VERTICAL ANCHORAGE

NEWTON’S third law of motion :

“ Every action has an equal and opposite

reaction.”
DEFINITIONS :
Moyers :
“ Resistance to displacement.”

T.M. Graber :
“The nature and degree of resistance to
displacement offered by an anatomic unit when
used for the purpose of effecting tooth
movement.”
 :
Proffit :
“Resistance to unwanted tooth movement.”
“Resistance to reaction forces that is provided
(usually) by other teeth, or (sometimes) by the
palate, head or neck (via extraoral force), or
implants in bone.”
Nanda :
“The amount of movement of posterior
teeth (molars, premolars) to close the
extraction space in order to achieve
selected treatment goals.”
CLASSIFICATIONS:
According to Moyers
According to manner of force application
(a) simple anchorage
(b) stationary anchorage
(c) reciprocal anchorage

According to the Jaws involved

(a) intra maxillary
(b) inter maxillary
According to site of anchorage
(a) intra oral
(b) extra oral -cervical
- occipital
- cranial
- facial
( c)muscular

According to number of Anchor units

(a)single or primary
(b) compound
(c) multiple or reinforced
Moyers :
According to the manner of force
application:
1. Simple anchorage :
Resistance to tipping
2. Stationary anchorage :
Resistance to bodily movement.
3. Reciprocal anchorage :
Resistance offered by two malposed
units ,when dissipation of equal and
opposite forces tends to move each units
towards a more normal occlusion
Correction of posterior cross bite through
cross elastics
 According to jaws involved
1. Intermaxillary
Resistance units are situated within the
same jaw
2 Intramaxillary
Resistance units situated in one jaw are used
to effect tooth movement in the other jaw
Class III Elastic
traction Class II Elastic traction
 According to the site of
anchorage
1. Intra oral :
 Resistance units are situated within the
oral cavity
 Intra-oral anatomic units are
• Teeth
• Palate
• Lingual alveolar bone of mandible
2. Extra oral :
 Resistance units are situated outside oral cavity
 Extra –oral anatomic units
a.) Cervical
b.) Occipital
c.) Cranial
d.) Facial
 :

3. Muscular :
Anchorage derived from action of
muscles.
eg. Lip bumper
 According to the number of anchorage
: units :
1. Single or primary anchorage:
Resistance provided by a single tooth
with greater alveolar support is used to
move another tooth with lesser support
2. Compound anchorage:
Resistance provided by more than one
tooth with greater support is used to
move teeth with lesser support
3. Reinforced anchorage:
 Anchorage in which more than one
type of resistance unit is utilized
 Augmentation of anchorage
• Extraoral appliances
• Upper anterior incline plane
• TPA
Nanda :
A anchorage : critical / severe
75 % or more of the extraction space is
needed for anterior retraction.
B anchorage : moderate
Relatively symmetric space closure (50%)
C anchorage : mild / non critical
75% or more of space closure by mesial
movement of posterior teeth
 BIOLOGICAL ASPECTS OF
ANCHORAGE :
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
 BIOLOGICAL ASPECTS OF
ANCHORAGE :
Factors affecting anchorage:

Cortical anchorage:
Cortical bone vs. medullary bone
Muscular forces:
Horizontal growers vs. vertical growers
BIOLOGICAL ASPECTS OF
ANCHORAGE :

PRESSURE RESPONSE CURVE :

 BIOLOGICAL ASPECTS OF
ANCHORAGE :
Pressure in the PDL= Force applied to a tooth
Area of force distributioin PDL

