How Has Skeletal Anchorage Changed The Orthodontic Strategies For Class 3 Correction In Adults Junji Sugawara. Episode 40. IOC 2020

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Farooq Ahmed

Junji talks through his experiences of pre- Skeletal Anchorage Systems (SAS) / bone plates and what has changed with SAS focusing on class 3 cases


  • Without Skeletal anchorage
    • Camouflage: Required extractions
    • Use of MEAW for control – technically challenging
    • Pre surgical preparation: Time consuming


  • SAS for camouflage lower arch distalisation
    • SAS positioned buccal to lower molars.
    • Indirect ligation to premolar with ligature
    • Distalisation with pushcoil from premolar to molar


  • SAS for camouflage upper arch protraction
    • SAS ‘I’ design (2 eyelets) positioned upper arch premolar region
    • Indirect ligation to molar with ligature
    • Mesialisation with pushcoil from molar to premolar


  • SAS for upper molar distalisation
    • SAS ‘Y’ design positioned on zygomatric buttress
    • Indirect ligation canine with ligature
    • Distalisation with pushcoil from canine to molar


  • SAS for surgery first
    • Placed same time as orthognathic surgery
    • Class 3 case, allows for distalisation post op – to decompensate upper incisors as described previously
    • Predictable final position of upper incisors
    • Treatment time less than 1 year


  • Sugawara, J., Daimaruya, T., Umemori, M., Nagasaka, H., Takahashi, I., Kawamura, H. and Mitani, H., 2004. Distal movement of mandibular molars in adult patients with the skeletal anchorage system. American journal of orthodontics and dentofacial orthopedics125(2), pp.130-138.
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