• Definition

• Classification

• Factors affecting anchorage

• Anchorage considerations in removable appliances

• Anchorage considerations in removable functional appliances

• Anchorage considerations in fixed functional appliances

• Anchorage considerations in fixed mechanotherapy

“ Resistance to displacement” ----- Moyers

“The nature and degree of resistance to displacement offered by an

anatomic unit when used for the purpose of effecting tooth
movement.” ----- T.M. Graber

“Resistance to unwanted tooth movement.” -----Proffit :

“The amount of movement of posterior teeth (molars,
premolars) to close the extraction space in order to achieve
selected treatment goals.” ----- Nanda

Anchorage is upmost important for the success of any

orthodontic treatment
• Biomechanics of orthodontics are not always designed to
move the tooth.

• In certain cases it is neceesary to hold certain teeth in the arch

“ anchor unit “
 Newton’s
Third law of motion

“ Every action has an equal and opposite reaction”

Moyers

• According to the manner of force application

1. Simple anchorage

Resistance to tipping.
 2. Stationary Anchorage

• pitting bodily movement of one group of teeth against tipping

of another

• Using example of a premolar extraction site, if the appliance

were arranged so that the anterior teeth could tip lingually
while the posterior teeth could only move bodily, the optimum
pressure for the anterior segment would be produced by about
half as much force as if the anterior teeth were to be retracted
bodily.
• This would mean that the reaction force distributed over the
posterior teeth would be reduced by half, and as a
consequence, these teeth would move half as much.

• It is important to note again, however, that successful

implementation of this strategy requires light force.
• If the force were large enough to bring the posterior teeth into
their optimum movement range, it would no longer matter
whether the anterior segment tipped or was moved bodily.
 p

3. Reciprocal

• forces applied to teeth and to arch segments are equal, and so

is the force distribution in the PDL.

• Diastema

• connected by an active spring

• The essentially identical teeth would feel the same force

distributed in the same way through the PDL and would move
toward each other by the same amount.
• A somewhat similar situation would arise if a spring were
placed across a first premolar extraction site, pitting the central
incisor, lateral incisor, and canine in the anterior arch segment
against the second premolar and first molar posteriorly.

"anchorage value" of any

tooth is roughly equivalent
to its root surface area.
 Bishara 240
According to the arches involved

1. Intraarch

• Anchorage units lie within the same jaw

• It may be reciprocal, stationary or of simple type

• Augumented with lip bumper and palatal button.

Resisting mesial migration of molar during retraction of anteriors

• Rather than basing anchorage on anotomic features various
spring and loop designs have been introduced

• Differential tooth movements differential pressures

 Separate canine retraction

 TM

2. Inter maxillary
(BAKER’S ANCHORAGE)

• Anchorage units situated in one jaw are used to effect tooth

movement in the opposing jaw.

• Elastic traction
 According to the site of anchorage

1. Intra oral

Anchorage established within the mouth.

2. Extra oral
Anchorage obtained outside the oral cavity.

a.) Cervical : eg. neck straps

b.) Occipital : eg. Head gears

c.) Cranial : eg. High pull headgears

d.) Facial : eg. Face masks

 3. Muscular

Anchorage derived from action of muscles.

eg. Lip bumper

 According to the number of anchorage units

1. Single or primary anchorage

Anchorage involving only one tooth.

2. Compound anchorage

Anchorage involving two or more teeth.

3. Reinforced anchorage:

Addition of anchorage sites.

eg. Mucosa, muscle, head, etc.

 Reinforced Anchorage

• differentially retract the anterior teeth,

anchorage of the posterior teeth could be

reinforced by adding the second molar

• This change the ratio of the root surface areas

more pressure in the PDL of the anterior teeth, and

therefore relatively more retraction of the anterior segment
than forward movement of the posterior segment.
• pressure-response curve

• Efficacy of light forces in controlling anchorage, and why

heavy force destroys anchorage.