Tooth movement increases as pressure increases

upto a point, remains at same level over a broad
range and then may gradually decline with
extremely heavy pressure.
Optimum force- for orthodontic purpose is
the lightest force that produces a maximum
or near maximum response
The magnitude of optimum force will vary
depending on the way it is distributed in the
PDL
 BIOLOGICAL ASPECTS OF
ANCHORAGE :
.
 ANCHORAGE LOSS:
Anchor loss in all 3 planes of space :
Sagittal plane:
- Mesial movement of molars,
- Proclination of anteriors
ANCHORAGE LOSS:
Vertical plane:
- Extrusion of molars,
- Bite deepening due to anterior extrusion
 ANCHORAGE LOSS:
Transverse plane:
- Buccal flaring due to over expanded arch
form and unintentional lingual root torque,
- Lingual dumping of molars,
VERTICAL
MALOCCLUSION
Vertical malocclusion
nature of the overlap of maxillary and
mandibular teeth
Open bite and Deepbite- dentoalveolar
structures
Hyperdivergent and Hypodivergent-skeletal
structures
 Hyperdivergent Hypodivergent
• Long face • Short face
syndrome syndrome
• Mandibular plane • Mandibular plane
angle greater than angle less than 20
30
 ETILOGICAL FACTORS

OPEN BITE DEEP BITE

• Faulty postural performance – • Over eruption of maxillary incisors
associated musculature • Incisor angulation
• Digit sucking haits • Width of anterior teeth
• Tongue activity • Excessive overjet
• Lymphatic tissue and obstructed • Undereruption of the molars
nasorespiratory function • Mandibilar ramus height
• Unfavorable growth patterns • Failure of natural eruption
• Imbalances between jaw
posture,occlusal and eruptive forces
and head position
• Mental retardation
• Heredity
 OPEN BITE CHRACTERISTICS

• Defects in eruption
 Cleidocranial dysplasia –mandible
prognathic,hypoplasia of maxilla and other facial
bone
 Carpenters syndrome –wide short skull,A-P
diameter is smaller
• Extreme skeletal open bites
 Crouzons syndrome –hypoplastic maxilla results
in mandibular prognathism
 Characteristics of skeletal open
bite
 Short mandibular ramus
 Downward rotation of posterior part of maxilla
 Downward backward rotation of mandible
 Increased lower anterior facial height
 Increased total anterior facial height
 Increased gonial ,mandibular and occlusal plane angles
 Decreased palatal plane angle
 Increased vertical maxillary and mandibular dentoalveolar
dimension
 Deep Bite Characteristics
 Overeruption of both maxillary and mandibular
anterior teeth and undereruption of molars
 Accentuated Curve of Spee
 Short lower anterior facial height and overclosure
 Lack of vertical development in posterior segment
 Mandibular skeletal retrusion
 Decrease in vertical facial dimensions
 Low mandibular plane angle
 Hypertonic muscles of mastication and
hyperactive muscles of mastication

etiological factors

Overclosure
 Studies-higher maximum bite force in subjects
with reduced or normal vertical dimensions
when compared to subjects with increased facial
dimensions
EXTRA ORAL
ANCHORAGE
 Headgears obtain support
• back of neck,
• cranial bones
- provide three –dimensional anchorage
control depending upon the type of headgear
and direction of force
Force is transmitted from headgear strap to
teeth via facebow or J-hooks
 Kingsley and Angle-19th century-used
occipital headgears to retract and intrude
maxillary incisors
 Oppenheim and Kloehn-recommended
application of extra-oral forces for mass
distal movement of teeth
Kingsley’s Angle’s
headgear headgear
 EXTRAORAL TRACTION

FACE BOWS J –HOOK HEADGEARS

INNER BOW OUTTER BOW

FACEBOW TUBES BENT UPWARD –POINT OF FORCE APPLICATION AND DIRECTION OF

FORCE LIE ABOVE CENTER OF RESISTANCE OF MAXILLARY MOLAR

Cervical (low –pull or Kloehn)
Facebow
Outer bow is longer than inner bow
Force is exerted below occlusal
plane ,producing both extrusive and
distalizing effects
Restrict forward growth of maxilla and/or to
prevent forward movement of the maxillary
posterior teeth
Use- decreased vertical skeletal dimensions
Molar extrusion
Kloehn – type
headgear
Occipital (High Pull) Facebow
Force is exerted above occlusal plane
Distalizing and intrusive effects
Use-patients with skeletal or dentoalveolar
open bite pattern and or steep mandibular
plane angle
In individuals in whom increase in vertical
dimension are to minimized or avoided
Outer bow-headcap-produce more
vertically directed force
• High pull facebow

