The level anchorage system

THE LEVEL ANCHORAGETHE LEVEL ANCHORAGE
SYSTEMSYSTEM
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INTRODUCTIONINTRODUCTION
• It is a complete orthodontic treatmentIt is a complete orthodontic treatment
system designed for those goal orientedsystem designed for those goal oriented
orthodontists who would like to treatorthodontists who would like to treat
efficiently to a predetermined goal andefficiently to a predetermined goal and
reach that goal on a routine basis. It isreach that goal on a routine basis. It is
designed to quantify the anchoragedesigned to quantify the anchorage
requirements of the orthodontic problemrequirements of the orthodontic problem
and thus clarify the necessary treatmentand thus clarify the necessary treatment
steps needed to reach the goal.steps needed to reach the goal.

SPECIALITY - SYSTEMSPECIALITY - SYSTEM
• Banded or bonded edgewise appliance.Banded or bonded edgewise appliance.
• Built-in tip, torque & offset.Built-in tip, torque & offset.
• Analysis and treatment planning chart with aAnalysis and treatment planning chart with a
step by step treatment procedure for sevenstep by step treatment procedure for seven
different extraction & non-extraction choices.different extraction & non-extraction choices.
• Timing chart aids in estimating the time neededTiming chart aids in estimating the time needed
for each step, and a self check chart helpsfor each step, and a self check chart helps
determine when to proceed with the nextdetermine when to proceed with the next
treatment step.treatment step.

EVOLUTIONEVOLUTION
• Charles Tweed was first to advocateCharles Tweed was first to advocate
anchorage.anchorage.
• He used standard edgewise appliance,He used standard edgewise appliance,
the tip, torque & offset bends had to bethe tip, torque & offset bends had to be
placed in each edgewise arch.placed in each edgewise arch.
• Disadvantage.Disadvantage.

EVOLUTIONEVOLUTION
• Reed Holdaway- preangulation of the edgewiseReed Holdaway- preangulation of the edgewise
appliance in the mandibular buccal segments.appliance in the mandibular buccal segments.
• Larry Andrews – first to introduced theLarry Andrews – first to introduced the
completely preadjusted appliance (straight wirecompletely preadjusted appliance (straight wire
appliance)appliance)
• Level anchorage system – combination ofLevel anchorage system – combination of
straight wire appliance with anchoragestraight wire appliance with anchorage
preparation as described by Holdaway.preparation as described by Holdaway.

Preadjustments of the Level anchorage appliancePreadjustments of the Level anchorage appliance

Two choices of distal crown tip for the mandibular buccalTwo choices of distal crown tip for the mandibular buccal
teeth: regular & major.teeth: regular & major.
The choice depends on the severity of the malocclusionThe choice depends on the severity of the malocclusion
and is determined by use of the analysis chart.and is determined by use of the analysis chart.
REGULAR MAJORREGULAR MAJOR

Measuring the severity of the malocclusionMeasuring the severity of the malocclusion
1.Depth of the curve of spee.1.Depth of the curve of spee.
2.Lower arch discrepancy.2.Lower arch discrepancy.
3.Space to upright the lower anteriors.3.Space to upright the lower anteriors.
4.Lower buccal anchorage to retract the canines4.Lower buccal anchorage to retract the canines
5.Anchorage to correct the ANB5.Anchorage to correct the ANB
6.Anchorage in relation to the mandibular plane6.Anchorage in relation to the mandibular plane
angle.angle.
7.Anchorage to retract the upper anteriors in7.Anchorage to retract the upper anteriors in
extraction cases.extraction cases.

ANCHORAGEANCHORAGE
• Tooth Anchorage- Axial inclinationTooth Anchorage- Axial inclination
• Anchorage savers –Anchorage savers –
Headgear.Headgear.
Palatal bar.Palatal bar.
Delaying extraction of the maxillaryDelaying extraction of the maxillary
premolars.premolars.
Lip bumpers & Functional appliances.Lip bumpers & Functional appliances.

The analysis chartThe analysis chart
1.1. Limits of the dentition – boundary withinLimits of the dentition – boundary within
which the correction of the malocclusionwhich the correction of the malocclusion
must take place.must take place.
2.2. Stability – lower incisor in angulation andStability – lower incisor in angulation and
a linear measurement in millimeters to N-a linear measurement in millimeters to N-
B line. Upper incisor it is related inB line. Upper incisor it is related in
angulation and a millimeterangulation and a millimeter
measurement to N-A & interincisal angle.measurement to N-A & interincisal angle.

The analysis chartThe analysis chart
3. Anchorage –preparation.3. Anchorage –preparation.
4. Function – canine protected occlusion.4. Function – canine protected occlusion.
5. Tissue response- force & tooth movement.5. Tissue response- force & tooth movement.
6. Vertical control6. Vertical control
7. Tongue posture7. Tongue posture

Analysis chartAnalysis chart

Instructions for using the analysis chartInstructions for using the analysis chart

Treatment steps, timing & self-checksTreatment steps, timing & self-checks

STEP-ISTEP-I

STEP-IISTEP-II

STEP-IIISTEP-III

STEP-IVSTEP-IV

STEP-VSTEP-V

STEP-VISTEP-VI

FINISHED CASEFINISHED CASE

AdvantagesAdvantages
• Precise treatment plan- analysis chartPrecise treatment plan- analysis chart
• Arch wire bending been reduced .Arch wire bending been reduced .
• Efficiency is improved- treatment steps &Efficiency is improved- treatment steps &
self-checks for each step.self-checks for each step.
• Nitinol arches are extremely smooth &Nitinol arches are extremely smooth &
resilient as result it provides a uniformresilient as result it provides a uniform
force for rotation, leveling, tipping & slidingforce for rotation, leveling, tipping & sliding
mechanics.mechanics.
• Patient knows the rate of progressPatient knows the rate of progress
(predictable time chart)(predictable time chart)

CONCLUSIONCONCLUSION
• A new case analysis and treatmentA new case analysis and treatment
planning chart has to be formulated to aidplanning chart has to be formulated to aid
in visualizing anchorage requirements, toin visualizing anchorage requirements, to
provide a better understanding to theprovide a better understanding to the
severity of the malocclusion, and toseverity of the malocclusion, and to
illustrate a treatment plan that shows howillustrate a treatment plan that shows how
to solve the orthodontic problem andto solve the orthodontic problem and
reach a predetermined goal.reach a predetermined goal.

Thank youThank you

The level anchorage system

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