Survival rate and stability of surface-treated and non-surface-treated orthodontic mini-implants: a randomized clinical trial

ABSTRACT Objectives: This clinical trial was conducted to evaluate the stability and failure rate of surface-treated orthodontic mini-implants and determine whether they differ from those of non-surface-treated orthodontic mini-implants. Trial Design: Randomized clinical trial with a split-mouth study design. Setting: Department of Orthodontics, SRM Dental College, Chennai. Participants: Patients who required orthodontic mini-implants for anterior retraction in both arches. Methods: Self-drilling, tapered, titanium orthodontic mini-implants with and without surface treatment were placed in each patient following a split-mouth design. The maximum insertion and removal torques were measured for each implant using a digital torque driver. The failure rates were calculated for each type of mini-implant. Results: The mean maximum insertion torque was 17.9 ± 5.6 Ncm for surface-treated mini-implants and 16.4 ± 9.0 Ncm for non-surface-treated mini-implants. The mean maximum removal torque was 8.1 ± 2.9 Ncm for surface-treated mini-implants and 3.3 ± 1.9 Ncm for non-surface-treated mini-implants. Among the failed implants, 71.4% were non-surface-treated mini-implants and 28.6% were surface-treated mini-implants. Conclusion: The insertion torque and failure rate did not differ significantly between the groups, whereas the removal torque was significantly higher in the surface-treated group. Thus, surface treatment using sandblasting and acid etching may improve the secondary stability of self-drilling orthodontic mini-implants. Trial registration: The trial was registered in the Clinical Trials Registry, India (ICMR NIMS). Registration number: CTRI/2019/10/021718

RESUMO Objetivos: Este ensaio clínico foi conduzido para avaliar a estabilidade e a taxa de falha de mini-implantes ortodônticos com superfície tratada, e determinar se elas diferem das dos mini-implantes ortodônticos sem superfície tratada. Desenho do estudo: Ensaio clínico randomizado com desenho de boca dividida. Instituição: Department of Orthodontics, SRM Dental College, Chennai/India. Participantes: Pacientes que necessitavam de mini-implantes ortodônticos para retração anterior em ambas as arcadas. Métodos: Mini-implantes ortodônticos autoperfurantes, cônicos, de titânio com ou sem tratamento de superfície, foram colocados em cada paciente, seguindo um desenho de boca dividida. Os torques máximos de inserção e de remoção foram medidos para cada mini-implante, usando um torquímetro digital. As taxas de falha foram calculadas para cada tipo de mini-implante. Resultados: O valor médio do torque máximo de inserção foi de 17,9 ± 5,6 Ncm para mini-implantes com superfície tratada e 16,4 ± 9,0 Ncm para mini-implantes sem superfície tratada. O valor médio do torque máximo de remoção foi de 8,1 ± 2,9 Ncm para mini-implantes com superfície tratada e 3,3 ± 1,9 Ncm para mini-implantes sem superfície tratada. Entre os implantes que falharam, 71,4% eram mini-implantes sem superfície tratada e 28,6% eram mini-implantes com superfície tratada. Conclusão: O torque de inserção e a taxa de falha não diferiram significativamente entre os grupos; porém, o torque de remoção foi significativamente maior no grupo com superfície tratada. Assim, o tratamento de superfície com jateamento e condicionamento ácido pode melhorar a estabilidade secundária dos mini-implantes ortodônticos autoperfurantes. Registro do estudo: Esse estudo foi registrado no Clinical Trials Registry, Índia (ICMR NIMS). Número de registro: CTRI/2019/10/021718

Correlation between cortical bone thickness at mini-implant insertion sites and age of patient

ABSTRACT Introduction: Orthodontic mini-implants (MI) are a reliable alternative to provide temporary orthodontic anchorage. Prior to miniscrew insertion, the best approach would be to evaluate each possible insertion site and measure the cortical bone thickness, and verify whether it would provide adequate primary stability. Objective: This study aimed to evaluate the difference in cortical bone thickness in areas of mini-implants insertion in patients of different ages, by means of cone beam computed tomography (CBCT). Methods: The sample of this retrospective study was composed of 123 CBCT scans, which were used to measure cortical bone thickness in the buccal and palatal inter-radicular space in the mesial region of the first permanent molars. These measures were compared by using the Student's t-test, ANOVA/Tukey tests, and Linear regression between male and female subjects, from 12 to 30 years old. Results: No significant difference was found in cortical bone thickness between sex, race and sagittal facial patterns. Significantly higher measurement values were observed in patients older than 12 years of age at all sites evaluated. The coefficient β at the adjusted linear regression analysis showed that at each increment in age, mean cortical thickness values increased by 0.06mm in the mandible, 0.03mm in the buccal region and 0.02mm in the palatal region of the maxilla. Conclusions: The increase in cortical bone thickness was positively associated with age; that is, the more advanced the patient's age was, the less chance there was of failure due to primary stability.