• Then the clinician is said to have slipped, burned or blown the

anchorage by moving the anchor teeth too much.
• In orthodontics terms such as critical anchorage ,noncritical
and burning anchorage are often used to describe the degree of
difficulty of space closure

Nanda

• Anchorge can be classified as

Group A : Critical maintainance of posterior tooth position

More than 75% of space is required for anterior retraction

Group B : symmetric space closure with equal movement of
anteriors and posteriors

Group C : non critical anchorage

75% or more of the space is utilised for mesial movement of

molars

Critical anterior anchorage

Burstone

• Group A arches

• Group B arches

• Group C arches
 Factors affecting anchorage

• Number of roots
• Shape, size and length of each root
multirooted > single rooted
longer rooted > shorter rooted
triangular shaped root > conical or ovoid root
larger surface area > smaller surface area
• Cortical anchorage:
Cortical bone vs. medullary bone
• Muscular forces:
Horizontal growers vs. vertical growers
• Position of tooth

• Mandibular second prernolars, which are placed between two

ridges-the mylohyoid and the external oblique, they provide an
increased resistance to mesial movement.

• Axial inclination of the tooth

• tooth inclined in the opposite direction to force applied,

provides greater resistance or anchorage
• Intercuspation
• Good intercuspation -- greater anchorage
• This is mainly because the teeth in one jaw are prevented
from moving because of the contact with those of the opposing
jaw

• Basal Bone
• Certain areas of the basal bone like the hard palate and the
Lingual surface of the mandible in the anterior region can be
used to augment the anchorage.
 p

• An obvious strategy for anchorage control would be

to concentrate the force needed to produce

tooth movement where it was desired, and then to dissipate the
reaction force over as many other teeth as possible, keeping
the pressure in the PDL of anchor teeth as low as possible.
 p

• A threshold, below which pressure would produce no reaction,

could provide perfect anchorage control --- teeth in the
anchorage unit.

• In fact, the threshold for tooth movement appears to be quite

low, but there is a differential response to pressure, and so this
strategy of "divide and conquer" is reasonably effective.
 p

• teeth behave as if orthodontic movement is proportional to the

magnitude of the pressure, up to a point.

• When that point is reached, the amount of tooth movement

becomes more or less independent of the magnitude of the
pressure, so that a broad plateau of orthodontically effective
pressure is created."
 p

• The best definition of the optimum force for orthodontic

purposes is the lightest force that produces a maximum or
near-maximum response (i.e., that brings pressure in the PDL
to the edge of the nearly-constant portion of the response
curve).

• Force greater than that, though equally effective in

production tooth movement, would be unnecessarily traumatic
and, is unnecessarily stressful to anchorage.
MECHANICAL ASPECTS OF ANCHORAGE CONTROL

• When teeth slide along an arch wire, force is needed for two
purposes
to overcome frictional resistance
create the bone remodeling needed for tooth movement

• Unfortunately, anchor teeth usually feel the reaction to both

frictional resistance and tooth movement forces, so controlling
and minimizing friction is an important aspect of anchorage
control.
Anchor loss in all 3 planes of space

Sagittal plane

- Mesial movement of molars,

- Proclination of anteriors

Vertical plane:

• - Extrusion of molars,

- Bite deepening due to anterior extrusion

 Transverse plane

- Buccal flaring due to over expanded arch form and

unintentional lingual root torque,

- Lingual dumping of molars,

 Anchorage in removable appliances

Active Clasps
part

Baseplate

Baseplate

- Point of attachment for the active components,

- Distribution of the reactionary forces to the teeth and tissues.

• To ensure adequate anchorage from baseplates:

- Extension as far as possible, also for stability,

- Close fit to the tissues,

- Contouring along the lingual gum margins,

- Adequate bulk of acrylic.

