International Journal of Research in Medical Sciences

Sharma D et al. Int J Res Med Sci. 2024 Nov;12(11):4378-4382

[Link] pISSN 2320-6071 | eISSN 2320-6012

DOI: [Link]
Review Article

Basic principles of anchorage: a review

Disha Sharma1, Gaurav Thakur2, Deepak Gurung3*, Amrita Thakur4

1
Department of Orthodontics, Regional Hospital, District Bilaspur, Himachal Pradesh, India
2
Department of Orthodontics, Hospital of Mental Health and Rehabilitation, Shimla, Himachal Pradesh, India
3
Department of Public Health, CMO Office, Bilaspur, Himachal Pradesh, India
4
Sacred Heart Convent School Dhalli, Shimla, Himachal Pradesh, India

Received: 02 September 2024

Revised: 17 October 2024
Accepted: 18 October 2024

*Correspondence:
Dr. Deepak Gurung,
E-mail: drdeepakgurung@[Link]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

During orthodontic treatment, teeth are subjected to various forces and moments, which generate reciprocal forces of
equal magnitude but opposite direction. To prevent unwanted tooth movements and ensure successful treatment
outcomes, it is essential to effectively manage these reciprocal forces. Numerous studies have explored different
anchorage systems in terms of their application, function, and effectiveness. However, practitioners often find it
challenging to interpret these findings due to the diversity in study designs, sample sizes, and methodologies. A solid
understanding of anchorage principles is crucial for applying them effectively. Anchorage control is a critical factor in
designing orthodontic appliances. While extraoral devices can provide stable anchorage, their effectiveness heavily
relies on patient cooperation. In contrast, intraoral anchorage tends to be less stable, often necessitating complex
appliances and sometimes the extraction of teeth. Nonetheless, intraoral systems have the advantage of requiring less
patient compliance. To achieve treatment objectives, it is vital to establish a biomechanical setup that delivers the
appropriate type and magnitude of force. This foundational understanding of anchorage principles will enhance the
effectiveness of orthodontic treatments.

Keywords: Orthodontic treatment, Anchorage, Reciprocal forces

INTRODUCTION Ideally, intraoral anchorage should remain stable and

utilize a source that lacks periodontal membrane, as this
Orthodontic anchorage, defined as the ability to membrane typically responds to tension and pressure,
counteract unwanted reactive tooth movements from facilitating movement within the bone.9-11
various sources, including adjacent teeth, the palate, the
head or neck, or dental implants embedded in the bone.1,2 CLASSIFICATION
In orthodontic treatment, anchorage loss can occur as a
side effect of mechanotherapy and is a significant Moyers according to the manner of force application:
contributor to treatment failures. This issue is often Simple anchorage: resistance to tipping, stationary
attributed to various factors, including the site of anchorage and resistance to bodily movement.4
extraction, the type of appliance used, patient age, dental
crowding, and the amount of overjet present.3-5 Over the Reciprocal anchorage
years, clinicians have sought biomechanical solutions to
enhance anchorage control. Pioneers like Tweed, Begg, Two or more teeth moving in opposite directions and
Holdaway, and Merrifield created various anchorage pitted against each other by the appliance.
systems aimed at improving treatment effectiveness.6-8

