intra-oral sources
-Extra-oral sources
Classification of anchorage
Anchorage planning
Anchorage loss
Classification of anchorage demand
References

INTRODUCTION
General principles of tooth movementTooth movement during orthodontic therapy is
brought about by forces generated by the active
components of an orthodontic appliance.
The force used to move teeth is derived from
certain anatomic areas, which act as anchors.
According to Newtons third law of motion, for
every action there is an equal and opposite
reaction.
In accordance with this low, the forces used to
move teeth may induce an equal and opposite
force on the anchorage units tending to cause
their movement which is not desirable.
The resistance that the anchorage areas offer to
these unwanted tooth movements is called
anchorage.

ANCHORAGE
DEFINITION Graber has defined anchorage in orthodontics
as the nature and degree of resistance to
displacement offered by an anatomic unit when
used for the purpose of effecting tooth
movement.

Proffit-the term anchorage, in its orthodontic

application, is defined in an unusual way: the
definition as resistance to unwanted tooth
movement includes a statement of what the
dentist desires.

White and Gardiner-anchorage is the site of

delivery from which a force is exerted.

Anchor-the force used to move teeth is derived

from certain anatomic area, which act as
anchors.

SOURCES OF ANCHORAGEAnchorage during orthodontic therapy is mainly

obtained from two sources-

1)Intra-oral sources-The teeth

-alveolar bone
-basal bone
-musculature

2)Extra-oral sources-cranium
-back of the neck
-facial bones

INTRA ORAL SOURCES

THE TEETHWhenever some teeth are moved orthodontically,
the remaining teeth of the oral cavity can act as
anchorage or resistance units.
The anchorage potential of teeth depends on a
number of factors such as-

1.Root formRound

roots-seen in bicuspids and palatal root of

maxillary molars-can resist horizontally directed
forces in any direction.
Flat roots-seen in mandibular incisors and
molars and buccal roots of maxillary molars-can
resist movement in mesio distal direction.
Triangular roots-seen in canines and maxillary
central and lateral incisors-offer the maximum
resistance to displacement.

2.Size and number of rootsMultirooted teeth with large roots have a

greater ability to withstand stress than single
rooted
teeth.

3.Root lengthThe

longer the root, the deeper it is embedded

in bone and the greater is its resistance to
displacement.

4.Inclination of toothA greater resistance to displacement is offered

when the forces exerted to move teeth is
opposite to that of their axial inclination.

5.Ankylosed teethAnkylosed teeth can serve as excellent anchors

whenever possible.

ALVEOLAR BONEThe alveolar bone that surrounds a tooth offers

resistance to tooth movement upto a certain
amount of force. when the force applied exceeds
a certain limit ,the alveolar bone permits tooth
movement by bone remodeling.

BASAL BONEIntraoral hard areas of basal bone include the

hard palate and the lingual surface of the
mandible in the region of the roots, can be used
to augment intramaxillary or inter-maxillary
anchorage.

MUSCULATUREThe normal tonus of facial and masticatory

muscles plays an important role in the normal
development of dental arches.
Dental anchorage may be increased by making
use of hypertonic labial musculature as in the
case of lip bumper.

EXTRA ORAL SOURCES

1.CRANIUM(OCCIPITAL AND PARIETAL
ANCHORAGE) Extra oral anchorage can be obtained by using
headgears that derive anchorage from the
occipital and parietal region of the cranium.
These device are used along with a facebow to
restrict maxillary growth or to move the dentition
or maxillary bone distally.

2.BACK OF THE NECK(CERVICAL

REGION)Extraoral anchorage can alternatively be
obtained from the neck or cervical region.
Such a type of headgear is called cervical
headgear.

3.FACIAL BONESThe frontal bone and the mandibular symphysis

offer anchorage during facemask therapy in order
to protect the maxilla.
Headgears that make use of anchorage from the
forehead and chin are called reverse headgear.

