Comparison of three methods of orthodontic anchorage: a prospective study / Noreen Fitrisha Mat Nor

The usage of TPAs and MIs in reinforcing orthodontic anchorage is well known. However, lack of study has been conducted to assess the effectiveness of TPA-Nance. Therefore, this study was conducted to compare the clinical effectiveness of three methods of anchorage; TPA, TPA-Nance, MI in the treatment of patients with malocclusion that required orthodontic anchorage. The effectiveness was measured by looking at the mesial movement of maxillary first permanent molar or known as anchorage loss during the period of maxillary canine retraction. In addition to that, the duration of treatment, cost of the appliance and patients’ oral health related quality of life (OHRQoL) towards the anchorage supplementation were taken into consideration. Thirty-six orthodontic subjects aged between 18 and 30 years old who required anchorage regime were recruited and they were equally divided into three groups. All the subjects received the allocated anchorage regime and subsequently, extractions of the maxillary first premolars were carried out, followed by provision of upper and lower fixed appliances. The clinical endpoint was Class I canines relationship bilaterally. Subjects’ OHRQoL were measured a week after the insertion of the allocated anchorage regime. There was a statistically significant difference in anchorage loss between the three anchorage groups (p<0.001). The highest amount of anchorage loss was seen in TPA group with 2.19 mm (SD 0.53) and 2.25 mm (SD 0.56) for right and left molar respectively. Meanwhile, TPA-Nance group showed anchorage loss of 1.23 mm (SD 0.22) right molar and 1.25 mm (SD 0.21) on left molar. On the other hand, MI had the lowest anchorage loss with mean of 0.33 mm (SD 0.23) and 0.11 mm (SD 0.17) on right and left molar respectively. There was a statistically significant difference in the treatment duration to achieve Class I canine relationship (p<0.05). TPA took the longest treatment time with 15.8 months (SD 3.5). The treatment duration with TPA-Nance was 13.8 months (SD 2.4). While MI was the shortest treatment with 11.9 months (SD 1.8) to achieve Class I canine relationship bilaterally. Apart from that, the S-OHIP-14 questionnaire analysis showed patients’ OHRQoL not significantly affected regardless of the anchorage regimes (p>0.05). In this study, the MI cost twice as much as the cost of TPA and TPA-Nance. If the MI had shown the least anchorage loss with rapid treatment duration, it may be cost savings. However, TPA-Nance also demonstrated of acceptable in controlling the anchorage with less than 2.0 mm of anchorage loss and it only cost RM 20 more when compared to TPA, hence, it would seem to represent good value for money. From the results obtained, all the anchorage regimes are effective for reinforcing orthodontic anchorage. However, TPA-Nance might be the suitable alternative method in reinforcing anchorage because it provides less anchorage loss in shorter treatment duration with reasonable price.