Dental implants are important orthodontic adjuncts for extending the scope of biomechanical therapy and enhancing clinical outcomes. Dental implants cost vary. Endosseous implants and osseous screws have been used for orthodontic anchorage for over 60 years. However, reliable prosthetic and retromolar devices, based on the technology introduced by Rraanemark, have an approximately 20-year clinical history. Over the past decade, palatal anchorage devices such as endosseous screws and siibperiosteal “onpiants” have evolved. Over the same period, a number of systems featuring intraalveolar miniscrew.s and micro.screws have been developed. Building on an extensive clinical experience with microscrevs, Kanomi developed a two-stage mini-implant method that was designed to osseointegrate (achieve rigid fixation within bone).
Clinical experience has demonstrated strengths and weaknesses for all of the implant anchorage devices in the ortiiodontic armamentarium. Additional research is needed to provide clear indications and contraindications for each type of implant anchorage. All of the currently available orthodontic anchorage devices have unique .surgical and abutment requirements. Hollowing a presentation of two applications ofthe well-established retromolar anchorage method, this chapter will focus on the surgery and biomechanics associated with the Kl System and dental implants cost.
Rigid osseous fixation (osseointegration) is a relative term, because even well-integrated endosseous implants demonstrate some flexure relative to supporting bone. For symmetrically threaded titanium implants, the long-term mechanism of rigid o.sseous fixation is rapid turnover of lamellar bone within 1 mm ofthe implant surface. In effect, osseointegration is physiologically similar to severe ankylosis. Although bone remodeling (turnover) is very rapid at the bone-implant interface, integrated implants cannot be moved orthodontically because there is no periodontal ligament.
Consistent with a high rate of bone remodeling, up to 40% of the implant surface is adjacent to resorption cavities, and is referred to as remodeling space. Thus, about 60% or more of the surface of the implant is rigidly integrated with bone at any point in time. By definition, osseointegrated implants do not move relative to supporting bone unless the interface is fractured. The good alternative to dental implants are affordable dentures.
Rigid implant anchorage has greatly expanded the therapeutic scope of orthodontic mechanics. Many partially edentulous patients with acquired malocclusions can be effectively managed without resorting to extensive extraoral anchorage, orthognathic surgery, and/or extensive prosthetic reconstruction. With implant anchorage, treatment focuses on saving as many teeth as possible and optimal repositioning ofthe residual dentition tor definitive prostheses. Endosseous implants and suhperiosteal onpiants are effective anchorages for a broad range of orthodontic applications in both the maxillary and mandibular arches.
Clinical techniques, associated with effectively using these devices, are based on the biologic rationale for achieving and maintaining osseointegrated abutments. Implants for orthodontic anchorage and prosthetic support are increasingly important avenues of multidisciplinary interaction for orthodontists, surgeons, and restorative dentists.