RESUMO Introdução: Os mini-implantes ortodônticos (MI) são uma alternativa confiável para fornecer ancoragem esquelética temporária. Antes da inserção do mini-implante, a melhor abordagem seria avaliar cada local de inserção possível, medir a espessura do osso cortical e verificar se proporcionaria uma adequada estabilidade primária. Objetivo: O presente estudo teve como objetivo avaliar a diferença na espessura do osso cortical em áreas de inserção dos mini-implantes em pacientes de diferentes idades, por meio da tomografia computadorizada de feixe cônico. Métodos: A amostra desse estudo retrospectivo foi composta por 123 tomografias computadorizadas de feixe cônico, que foram utilizadas para medir a espessura do osso cortical nos espaços inter-radiculares vestibular e palatino na região mesial dos primeiros molares permanentes. Essas medidas foram comparadas por meio dos testes t de Student, ANOVA/Tukey e regressão linear entre os sexos masculino e feminino, de 12 a 30 anos. Resultados: Não houve diferença estatisticamente significativa na espessura cortical, quando comparados sexo, cor da pele e padrão facial sagital. Foram verificadas medidas significativamente maiores em pacientes com idade superior a 12 anos em todos os sítios avaliados. O coeficiente β da análise de regressão linear ajustada mostrou que, a cada incremento da idade, os valores médios da espessura cortical aumentaram 0,06 mm na mandíbula, 0,03 mm na região vestibular e 0,02 mm na região palatina da maxila. Conclusão: O aumento da espessura do osso cortical teve associação positiva com a idade, ou seja, quanto mais avançada a idade do paciente, menor a chance de falha, devido à estabilidade primária.

Vertical Play of Straight Wire Appliance Aids Correction of Gummy Smile and Bimaxillary Incisor Proclination with Mini Implant Anchorage

@#This report aimed to describe an effective biomechanics to control the upper incisors inclination during the correction of gummy smile with bimaxillary proclinations. A 14-year-old female presented with a Class II division I incisor relationship complicated with bimaxillary proclination on a Class 2 skeletal base. The lips were incompetent, showing 7 mm of upper incisors at rest and 5mm maxillary gingival display on smiling with normal upper lip length. Treatment involved extraction of all first permanent premolars followed by upper and lower fixed appliances. Intrusion of the upper incisors with controlled labial crown torque was accomplished with mini-implant anchorage placed bilaterally on the infrazygomatic crests with the retraction forces above the centre of resistance using 0.019x0.025-in stainless steel archwire in 0.022-in slot. The 0.019x0.025-in stainless steel archwire in 0.022-in slot provided the vertical play to favour lingual crown tipping despite having forces above the centre of resistance for concurrent anterior segment intrusion.

Cone-beam computed tomography-based diagnosis and treatment simulation for a patient with a protrusive profile and a gummy smile / 대한치과교정학회지

For patients with bimaxillary protrusion, significant retraction and intrusion of the anterior teeth are sometimes essential to improve the facial profile. However, severe root resorption of the maxillary incisors occasionally occurs after treatment because of various factors. For instance, it has been reported that approximation or invasion of the incisive canal by the anterior tooth roots during retraction may cause apical root damage. Thus, determination of the position of the maxillary incisors is key for orthodontic diagnosis and treatment planning in such cases. Cone-beam computed tomography (CBCT) may be useful for simulating the post-treatment position of the maxillary incisors and surrounding structures in order to ensure safe teeth movement. Here, we present a case of Class II malocclusion with bimaxillary protrusion, wherein apical root damage due to treatment was minimized by pretreatment evaluation of the anatomical structures and simulation of the maxillary central incisor movement using CBCT. Considerable retraction and intrusion of the maxillary incisors, which resulted in a significant improvement in the facial profile and smile, were achieved without severe root resorption. Our findings suggest that CBCT-based diagnosis and treatment simulation may facilitate safe and dynamic orthodontic tooth movement, particularly in patients requiring maximum anterior tooth retraction.

