Résumé
Implants obtained popularity in Orthodontics by to make easy the maximum anchorage with the minimal patient׳s compliance. In this context, osseointegrated implants has been frequently used as auxiliaries of orthodontic treatments, substituting in some cases inter maxillaries elastics and extra oral appliances. These implants show as advantage a independence in opposite the patient׳s compliance, the anchorage possibility in periodontal loss cases, over there an esthetic improvement and the comfort propitiated, showing more expected results. This article approach the orthodontic treatment of a clinic case of Class II, division 1 malocclusion, non-extraction accomplished and with palatal implant to distalization of latter teeth.
Résumé
Palatal implants have been used to establ ish stat ionary anchorage. The stability of a palatal implant for distalization of molars bodily and for anchorage maintenance was assessed. The implant was a stepped screw titanium (4.5 mm diameter x 8.5 mm length), and it was placed in the palatal region. A surgical template containing a metal drill housing was prepared. Angulation of the drill housing was controlled according to the radiologic tracing of the maxilla transferred to a plaster cast section in the paramedian plane. The implant was placed using a noninvasive technique and left transmucosally to facilitate the surgical procedure and to reduce the number of operations. The paramedian region was selected (1) to avoid the connective tissues of the palatine suture and (2) because it is considered to be a suitable host site for implant placement. After three months of healing, the implant was osseointegrated and orthodontic treatment was initiated. The results showed that the molars were distalized bodily at five months, and no anchorage loss was observed. At the end of the treatment, the smile was improved, and an ideal Class I molar and canine relationship, an ideal overbite, and an ideal overjet were all achieved. In conclusion, palatal implants can be used effectively for anchorage maintenance and in space-gaining procedures. Use of a three-dimensional surgical template eliminated implant placement errors, reduced chair time, minimized trauma to the tissues, and enhanced osseointegration. This method can be used effectively to achieve distalization of molars bodily without anchorage loss.
Résumé
Introducción y Objetivo: El manejo del anclaje es fundamental para el éxito del tratamiento en ortodoncia fi ja, sin embargo no hay consenso acerca de la efectividad del anclaje esquelético para la retracción de los dientes anteriores. El objetivo fue evaluar la efectividad del anclaje esquelético para el cierre de espacios en el arco maxilar.Materiales y Métodos: Se realizó una revisión sistemática de literatura a partir de las bases de datos PubMed, Lilacs, Cochrane, Scielo. Se incluyeron ensayos clínicos controlados, donde el anclaje esquelético fuera utilizado para el cierre de espacios; tresrevisores analizaron los resúmenes y textos completos para considerar el cumplimiento de los criterios de inclusión y exclusión de manera independiente, en un formato de extracción de datos.Resultados: Se identifi caron 324 artículos, de los cuales 316 fueron rechazados después de la evaluación, de los ocho estudios inicialmente seleccionados, cinco fueron excluidos. Sólo tres estudios cumplieron con los criterios de inclusión. Se realizó un metanálisis con el método de efectos aleatorios para el movimiento mesial del molar superior, en el cual los dispositivos de anclaje esquelético temporal mostraron ser más efectivos en el control del anclaje en -2,72 mm (-4,10,- 1,33 IC95%) al compararlos con los métodos de anclaje ortodóntico convencional, esta diferencia fue estadísticamente signifi cativa. Conclusiones: El anclaje esquelético temporal parece ser más efectivo para controlar el movimiento mesial del molar durante el cierre de espacios, comparado con el anclaje ortodóntico convencional, sin embargo la evidencia científi ca en la literatura es escasa.
Introduction and Objetive: Anchorage management is essential for successful fi xed orthodontic treatment; however there is no consensus about the effectiveness of skeletal anchorage for anterior teeth retraction. The aim of this review was to evaluate the effectiveness of skeletal anchorage forspace closure in the maxillary arch. Materials and Methods: A systematic review of the literature was performed in PubMed, Cochrane, Lilacs, Scielo databases. Controlled clinical trials were included, where skeletal anchorage was used for space closure. Three reviewers examined the abstracts and full texts to determine fulfi llment of the inclusion and exclusion criteria independently in a data extraction form. Results: 324 papers, out of which 316 were excluded after the evaluation of title and abstract of the eight initially selected trials. Only three trials met the inclusion criteria.A meta-analysis was performed with a random effects method for the mesial movement of upper molars in which the temporary skeletal anchorage devices showed to be more signifi cantly moreeffective in controlling anchorage -2,7 mm (-4,10,-1,33 CI 95%) when compared to the conventionalanchorage control methods.Conclusions: Temporary skeletal anchorage seems to be more effective in controlling the movement of molars during mesial space closure, when compared to the conventional orthodontic anchorage although evidence in the literature is limited.