decrease vertical development of maxilla

allow autorotation of mandible

maximize horizontal expression of madibular

growth
Combination Facebow
Cervical facebow and High pull facebow
used in combination
Alter direction of force along plane of
occlusion
High Pull Cervical pull Combination
pull
 TYPES OF HEADGEARS
J-HOOK HEADGEAR
Head gear may be attached by ‘J’ hooks -J-hooks to
archwire or to hooks soldered to archwire
‘J’ hook headgear classification
i) High pull ‘J’ hook head gear

ii) Straight pull ‘J’ hook head gear

iii) Low pull ‘J’ hook head gear

Use-flared maxillary incisors retracted using high pull or

straight pull headgears
Center of resistance
the center of resistance is the point on the
body where a single force would produce
translation i.e ., all points moving in parallel,
straight lines
maxillary first molar, the center of resistance
is estimated to be in the trifurcation of the
roots.
Center of resistance of maxilla located above
the premolar roots
 BIOMECHANICS
• Headgear –deliver only a net single simple
force
• A force is a vector quantity having both
magnitude and direction
 Clinical applications of headgear
 There are four main uses of headgear force

1. Anchorage control
2. Tooth movement
3. Orthopedic changes
4. Controlling the cant of the occlusal plane
 Anchorage control
 Class II treatment, headgear force can play a major role in
ensuring that buccal segment teeth do not move mesially
when anteriors are retracted.
 Intraoral mechanics often result in eruption of teeth and
moment of force –expressed at the center of resistance of
tooth produces root buccal ,crown-lingual moment ,tip
molar crown into lingual crossbite
 Headgear produces a vertical force greater than the force of
side effect
 Headgear used to maintain first molar width
Vertical force on Vertical component of
molar tube, a side occipital headgear force
effect of intraoral negates extrusive intraoral
mechanics force side effect
Tooth Movement
Adjustment of outer bow such that a
horizontal force is produced that passes
through the center of resistance of maxillary
first molar and the patient wears the headgear
at a level of 14 hours each night consistently
Clinical experience shows that the first molars
will move distally 2mm in 24 months without
tipping.
Orthopedic Changes
Headgear force is applied through center of
resistance of maxilla ,lie at apical level
between maxillary premolars and if
preadolescent patient wears headgear 12
hours each night(at least 14 hours each
night-adolescent patient)

