Download How to Improve TAD Stability in the

Mini-Implants in the Anterior Palate:
How to improve Stability in the Long-term
Björn Ludwig / Traben-Trarbach / Germany
Benedict Wilmes / University of Düsseldorf / Germany
Stability
Stability of Mini-implants
Phase
of low stability
Secondary
stability
Primary
stability
1
2
3
4
5
6
7
8
9
Weeks
Stability of Mini-implants
How to measure primary stability:
- Insertion Torque
(in vivo / in vitro)
- Resonance Frequency Analysis (RFA)
(in vivo / in vitro)
- Periotest
(in vivo / in vitro)
- Lateral loading / Pull Out Test
(in vitro)
Stability of Mini-implants
Insertion site?
ISQ
 No difference between median
and paramedian insertion
40
median
Resonance
Frequency
Analysis
35
30
25
ns
20
**
*
*
0
2
ns
paramedian
median
15
10
5
paramedian
0
4
6 Weeks
Nienkemper M, Pauls A, Wilmes B, Drescher D. Development of mini-implant stability
over the initial healing period: A prospective clinical pilot study. Angle Orthod. 2013
Nienkemper M, Pauls A, Wilmes B, Drescher D. Effect of implant length on mini-implant stability
during the initial healing period: A prospective clinical study, Head and Face Med 2013
Nienkemper M, Pauls A, Ludwig B, Drescher D. Stability of paramedian inserted palatal miniimplants at the initial healing period: a controlled clinical study. Clin Oral Implants Res. 2013
Stability of Mini-implants
Success rate in the anterior palate: 97.9%
Karagkiolidou A, Ludwig B, Pazera P, Gkantidis
N, Pandis N, Katsaros C. Survival of palatal
miniscrews used for orthodontic appliance
anchorage: A retrospective cohort study.
Am J Orthod Dentofacial Orthop. 2013
1. Low failure rate
2. No root damage
3. Tad´s not in the path
Stability of Mini-implants
Stability of Mini-implants
Optimal
site
-Thick Bone
-Thin Mucosa
Restricted
site
Ludwig B, Glasl T, Bowman J, Wilmes B, Kinzinger G, Lisson G. Anatomical Guidelines
for Miniscrew Insertion: Palatal Sites. J Clin Orthod. 2011:45(8):433-441
Mini-Implants with Abutments
Mini-implant
Abutments
Coupling with the appliance
Mini-Implants with Abutments
Screwed
Screwed
Spider Screw Benefit
HDC
PSM
Bonded
Orthoeasy
Forestadent
Bonded
Dual Top
Jeil
Mini-Implants with Abutments
Benefit System
Wilmes B, Drescher, D.
A mini-implant system with
interchangeable abutments.
J Clin Orthod 2008; 42:574-580
Beneplate System
Wilmes B, Drescher, D. Nienkemper M.
A miniplate system for improved
stability of skeletal anchorage.
J Clin Orthod 2009; 43:494-501
Mini-Implants with Abutments
Pre-drilling in adults
Handpiece
Insertion
 Orthodontist could insert
Stability of Mini-implants
 Consider angle of insertion!
Mechanics with palatal TAD´s
Molar distalization
Beneslider
Pendulum B
Molar mesialization
T-Bow
RPE / Class III
Hybridhyrax
Molar
Intrusion
Mesialslider
Molar
anchorage
Alignment of
retained teeth
Beneslider
Beneplate
Benetube
Wilmes B, Drescher, D. Nienkemper M. Beneplate - A miniplate system for
improved stability of skeletal anchorage. J Clin Orthod 2009; 43:494-501
Wilmes B, Drescher D. Application and effectiveness of the Beneslider molar
distalization device. World J Orthod. 11:331–34
Combination of distalization mechanics and…
… conventional braces
… lingual braces
… Aligners
Beneslider
Beneslider
Beneslider
Beneslider & Aligner
J Clin Orthod 2012:390-8
Beneslider & Aligner
Beneslider & Aligner
Beneslider & Aligner
Beneslider & Aligner
Beneslider & Aligner
Beneslider & Aligner
Beneslider & Aligner
Beneslider & Aligner
Beneslider & Aligner
Beneslider, Efficiency?
Study:
N=51
- Moderate implant tipping in 2 cases
- Distalization effect: 3.6 mm (+/- 1.9 mm)
- Distalization speed: 0.6 mm/month
Nienkemper M, Wilmes B, Yamaguchi S, Pauls A, Drescher D.
Treatment efficiency of Mini-implant borne distalization depending on age and eruption of
the second molars. J Orofac Orthop 2014
Pendulum B
0.8 mm TMA
Wilmes B. Clinical management of the Beneslider and the Pendulum B appliances for
maxillary molar distalization. In: Moschos Papadopoulus: Skeletal anchorage in orthodontic
treatment of Class II malocclusion: Contemporary applications of orthodontic implants,
miniscrew implants and mini plates. Amsterdam. Mosby, Elsevier (in press)
Pendulum B
Upper molar mesialization
T-Bow
Mesialslider
Indirect
Anchorage
Direct
Anchorage
Upper molar mesialization
If missing 3,4,5 or 6: no brackets needed
Mesialslider
T-Mesialslider
Hybrid-Hyrax
Wilmes B, Fields of Application of Mini-Implants. In: Ludwig, Baumgaertel,
Bowman: Mini-Implants in orthodontics. Innovative anchorage concepts. London,
Berlin etc. Quintessence. 2008: 91- 122
Wilmes B, Nienkemper M, Drescher D. Application and effectiveness of a new miniimplant and tooth-borne rapid palatal expansion device. World J Orthod.2010
Hybrid-Hyrax
 Force near the CR of the maxilla
Baumgaertel S, Ludwig B, Kinzinger G, Zorkun B, Glasl B, Wilmes B.
