A to Z

ORTHODONTICS
Volume: 04

ANCHORAGE
Dr. Mohammad Khursheed Alam
BDS, PGT, PhD (Japan)

First Published August 2012

Dr. Mohammad Khursheed Alam

All rights reserved. No part of this publication may be reproduced stored in a retrieval system,
or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise, without prior permission of author/s or publisher.

ISBN: 978-967-5547-93-5
Correspondance:

Dr. Mohammad Khursheed Alam

Senior Lecturer
Orthodontic Unit
School of Dental Science
Health Campus, Universiti Sains Malaysia.
Email:
dralam@gmail.com
dralam@kk.usm.my

Published by:
PPSP Publication
Jabatan Pendidikan Perubatan, Pusat Pengajian Sains Perubatan,

Universiti Sains Malaysia.

Kubang Kerian, 16150. Kota Bharu, Kelatan.

Published in Malaysia

Contents
1. Anchorage...................................................3
2. Classification..........................3-5
3. Source of anchorage.....4-7
4. Description of different types of anchorage........7-9
5. Causes of loss of anchorage.... 9
6. Means to detect anchorage loss.............................9-10
7. Means to increase anchorage value...10
8. Anchorage loss and sign........ 10-11
9. Anchorage preparation..11

Anchorage
Graber has defined anchorage in orthodontics as the nature and degree of
resistance to displacement offered by an anatomic unit for the purpose of
effecting tooth movement.
White & Gardener - Anchorage is the site of delivery from which a force is
exerted.
* Tooth movement during orthodontic therapy is brought about forces
generated by active component of an orthodontic appliance. The force is
used to move the teeth are derived from certain anatomic areas which act
is anchorage.
Classification:
(A) According to manner of force application:
(1) Simple anchorage.
(2) Stationary anchorage.
(3) Reciprocal anchorage.
(B) According to jaws involved:
(1) Intra maxillary.
(2) Inter maxillary.
(C) According to the site of anchorage:

(1) Intra oral.

(2) Extra oral

A) Cervical.

(3) Muscular.

B) Occipital
C) Cranial
D) Facial.

(D) According to the number of anchorage units:

(1) Single or primary anchorage.
(2) Compound anchorage.
(3) Multiple or reinforced anchorage.
(E) Depends on anchorage loss:
(1) Maximum anchorage (Type A anchorage)
A situation in which the treatment objectives require that no or very little
anchorage can be lost.
(2) Moderate anchorage (Type B anchorage)
A situation in which anchorage is not critical and space closure should be
performed by reciprocal movement of both the active and the anchorage
segment.
(3) Minimum anchorage (Type C anchorage)

A situation in which, for an optimal result, a considerable movement of the

anchorage segment (anchorage "loss") is desirable, during closure of
space.
Source of anchorage
During orthodontic therapy it is mainly obtained from two sources:
1. Intraoral source
2. Extraoral source
Intraoral source: The intraoral sources of anchorage include the teeth,
alveolar bone, the basal jaw bone, the musculature.
The teeth themselves can resist movement. The anchorage potential of
teeth depends on a member of factors such as root form, root size, no of
roots, root length, and root inclination.
Root form: On cross section of roots can be of three types, round, flat and
triangular.
Round roots as seen in bi cuspids and palatal root of maxillary molars can
resist horizontally directed forces in any direction.
Flat roots for an example those of mandibular incisors and molars and
buccal roots of maxillary molar can resist movements in mesio-distal
direction.

Triangular roots of canine and maxillary central and lateral incisor offer the
maximum resistance to displacement compared to round or flat root form.
Size and no of root: Multi rooted with large root have a greater ability to
withstand stress than single rooted teeth.
Root length: The longer the root the deeper it is embedded in bone and
the greater is its resistance to displacement.
Inclination of tooth: The greater resistance to displacement is offered
when the course exerted to move teeth is opposite to that of their axial
inclination.
Ankylosed teeth: Orthodontic movement of such teeth is not possible and
they can therefore serve as excellent anchors whenever possible.
Alveolar bone: When the force applied exceed a certain limit, the alveolar
bone permits tooth movement by bone remodeling.
Basal bone: The areas include the hard palate and the lingual surfaces of
the mandible in the region of the roots of basal bones are available
intraorally as source of anchorage.
Musculature:

Muscle causes flaring and spacing of teeth. Hypertonic

muscles cause collapse of the teeth lingually.

