V-BEND AND ANCHORAGE IN

ORTHODONTICS

Mehak Arya
I yr MDS
Dept of Orthodontics
 • V Bend mechanics
• Centered v bend
• Off centered v Bend
• Anchorage
• Definition
• Classification
• Methods to augment anchorage
• References
OUTLINE
 STATIC EQUILLIBRIUM

 Equilibrium is defined as “a state of balance between or among the

opposing forces, resulting in the absence of acceleration”
 Concept is based on Newton law of motion
 To meet requirement of equilibrium
a) Sum of all forces present in horizontal direction must be zero
b) Sum of all forces present in vertical direction must be zero
c) And sum of all moments present must be zero
 V-BEND

CENTRE V-BEND OFF CENTRE V-BEND

 CENTRE V-BEND

 Archwire with centre V-bend is inserted into brackets

on two teeth a certain distance apart, the angulation of
wire produces two equal & opposite moment on either
side.
 There is no force produced, the system is in
equilibrium.
 OFF CENTRE V- BEND

 When arch wire with v-bend inserted into bracket ,such that one end is close to one tooth
than other.
 Angulation of wire to be inserted into bracket closer to v-bend is greater than that on
other side
 Greater angulation side causes greater moment of tooth & smaller angulation causes
small moment in opposite direction
 This do not meet requirement of equilibrium
 OFF CENTRE V- BEND

• If we shift the bend slightly towards the

molar.
• The bracket A -greater moment than
bracket B because angle of entry in bracket
A has increased while that in bracket B has
reduced.
• Though the two moments are acting in
opposite directions, their sum total cannot
become zero, but will leave a residual
moment.
 AT 1/3 OF THE DISTANCE

• It has been experimentally found by

Burstone and Koenig that when the bend
reaches 1/3 of the distance between the
two brackets,
• the moment at the Bracket B becomes
zero.
• When the bend is at 1/3 position, the longer
segment assumes a relation which is parallel to
the bracket slot.
• Therefore, the moment at bracket B becomes
zero, With further shifts of the bend towards
bracket A, bowing in the longer segment
increases further so that the wire now has an
angular relation which is opposite to what it was
all along.
• Thus, the direction of the moment reverses and
becomes identical to that in bracket A.
 AT LESS THAN 1/3 OF DISTANCE

• As the bend is shifted further towards

bracket A, a moment is again created at
bracket (which keeps increasing with
further shifting of the bend) but it has the
same direction as that in bracket A.
• The moments at both brackets add
together.
• The equilibrium moment and the vertical
forces producing them are also
correspondingly larger.
 TWO SYMMETRICALLY PLACED OFF-CENTERED
BENDS

• It will also have an effect similar to

the centered V bend.

• As shown by Mulligan, it is easier

to create these bends intra-orally
when the inter-bracket span is
large and strong moments are to
be developed.
ANCHORAGE
 DEFINITION

Proffit :
• “Resistance to unwanted tooth movement.”

• “Resistance to reaction forces that is provided (usually) by other teeth,

or (sometimes) by the palate, head or neck (via extraoral force), or
implants in bone.”
 DEFINITION

T.M. Graber :
• “The nature and degree of resistance to displacement offered by an anatomic unit
when used for the purpose of effecting tooth movement.”

Nanda :
• “The amount of movement of posterior teeth (molars, premolars) to close the
extraction space in order to achieve selected treatment goals.”
According to Newton's Third Law of Motion

“To every action there is an equal & opposite

reaction”

●
ANCHORAGE = resistance to unwanted tooth movement.

●
ANCHORAGE UNITS : The areas or units which provide this
undesirable movement.
 CLASSIFICATION
Moyers :
According to the site of anchorage:
1. Intra oral : Anchorage established within the mouth.
• Teeth:
• Root form
• Size and number of root
• Root length
• Ankylosed Tooth
• Muscular : Anchorage derived from action of muscles. eg. Lip Bumper.
2. Extra oral : Anchorage obtained outside the oral cavity.
a.) Cervical : eg. neck straps
b.) Occipital : eg. Head gears
c.) Cranial : eg. High pull headgears
d.) Facial : eg. Face masks
 CLASSIFICATION

Moyers :
• According to the manner of force application:
1. Simple anchorage :
Resistance to tipping.

2. Stationary anchorage :
Resistance to bodily movement.

3. Reciprocal anchorage :
Two or more teeth moving in opposite directions and pitted
against each other by the appliance.
 CLASSIFICATION

Moyers :
According to the jaws involved:
1. Intra maxillary :
Anchorage established in the same jaw.

2. Inter maxillary :
Anchorage distributed to both jaws.
 CLASSIFICATION

Moyers :
• According to the number of anchorage units :
1. Single or primary anchorage:
Anchorage involving only one tooth.

