Skeletal anchorage in orthodontics--basics and clinical application

Abstract

This review article describes the basics and clinical applications of skeletal anchorage in orthodontics, namely: areas of indication, anchorage devices, insertion areas, indications, potential complications, and their use in growing patients. The areas for skeletal anchorage include orthodontic-prosthetic anchorage, orthodontic anchorage, and skeletal anchorage in orthopedic therapy procedures. The anchorage devices currently available are: prosthetic implants, mini screws, palatal implants, onplants, bone anchors, zygoma wires and skeletally-supported distractors. The insertion areas described so far (according to therapeutic procedure and bone supply available) include edentulous jaw sections, the interdental septum, infra-apical and supra-apical areas, the palate (median, paramedian, lateral), the retromolar area, and the zygomatic bone. Force systems are applied (direct or indirect anchorage) according to surgical and orthodontic or orthopedic requirements. Skeletal anchorage devices should be selected according to the following criteria. Is the anchorage task unifunctional or multifunctional? How many anchorage devices are required for the therapy in question? What is the success rate of the various anchorage devices; what are the applicable biomechanics and soft tissue or hard tissue conditions in the insertion area? The success rates for miniscrews are currently between 80% and 90%, and over 90% for palatal implants. The potential of skeletal anchorage is broadening the current orthodontic treatment spectrum, guaranteeing the practitioner absolute control of anchorage by avoiding the unpredictable reactions of periodontal anchorage, leading to a reduction in unwanted side effects.