Autotransplantation: A biological treatment alternative for a patient after traumatic dental injury / 대한치과교정학회지

Traumatic dental injury is considered a public dental health problem because of a high childhood incidence, high treatment costs, and prolonged treatment time. Although management guidelines for traumatized teeth have been outlined, tooth loss following trauma is occasionally unavoidable. Here, we describe the successful interdisciplinary management of a traumatized central incisor in an 11-year old boy that was extracted because of a poor prognosis and restored by the autotransplantation of an immature donor tooth into the site. The patient underwent orthodontic treatment in order to close the donor site space and bring the autotransplanted tooth to an ideal position. Postorthodontic treatment radiographs and photographs revealed an esthetic and functional natural tooth replacing the lost tooth. The findings from this case suggest that autotransplantation offers unique advantages as a treatment modality for the restoration of missing teeth, particularly in growing children.

Average interradicular sites for miniscrew insertion: should dental crowding be considered?

ABSTRACT Objective: To define a map of interradicular spaces where miniscrew can be likely placed at a level covered by attached gingiva, and to assess if a correlation between crowding and availability of space exists. Methods: Panoramic radiographs and digital models of 40 patients were selected according to the inclusion criteria. Interradicular spaces were measured on panoramic radiographs, while tooth size-arch length discrepancy was assessed on digital models. Statistical analysis was performed to evaluate if interradicular spaces are influenced by the presence of crowding. Results: In the mandible, the most convenient sites for miniscrew insertion were in the spaces comprised between second molars and first premolars; in the maxilla, between first molars and second premolars as well as between canines and lateral incisors and between the two central incisors. The interradicular spaces between the maxillary canines and lateral incisors, and between mandibular first and second premolars revealed to be influenced by the presence of dental crowding. Conclusions: The average interradicular sites map hereby proposed can be used as a general guide for miniscrew insertion at the very beginning of orthodontic treatment planning. Then, the clinician should consider the amount of crowding: if this is large, the actual interradicular space in some areas might be significantly different from what reported on average. Individualized radiographs for every patient are still recommended.

RESUMO Objetivo: elaborar um mapa dos espaços inter-radiculares nos quais os mini-implantes podem ser inseridos, em um nível coberto por gengiva inserida; e avaliar se existe correlação entre o apinhamento dentário e a disponibilidade de espaços. Métodos: radiografias panorâmicas e modelos digitais de 40 pacientes foram selecionados seguindo critérios de inclusão. Os espaços inter-radiculares foram medidos nas radiografias panorâmicas, enquanto a discrepância de modelo foi avaliada nos modelos digitais. Realizou-se, então, uma análise estatística para avaliar se os espaços inter-radiculares foram influenciados pela presença do apinhamento dentário. Resultados: na mandíbula, os locais mais adequados para a inserção dos mini-implantes foram os espaços compreendidos entre os segundos molares e primeiros pré-molares; na maxila, entre os primeiros molares e segundos pré-molares, bem como entre caninos e incisivos laterais, e entre os dois incisivos centrais. Os espaços inter-radiculares entre os caninos e incisivos laterais superiores e entre o primeiro e o segundo pré-molares inferiores mostraram-se influenciados pela presença do apinhamento dentário. Conclusões: o mapa dos espaços inter-radiculares mais adequados aqui proposto pode ser adotado como um guia geral para a inserção de mini-implantes, e pode ser usado logo ao início do planejamento do tratamento ortodôntico. Em seguida, o clínico deve levar em consideração a quantidade de apinhamento: caso esse seja grande, o real espaço inter-radicular, em algumas áreas, poderá ser significativamente diferente da média aqui relatada. Assim, recomenda-se que sempre sejam feitas radiografias individualizadas para cada paciente.

Bone cutting capacity and osseointegration of surface-treated orthodontic mini-implants / 대한치과교정학회지

OBJECTIVE: The objective of the study was to evaluate the practicality and the validity of different surface treatments of self-drilling orthodontic mini-implants (OMIs) by comparing bone cutting capacity and osseointegration. METHODS: Self-drilling OMIs were surface-treated in three ways: Acid etched (Etched), resorbable blasting media (RBM), partially resorbabla balsting media (Hybrid). We compared the bone cutting capacity by measuring insertion depths into artificial bone (polyurethane foam). To compare osseointegration, OMIs were placed in the tibia of 25 rabbits and the removal torque value was measured at 1, 2, 4, and 8 weeks after placement. The specimens were analyzed by optical microscopy, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS). RESULTS: The bone cutting capacity of the etched and hybrid group was lower than the machined (control) group, and was most inhibited in the RBM group (p < 0.05). At 4 weeks, the removal torque in the machined group was significantly decreased (p < 0.05), but was increased in the etched group (p < 0.05). In the hybrid group, the removal torque significantly increased at 2 weeks, and was the highest among all measured values at 8 weeks (p < 0.05). The infiltration of bone-like tissue surface was evaluated by SEM, and calcium and phosphorus were detected via EDS only in the hybrid group. CONCLUSIONS: Partial RBM surface treatment (hybrid type in this study) produced the most stable self-drilling OMIs, without a corresponding reduction in bone cutting capacity.

