How do geometry-related parameters influence the clinical performance of orthodontic mini-implants? A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to investigate how parameters related to geometry influence the clinical performance of orthodontic mini-implants (MIs). Systematic searches were performed in electronic databases including MEDLINE, Scopus, Web of Science, Virtual Health Library, and Cochrane Library and reference lists up to March 2016. Eligibility criteria comprised clinical studies involving patients who received MIs for orthodontic anchorage, with data for categories of MI dimension, shape, and thread design and insertion site, and evaluated by assessment of primary and secondary stability. Study selection, data extraction, quality assessment, and a meta-analysis were carried out. Twenty-seven studies were included in the qualitative synthesis: five randomized, eight prospective, and 14 retrospective clinical studies. One study with a serious risk of bias was later excluded. Medium and short MIs (1.4-1.9mm diameter and 5-8mm length) presented the highest success rates (0.87, 95% CI 0.80-0.92). A maximum insertion torque of 13.28Ncm (standard error 0.34) was observed for tapered self-drilling MIs in the mandible, whereas cylindrical MIs in the maxilla presented a maximum removal torque of 10.01Ncm (standard error 0.17). Moderate evidence indicates that the clinical performance of MIs is influenced by implant geometry parameters and is also related to properties of the insertion site. However, further research is necessary to support these associations.

Evaluation of pharyngeal airway space amongst different skeletal patterns.

The aim of the present study was to evaluate the dimensions of the pharyngeal airway space (PAS) in awake, upright children with different anteroposterior skeletal patterns using cone beam computed tomography (CBCT). The volume, area, minimum axial area and seven linear measurements of PAS were obtained from the CBCT images of 50 children (mean age 9.16 years). The patients were divided in two groups according to the ANB angle (group I 2° ≤ ANB ≤ 5°; group II ANB > 5°). Means and standard deviations of each variable were compared and correlated using independent t-test and Pearson's correlation test. There were statistically significant differences in the following parameters: angle formed by the intersection between NA and NB lines (p<0.001), angle formed by the intersection between SN and NB lines (p<0.05), Minimal pharyngeal airway space between the uvula and the posterior pharyngeal wall (p<0.05), airway volume (p<0.01), airway area (p<0.01) and minimum axial area (p<0.05). The anteroposterior cephalometric variable SNB had positive correlation with the variables PAS-UP (p<0.01), Minimal pharyngeal airway space between the uvula tip and the posterior pharyngeal wall (p<0.05), Pharyngeal airway space on mandibular line (p<0.05), Minimal pharyngeal airway space between the back of the tongue and the posterior pharyngeal wall (p<0.05), volume airway (p<0.05), airway area (p<0.05) and minimum axial area (p<0.05). The vertical cephalometric variables angle formed by the intersection between SN and GoGn lines (p<0.05) and angle formed by the intersection between FH and mandible plane (p<0.05) showed negative correlation with PAS-UT. These results showed that PAS was statistically larger in group I than group II, indicating that the dimensions of the PAS are affected by different anteroposterior skeletal patterns.

In vitro evaluation of insertion and removal torques of orthodontic mini-implants.

This study evaluated the influence of bone cortical thickness on the maximum torque required for insertion and removal of orthodontic mini-implants of different shapes. Five different types of orthodontic mini-implants were examined Cylindrical 1 (CYM), Cylindrical 2 (CYI) and Cylindrical 3 (CYT) Conical 1 (CON), Conical 2 (COS). Insertion and removal torque tests were performed in mini-pig medullary bone (8mm thick) and cortical bone 1, 2, 3 and 6mm thick. A digital torque meter measured the torque forces; the maximum values of insertion and removal were obtained (N/cm). There were no statistically significant differences between the different implants in the torque forces required for insertion and removal from medullary bone (P>0.05). During insertion into 1-2mm cortical bone, COS, CON and CYT had torque values statistically higher, but CON had higher torque values compared with the others when 3-6mm cortical bone was used (P<0.05). The removal torque values were significantly lower for CYM and CYI. Conical type mini-implants require a greater torque force for insertion and removal compared with cylindrical types. Torque values were directly related to cortical thickness.