• Wire components

- Labial bow:

Prevents proclination of incisors

Stationary anchorage
 Anchorage considerations in functional appliances

• Anchorage obtained by:

- capping of incisal margins of lower incisors

- proper fit of cusps of teeth into the acrylic

- deciduous molars used as anchor teeth

• Tissue borne appliances

- Vestibular screen, Frankel’s function regulator

• Anchorage by acrylic extending into vestibule

 GR

Anchorage considerations in fixed functional appliances

Herbst Appliance
 GR

Acrylic splint herbst appliance

 GR

JASPER JUMPER

• Alignment of the upper and lower anterior teeth during the

initial phases of orthodontic treatment must be completed.
Full-sized (or nearly full-sized) arch wires should be inserted
into the brackets in both arches before the placement of the
force modules.
 GR
• arch wires should be tied or cinched back posteriorly to
increase anchorage , including second molars whenever
possible.

• The clinician can place posterior tip-back bends in the

mandibular arch wire to enhance anchorage.

• Alternatively, lower incisor brackets with 5° of lingual crown

torque incorporated into the slot of the bracket also can be
used to prepare anchorage.
 Graber

Anchorage considerations in fixed mechanotherapy

Impacted tooth
• After the intial alignment all the teeth are transformed into a
composite and rigid unit ,in which each of the teeth play an
integral part.

• Flexible archwire heavier wire

• Play with in the bracket is minimal there by maximizing the

anchorage value of each tooth
 Gv2
Intrusion of incisors

• extrusive forces and moments that tend to tip their crowns

distally are applied on molars

• intrusive forces are kept light and some appliances are added
to molar

1) Low palatal bar to counteract extrusive forces

2) High pull headgear to counteract extrusive and tipping

components

3) Sectional wire from first to second molars to prevent distal

tipping.
 BEGG TECHNIQUE

• Use of vertical slot

• Use of light forces for tipping teeth

• Use of optimal forces, so that extra oral forces are not

required

• No anchorage preparation necessary

• Storey and Smith’s experiment on differential forces

“ There is an optimum range of force which produces

maximum amount of tooth movement through bone, and
with forces above or below this range there is reduced tooth
movement.”

• Canines -- 150-200 gm.

• Further increase of force reduced the canine movement till it

approached zero

• molar --- 300-500 gm.

 stage I

Sagittal
lower molar anchorage
Upper molar anchorage
- stiff lower wire ( 0.018” P or
- upper Cl I elastics not
P+)
used
- light (yellow or road runner)
- TPA , when using power elastics
arms and palatal elastics - molar stop in case of Cl II and
( also consolidating the first lower Cl I elastics
and second molars) - lip bumper in critical
anchorage cases
stage II
• heavy arch wires ( 0.018 or 0.020) to maintain rotational

correction, deep bite correction and arch form

• Mild anchor bends to maintain over bite correction

• Anterior anchorage for posterior protraction:

- braking springs, angulated T pins

- combination wires with anterior rectangular ribbon

mode and posterior round wire

 stage III
1. Torquing auxiliaries and uprighting springs

Sagittal
- reverse torquing auxiliary on lower incisors
- headgear or TPA on upper molars and lip bumper on lower molars

Vertical
- high pull headgear, TPA or posterior bite blocks
- molar uprighting springs in case of second premolar and first
molar extraction cases
Transverse

• Contraction and toe-in in heavy base wires

• TPA or overlay wires

• Molar torquing auxiliary for buccal root torque

 GS

TWEED TECHNIQUE

“ When teeth are tipped distally as they are in anchorage

preparation, osteoid tissue appears to be laid down adjacent to
the mesial surface of the tooth being moved distally.”

- Kaare Reitan
 GS
First degree or minimal anchorage preparation

• ANB = 0 – 4
• Facial esthetics were good

• anchorage preparation consisted of inclining the terminal

molars which are angulated such that the direction of pull of
the intermaxillary elastic force during function will not exceed
90° when related to the long axis of these teeth.
 GS
Second degree or moderate anchorage preparation

• ANB angle exceeds 4.5° with a Class II profile

• banding of mandibular second molars and angulating their

distal marginal ridge is at gum level.

• direction of pull from the Class II elastics > 90°

• depress rather than elongate the terminal molars.