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According to the jaws involved: Intra-maxillary: (T.P.A.), a Nance holding arch, or a lower lingual arch.
Anchorage established in the same jaw. Inter-maxillary: Additionally, tissue anchorage, such as that provided by a
Anchorage distributed to both jaws (Baker’s anchorage lip bumper, can effectively distalize molars.13
1904). According to the site of anchorage: Intra oral:
Anchorage established within the mouth. Extra oral: Prepared anchorage
Anchorage obtained outside the oral cavity. a) Cervical:
Neck straps, b) Occipital: head gears; c) Cranial: High Prepared anchorage involves positioning the teeth at a
pull headgears and d) Facial: Face masks. Muscular: distoaxial inclination, significantly enhancing their
Anchorage derived from action of muscles e.g. vestibular resistance to displacement. This technique is particularly
shields. effective for controlling anchorage when it is crucial for
treatment success.14
According to the number of anchorage units: Single or
primary anchorage: Anchorage involving only one Active root thrust
tooth. Compound anchorage: Anchorage involving two or
more teeth. Reinforced anchorage: Addition of non- This concept, introduced by Dr. Calvin Case in 1908,
dental anchorage sites. e.g. Mucosa, muscle, head, etc. involves enhancing bodily resistance in the anchorage
area by using extensions that are affixed to the bands of
According to Nanda: A anchorage: critical / severe (75% the molar teeth.
or more of the extraction space is needed for anterior
retraction). B anchorage: moderate [Relatively symmetric Cortical anchorage
space closure (50%)]. C anchorage: mild / non critical
(75% or more of space closure by mesial movement of Cortical bone is more resistant to resorption compared to
posterior teeth).3 medullary bone, and the concept of cortical anchorage
leverages this property. Ricketts suggested that torquing
According to Burstone: Group A arches, group B arches the roots of buccal teeth outward against the cortical plate
and group C arches.11 can help prevent their mesial movement.10 Torquing
movements are restricted by the facial and lingual cortical
Natural anchorage plates. If a root is consistently pressed against the cortical
plate, tooth movement is significantly hindered, leading
Natural anchorage is derived from the resistance provided to a higher risk of root resorption and, in some cases,
by the dental arch, based on the application of forces potential penetration of the cortical bone.
between individual teeth or groups of teeth.
Graber has classified anchorage as: Intra- maxillary
Simple anchorage: It refers to the way forces are applied, anchorage and inter-maxillary anchorage.1,12
which can lead to the displacement or alteration of the
axial inclination of the teeth that serve as the anchorage Intramaxillary anchorage refers to a situation where all
unit in the direction of the force. Essentially, the resistance units are located within the same jaw.
resistance of the anchorage unit to tipping is used to Appliances placed solely in either the maxillary or
facilitate the movement of other teeth. mandibular arch are classified as intramaxillary resistance
units.
Reciprocal anchorage: This involves opposing two teeth
or groups of teeth with equal anchorage value to create Intermaxillary anchorage involves using resistance units
reciprocal tooth movement. For example, when closing a in one jaw to facilitate tooth movement in the opposite
diastema, the two central incisors can be used against jaw. To effectively utilize the space created by
each other in this manner. extractions, a more logical classification of anchorage can
be beneficial. In the mandibular arch, anchorage can be
Stationary anchorage: Dental anchorage that involves the categorized into three classes: minimum, moderate, and
application of force resulting in the bodily displacement maximum.14-16
of the anchorage unit within the plane of the force is
known as stationary anchorage.12 This concept refers to Minimum anchorage mechanics rely on reciprocal forces
the benefit gained by using the bodily movement of one between the posterior and anterior teeth without
group of teeth to counteract the tipping of another group. attempting to maintain a moment on the anchorage area.
This approach is chosen when the mandibular posterior
Reinforced anchorage teeth are allowed to move mesially into half or more of
the extraction site.
This involves strengthening the anchorage or resistance
area by increasing the number of resistance units or Moderate anchorage involves applying an active root
employing additional aids. A straightforward method for thrust or moment on the anchorage teeth, resulting in
reinforcing anchorage is to place bands on the second bodily resistance in that area. This method is used when
molars. Other methods include using a transpalatal arch

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the mandibular posterior teeth are allowed to advance canines and anterior teeth. Anchorage is often obtained
into one fourth to one half of the extraction site. from the mandibular buccal teeth, with forces applied
reciprocally within the arch to the mandibular canines
Maximum anchorage mechanics focus on strengthening and anterior teeth. A force system can be chosen to limit
the anchor teeth by utilizing all available resources and the forces to these teeth, either individually or as a group.
minimizing the workload on the anchorage area by
generating forces outside the mandibular arch as much as In class II cases, the demand on the mandibular
possible. This approach is used when the mandibular anchorage increases as the work load is increased in the
posterior teeth are permitted to advance into no more than form of: Retraction of maxillary canines and incisors,
one fourth of the extraction site. correction of class II molar relation, workload is further
increased if it is skeletal class II, retraction of mandibular
It's important to recognize that, regardless of the case anterior teeth, a minimum or moderate anchorage class II
classification, anchorage needs will be influenced by the case remains so if: Retraction in maxillary arch can be
total workload and available space, and the mechanics carried out by inter-arch mechanics, retraction of
used in each case will be similar. mandibular anteriors is minimal and it also depends on
the class II correction and if it is dental or dental and
BIOLOGICAL ASPECTS OF ANCHORAGE skeletal.

Factors affecting anchorage If cervical or occipital forces are not applicable, the
classification shifts from minimum to moderate, as the
Number of roots: a greater number of roots, anchorage is mandibular arch must handle more load. In this scenario,
more, shape, size and length of each root: conical roots it's acceptable for the mandibular molars to shift forward
offer more anchorage than cylindrical. Multi rooted into the available space. However, applying bodily thrust
>single rooted; Longer rooted >shorter rooted; triangular is essential to enhance resistance and prevent the
shaped root >conical or ovoid root; larger surface area mandibular molars from advancing too quickly, which
>smaller surface area. Cortical anchorage: cortical bone could compromise their anchorage potential. The
vs medullary bone. Muscular forces: horizontal growers additional force from class II elastics can accelerate the
vs. vertical growers. Relation of contiguous teeth. Forces mesial tipping of the mandibular molars, while the bodily
of occlusion. Age of the patient and individual tissue thrust works to counteract this tipping and reduce the rate
response.17-20 of their movement.3

ANCHORAGE LOSS MODERATE ANCHORAGE

Anchor loss can occur in all 3 planes of space.1,2,21-23 In a moderate anchorage scenario, mandibular molars can
be allowed to shift into one-fourth to one-half of the
Sagittal plan: Mesial movement of molars and extraction site. However, it is crucial to maintain bodily
proclination of anteriors. resistance consistently to prevent forward tipping of the
mandibular molars and bicuspids. This resistance not
Vertical plane: Extrusion of molars and bite deepening only slows the movement of the buccal segments but also
due to anterior extrusion. provides the necessary support for the forces needed to
move canines and anterior teeth distally into half or more
Transverse plane: Buccal flaring due to over expanded of the extraction site. By carefully balancing the forces in
arch form and unintentional lingual root torque and both the anchorage and working areas, these goals can be
lingual dumping of molars. effectively achieved.