CLASSIFICATION OF
ANCHORAGE(MOYERS)
ACCORDING TO THE MANNER OF FORCE
APPLICATION1.Simple Anchorage
2.Stationary Anchorage
3.Reciprocal Anchorage

ACCORDING TO JAW INVOLVED1.Intramaxillary

2.Intermaxillary
ACCORDING TO THE SITE OF ANCHORAGE1.Intraoral
2.Extraoral:
a.Cervical
b.Occipital
c.Cranial
d.Facial
3.Muscular

ACCORDING TO THE NUMBER OF

ANCHORAGE UNITS1.Single or primary anchorage
2.Compound anchorage
3.Multiple or reinforced anchorage

Simple anchorage- removable appliance

incorporating a screw for buccal movement of a
palatally placed premolar

SIMPLE ANCHORAGEIt is defined as dental anchorage in which the

manner and application of force is such that it
tends to change the axial inclination of the tooth
or teeth that form the anchorage units in the
plane of space in which the force is being
applied.
Thus the resistance of the anchorage unit to
tipping is utilized to move another tooth or teeth.
Example-removable appliance incorporating a
screw for buccal movement of a palatally placed
canine.

STATIONARY ANCHORAGEIt is defined as dental anchorage in which the

manner and application of force tends to displace
the anchorage unit bodily in the plane of space in
which the force is being applied.
The anchorage provided by a tooth resisting
bodily movement is considerebly greater than
one resisting tipping force.

Examples ofreciprocal anchorage-(A)Finger spring used to

close a midline (B)Correction of midline diastema using elastic
(C)Cross bite elastics for correction of single tooth posterior
cross bite (D)Arch expansion using a removable appliance
incorporating a coffin spring

RECIPROCAL ANCHORAGEIt refers to resistance offered by two malposed

units when the dissipation of equal and opposite
forces tends to move each unit towards a more
normal occlusion.
Here two teeth or two groups of teeth of equal
anchorage value are made to move in opposite
directions.
Examples-closure of a midline diastema by
moving the two central incisors towards each
other.
-The use of crossbite elastics and
dental arch expansion .

INTRA ORAL ANCHORAGEAnchorage

in which all the resistance units are

situated within the oral cavity is termed intraoral
anchorage.
The teeth to be moved and the anatomic areas
that offer anchorage are all within the oral cavity.
Intraoral units are- the teeth,palate and lingual
alveolar bone of mandible.

(A) Occipital headgear-anchorage from the cranium(B)face mask for

protection of maxilla-anchorage from forehead and chin
Examples of extraoral anchorage

EXTRAORAL ANCHORAGE-

Anchorage in which the resistance units are

situated outside the oral cavity is termed
intraoral anchorage.
Extraoral units are-occiput,back of the
neck,cranium and face.
Examples-use of headgear that derive
anchorage from the cervical or cranial regions
and facemask that derives anchorage from the
facial bones.

Lip bumper utilizing muscular

anchorage

MUSCULAR ANCHORAGE

In certain cases the perioral musculature is

employed as resistance units.
Muscular anchorage makes use of forces
generated by muscle to aid in the movement of
teeth.
Example-use of a lip bumper to distalize the
molars.

INTRAMAXILLARY ANCHORAGE
When all the units offering resistance are
situated within the same jaw.
In this type of anchorage the teeth to be moved
and the anchorage units are all situated either
entirely in the maxillary or the mandibular
arches.

BAKERS Anchorage-(A)ClassII intermaxillray anchorage (B) ClassIII

intermaxillary anchorage

INTERMAXILLARY ANCHORAGE
Anchorage in which the resistance units situated
in one jaw are used to effect tooth movement in
opposing jaw is called intermaxillary anchorage.
It is also termed BAKERS ANCHORAGE.
Examples-class II elastics traction applied
between the lower molar and upper anteriors
-class III elastics traction applied
between the upper molar and lower anteriors

SINGLE OR PRIMARY ANCHORAGE

Cases wherein the resistance provided by a
single tooth with greater alveolar support is used
to move another tooth with lesser support is
referred to as single or primary anchorage.

COMPOUND ANCHORAGE
Anchorage where the resistance provided by
more than one tooth with greater support is used
to move teeth with lesser support is called
compound anchorage.

