Keles Ahmet, Erverdi Nejat, Sezen Serdar
Department of Orthodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey.
Angle Orthod. 2003 Aug;73(4):471-82. doi: 10.1043/0003-3219(2003)073<0471:BDOMWA>2.0.CO;2.
Palatal implants have been used over the last two decades to eliminate headgear wear and to establish stationary anchorage. In this case report, the stability of a palatal implant for distalization of molars bodily and for anchorage maintenance was assessed. The implant was a stepped screw titanium (4.5 mm diameter x 8 mm length), and it was placed in the palatal region for orthodontic purposes. A surgical template containing a metal drill housing was prepared. Angulation of the drill housing was controlled according to the radiologic tracing of the maxilla transferred to a plaster cast section in the paramedian plane. The implant was placed using a noninvasive technique (incision, flap, and suture elimination) and left transmucosally to facilitate the surgical procedure and to reduce the number of operations. The paramedian region was selected (1) to avoid the connective tissues of the palatine suture and (2) because it is considered to be a suitable host site for implant placement. After three months of healing, the implant was osseointegrated and orthodontic treatment was initiated. For molar distalization, the Keles Slider appliance was modified and, instead of a Nance button, a palatal implant was used for anchorage. The results showed that the molars were distalized bodily at five months, and no anchorage loss was observed. At the end of the treatment, the smile was improved, and an ideal Class I molar and canine relationship, an ideal overbite, and an ideal overjet were all achieved. In conclusion, palatal implants can be used effectively for anchorage maintenance and in space-gaining procedures. Use of a three-dimensional surgical template eliminated implant placement errors, reduced chair time, minimized trauma to the tissues, and enhanced osseointegration. This method can be used effectively to achieve distalization of molars bodily without anchorage loss.
在过去二十年中，腭部种植体已被用于避免佩戴口外弓并建立稳定的支抗。在本病例报告中，评估了用于磨牙整体远中移动及支抗维持的腭部种植体的稳定性。该种植体为阶梯状钛质螺钉（直径4.5毫米×长度8毫米），为正畸目的将其植入腭部区域。制备了一个包含金属钻孔套管的手术模板。根据转移至正中旁矢状面石膏模型切片上的上颌骨放射学描记图来控制钻孔套管的角度。采用无创技术（无需切口、翻瓣和缝合）植入种植体，使其留在黏膜下，以简化手术过程并减少手术次数。选择正中旁区域是因为（1）可避开腭中缝的结缔组织，（2）该区域被认为是适合种植体植入的宿主部位。愈合三个月后，种植体实现骨整合，随后开始正畸治疗。为了使磨牙远中移动，对凯莱斯滑动矫治器进行了改良，用腭部种植体代替了南斯纽扣作为支抗。结果显示，磨牙在五个月时实现了整体远中移动，未观察到支抗丧失。治疗结束时，患者的笑容得到改善，实现了理想的I类磨牙和尖牙关系、理想的覆合和覆盖。总之，腭部种植体可有效用于支抗维持和增加间隙的操作中。使用三维手术模板消除了种植体植入误差，减少了椅旁操作时间，使组织创伤最小化，并增强了骨整合。该方法可有效实现磨牙的整体远中移动且不发生支抗丧失。