2. Compound anchorage:
Anchorage involving two or more teeth.

3. Reinforced anchorage:
Addition of non dental anchorage sites.
eg. Mucosa, muscle, head, etc.
 CLASSIFICATION

Acc. To Nanda :
• A anchorage : maximum
• B anchorage : moderate
• C anchorage :minimum
• Group A space closure—includes 75%–100%
space closure from anterior retraction and 25%
closure from posterior anchorage movement.
There is a critical posterior anchorage.
• Group B space closure—includes an equal
amount of anterior and posterior tooth
movement to close the space.
• Group C space closure—includes 75%–100%
posterior protraction and 25% anterior retraction.
• Group D With the introduction of skeletal
anchorage systems (SAS) and temporary
anchorage devices to the orthodontic
armamentarium, 100% anchorage conservation is
a possibility and hence additional category of
absolute anchorage is added.
 METHODS TO AUGMENT ANCHORAGE

1. Balancing the root surface area of

moving units v/s the anchor units:

• Including second molars early in treatment also helps

in increasing the posterior anchorage.

• Two stage retraction: involving separate cuspid distal

movement followed by incisor retraction, too makes
use of this idea.
2. Influence of growth pattern
on anchorage

• A low mandibular plane angle indicating

a horizontal growth pattern has a strong
masseteric-pterygoid sling that resists
the mesial or vertical displacement of
the posterior teeth more effectively, and
vice versa
3. Cortical anchorage

• Ricketts introduced the concept

• The roots of posterior teeth are torqued buccally to
the extent that they start pressing against the buccal
cortical plate
• The mesial drag on these teeth during anterior retraction
is resisted by their contact against the cortical plate.
4. Added components for reinforcing
anchorage

• Transpalatal arch
• Robert A. Goshgarian introduced transpalatal arch (TPA).
• It is constructed from 0.9 or 1.25 mm stainless steel wire
and crosses the palate to connect one molar or premolar to
a contralateral tooth.
• A constant tongue pressure in a vertical direction on a TPA,
which is kept slightly away from the palate, would resist the
extrusion of upper molars, thereby augmenting vertical
anchorage
Almuzian M, Alharbi F, Chung LL, McIntyre G. Transpalatal, nance and lingual arch
appliances: clinical tips and applications. Orthodontic Update. 2015 Jul 2;8(3):92-100.
• Nance palatal arch

• Nance palatal arch (NPA) was one of the earliest

modifications of the TPA, first described in 1947
• The palatal wire is welded/soldered to the molar
bands and is connected anteriorly by an acrylic
button positioned in the highest part of the palatal
vault resting on non‐compressible mucosa
• It offers more anchorage However, these also may
not fully resist the forward movement in a critical
anchorage situation.
• Vertical holding appliance

• It is a modification of the TPA with an acrylic pad.

• It is fabricated with banded maxillary permanent first molars and a dime-
size acrylic button at the sagittal and vertical level of the gingival margin
of the molar bands.
• The acrylic button is away from the palate by 2 mm or more. Four helices
are incorporated into the wire configuration for flexibility.
• The VHA uses tongue pressure to reduce the vertical dentoalveolar
development of the maxillary permanent first molars.
• Lingual Holding arch

• 0.9 mm diameter wire is used for construction

• The stainless steel wire can be either welded/soldered to molar
bands, inserted into molar sheaths (removable)
• It extends along the lingual contour of the mandibular
dentition from one side of the first molar to the other side of the
first molar.
• An adjustment loop can be placed in the region of second
deciduous molar or second premolar
 • Both appliances are moderately effective in preserving anchorage (anchorage loss of
around 1 mm over 6 months) and there was no difference in anchorage support between
the groups but TPA was well tolerated by the patient

Stivaros N, Lowe C, Dandy N, Doherty B, Mandall NA. A randomized clinical trial to compare the
Goshgarian and Nance palatal arch. Eur J Orthod 2010; 32: 171−176
 COMPLICATIONS

• Breakage and cement failures

• Oral hygiene difficulties
• Impinging on the palatal mucosa as the molars move mesially
• Frequent need for TPA removal and recementation during
space-closing mechanics

Almuzian M, Alharbi F, Chung LL, McIntyre G. Transpalatal, nance and lingual arch appliances: clinical
tips and applications. Orthodontic Update. 2015 Jul 2;8(3):92-100.
• Mini implants and skeletal anchorage system
• Temporary anchorage devices (TAD) in the form of miniscrews and its
variants have been integrated in orthodontic armamentarium. These
devices provide excellent source of the anchorage.
• DIRECT ANCHORAGE • INDIRECT ANCHORAGE
REFERENCES

• Essentials of Orthodontic Biomechanics by Dr. V. P. Jayade

• Kharbanda OP. Orthodontics: Diagnosis and Management of Malocclusion and
Dentofacial Deformities, E-Book. Elsevier Health Sciences; 2019 Nov 14.
• Stivaros N, Lowe C, Dandy N, Doherty B, Mandall NA. A randomized clinical trial to
compare the Goshgarian and Nance palatal arch. Eur J Orthod 2010; 32: 171−176
• Almuzian M, Alharbi F, Chung LL, McIntyre G. Transpalatal, nance and lingual
arch appliances: clinical tips and applications. Orthodontic Update. 2015 Jul
2;8(3):92-100.