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ANCHORAGE

Dr. Md. Kamal Abdullah


BDS, MS (Orthodontics)
Fellow WFO (USA)
Assistant Professor
Islami Bank Medical College Dental Unit, Rajshahi
DEFINITION
• Anchorage in orthodontics as the nature
and degree of resistance to displacement
offered by an anatomic unit for the
purpose of tooth movement.

• Anchorage may be defined as the site


from which a force is exerted.
According to Newton's Third Law of Motion

“To every action there is an equal


& opposite reaction”

● ANCHORAGE = resistance to unwanted tooth movement.

●ANCHORAGE UNITS : The areas or units which provide


this undesirable movement.
Each orthodontic appliance consists
of two elements

1) Anchor Unit
2) Moving Unit
Classification
 ACCORDING TO MANNER OF FORCE APPLICATION
1. SIMPLE
2. STATIONARY
3. RECIPROCAL
 ACCORDING TO JAWS INVOLVED
1. INTER MAXILLARY
2. INTRA MAXILLARY
 ACCORDING TO SITE
1. INTRA 0RAL
2. EXRAORAL
3. MUSCULAR
 ACCORDING TO NUMBER OF ANCHORAGE UNITS
1. SINGLE OR PRIMARY
2. COMPOUND
3. MULTIPLE OR REINFORCED
Classification of Anchorage Cont…

 According to Manner of Force Application

1) Simple Anchorage

2) Stationary Anchorage

3) Reciprocal Anchorage
 Simple Anchorage
●When the manner & application of force is
such that it tends to change the axial
inclination of the tooth or teeth.
((Resistance to tipping))

 Simple anchorage is obtained by engaging a


greater number of teeth than are to be moved
 The root surface area of the anchorage unit
should be at least double that of the units to
be moved.
Simple Anchorage
 Stationary Anchorage
●When the application of force tends to
displace the anchorage unit bodily.
(( Resistance to bodily movement))

 The anchorage potential of teeth being moved


bodily is considerably greater as compare to
teeth being moved using a tipping force.
Stationary Anchorage
 Reciprocal Anchorage
When two teeth or two sets of teeth

move to an equal extend in an opposite


direction .

 Here the root surface area of the


anchorage unit is equal to that of the teeth
to be moved.
 The effect of the forces exerted is equal.
Reciprocal Anchorage
Classification of Anchorage Cont…

 According to Jaw Involved

 Intra-maxillary

 Inter-maxillary
 Intra-maxillary
Teeth are to be moved and the anchorage
units are in the same arch (Either maxilla or
mandible)
Eg. Elastic chains are used to retract the anterior
segment using the posterior teeth as anchorage unit.
Eg. TPA
SUB DIVISION :
1. Simple
2. Stationary
3. Reciprocal
 Inter-maxillary
• Teeth are to be moved in one arch and
resistance units are in opposite arch
• Also called “Baker’s anchorage”
 Eg: Class II, Class III elastics

SUB DIVISION :
1. Simple
2. Stationary
3. Reciprocal
Class II Elastics
Class III Elastics
Classification of Anchorage Cont…

 According to Site Involved


 Intra-oral
 Extra-oral
• Cervical
• Cranial
• Facial
• Muscular
 Intra-oral
The anchorage units lie within the oral
cavity. They include:
• The teeth
• The alveolar bone
• The basal bone
• The cortical bone
• The musculature
The teeth
 When one teeth moves the others can
act as anchorage units, it depends on
 Root form
 Root size
 No of roots
 Root length
 Root inclination
 Root form: On cross section of roots can be of
three types- round, flat and triangular.
 Round roots as seen in bicuspids and palatal
root of maxillary molars can resist
horizontally directed forces in any direction.
 Flat roots for an example those of
mandibular incisors and molars and buccal
roots of maxillary molar can resist
movements in mesio-distal direction.
 Triangular roots of canine and maxillary
central and lateral incisor offer the
maximum resistance to displacement
compared to round or flat root form.
 Size and no of root: Multi rooted and/or large
root have a greater ability to withstand stress
than single rooted teeth.
 Root length: The longer the root the deeper it
is embedded in bone and the greater is its
resistance to displacement.
 Inclination of tooth: The greater resistance
to displacement is offered when the course
exerted to move teeth is opposite to that of
their axial inclination.
 Ankylosed teeth: Orthodontic movement of
such teeth is not possible and they can
therefore serve as excellent anchors whenever
possible.
 Alveolar bone
 Alveolar bone resist tooth movement up
to its limit, beyond that it allow tooth
movement by remodeling
 Healthy alveolar bone-more anchorage

