Solues Com Micro Implantes Solutions With Microimplants

A. KORRODI RITTO D.D.S, PHD HEE-MOON KYUNG DDS, MSD, PHD

utilizao de uma ancoragem estvel em ortodontia, permite eliminar os movimentos indesejveis nos dentes de ancoragem quando eles se utilizam para este fim. Esta forma de ancoragem substitui os procedimentos tradicionais como a traco extra-oral, ou aparelhos intra-orais como o boto de Nance ou outros aparelhos mais complicados que necessitam de alguma colaborao da parte do paciente. Isto significa que o ortodontista no mais est na dependncia do paciente, o que permite tambm ter mais sucesso no tratamento dos adultos. Este sistema de ancoragem permite a aplicao de foras continuas, diminuindo o tempo de tratamento.

he use of stable anchorage in orthodontics may

help avoid unwanted movements of the anchorage teeth. This approach replaces traditional procedures that use extraoral elements, such as headgear, or intraoral appliances such as Nance buttons or other complicated appliance designs, which need patient cooperation. This means that the orthodontist is no longer dependent on patient compliance, which will increase the number of adult treatments in our practice. This anchorage system gives the orthodontist added benefit because the orthodontic forces, applied continuously, might even shorten the overall treatment time. Endosseous implants made from a variety of materials and designs have been used in orthodontic treatment for anchorage since many years 1,2. Endosseous implants osseointegrate after unloaded healing periods. After achieving osseointegration, it is possible to use them for orthodontic purposes. Conventional implants are limited by space. They can only be placed in retromolar or edentulous areas. Furthermore the surgical procedure, the cost and the delay between implantation and orthodontic force application are the major drawbacks.

Os implantes construdos em vrios materiais e com vrios desenhos tm vindo a ser usados no tratamento ortodntico como forma de ancoragem 1,2 . Os implante osteo-integrados requerem um perodo longo antes de se poder aplicar as foras. Esto normalmente limitados pelo espao, podendo apenas ser colocados no espao retromolar e nas zonas desdentadas. Alm disso, a fase cirurgica, o custo, e o espao de tempo entre a implantao e a aplicao da fora, so apontados como desvantagens.

A. Korrodi Ritto, Especialista em Ortodontia. e-mail ritto@mail.telepac.pt; Hee-moon Kyung is Professor Department of Orthodontics, School of Dentistry, Kyung-pook National University, Taegu Korea. e-mail hmkyung@knu.ac.kr

Vrios mtodos para ancoragem ssea tm vindo a ser testados: parafusos em vitalium, fibra de carbono, implantes de xido de alumineo revestidos, placas e parafusos em ao inox, implantes Branemark10,11, implantes retromolares10, onplants14, arames zigomticos15, dentes anquilosados16, implantes palatinos17, mini-placas18 e mini-parafusos 5-9,21. A introduo de implante palatinos passou a ser uma tcnica aceite para ancoragem maxilar. A espessura do osso palatino nessa zona permite a colocao de um implante estvel, e um aparelho rigido pode ser a aplicano com conexo aos premolares ou molares. A reaco das foras geradas sobre os primeiros molares so transmitidas ao implante atravs da barra palatina, fazendo com que o implante funcione como sistema indirecto de ancoragem.

Various methods for bone anchorage have been tested: vitallium screws, vitreous carbon, bioglasscoated aluminium oxide implants, stainless steel plates and screws, Branemark implants10,11, retromolar implants 10, onplants 14, zygomatic wires 15 , ankylosed teeth 16, palatal implants 17, miniplates 18 and mini screws 5-9,21. The introduction of palatal implants has become an accepted technique for orthodontic anchorage in the maxilla. The thickness of the anterior midpalatal bone allows a more stable implant to be placed there, and a rigid appliance can be connected from the central implant to the first premolars or molars. The reaction forces generated are first applied to the first molars and then transmitted to the implant by the transpalatal arch, making the implant system an indirect anchorage unit.

Fig.1 - Diferentes formas de mesializao molar. Fig.1 - Different approaches for molar masialization

Fig.2 - Mesializao do molar inferior com aparelho fixo lingual e mini-implante por vestibular. Fig.2 - Lower molar mesializations with lingual fixed appliance and vestibular microimplant.

Devido osteo-integrao e ao largo diametro do implante, preciso um sistema especial para a sua remoo no final do tratamento,deixando uma cavidade no osso com cerca de 5mm. Alguns autores aconselham deixar a parte subgengival do implante no osso, de forma permanente. Os mini parafusos e as mini placas tm vantagens sobre os implantes cilindricos osteo-integrados e onplants, devido facilidade de manipulao, aplicao imediata da fora e irritao minima dos tecidos6,10,11,19,20.

Because of osseointegration and the large diameter of the implant, a hollow explantation drill must be used to remove the implant at the end of treatment, leaving a bone cavity with a diameter of about 5mm. Some authors advise leaving the subgengival part of the implant in the bone permanently. Miniscrews and miniplates have been found to have advantages over cylindrical endosseous implants and disc-shaped onplants, including ease of manipulation, ability to withstand immediate force loading, and minimal irritation of the oral tissues6,10,11,19,20.