 GS

Third degree or total anchorage preparation

ANB >/= 5°

• The anchorage preparation was such that all the molars and
premolars were tipped distally with the distal marginal ridge of
the second molar being located below the gum level.
 ROTH’S MODIFICATION

• Mand 1st PM – 1st M

should be uprighted 30 distal form a normal

mesioaxial position of 20

• Hence lower premolars and molars have a distal tip of –1

This serves to prepare anchorge in mandibular buccal
segments.
Factors that tend to slip the anchorage forward are :

• The use of resilient wires and continuous wires in attempting to

level a deep curve of spee

• Attempts to gain rapid bracket alignment with resilient wires.

• Attempts to upright distally inclined canines.

• Attempts at moving the roots of maxillary incisor teeth
lingually.

• Attempts at arch expansion with a labial wire

• Attempting to retract proclined anterior teeth through an

extraction site using reciprocal force.
• According to Roth banding of second molars at the onset of
treatment can minimize the need for extra oral reinforcement
of anchorage.

• In en-masse retraction the six anterior teeth are pitted against

four teeth, two second premolar’s and two molars in an first
premolars extraction case. Where as if second molars are
banded six anterior teeth are pitted against six posterior teeth.
• When leaning forward or labially, the anterior teeth provide
excellent anchorage to resist displacement .

• Hence initially to retract and upright these anteriors, an

Asher’s facebow in both upper and lower arches can be used
for up to 6 to 8 weeks.

• Once the incisors are up righted they offer very little

resistance as an anchor unit and can be easily retracted.
 VARI –SIMPLEX DISCIPLINE

• maxillary arch

• let mandibular anterior drift distally - “driftodontics”

• - 6 tip in the lower molar to conserve anchorage -- tweed
principle
• Headgear or retractor is used which is unquestionably the most
effective method of controlling anchorage.

Maxillary and mandibular holding appliances used by Alexander

are
• Transpalatal arch with Goshgarian type design.
• Nance holding arch
• Lingual arch
• Lip bumper
 BIOPROGRESSIVE THERAPY

• Retraction and Uprighting cuspids with sectional arch

mechanics.

• Intermittent headgear wear will provide moderate anchorage in

extraction treatment.

• Full time headgear wear in Bioprogressive therapy is used

where orthopedic correction is prescribed.
• Different mechanics are needed in varying facial types and
muscular patterns.

• Branchyfacial -- natural anchorage -- moderate anchorage

• maximum anchorage --- vertical growth pattern

• Maximum lower molar anchorage is maintained through the

action of long lever arm of the utility arch.
• During cuspid retraction on sectional arches, the utility arch is
used to intrude or stabilize the incisors.
• Four mechanical adjustments are placed against the molars in
establishing maximum anchorage effect.

• Buccal root Torque

• Expansion

• Tip back

• Distal molar rotation of 300 is also placed. The molar needs to

be positioned to resist the forward drag on it during cuspid
retraction
• In extreme vertical pattern, 3mm of forward movement would
still require maximum anchorage to hold.

• While 3-4 mm forward movement in a strong, deep bite

brachyfacial type would require minimum anchorage and
special efforts to advance the molars.

• In minimum anchorage cases, to advance the lower molar

forward the four anchoring factors of torque , tip – back,
expansion and rotation are minimized.
 Vanarsdall -689

Tweed merrifield edwise appliance

Movement is accomplished by using 10 teeth as “anchorage

units” to tip 2 teeth and is often reffered as Merrifield “10-2”
system.

In the initial step of treatment second molar is tipped to its

desired position and compensatory bend is given mesial to it to
maintain its tip ,the same is followed with 1st molar and second
premolar .
 LEVEL ANCHORAGE SYSTEM Terrell Root

TOOTH ANCHORS

• Resistance to movement • Distance to move

• Changing the axial
inclination of the anchor teeth
• Increased by extraction
• Class III elastics that tip
the lower buccal crowns
distally also increases distance
to move
 ANCHOR SAVERS

• Reduce the amount of tooth anchorage necessary to correct

malocclusion

• Use of headgear or palatal bar

• Postponement of extraction of maxillary premolars till later in

treatment

• Lip bumpers

• muscular pattern of low mandibular angle cases.

