Khaled

Presented by:
Dr. Khaled
Aynaoui
differential moments miniscrews
• Introduction
According to Rajcich and Sadowsky (1997)
using differential moments for achieving anchorage control. They showed that
cephalometrically maxillary molars only moved 0.7 mm mesially, while plaster models
showed 0.5 mm of mesial movement.
According Martins et al. (2009)

anchorage preservation with T-loop springs, The results showed 0.3 mm of molar
protraction for every 1.0 mm of canine retraction.
Park et al. (2008), compare of anterior teeth retraction using titanium screws with the Tweed–
Merrifield technique.
The Mini screw group showed less anchorage loss compared with the Tweed–Merrifield group.
Treatment time in the Mini screw group was significantly less than the Tweed–Merrifield group
Upadhyay et al. (2008). Compare mini-implants in en-masse retraction of six anterior teeth
compared with conventional methods.
The maxillary molars showed 0.55 mm of distal movement in the mini implant group
1.95 mm mesial movement in conventional group.
Upadhyay et al. (2008) conducted a study to determine the
efficiency of mini-implants in en-masse retraction of six
anterior teeth compared with conventional methods.
However, different methods of anchorage control were performed
in the second group, and intermaxillary elastics were also used.
The maxillary molars showed 0.55 mm of distal movement in
the miniimplant group and 1.95 mm mesial movement in
conventional group. These results concurred with a very similar
recent study where no molar anchorage loss was observed in
the miniimplant group compared with 1.73 mm molar mesial
movement in the
en-masse retraction group (Basha et al., 2010).
Based on the literature, The objective of this prospective study was to compare and
analyze the amount of anchorage loss during space closure by anterior retraction
following first premolar extraction. Additionally, the study was designed to evaluate
the type of tooth movement achieved after incisor retraction (i.e. tipping, controlled
tipping, or translation) and the changes in lip position between both groups
The null hypothesis of this study was that there would be no difference in the mean
molar anchorage loss during space closure after maxillary first premolar extractions
between the differential moment technique and Mini screw supported space
closure.
• Materials and methods
• inclusion criteria:
1.Angle Class II molar and
canine relationship or
AngleClass I malocclusion with
bialveolar dental protrusion
2. all permanent teeth erupted
(except second and third
molars)
3. good oral hygiene.
• The exclusion criteria:

1. missing permanent teeth
(except third molars)
2. medical issues that could
affect tooth movement.
Space closure guidelines
(G1, differential (G2, miniscrew
moments) group)
Nickel titanium wires (Carriere 0.022

pre adjusted) were used for the
levelling and aligning phase of
treatment.
• 0.016 × 0.022 in. stainless steel wire • 0.016 × 0.022 in. stainless steel wire
used as a base arch wire was used as the base archwire.
• 0.017 × 0.025 in. nickel titanium (NiTi) • miniscrew with dimensions of 1.8-2 mm
intrusion arch in width by 8–9 mm in length was
• Nickel titanium coil springs (150 g of placed in each quadrant between the
force) maxillary second premolars and first
• both base wireand intrusion arch were molar
• Two hooks (2 mm in length) were spot-
removed.
• 0.017 × 0.025 in. CNA™ Mushroom welded to the archwire between lateral
Loop™ Archwire incisors and canines
• NiTi coil springs (150 g of force)
Lateral cephalogram analysis
Result
Discussion
• In comparison Rajcich et al. (1997) :
In this paper G1 anchorage reinforcement method showed 0.44 ±
0.3 mm of anchorage loss for every millimeter of incisor
retraction (Table 5).
• Rajcich et al. (1997) showed significantly less anchorage loss.This
might be attributed to the protocol used for anchorage control.
Rajcich et al. (1997) used an auxiliary archwire which produced 40
g of intrusive force on the anterior teeth in order to produce the
tip-back moment on the molars, while in our study only 25 g of
intrusive force was used, which in turn translated into a lesser tip-
back moment on the first molar.
Moreover, in addition to the auxiliary arch, they also used an off
centered V-bend mesial to the second premolar to reinforce the
anchorage. No V-bend was employed in our study to further
reinforce the
anchorage.
• In a study by Martins et al. (2009), using this measuring technique, a 0.3 mm molar
protraction for every millimeter of canine retraction was observed using a T-loop
with differential moment mechanics.
Their results mirror the findings in this study.
• Treatment changes (T2–T1) in G1 showed that there was no difference in the vertical
position or angulations of the molars. Also, there was no change in the vertical or
horizontal position of the incisor apex. However, there was a significant change in
the incisor angulation from T1 to T2. This indicates that differential moment strategy
and, specifically, the use of mushroom loops produce controlled tipping of the
incisors. These results are in agreement with the study done by Hart et al. (1992).
• The miniscrew group (G2) also showed no difference in the vertical position of the
molar and incisor apex horizontal position; however, a significant amount of molar
tip back or anchorage gain was noted (Table 4), indicating a distal force on the molar. A
similar finding was reported by Upadhyay et al. (2008) in a study evaluating space
closure with miniscrews in bimaxillary protrusive patients. This finding can be attributed
to the friction of the wire sliding through the tube of the molars.
• Conclusion
According to the results of our study, both treatment
methods, (differential moments and miniscrews), are
effective ways of controlling anchorage in cases requiring
premolar extraction with anterior teeth retraction but :
• there is statistically and clinically significant anchorage

loss when differential moments are used compared
with TADs.
• there is greater anterior torque control when
differential moments are used compared with TADs.
• there is no difference in the amount of lip retraction
when TADs are used compared with differential
moments.

Khaled

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Khaled

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According Martins et al. (2009)

• The exclusion criteria:

Nickel titanium wires (Carriere 0.022

• there is statistically and clinically significant anchorage

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