Fig.3 - Intruso dos incisivos inferiores. Barra lingual colada, e dois ganchos estticos colocados nas faces laterais dos ncisivos laterais. Fig.3 - Lower incisors intrusion. Lingual bonded S.S. bar and clasps on lateral incisors.

Fig.4 - Mini-implante sob a espinha nasal anterior e ligadura elstica para intruso dos incisivos superiores, enquanto a retraco com molas nitinol feita atravs de dois mini-implantes ao nvel dos molares superiores. Fig.4 -Microimplant o n the nasal spine area. The intrusion of the upper incisors was obtained with an elastic ligature from the arch to the miniimplant. The upper retraction was done with NITI coil springs and two microimplants on the molar regioin.

Vrias tcnicas foram introduzidas nos ltimos anos. A utilizao de parafusos bicorticais um novo mtodo ortodntico de ancoragem aplicado quando h espao suficiente entre as raizes. O uso de mini

Many approaches have been introduced in recent years. The use of bicortical screws is a new method for orthodontic anchorage where a sufficient gap between two roots is mandatory to avoid harming

Fig.5 - Uso de trs micro-implantes para intruso dos molares superiores. Fig.5 - The use of three microimplants for molar intrusion

placas de osteosintese outro mtodo recente, mas que implica uma etapa cirurgica.3,4,12. Por fim os mini implantes constituem uma recente tcnica para ancoragem ortodntica. O mini implante para ancoragem deve ser o mais pequeno possivel, de forma a ser usado em qualquer rea do osso alveolar ou apical. A fase cirurgica deve ser to fcil qunato possivel para ser exercida pelo ortodontista. No na realidade complicada pois os parafusos so colocados directamente atravs da gengiva, sem retalho muco-periosseo. Aps a sua colocao pode ser aplicada fora de imediato.

the existing dentition. The use of osteosynthesis miniplates is another approach where a surgical procedure is needed3,4,12. The use of mini implants is another recent technique to be used for orthodontic anchorage. The mini-implant for orthodontic anchorage should be small enough to place in any area of alveolar bone, even apical bone. The surgical procedure should be easy enough to be performed by an orthodontist. It is really uncomplicated because the screws are placed directly through the gengiva, without a mucoperiosteal flap, and can be loaded immediately after insertion.

Fig.6 - Aplicao de mini-implantes como sistema de ancoragem estvel para retraco em massa dos seis dentes anteriores, com tcnica fixa lingual. Fig.6 - Miniimplants as stable anchorage during en mass retraction of the upper front teeth, with lingual technique.

Eles podem ser usados na regio anterior ou posterior, atravs de elsticos ou molas aplicadas aos dentes.

Mini-implants can be used in the anterior or posterior region and attached with elastics or coils springs to the fixed appliance for direct anchorage. 5

Fig.7 - Recuo em bloco dos dentes anteriores, com a ajuda de dois mini-implantes colocados em mesial dos molares superiores. Fig.7 - Retraction of the upper front teeth with the aid of two microimplants.

O mini implante deve ter uma fcil remoo aps a sua utilizao. A principal desvantagem a proximidade da superfcie radicular, que pode ser tocada durante a sua colocao ou durante a movimentao dentria. No entanto, o risco diminuto se seguir a tcnica de Park e colaboradores8. Vrios desenhos de mini implantes foram descritos, bem como procedimentos de colocao 5-9,13. Neste artigo descrevemos vrias solues com mini implantes.

Anchorage can be adapted to changing treatment needs in different parts of the dental arches. The implant should be easily removable after orthodontic traction. The main disadvantage of these screws is their proximity to the roots, which may be damaged during placement of the screws or when the adjacent teeth are displaced, however, if we follow the technique proposed by Park and Co there is no risk of root damage during surgical procedure8. Several designs of mini-implants were described in literature as well as placement procedures 5-9,13. In this article we describe many solutions for orthodontic purposes with mini implants.

Fig.9 - Retraco dos dentes anteriores e inferiores com a ajuda de micro-implantes. Fig.9 - Retraction of upper and lower front teeth with stable anchorage with microimplants. Fig.8 - Retraco dos dentes anteriores com micro-implantes. Fig.8 - Upper front teeth retraction with microimplants

Fig.10 - Different approaches for uprighting molars. Placement of two miniimplants in the edentulous area, and a bonded bracket. This kind of technique give many solutions for orthodontic treatment of patients with teeth missing. Fig.10 - Vrias formas de verticalizao molar. Colocao de dois mini-implantes e colagem de um bracket. Este tipo de tcnica permite vrias solues para o tratamento ortodntico de pacientes com faltas de dentes.

Fig.11 - Distalizao de prmolar com ancoragem num micro-implante. Fig.11 - Premolar distalization with miniimplant anchorage.

Fig.13 - Retraco do canino Fig.13 - Canine retraction Fig.12 - Mesializao do molar superior com ancoragem estvel. Fig.12 - Mesialization of the upper molar with stable anchorage.

Biliography
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