Extraoral anchorage

Certain extra oral areas can also be used when adequate resistance
cannot be obtained from intra oral sources for the purpose of anchorage
.The extra oral sources of anchorage include.
1. the cranium
2. the back of the neck
3. the facial bones
Cranium (occipital / parietal anchorage)
Using head gears that derive anchorage from the occipital or parietal region
of the cranium. These devices are used along with a face bow to restrict
maxillary growth or to move the dentition or maxillary bone distally.
Back of the neck (cervical anchorage):
Extra oral anchorage can alternatively be obtained from the neck or
cervical region. Such a type of head gear is called cervical head gear,
Facial bones:
The frontal bone and the mandibles symphysis offer anchorage during face
mask therapy in order to protract the maxilla. A maxillary head gear that
makes use of anchorage from the forehead and chin are called reverse
headgears.
Description of different types of anchorage
1. Single/Simple

(A) Simple Anchorage: when a tooth with a longer root area is used to
move another tooth with a smaller root area in the same dental arch
(B) Compound simple: when a greater number of teeth are used to move a
smaller number of teeth in the same dental arch
2. Stationary anchorage: This is a compound anchorage where the teeth
only can move bodily to resist anchorage.
3. Reciprocal Anchorage
The anchorage is said to be reciprocal in those case where it is designed
that two teeth or low groups of teeth shall move to an equal extent towards
each other or in opposite direction.
It is necessary that each group should offer equal resistance lest, the
movement will be unequal.
Example: (1) Dental arch expunsion. [Upper expansion plate]
(2) Pin & tube appliance to approximate 1/1.
(3) Closure of midline diastema.
(4) Use of cross bite elastics.
(5) Correction of single tooth crossbite.
Intramaxillary anchorage: Anchorage obtained from a tooth/teeth in one
jaw to move the tooth/teeth in the same jaw, It may be simple (single /
compound), re-inforced or reciprocal.

Intermaxillary anchorage: where the teeth in one arch are used for
anchorage to move the teeth in other arch.
Causes of loss of anchorage:
1. Not wearing the appliance adequate
2. Too much activation of springs or active components
3. Presence of acrylic or any obstruction on the path of tooth movement
4. Poor retention of appliance.
5. Anterior bite plane: as this withdraws the occusal interlock,
6. Anchor root area, not sufficiently greater, then the root area of tooth or
teeth to be used,
7. If appliance encourage tipping movement of anchor teeth and bodily
movement of the teeth to be moved.
Means to detect anchorage loss
1. Position of another teeth, in relation to the teeth in the same and
opposite arch.
2. Increase in overjet.
3. Fit of the appliance in the mouth.
4. Measurements of the distance of anchor teeth from midline.
5. Measurements from palatal rugae and frenum.

6. Observation of the spacing mesial/distal to the anchor teeth.

7. Inclination of the anchor teeth.
8. Radiological examination.
Means to increase anchorage value:
1. Intermaxillary traction.
2. Inclined anterior bite plane.
3. Extra oral traction occipital, occipital-cervical or cervical.
4. Toe in & Tip back bends [Anchor bends for posterior anchorage] and
Apical torque [for anterior anchorage] on arch wire so that anchor teeth
can only move bodily.
5. Banding or using good number of teeth for anchorage or moving small
number of tooth at a time.
6. Use of palatal and lingual arches.
7. Use of vertical springs on anchor teeth to encourage bodily movement
only.
Anchorage loss and signs
Anchorage loss is the movement of the reaction unit or the anchor unit
instead of the teeth to be moved.
Signs:
1. Mesial movement of molars.

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2. Closure of extraction space by movement of posterior teeth.

3. Proclination of anterior teeth.
4. Spacing of teeth.
5. Increase in overjet.
6. Change in molar relations.
7. Buccal cross bite of upper posteriors.
Anchorage preparation
A procedure commonly used in the Tweed technique, during which the
molars and premolars are tipped distally prior to retraction of the anterior
teeth. The theory behind it is that it increases the anchorage value of the
posterior segments, allowing further retraction of the canines and incisors
with less anchorage loss.