Forward component of maxillary growth is

redirected
 Orthopedic changes

Force passing
through center of
resistance of maxilla
Controlling the cant of Occlusal
plane
Headgear force is used to control the cant of
occlusal plane in Class II patients
Headgear force is used to flatten occlusal
plane for the reasons of posttreatment
stability
Steepen OP,Erupt and Prevent Mesial Movement
•Cervical headgear with low outer bow generates large moment
about center of resistance steepen occlusal plane
•Vertical component –headgear acting at resistance center will
erupt unit
•Distal component will tip unit distally
In rotating unit-using large moment in
comparision to applied force through center
of resistance-one should use low strap forces
to avoid high local stress in periodontal
ligament
150-200 g per side
If line of action of headgear force passes
close to or through units center of
resistance ,400-500 g per side
Occipital headgear –to control occlusal plane and prevent side
effects from maxillary incisor intrusion
Headgear force applied away from molars center of resistance
generate-large counterclocwise moment negating
clockwise moment from intrusion arch
Outer bow bent high and cut short to provide desired line of
action
 Moment of force
 Forces not acting through the center of resistance do not
solely produce linear motion.
 The moment of force results in some rotational movement.
The moment of force is the tendency for a force to produce
rotation.
 It is unrecognized in clinical orthodontics. awareness of
moment of force is required to develop effective and
efficient appliance designs.
 Two variables determine the moment of force – the
magnitude of the force and the distance. Either one can be
manipulated by the clinician to achieve the desired force
systems
 In 1971 Armstrong demonstrated the importance
of the precise control of magnitude, direction, and
duration of extraoral force to increase its
efficiency and effectiveness in treating
malocclusions in the late mixed dentition.
 Gould has shown how changes in the inclination
of the facebow affect the direction of the force and
ultimately the direction of tooth movement.
 Greenspan presented reference charts elaborating
the different moments and forces produced with
the various headgear designs.
Moments (M) and forces produced by force
vectors applied at varying positions relative to the
center of resistance (CR) of maxillary 1st molar.
The vertical (V} and horizontal (H) forces are
proportional in magnitude to the legs of the
triangle that is constructed
. (a) the vertical and horizontal components of
the force are approximately equal. The moment's
direction is counterclockwise since the line of
force is above CR. The magnitude of M is the
product of LF times the perpendicular distance
(identified as P)from LF to CR.
LF goes through CR in (b) thus there is no M
produced. The tooth will translate parallel to the
line of force. The posterior force component is
larger than the superior.
The LF in (c) will produce a posterior and
inferior movement. The moment (P x LF) is
below CR and is therefore clockwise.
The magnitude of the moment produced by
the headgear is calculated by multiplying
the perpendicular distance (P) from the LF
to the CR by the magnitude of the force.
Thus, for a given force, the greater the
distance from the CR that the force is
applied, the greater will be the moment.
 1.
2.
3.
Class II growing patients with
deep overbite.adequate freeway
space,overbite correction is
planned via posterior extrusion
Outer bow low ,force system at
units center of resistance has
extrusive component ,distal
component and large moment that
steepen occlusal plane
Headgear force line of action passes
through units center of
resistance,extrusive ,distal
component and no moment
Outer bow high,headgear force line
of action passes distal to units
center of rsistance .Outer bow
should be long for this
configuration.Equivalent force
system at units center of resistance
has large extrusive ,distal force
component and a moment that tend
to flatten occlusal plane
1. Occipital pull with short outer bow ,angulated
high ,headgear LOF anterior to units center of
resistance .force system at units center of
resistance with a moment that flattens occlusal
plane and distal and intrusive force components
2. Headgear force LOFpasses through units center
of resistance,no moment generated,intrusive and
distal components of force are acting
3. Combination headgear short outer bow
angulated such that LOF passes through center
of resistance result-pure distal force passing
through center of resistance
USE- redirect maxillary horizontal growth in Class II
or to move maxillary molars distally
4 Occipital pull with long outer bow ,equivalent
force system at units center of resistance has a
moment that steepen occlusal plane ,force with
intrusive and distal component
Asymmetric headgear
Buccal occlusion is asymmetric eg Cass I
on one side and Class II on other side
Asymmetric headgear-distal force exists on
both sides ,but it is three times greater on
long outer bow side than on short outer bow
side
CHIN CUP
 Chin Cup
• It is use to restrict the forward and downward growth of the mandible

• Chin cup facebow assembly consists of

 Chin cup that covers chin
 Headcap
 Adjustable elastic strap that connects chincup with the head cap

Type :
1. Occipital pull chin cup.
2. Vertical pull chin cup.
Occipital pull chin cup

Anchorage-occpital region
of head
Use-Class III malocclusion with mild to
moderate mandibular prognathism
Successful in patients who can bring
their incisors close to an edge to edge
position at centric relation
Indicated in patients with slightly protrusive
Lower incisors as they produce lingual tipping
of lower incisors
Vertical pull chin cup