(A)Upper anterior inclined plane

(B)Sved plane

Examples of reinforced anchorage

REINFORCED OR MULTIPLE
ANCHORAGE
Anchorage in which more than one type of
resistance unit is utilized is termed reinforced
anchorage.
Reinforced anchorage refers to the
augmentation of anchorage by various means
such as extraoral appliance,upper anterior
inclined plane or a transpalatal arch connecting
the two maxillary molars.

Methods of reinforcing anchoragea.extraoral forces to augment

anchorageSuch as cranium,back of neck and face can be
used to reinforced anchorage.

b.upper anterior inclined planeA removable appliance incorporating an upper

anterior inclined plane results in forward glide of
mandible during closure of the jaw.
This result in stretching of the retractor muscle
of mandible,which subsequently contracts and
forces the mandible against the upper inclined
plane.

Thus a distal force is applied on the maxillary

teeth thereby reinforcing maxillary anchorage.
A modification of anterior inclined plane is the
SVED APPLIANCE that has an additional upper
incisal capping.

(A)Transpalatal arch
(B)Lingual arch
Examples of reinforced anchorage

c.use of transpalatal arch and lingual

archesTranspalatal arch is a wire that spans the palate
in a transverse direction connecting the first
permanent molars of either side.They are used in
fixed mechano therapy to augment anchorage.
An arch connecting the contralateral lower
molars running along the lingual aspect of the
mandibular arch prevents mesial movement of
the lower molars.This is called the ligual arch.
The lingual arch and transpalatal arch are
soldered to the lingual aspect of molar bands
that are cemented to these teeth.

d.use of implantsImplants are slowly being introduces as sources

of anchorage.
They are specially useful in patients who have
lost lot of teeth or hypodontia.

Intraoral aids may be limited in their anchorage

potential,endoosseous implants are a valuable
alternative for stable intra oral anchorage.
Microimplants as a source of anchorage in
orthodontic treatment is relatively new.

ANCHORAGE PLANNING
The requirement depends on a number of
factors,which are listed below-

1.Number of teeth being movedThe greater the number of teeth being

moved,the greater is the demand on the
anchorage.

2.Type of teeth being movedThe movement of slender anterior teeth offers

lesser strain on the anchorage than robust
multirooted teeth.

3.Type of tooth movementWhenever bodily tooth movements is

required,there is a greater strain on the
anchorage.
In contrast,tipping tooth movements offer a
relatively lesser strain on the anchorage units.

4.Duration of tooth movementTreatment of a prolonged duration places an

undue strain on the anchorage.

5.Skeletal pattern-

Patients who exhibit vertical skeletal growth

pattern show more tendency for mesial tooth
movement and anchorage loss.
Patients who exhibit a horizontal growth pattern
show lesser tendency for the mesial movement
of the anchor teeth.
This is attributed to the strong facial
musculature they exhibit.

6.Occlusal interlockA good buccal occlusion may act to resist tooth

movement.

ANCHORAGE LOSSIn spite of the precaution taken in planning

anchorage, a certain amount of unwanted
movement of the anchor teeth invariably occurs
during orthodontic treatment.Such unwanted
movement of anchor teeth is called ANCHORAGE
LOSS.

CLASSIFICATION OF ANCHORAGE
DEMANDBased on the anchorage loss that is
permissible,the anchorage demand of an
extraction case can be of three typesa.Maximum anchorage cases
b.Moderate anchorage cases
c.Minimum anchorage cases

Maximum anchorage

Maximum anchorage casesIn cases where anchorage demand is very

high,not more than of the extraction space
should be lost by forward movement of the
anchor teeth.
The anchorage in these patients should be
augmented to avoid unwanted movement of the
anchor teeth.

Moderate anchorage

Moderate anchorage casesIn these cases, the anchor teeth can be

permitted to move forward into 1/4th to of the
extraction space.

Minimum anchorage

Minimum anchorage casesIn these cases, the anchorage demand is very

low.
More than half of the extraction space can be
lost by the anchor teeth moving mesially.

ReferencesS.I.Bhalajhi:Orthodontics :The art and

science,Fourth edition
Graber TM-Orthodontics:Principles and
practice,Third edition
Profitt WR:Contemporary orthodontics,fourth
edition
Robert E Moyers:Hand book of orthodontics