PRINCIPLES OF ANCHORAGE CONSERVATION In a class I moderate anchorage situation, bodily

resistance in the anchorage area is employed to
Class I, class II, and class III cases may have minimum, counterbalance the forces in the working area. Space
moderate, or maximum anchorage requirements, as well closure in the maxillary arch is accomplished through
as variations in class II cases with different mandibular mechanics within the arch itself. If the anchorage space is
plane angles, such as low and high. Minimum anchorage depleted, mandibular anchorage will be unavailable for
needs are seldom observed in class II skeletal issues, retracting the anterior teeth. In such instances, class III
while maximum anchorage requirements are infrequently elastics combined with extraoral anchorage in the
seen in class II cases with a low mandibular plane maxillary arch can facilitate the movement of the
angle.2,3 mandibular anterior teeth. Additionally, extraoral
anchorage helps resist forces applied to the maxillary
MINIMUM ANCHORAGE anterior teeth.

In class I minimum anchorage scenarios, the primary In class II cases, the mechanics used are consistent
tasks typically involve aligning and distally tipping the whether the classification is purely dental or involves a

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combination of dental and skeletal factors. The additional CONCLUSION

workload for retracting the maxillary anteriors and
canines in class II dental cases, and an even greater Anchorage plays a crucial role in orthodontics, especially
workload in class II dental and skeletal cases, necessitates when forces are applied solely to the teeth, for several
torque control for the bodily displacement of the reasons: It reflects the resistance needed to prevent
maxillary anteriors. This level of control is typically not unwanted tooth movement while allowing desired
achievable from moderate anchorage in the mandible, movement to occur. It provides insight into the resistance
particularly if there are specific anchorage needs in that that specific teeth will offer, indicating the type of
area. If class II correction is introduced into a moderate movement that can be anticipated. It influences the
anchorage situation in the mandibular arch, it will remain selection of the appliance required to achieve the desired
moderate only if the required adjustments in the tooth movement.
maxillary arch do not depend on the mandibular arch for
anchorage. All orthodontic forces are reciprocal in nature. For true
reciprocity to occur, teeth with equal resistance must be
Relationship of tooth movement to force engaged against one another, with the expectation that all
teeth experiencing the force will move an equal distance
To achieve effective tooth movement, it’s essential to toward the desired position.
concentrate the applied force at the desired site while
dissipating the reaction force across multiple adjacent There are three main methods to enhance the resistance of
teeth. This approach minimizes the pressure in the teeth: The connector between the tooth and the force-
periodontal ligament (PDL) of the anchorage teeth. An generating mechanism can be designed to be stationary,
ideal scenario occurs when the pressure remains below a ensuring that any movement of the tooth occurs in a
certain threshold, ensuring that no reaction is generated bodily manner rather than through tipping. The arch wire
and allowing for optimal anchorage control. This means can be shaped to facilitate bodily movement of the tooth
it’s only necessary to ensure that the force applied does instead of tipping. Incorporating more teeth in the section
not exceed the threshold for initiating movement in the of the dental arch where movement is not intended,
teeth within the anchorage unit.1 compared to the area where movement is desired, can
also increase resistance.
Amount of tooth movement and magnitude of pressure,
up to a point Anchorage control is a critical factor in the design of all
orthodontic appliances. While extraoral devices can
Once the optimal threshold is reached, the amount of provide stable anchorage, their effectiveness often relies
tooth movement becomes independent of the pressure on patient cooperation. In contrast, intraorally derived
magnitude. The ideal orthodontic force is the lightest one anchorage tends to be less stable, which can lead to the
that elicits a near-maximum response. While forces need for more complex and sometimes inefficient
greater than this optimal level can still be effective, they appliances, often resulting in the extraction of teeth.
can cause unnecessary trauma and stress to the However, a key advantage of these intraoral appliances is
anchorage.24,25 that they require less extensive cooperation from the
patient.
Anchorage value
If there were reliable intraoral anchor points that
The anchorage value of a tooth is generally proportional remained stable throughout treatment and were
to its root surface area. In each arch, the surface area of comfortable, biocompatible, and minimally intrusive, it
the molars and second premolars is roughly comparable would significantly simplify and enhance appliance
to that of the incisors and canines.2 design. Effectively conserving anchorage in the right
areas and at the appropriate times is one of the most
ANALYSIS AND TREATMENT PLAN CHART challenging yet crucial tasks in orthodontics. Establishing
the correct biomechanical setup to deliver the appropriate
Analysis and treatment plan chart were treatment time for type and magnitude of force is essential to meet treatment
each step, length of time class II and class III elastics goals.
were worn, type of head gear & length of time worn,
length of time palatal bars were worn and high/ low Funding: No funding sources
mandibular plane angle. Conflict of interest: None declared
Ethical approval: Not required
PURPOSE OF FILLING ANALYSIS CHART
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