ADVANCEMENT IN ANCHORAGE
Skeletal anchorage: Micro implant / TAD / Screw implant

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Bibilography:
1. Bhalajhi SI. Orthodontics The art and science. 4th edition. 2009
2. Gurkeerat Singh. Textbook of orthodontics. 2nd edition. Jaypee, 2007
3. Houston S and Tulley, Textbook of Orthodontics. 2nd Edition. Wright, 1992.
4. Iida J. Lecture/class notes. Professor and chairman, Dept. of Orthodontics, School of dental
science, Hokkaido University, Japan.
5. Lamiya C. Lecture/class notes. Ex Associate Professor and chairman, Dept. of Orthodontics,
Sapporo Dental College.
6. Laura M. An introduction to Orthodontics. 2nd edition. Oxford University Press, 2001
7. McNamara JA, Brudon, WI. Orthodontics and Dentofacial Orthopedics. 1st edition, Needham
Press, Ann Arbor, MI, USA, 2001
8. Mitchel. L. An Introduction to Orthodontics. 3 editions. Oxford University Press. 2007
9. Mohammad EH. Essentials of Orthodontics for dental students. 3rd edition, 2002
10. Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 4th edition, Mosby Inc., St.Louis,
MO, USA, 2007
11. Sarver DM, Proffit WR. In TM Graber et al., eds., Orthodontics: Current Principles and
Techniques, 4th ed., St. Louis: Elsevier Mosby, 2005
12. Samir E. Bishara. Textbook of Orthodontics. Saunders 978-0721682891, 2002
13. T. M. Graber, R.L. Vanarsdall, Orthodontics, Current Principles and Techniques, "Diagnosis and
Treatment Planning in Orthodontics", D. M. Sarver, W.R. Proffit, J. L. Ackerman, Mosby, 2000
14. Thomas M. Graber, Katherine W. L. Vig, Robert L. Vanarsdall Jr. Orthodontics: Current Principles
and Techniques. Mosby 9780323026215, 2005
15. William R. Proffit, Raymond P. White, David M. Sarver. Contemporary treatment of dentofacial
deformity. Mosby 978-0323016971, 2002
16. William R. Proffit, Henry W. Fields, and David M. Sarver. Contemporary Orthodontics. Mosby
978-0323040464, 2006
17. Yoshiaki S. Lecture/class notes. Associate Professor and chairman, Dept. of Orthodontics, School
of dental science, Hokkaido University, Japan.
18. Zakir H. Lecture/class notes. Professor and chairman, Dept. of Orthodontics, Dhaka Dental
College and hospital.

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Dedicated To

My Mom, Zubaida Shaheen

My Dad, Md. Islam
&
My Only Son
Mohammad Sharjil

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Acknowledgments
I wish to acknowledge the expertise and efforts of the various
teachers for their help and inspiration:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

Prof. Iida Junichiro Chairman, Dept. of Orthodontics,

Hokkaido University, Japan.
Asso. Prof. Sato yoshiaki Dept. of Orthodontics, Hokkaido
University, Japan.
Asst. Prof. Kajii Takashi Dept. of Orthodontics, Hokkaido
University, Japan.
Asst. Prof. Yamamoto Dept. of Orthodontics, Hokkaido
University, Japan.
Asst. Prof. Kaneko Dept. of Orthodontics, Hokkaido
University, Japan.
Asst. Prof. Kusakabe Dept. of Orthodontics, Hokkaido
University, Japan.
Asst. Prof. Yamagata Dept. of Orthodontics, Hokkaido
University, Japan.
Prof. Amirul Islam Principal, Bangladesh Dental college
Prof. Emadul Haq Principal City Dental college
Prof. Zakir Hossain Chairman, Dept. of Orthodontics,
Dhaka Dental College.
Asso. Prof. Lamiya Chowdhury Chairman, Dept. of
Orthodontics, Sapporo Dental College, Dhaka.
Late. Asso. Prof. Begum Rokeya Dhaka Dental College.
Asso. Prof. MA Sikder Chairman, Dept. of Orthodontics,
University Dental College, Dhaka.
Asso. Prof. Md. Saifuddin Chinu Chairman, Dept. of
Orthodontics, Pioneer Dental College, Dhaka.

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Dr. Mohammad Khursheed Alam

has obtained his PhD degree in Orthodontics from Japan in 2008.
He worked as Asst. Professor and Head, Orthodontics
department, Bangladesh Dental College for 3 years. At the same
time he worked as consultant Orthodontist in the Dental office
named Sapporo Dental square. Since then he has worked in
several international projects in the field of Orthodontics. He is
the author of more than 50 articles published in reputed journals.
He is now working as Senior lecturer in Orthodontic unit, School

of Dental Science, Universiti Sains Malaysia.

Volume of this Book has been reviewed by:

Dr. Kathiravan Purmal

BDS (Malaya), DGDP (UK), MFDSRCS (London), MOrth
(Malaya), MOrth RCS( Edin), FRACPS.
School of Dental Science, Universiti Sains Malaysia.
Dr Kathiravan Purmal graduated from University Malaya 1993.
He has been in private practice for almost 20 years.
He is the first locally trained orthodontist in Malaysia with
international qualification. He has undergone extensive
training in the field of oral and maxillofacial surgery and
general dentistry.

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