Anchorage-parietal region of head

 Creates vertically acting forces against craniofacial complex
 Vertical pull chin cups use-
- class III patients with anterior open bite
tendencies
- patients with increased anterior vertical
dimension
 Result –decrease in mandibular plane and gonial angles and increase
in posterior facial height
 Vector force should be 90 degree to occlusal plane and pass through
center of resistance of entire arch
 Pearson –12 hours a day ,
force 500 grams
 Pearson-use of posterior bite block with a vertical pull chin cup
BITE BLOCKS
 POSTERIOR BITE BLOCKS
Vertical component of skeletal and dental
development can be modified with posterior
bite blocks
Bite block designs
 Removable
 Fixed types
 Removable type-wire framework and acrylic
of varying thickness
 Bonded acrylic splint expanders
Use-control posterior teeth eruption
-treatment of simple anterior crossbite
 With acylic coverage on occlusal surfaces,eruption of posterior
teeth is inhibited ,in some instances slight intrusion of posterior
teeth occur
 Slight extrusion of teeth not incorporated into appliance leads to
closure of anterior open bite
 After removal of expander ,slight autorotation of mandible occurs
If acrylic on occlusal surfaces is built up
additional few millimeters ,muscles are
elongated and forces against occlusion may
be increased
Placement of posterior bite blocks can
prevent eruption of posterior teeth in
growing patients ,tooth intrusion in adults is
difficult
 Repelling magnets embedded in bite block
appliance –superoanterior maxillary
displacement and molar intrusion
Disadvantages
• root resorption-excessive intrusive forces
• deviated mandibular jaw posture produces
skeletal asymmetries
• unilateral crossbites
ANTERIOR BITE PLATE
Opens the bite anteriorly with a bite
plate ,then allowing posterior teeth to erupt
into occlusion
Simple anterior bite plate often is used in
conjunction with cervical extraoral traction
to open the bite and prevent accidental
incisor interference
Used as an adjunct to fixed appliance
treatment in which patients otherwise would
have heavy contact on brackets
TRANSPALTAL ARCH
Robert A.Goshgarian
of Waukegan ,Illinois
1972
 TPA
 USE
• molar rotation
• molar expansion
• molar stabilization
• Reinforcement of molar anchorage
• Molar intrusion
 For molar intrusion ,palatal arch is placed away from palate to
transmit intrusive forces of tongue on molars
 Yuhi et al – found that tongue pressure exerted on TPA during
swallowing showed a tendency to increase –loop was positioned
more distally
 Maximum tongue pressure-loop TPA
positioned in palatal midline between right
and left second permanent molars
 Recommended positioning of loop of TPA
4mm from palate for practical application
Cetlin-TPA can prevent molar extrusion
and can encourage molar intrusion
By enlarging midline omega loop and
directing loop mesially ,force of tongue
may produce an intrusive force on teeth to
which TPA is anchored
 The effect of TPA on tongue function has been
evaluated in two clinical studies
• Lazzara
• Weisenberg
 Definitive studies of relationship between lingual
function and forces produced against TPA have not been
reported
 Thus we do not anticipate molar ntrusion as a routine
treatment effect of TPA
IMPLANTS
 IMPLANTS :
Boucher: ‘Implants are alloplastic devices
which are surgically inserted into or onto jaw
bone.’
Why implants?
Limitations of fixed orthodontic therapy:
Headgear compliance
Reactive forces from dental anchors
HISTORY