• Anchorage in this system can be very well explained under
following headings.

• Appliance prescription

• Measuring anchorage requirements

• Measuring anchoring available

Appliance prescription

• According to the severity of malocclusion and anchorage

requirements

• Regular prescription has 40 distal tip in the premolars, 60 tip

in first molars and 100 tip in second molars.

• Major prescription has 60 distal tip in the premolars and 100 in

first molar and 150 in second molar.
Anchorage requirements -- negetive value

1)Curve of spee
2)Lower arch descripency :crowding or spacing
3)Space needed to upright lower anteriors
4)Anchorage needed to retract lower canines
5)Anchorage needed to correct ANB
6)Additional anchorage needed if mandibular plane angle is high
7) Anchorage needed to retract anteriors in xn cases
Anchorage available -- positive value

• high pull headgear or high pull J – hook

• 1 pound pressure -- 12 hours per day

reduces ANB by 10 every 6 months.

• Trans palatal bar due to tongue pressure decreases the vertical

descent of maxillary buccal segments. This reduction in
vertical facial height closes the MPA

40 of closing – 0.5mm of space available

• Delaying extractions of first premolars prevents any further
migration of upper molars.

1 year reduces the need for mandibular anchorage space by

1mm.

• Class III elastics used in conjunction with headgear, tends to

tip the buccal segments distally at the rate of 0.5mm per side
per month. Anchorage space created by the use of class III
elastics is 1mm per month for upto 6mm.
• In L.A.S. anchorage available to treat a malocclusion is
measured and anchorage required to reach a predetermined
goal is also measured.

• An analysis chart is prepared that balances the both.

• A self check systems is written so that the orthodontist can

proceed on a step –by-step path to a predetermined goal.
 MB

• In preadjusted appliance there is a tendency of anterior teeth to

procline forward during the initial phase.

• This results from the tip built into the anterior brackets and it
is more pronounced in the upper arch, where the built-in tip is
greater.
Elastic forces SAGGITAL

• anchorage loss

• tipping and rotating anterior teeth distally,

• increasing the curve of spee -- deepening the bite.

• laceback’s

• bend the archwire distally

vertical

• prevent extrusion of posterior teeth and opening up of

mandibular plane angle ( high angle cases)

• Upper second molars not banded or archwire step placed

distal to first molars

• Palatal bars -- effect of the tongue

• headgear

• biteplates
 R N 342

Implants

• Maximun anchorage means using favourably using 75% of

space.

• In some caes maximum anchorage is insufficient ,and the

treatment goal require 100%of space .

• stationary anchorage can be used for this purpose

• Traditionally --- extraoral appliances

 Implants

• In the form of mini plates and screws are available

• Offers light continous forces

• Intrusion of posteriors to close an anterior open bite

• Distal movement of molars

• Retaction and intrusion of protruding upper incisors

• Positioning individual tooth when no other satisfactory

anchorage is available.
 Zygoma Ligatures

• Indicated in patients without sufficient posterior anchorage in

whom other forms of anchorage have been ruled out

• Best bone quality is found in the zygomatic arch and

infrazygomatic crest in a partially edentulous patient
• Hand book of orthodontics – Moyers

• Orthodontic principals and practice –T.M Graber

• Removable orthodontic appliances - Graber and Neumann.

• Dentofacial orthopedics with functional appliance-

Graber ,Ralosi,Petrovic

• Contemporary orthodontics –Profitt

• Orthodontics current principles techniques-- varnarsdal

• Temporary anchorage device – Ravindra nanda

• Contemporary orthodontics – profit

• Bishara

• Gurkersigh

• Rivindranath

• Rickets

• Graber and Rakosi

• Graber

• Moyers

• Removable appliances