Application of a new visco-elastic FEM-Model and analysis of miniscrew
supported Hybrid-Hyrax treatment. Am J Orthod Dentofacial Orthop 2013
Hybrid-Hyrax
Goal 1:
No load on the bicuspids/
deciduous molars
No/less tipping of the teeth
Wilmes B. Fields of Application of Mini-Implants. In: Ludwig B, Baumgaertel S, Bowman JS, editor.
Mini-Implants in Orthodontics Innovative Anchorage Concepts. London: Quintessence Publishing
Co Ltd;2008. p. 91-122
Maxillary advancement using a Facemask
Mesial migration of the dentition
Goal 2:
Avoid mesial migration
of the teeth
Just skeletal maxillary
advancement
011351
Transfer of the force
to the bone
F
Ngan P, Yiu C, Hu A, Hagg U, Wei SH, Gunel E. Cephalometric and occlusal changes following
maxillary expansion and protraction. Eur J Orthod 1998;20:237-254.
Williams MD, Sarver DM, Sadowsky PL, Bradley E. Combined rapid maxillary expansion and
protraction facemask in the treatment of Class III malocclusions in growing children: a prospective longterm study. Semin Orthod 1997;3:265-274.
Hybrid-Hyrax
Mini-Implants with abutments
Hyrax Expander
Hybrid-Hyrax / Facemask
Hybrid-Hyrax / Facemask
Nienkemper M, Wilmes B, Pauls A, Drescher D. Maxillary protraction using a
hybrid hyrax - facemask combination. Prog Orthod 2013
Hybrid-Hyrax / Facemask
Hybrid-Hyrax / Facemask
+ Alt-Ramec
Wilmes B, Ngan P, Liou E, Franchi L, Drescher B,
Early Class III Facemask Treatment with the Hybrid Hyrax and Alt-RAMEC Protocol
J Clin Orthod 2014
Hybrid-Hyrax / Facemask
WITS -8.2 mm
Alt-Ramec
WITS -1.1 mm
Hybrid-Hyrax / Facemask
Alt-Ramec
Clinical Studies needed….
Hybrid-Hyrax / Facemask
Hybridhyrax
Mentoplate
Wilmes B, Kau CH, Ludwig B, Drescher D. Early Class III
Treatment with a Hybrid Hyrax-Mentoplate Combination,
J Clin Orthod 2011
Hybridhyrax and Mentoplate
Hybridhyrax and Mentoplate
Peter Ngan, Hong He, and Benedict Wilmes.
Early Treatment of Class III Malocclusion.
In: Peter Ngan, Class III Malocclusion: Craniofacial Biology and Treatment
Strategies" Oak Park. Bentham eBooks (in press)
Hybridhyrax and Mentoplate
Before
WITS: -8.3 mm
8 months
After
WITS: -2.8 mm
Hybridhyrax and Mentoplate
17 years
Overview early class III treatment
Conv.RPE +
Facemask
Surgery?
Skeletal
Efficiency?
No
Hybrid Hyrax Hybrid Hyrax
+ Facemask + Mentoplate
4 Bollard
Plates
2 mini-implants 4 miniplates
2 mini-implants 1 miniplate
Molar anchorage
Molar anchorage
Molar intrusion
J Clin Orthod 2013
Molar intrusion
Forced eruption of retained teeth
Forced eruption of impacted teeth
Outlook: Multipurpose appliances…
Wilmes B, Ludwig, B, Katyal V, Nienkemper M, Rein A, Drescher D.
The Hybrid Hyrax Distaliser, a new all-in-one appliance for rapid palatal expansion, early
class III treatment and upper molar distalisation. J Orthod (in press)
Conclusions: 1. Anterior palate is the best insertion site
Ludwig B, Glasl T, Bowman J, Wilmes B, Kinzinger G, Lisson G. Anatomical Guidelines
for Miniscrew Insertion: Palatal Sites. J Clin Orthod. 2011:45(8):433-441
Conclusions: 2. Tad´s with abutments for the palate
Molar distalization
Beneslider
Pendulum B
Molar mesialization
T-Bow
RPE / Class III
Hybridhyrax
Molar
Intrusion
Mesialslider
Molar
anchorage
Alignment of
retained teeth
Conclusions: 3. No difference between median and lateral
Conclusions: 4. Just do it !
Insertion of mini-implants in the palate is very easy!!!
 Orthdontists can do it
Courage!
Palatal Mini-implants
[email protected]
www.uniklinik-duesseldorf.de/kieferorthopaedie
Thank you very much for your attention!