Gainsforth and Higley - ( 1945 ) – first

introduced concept of skeletal anchorage
using vitallium ramal screws in dogs
Creekmore and Eklund - reported a case in
which vitallium implant was placed just
below ANS and used for anchorage
Kanomi –reported on use of implants for intruding lower
anterior teeth and molars
Costa et al –placed miniscrews in region of infrazygomatic
ridge for use as ortodontic anchorage for intrusion of upper
molar teeth
Sherwood et al and Umemori et al intruded upper and
lower posterior teeth in patients with skeletal open bite
using titanium miniplates as anchorage
Paik et al used midpalatal miniscrew implant anchorage to
intrude maxillary dentition in patient with vertical
maxillary excess
Sugawara et al –intruded mandibular molars
using miniplate anchorage
Screw design
 Length-thickness of both soft tissue and cortical
bone at the site of placement
 Midpalatal area-thin soft tissue covers dense
cortical bone-shorter length screw-5mm
 Buccal alveolar area –thick gingival soft tissue
covers less dense cortical bone- 6mm
 Retromolar pad area- less than or equal to 8mm
 Palatal alveolar region-gingival tissue thicker-
less than or equal to 7 mm
Indications For Intrusion
Minicrew implant anchorage for intrusion of
posterior teeth is indicated –anterior open bite
or vertical maxillary excess in whom reduction
of lower anterior facial height is desirable
Intrusion of both upper and lower molars-
patients with severe anterior open bite
Closure of mandibular plane angle and
reduction in anterior facial height-intrusion of
entire upper and lower dentition
Design of appliance
Upper molar intrusion –midpalatal
miniscrew implant plus Transpalatal arch
Lower molar intrusion –buccal interdental
miniscrew implant plus lingual arch
Intrusion of entire upper dentition or intrusion
of upper posterior teeth

Midpalatal miniscew position is usually level with first

molars
TPA-5mm away from palatal soft tissue
E –Chain attached between hooks soldered to arch and
miniscrew to generate intrusive force
Alternative approach –use interradicular miniscrew in
either buccal or palatal bone with TPA
Palatal arch – heavier gauge wire to prevent buccal /palatal
tipping –posterior teeth during intrusion
a

Intrusion of upper teeth using midpalatal miniscrew

anchorage
To encourage bodily intrusion of molars ,the
palatal /lingual arch made- 1.1 mm stainless
steel wire
Upper arch-As intrusive force is applied
over a period of time some palatal tipping
of molar can be observed ,so heavier
gauge can reduce such tipping
Lower Arch-Buccal crown tipping
resulting in posterior crossbite-so use
Lingual arch with heavy gauge stainless
steel wire
To avoid tipping in upper arch is to insert
additional buccal alveolar miniscrews and
apply intrusive force buccally and lingually
simultaneously
Ways of applying intrusive force
in upper arch
Patient with deep palate,kobayashi hooks can help to secure
the elastic chain to miniscrew head
Using an elastomeric ring to secure chain
Stops made of composite to secue chain to TPA
Miniscrew head covered with composite to prevent tongue
irritation
Intrusive force applied- nickel titanium springs
Intrusion of entire lower dentition or lower
posterior teeth

In lower arch ,miniscrews are inserted in

interradicular bone between first and second
molars
A rectangular archwire is engaged in lower
fixed appliance and lingualarch is placed
Elastic chain tied between archwire and
buccal alveolar miniscrews to apply
intrusive force
Intrusion of upper anterior teeth
Miniscrew placed between roots of incisor teeth
Single miniscrew- between central incisor roots
Single force applied at center of arch –reverse
smile line created as incisors intrude
Two miniscrews –one on either side of arch
between lateral incisor and canine roots
More apical placement –miniscrew will
minimize possibility of miniscrew root contact
I
 Implants for dental anchorage
a) Implants for intrusion of teeth

