wilmes. and ludwig
TRANSCRIPT
Benedict Wilmes / University of Düsseldorf / Germany
Mini-Implants in the Anterior Palate:
How to improve Stability in the Long-term
Björn Ludwig / Traben-Trarbach / Germany
1 2 3 4 5 6 7 8 9 Weeks
Sta
bility
Primarystability
Secondarystability
Phaseof low stability
Stability of Mini-implants
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)
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 mini-
implants at the initial healing period: a controlled clinical study. Clin Oral Implants Res. 2013
No difference between median
and paramedian insertion
Insertion site?
paramedian
median
**
*
*
ns
ns
0
5
10
15
20
25
30
35
40
0 2 4 6
paramedianmedian
Resonance
Frequency
Analysis
ISQ
Weeks
Stability of Mini-implants
1. Low failure rate2. No root damage3. Tad´s not in the path
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
Success rate in the anterior palate: 97.9%
Stability of Mini-implants
Stability of Mini-implants
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
Optimal
site
-Thick Bone
-Thin Mucosa
Restricted
site
Stability of Mini-implants
Coupling with the appliance
Mini-implant Abutments
Mini-Implants with Abutments
Mini-Implants with Abutments
BenefitPSM
OrthoeasyForestadent
Dual TopJeil
Screwed Bonded Bonded
Spider ScrewHDC
Screwed
Wilmes B, Drescher, D. A mini-implant system with interchangeable abutments. J Clin Orthod 2008; 42:574-580
Benefit System 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
Orthodontist could insert
Handpiece
Pre-drilling in adults
Insertion
Mini-Implants with Abutments
Stability of Mini-implants
Consider angle of insertion!
Molar mesialization
Molar distalization
Beneslider Pendulum B
T-Bow Mesialslider
RPE / Class IIIHybridhyrax
Alignment ofretained teeth
MolarIntrusion
Molar anchorage
Mechanics with palatal TAD´s
Beneslider
Benetube
Beneplate
Wilmes B, Drescher, D. Nienkemper M. Beneplate - A miniplate system for improved stability of skeletal anchorage. J Clin Orthod 2009; 43:494-501Wilmes B, Drescher D. Application and effectiveness of the Beneslider molar distalization device. World J Orthod. 11:331–34
… conventional braces
… lingual braces
… Aligners
Combination of distalization mechanics and…
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
- Moderate implant tipping in 2 cases
- Distalization effect: 3.6 mm (+/- 1.9 mm)
Study:
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
N=51
- Distalization speed: 0.6 mm/month
Beneslider, Efficiency?
Pendulum B 0.8 mm TMA
Wilmes B. Clinical management of the Beneslider and the Pendulum B appliances formaxillary molar distalization. In: Moschos Papadopoulus: Skeletal anchorage in orthodontictreatment 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
Direct
Anchorage
Indirect
Anchorage
Upper molar mesialization
If missing 3,4,5 or 6: no brackets needed
Mesialslider
T-Mesialslider
Wilmes B, Nienkemper M, Drescher D. Application and effectiveness of a new mini-implant and tooth-borne rapid palatal expansion device. World J Orthod.2010
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
Hybrid-Hyrax
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
Force near the CR of the maxilla
Hybrid-Hyrax
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
Goal 1:
No load on the bicuspids/
deciduous molars
No/less tipping of the teeth
Hybrid-Hyrax
011351
FTransfer of the force
to the bone
Maxillary advancement using a Facemask
Mesial migration of the dentitionGoal 2:
Avoid mesial migration
of the teeth
Just skeletal maxillary
advancement
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 long-
term 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 Alt-Ramec
WITS -8.2 mm WITS -1.1 mm
Hybrid-Hyrax / Facemask Alt-Ramec
Clinical Studies needed….
Hybrid-Hyrax / Facemask
Wilmes B, Kau CH, Ludwig B, Drescher D. Early Class III Treatment with a Hybrid Hyrax-Mentoplate Combination, J Clin Orthod 2011
Mentoplate
Hybridhyrax
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
WITS: -8.3 mm WITS: -2.8 mm
Before After8 months
Hybridhyrax and Mentoplate
17 years
Overview early class III treatment
Conv.RPE +Facemask
Hybrid Hyrax+ Facemask
4 Bollard Plates
Surgery?
Skeletal Efficiency?
No 2 mini-implants2 mini-implants1 miniplate
4 miniplates
Hybrid Hyrax+ Mentoplate
Molar anchorage
Molar anchorage
J Clin Orthod 2013
Molar intrusion
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)
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: 1. Anterior palate is the best insertion site
Molar mesialization
Molar distalization
Beneslider Pendulum B
T-Bow Mesialslider
RPE / Class IIIHybridhyrax
Alignment ofretained teeth
MolarIntrusion
Molar anchorage
Conclusions: 2. Tad´s with abutments for the palate
Conclusions: 3. No difference between median and lateral
Conclusions: 4.
Courage!
Insertion of mini-implants in the palate is very easy!!!
Orthdontists can do it
Just do it !