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Buccal Miniscrews: Ramesh Sabhlok
Join me for a summary of a lecture by Ramesh Sabhlok,
looking at one of the most popular sites for TAD placement, the maxillary buccal
interradicular site.
The most common site in maxilla for implant placement
is between 2nd premolar and 1st molar in the keratinized gingiva.
Two factors
1.
Buccal bone thickness
2.
Inter radicular distance
Bone thickness:
·
Greatest bone width of bone is
between 2nd premolar and 1st molar, and considered ‘safe
zone’ thickness of bucco-palatal bone 10.2-11.4mm ( Pogio 2006 Angle
orthodontics )
Inter-radicular distance
·
2nd premolar and 1st
molar: 3.2mm (SD 0.6mm)- 3.5mm (SD
0.8mm) when 4-6mm from the CEJ, largest clearance of interradicular space in
the buccal aspect of maxilla Lee 2009
·
Gradually decreases apically,
therefore it is advised to place the mini implant at height of 4-6 mm from CEJ,
at 2 mm height only 2.7mm interradicular
·
In the maxilla, the more anterior
and the more apical, the safer the location becomes.
·
Increased after levelling and
alignment, delay placing if possible
‘SAFE DEPTH’
proposed by Ramesh
·
depth of from the bone surface to
the narrowest interradicular space at a given height which is safe = 3.2mm
interradicular distance for 1.2mm width TAD AND 3.5mm for a 1.5mm TAD.
·
Safety depth (height) is 4mm.
o
2mm depth the greatest inter
radicular distance 2.4mm, not safe
Angulation
·
A 20-30o angle, places
the interradicular aspect of the miniscrw apically, where the interradicular is
the greatest. This reduces root contact, increases retention with more cortical
plate engagement, allows use of longer miniscrews as well as greater
distalisation prior to relocation Deguchi 2006.
Extraction of 3rd molars
·
Classic papers looking at the
Pendulum appliance by Kinzinger 2004 showed extraction of 3rd molars
resulted in greater bodily distalisation on the maxillary arch.
·
However recent CBCT paper by Lee
2019 show that with miniscrew distalisation there was no difference bodily
movement with extraction of 3rd molars and non-extraction.
Concept of biologic width
1-1.5mm of periodontium surrounding the implant,
Lecture title
Summary from AAO 2022 lecture: Non- compliance &
Predictable class II correction with Micro implant Anchorage
Dedication
Episode is dedicated to the late Dr Anam Humdani, a
London based dentist who tragically died aged 29
https://www.justgiving.com/fundraising/zayaan-humdani
·
Contents: Shanya Kapoor
·
Editing and Production: Farooq Ahmed
View all episodes
By Farooq Ahmed
5
77 ratings
Join me for a summary of a lecture by Ramesh Sabhlok,
looking at one of the most popular sites for TAD placement, the maxillary buccal
interradicular site.
The most common site in maxilla for implant placement
is between 2nd premolar and 1st molar in the keratinized gingiva.
Two factors
1.
Buccal bone thickness
2.
Inter radicular distance
Bone thickness:
·
Greatest bone width of bone is
between 2nd premolar and 1st molar, and considered ‘safe
zone’ thickness of bucco-palatal bone 10.2-11.4mm ( Pogio 2006 Angle
orthodontics )
Inter-radicular distance
·
2nd premolar and 1st
molar: 3.2mm (SD 0.6mm)- 3.5mm (SD
0.8mm) when 4-6mm from the CEJ, largest clearance of interradicular space in
the buccal aspect of maxilla Lee 2009
·
Gradually decreases apically,
therefore it is advised to place the mini implant at height of 4-6 mm from CEJ,
at 2 mm height only 2.7mm interradicular
·
In the maxilla, the more anterior
and the more apical, the safer the location becomes.
·
Increased after levelling and
alignment, delay placing if possible
‘SAFE DEPTH’
proposed by Ramesh
·
depth of from the bone surface to
the narrowest interradicular space at a given height which is safe = 3.2mm
interradicular distance for 1.2mm width TAD AND 3.5mm for a 1.5mm TAD.
·
Safety depth (height) is 4mm.
o
2mm depth the greatest inter
radicular distance 2.4mm, not safe
Angulation
·
A 20-30o angle, places
the interradicular aspect of the miniscrw apically, where the interradicular is
the greatest. This reduces root contact, increases retention with more cortical
plate engagement, allows use of longer miniscrews as well as greater
distalisation prior to relocation Deguchi 2006.
Extraction of 3rd molars
·
Classic papers looking at the
Pendulum appliance by Kinzinger 2004 showed extraction of 3rd molars
resulted in greater bodily distalisation on the maxillary arch.
·
However recent CBCT paper by Lee
2019 show that with miniscrew distalisation there was no difference bodily
movement with extraction of 3rd molars and non-extraction.
Concept of biologic width
1-1.5mm of periodontium surrounding the implant,
Lecture title
Summary from AAO 2022 lecture: Non- compliance &
Predictable class II correction with Micro implant Anchorage
Dedication
Episode is dedicated to the late Dr Anam Humdani, a
London based dentist who tragically died aged 29
https://www.justgiving.com/fundraising/zayaan-humdani
·
Contents: Shanya Kapoor
·
Editing and Production: Farooq Ahmed
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