Creekmore in 1983 published a case report of usage of a vitallium implant for

anchorage, while intruding the upper anterior teeth. The vitallium screw was
inserted just below the anterior nasal spine (ANS) after an unloading period
of 10 days, an elastic threads was tied from head of the screw to the archwire
within one year, 6mm intrusion was demonstrated.
Intrusion of lower anterior teeth
Intrusion of lower anterior teeth-miniscrew placed
between roots of incisor teeth
Inter-radicular space is narrow between lower
incisors so better to use smaller diameter( <1.6
mm ) miniscrew,place it more apically to avoid
root-miniscrew contact
Optimum force levels
Force- 250-300 g per side for intrusion of
entire dentition
Force60-120 g (10-20 g per tooth ) applied
for intrusion of anterior teeth
 Intrusion of single molar
Pure molar intrusion
• Line of force should pass through center of resistance both
on lateral view and on frontal view to prevent
buccolingual or mesiodistal tipping during intrusion
• Cres of upper first molar –at center of occlusal table ,close
to palatal root
• Recommended insertion points of miniscrew-mesial
interdental area on buccal surface and distal interdental
area on palatal side
• So combined bilateral force from buccal and palatal side
will produce line of force passing through Cres of molar
Additional miniscrews can be placed on
either side of alveolar slope to enhance the
adjustibility of force direction
Three or four miniscrew implants are useful
to prevent or correct the tipping of molars
especially if molars is severely extruded
Biomechanics
 Intrusion of adjacent molars
Two adjacent molars can be intruded with two
miniscrews inserted in interproximal buccal and
palatal area
Cres is expected to be localized below proximal
contact close to molar
Two miniscrews placed at interproximal
interdental area produces a line of force close to
Cres of neighbouring molars leading to
segmental intrusion without additional
miniscrew
Intrusion of molars on both sides
Single miniscrew-palate
Intusive force deliverd through TPA
TPA-slightly expanded-prevent molars from
tipping palatally
If buccolingual position cannot be controlled
during intrusion,additional miniscrews on buccal
side may be necessary
Miniscrew should be in line connecting central
fossa of both molars
Miniplates
Positioning of miniplates
Maxillary sites –zygomatic butress
-piriform rim
Two sites are always thick to fix plates on
bone with screws
Zygomatic butress-Y-Plate-intrude and
distalize upper molars
Piriform rim-I-Plate –Intrusion and
protraction of upper molars
Mandible
Possible to fix screws in most
locations ,except for sites adjacent to mental
foramen
L-plate and T- plate placed in mandibular
body to intrude ,protract ,or distalize lower
molars or at anterior border of ascending
ramus to extrude impacted molars
Intrusion of maxillary molars
After engagement of rigid rectangular
archwire in buccal side and TPA in lingual
side,
Intrusive force will be provided from Y-
plates placed at zygomatic butresses
Intrusive force –upto 400 gram force on
each side
Intrusion of mandibular molars
Intrusive force of about 400-500 gram force
will be provided from L-plates placed at
molar region of mandibular body
Lingual arch or lingual crown torque to
rectangular archwire to prevent molar
buccal flaring
 ANCHORAGE
CONTROL IN MBT
TECHNIQUE
BENNETT AND MCLAUGHLIN:
Anchorage control:
‘The maneuvres used to restrict undesirable
changes during the opening phase of
treatment, so that leveling and aligning is
achieved without key features of the
malocclusion becoming worse.’
Vertical Anchorage Control:
Incisor Vertical Control:
 Distally tipped canines cause extrusion of the incisors- avoided by not
bracketing the incisors or not tying the arch wire into incisor brackets
 Don’t bracket incisors at start of treatment or not tying archwire into
incisor bracket slots,but allowing it to lay incisally until canine roots
have been uprighted and moved distally-lacebacks
 Vertical control of canines:
 Avoid early engagement of high labially
placed canines
 To avoid unwanted vertical movement of
lateral incisors and premolars does not
occur
Vertical Anchorage Control:
Molar Vertical Control:
 Upper second molars generally
not initially banded;to avoid
extrusion step placed behind
the first molar
 Attempt to achieve bodily
movement during expansion to
avoid extrusion of palatal cusps
so fixed expander ,sometimes
combined with high pull
headgear

