Skeletally based miniplate supported orthodontic anchorage

Skeletally based miniplate supported orthodontic anchorage
February 2005
Keith H. Sherwood, DDS * *
James G. Burch, DDS, MS ÇƒÜ
Journal of Oral and Maxillofacial Surgery Online
Orthodontic treatment is often limited by the severity of malocclusion and biomechanical restrictions of available appliances. Many devices and techniques have been developed over decades to assist or augment orthodontic anchorage. Headgear, Pendulum1 and Herbst appliances,2 magnets,3 and elastics, alone and in combination, are examples of the many options available to the orthodontist to control the movement of teeth. All of these purely orthodontic techniques have practical limitations related to patient compliance, reliance on tooth or soft tissue support, or the complex nature of the malocclusion to be treated. Adjunctive surgery is often required to achieve acceptable results.
The concept of using implants for orthodontic anchorage has been studied for over 25 years.4ÇƒÏ6 Traditional endosseous implants placed in the alveolar bone and used as orthodontic anchors have been extensively reported.7ÇƒÏ11 More recently, midpalatal endosseous implants, miniscrews, and miniplates have been used successfully for skeletal anchorage to correct malocclusions that are difficult or impossible to treat with traditional orthodontic methods.
Jenner and Fitzpatrick12 first reported the use of an osteotomy plate for orthodontic anchorage in 1985. More recently, investigators have used miniplates in the mandible13 and the maxilla14 to assist in correcting skeletal open bite deformities in adult patients who would normally require orthognathic surgery. Miniplates for orthodontic anchorage have also been demonstrated in patients with supererupted posterior teeth15 and to distalize molars.16
Miniplate anchorage has been used with success for over 5 years at Nova Southeastern University to assist in closing skeletal anterior open bite, intrude supererupted teeth, and as anchorage adjuncts for sagittal tooth movement. As shown in Figure 1, a miniplate is secured to the zygomatic strut with 2 or 3 mini screws. The last loop on the plate is allowed to project transmucosally into the buccal vestibule. The orthodontist uses this last loop on the miniplate to attach an elastic thread or other device to the bands or brackets on posterior teeth.
FIGURE 1. Schematic of miniplate used for intrusion of molars.
Sherwood and Burch. Miniplate Supported Orthodontic Anchorage. J Oral Maxillofac Surg 2005.

For treating open bite, the posterior teeth are intruded allowing autorotation of the mandible and closure of the anterior open bite. It has been shown that posterior vertical dentoalveolar excess is frequently the etiology of skeletal anterior open bite in adults.17 As a result, the maxillary strut is often the location of choice when placing miniplates to correct anterior open bite. However, the miniplates are versatile and biocompatible and can be placed nearly anywhere to suit the needs of the orthodontist.
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