 Basal bone
 Certain areas act as resistance areas-
provide good anchorage-hard palate,
lingual surface of mandible
 Extra-oral
(anchorage obtained from outside
mouth)
Cervical
Occipital
Facial
Muscular
 Extra-oral Cont…

1. Cranium (Occipital anchorage): Anchorage


obtained from occipital bone
e.g.: Head gear to restrict maxillary growth
2. Cervical: Anchorage from cervical or neck
region
e.g.: Cervical head gear
3. Facial bones: Face mask used to protract
maxilla take anchorage from forehead and chin
4. Musculature: Hypertonic labial musculature
used for anchorage in lip bumper
High Pull Headgear
Cervical headgear
Face Mask
Lip Bumper
Classification of Anchorage Cont…

 According to Number of Units


 Single or Primary Anchorage

 Compound Anchorage

 Reinforced Anchorage
 Single or Primary Anchorage

●The resistance provided by single tooth with


greater alveolar support is used to move another
tooth with lesser alveolar support.

E.g.. Molar being used


to retract a premolar
 Compound Anchorage

●The resistance is provided by more than one


tooth with greater support is used to move teeth
with less support.
Eg. Retracting incisors
using loop mechanics
 Reinforced Anchorage

The anchorage units are reinforced by the


use of more than one type of resistance
units.
Anterior inclined plane
Exerts a backward pull
On the maxillary appliance
through the mandible.
● SVED BITE PLANE :
Prevent from being inclined
labially.
● A rigid labial bow :
To engage labial surface of
the incisor at the junction
of cervical & medial third
of each crown.
• Banding of 2nd molar for the retraction of
permanent canine.
Classification of Anchorage
 According to Space Available
 Minimum Anchorage

 Moderate Anchorage

 Maximum Anchorage

 Absolute Anchorage
 Minimum Anchorage

2/3rd space utilized by the movement of


anchor unit
 Moderate Anchorage
1/2 space utilized by the movement of anchor
unit & remaining 1/2 by the movement of
moving unit
 Maximum Anchorage
Anchorage demand is very high
Not more than ¼ th of the extraction space should
be lost by forward movement of the anchor teeth
 Absolute Anchorage

Absolutely no movement of anchor


unit e.g. Implants (TAD)
• Implants have become one of the best sources of
reliable anchorage.
FACTORS AFFECTING ANCHORAGE
i. Number of teeth being moved: To move greater
number of teeth, anchorage should be more.
ii. Type of teeth: Teeth having more surface area
require more anchorage.
iii. Type of movement: Bodily movement require more
anchorage.
iv. Duration: Prolonged treatments require good
anchorage
v. Skeletal growth pattern:
a) A) Vertical-require more anchorage due to poor
tonicity of facial muscles
b) B) Horizontal-vice versa
vi. Occlusal interlock: Good occlusion=good anchorage
CAUSES OF LOSS OF ANCHORAGE
i. Not wearing the appliance adequately.
ii. Too much activation of springs or active
components.
iii. Presence of acrylic or any obstruction on the
path of tooth movement.
iv. Poor retention of appliance.
v. Anterior bite plane: as this withdraws the
occlusal interlock.
vi. Anchor root area, not sufficiently greater, than
the root area of tooth or teeth to be moved
vii. If appliance encourage tipping movement of
anchor teeth and bodily movement of the teeth
to be moved.
ANCHORAGE LOSS AND SIGNS

i. Mesial movement of molars.

ii. Closure of extraction space by


movement of posterior teeth.

iii. Proclaination of anterior teeth.

iv. Spacing of teeth.

v. Increase in over jet.

vi. Change in molar relations.

vii. Buccal cross bite of upper posteriors.


ANCHORAGE LOSS AND SIGNS
i. Incorporate as many teeth as possible in
anchorage unit.
ii. Reduce number of teeth in moving unit.
iii. Use of anchorage bends (Tip-back, Toe-in)
iv. Reduce the force applied to the optimal for
producing the required tooth movement
v. Reinforce intra-oral anchorage with extra-oral
anchorage.
vi. Use of palatal or lingual arch.
vii. Use of intra/inter maxillary elastics.
viii.Use of lip bumper-anchorage from
musculature
ix. Cortical anchorage
Anchorage to be Considered

 In Antero-posterior plane
(Anchorage loss appears in the form of movement of
anchor unit in antero-posterior plane e.g. bodily mov.
or tipping)
 In Vertical plane
(Anchorage loss appears in the form of extrusion of
molars or Tip back of molars so care must be taken
when planning to treat High angle cases)
 In transverse plane
(anchorage loss in the form of buccal flaring)