 Palatal bars
 Palatal bars-lie 2mm away from palate so
tongue exert vertical intrusive effect
 In high angle cases, high-pull or
combination pull headgear
 Upper or lower posterior bite plate-in molar
region ,minimize extrusion of molars
 ANCHORAGE
CONSIDERATION IN BEGGS
AND TIP EDGE
 VERTICAL ANCHORAGE
Loss of anchorage in the form of extrusion of
molars occurs due to
• Anchor bends in both arches
• Vertical component of class II elastics in lower
arch
 Masticatory forces normally provide resistance
to molar extrusion so vertical anchorage is
adequate in normal or low mandibular plane
angle but inadequate in high angle cases
 In high angle cases TPA is kept slightly
away from palate . TPA , when using
power arms and palatal elastics ( also
consolidating the first and second molars)
 Upper palatal elastics or elastics from
power arms soldered to upper molar bands
are used ,when true intrusion of upper
incisors is desired
 They intrude as well as retract upper
anteriors
 High Pull headgear may also be used in high
angle cases for minimizing extrusion of lower
molars
 Elastics used are very light (yellow) or ultralight
roadrunner elastics
 EVAA appliance or posterior acrylic bite blocks
can also be used simultaneously helps in
reducing extrusion of both upper and lower
molars
 EVAA stands for (in Dutch) experimental fixed
appliance activator. It is a solid block of acrylic
with protruding wires that are inserted into the
tubes of upper molar bands
 The appliance is constructed so that the mandible
is forced into a forward position in closing.
 Fixed appliances can be placed to align teeth at the
same time as the orthopaedic treatment.
 When anterior intrusion requirement is
great ,molars are taxed to greater extent in
vertical direction ,in such cases archwire is
engaged in molar tubes on both first and
second molars for additional anchorage
 Anchorage bends
 Correct position-2 mm in front of molar tubes
 Placing them further forward will cause
them to protrude occlusally and will lessen
the amount of overbite reduction imparted to
anterior segment
 Anchor bends not only boost the anchorage
available from first molars but also exert
vertical control
 Angle of tip back depends on amount of intrusive
deflection archwire produces at midline
 Cases where no overbite reduction is required
bends –minimal, just to prevent molar
tipping ,only couple of active gingival deflection
at midline
 Low mandibular angle,deepbite cases,anchor
bends-stronger,maximum vertical deflection
permitted –can be to the depth of labial sulcus
 Intrusive force distributed between six anterior
teeth is 50 grams
 How many degrees of anchor bend will be
required to achieve the desired amount of
anterior arch deflection will also vary with the
angulation of molars
 If lower molars are tipped mesially , the amount
of bend needed will be reduced accordingly
 Anchor bends should be used in round molar
tubes ,with premolars omitted from the appliance
 Using Class II elastics and anchor bends –incorporate
overall expansion in lower arch as both components
exert some elevating effect on molar tube ,which
causeslingual crown deflection
• 5mm expansion each side ,across molars
• 10 mm difficult deep bite cases
• Upper molars –no intermaxillary elastics –a marginal
degree of archwire expansion required
BALANCE AND
DISTRIBUTION OF FORCES

Anchorage bends
prevent mesial
migration molars by
imparting mesial apical
resistance
CONCLUSION

Conservation of anchorage in the correct areas

and at the proper time is one of the most
important & difficult tasks in orthodontics.

The biomechanical setup that delivers the

correct type & magnitude of force must be
established to achieve the goals of the treatment.
References

Contemporary orthodontics-William
R.Proffit
Refined Begg for modern times-
DrVijay Jayade
Tip Edge-Richard Parkhouse
Biomechanics in orthodontics-
Michael.R.Marcotte
Biomechanics in Clinical
Orthodontics-Ravindra Nanda
Temporary Anchorage Devices-
Ravindra Nanda
New Vistas in Orthodontics-
Lysle .E.Johnston
Systemized Orthodontic Treatment
Mechanics –Meclaughlin Bennett Trevisi
Early Treatment of vertical skeletal
dysplasia ;The Hyperdivergent
phenotypeAJO 2000 ,118:317-27