Analysis of midpalatal miniscrew-assisted maxillary molar distalization patterns with simultaneous use of fixed appliances: A preliminary study / 대한치과교정학회지

Skeletal anchorage-assisted upper molar distalization has become one of the standard treatment modalities for the correction of Class II malocclusion. The purpose of this study was to analyze maxillary molar movement patterns according to appliance design, with the simultaneous use of buccal fixed orthodontic appliances. The authors devised two distinct types of midpalatal miniscrew-assisted maxillary molar distalizers, a lingual arch type and a pendulum type. Fourteen patients treated with one of the two types of distalizers were enrolled in the study, and the patterns of tooth movement associated with each type were compared. Pre- and post-treatment lateral cephalograms were analyzed. The lingual arch type was associated with relatively bodily upper molar distalization, while the pendulum type was associated with distal tipping with intrusion of the upper molar. Clinicians should be aware of the expected tooth movement associated with each appliance design. Further well designed studies with larger sample sizes are required.

Effect of angled installation of orthodontic mini-implants on primary stability

AIM: The aim of this work was evaluate the insertion and removal torque for orthodontic mini-implants inserted in different inclination. Materials and methods: Ten self[drilling mini-implants from the brand SIN (Sistema de Implantes Nacional, São Paulo/SP, Brazil), and the surgical kit for their insertion were used. Two plaques of synthetic bone of 120mm x 170mm x 41,5mm were used (Sawbones, Pacific Research Laboratories Inc, Vashon, Wash), with 1,5mm height, simulating the cortical bone (density 40 pcf) and 40 mm simulating the medullary bone (density 15 pcf). In each block, five areas were demarcated for each mark, totalizing ten areas. The ten mini-implants were inserted by the same operator, previously calibrated; five of them at 900 and five at 600, using the manual key kit. After the insertion of all the mini-implants, the final threading and the reading of insertion torque value were carried out with a manual torque wrench digital Lutron TQ[8800 (Lutron Electronic Enterprise Co., Ltd, Taipei, Taiwan) until the trans-mucosal profile achieve the cortical bone. The maximum insertion torque value was registered in N/cm. After all the implants inserted, the measurement of removal torque was started, performed in the same way of insertion, but in the opposite anticlockwise. The results were submitted to the T test (parametric) and to a Mann-Whitney test (non-parametric). Results: The results demonstrated that the insertion torque was lower than the removal one in both insertion degrees, with statistically significance. Despite insertion torque at 90 degrees had been lightly higher than that inserted at 60 degrees, they were not statistically significant. Conclusion: In view of the results, it was possible conclude that insertion at 60º angulation does not offer advantages to the primary stability for orthodontic mini-implants.

En-masse retraction with a preformed nickel-titanium and stainless steel archwire assembly and temporary skeletal anchorage devices without posterior bonding / 대한치과교정학회지

OBJECTIVE: To evaluate the therapeutic effects of a preformed assembly of nickel-titanium (NiTi) and stainless steel (SS) archwires (preformed C-wire) combined with temporary skeletal anchorage devices (TSADs) as the sole source of anchorage and to compare these effects with those of a SS version of C-wire (conventional C-wire) for en-masse retraction. METHODS: Thirty-one adult female patients with skeletal Class I or II dentoalveolar protrusion, mild-to-moderate anterior crowding (3.0-6.0 mm), and stable Class I posterior occlusion were divided into conventional (n = 15) and preformed (n = 16) C-wire groups. All subjects underwent first premolar extractions and en-masse retraction with pre-adjusted edgewise anterior brackets, the assigned C-wire, and maxillary C-tubes or C-implants; bonded mesh-tube appliances were used in the mandibular dentition. Differences in pretreatment and post-retraction measurements of skeletal, dental, and soft-tissue cephalometric variables were statistically analyzed. RESULTS: Both groups showed full retraction of the maxillary anterior teeth by controlled tipping and space closure without altered posterior occlusion. However, the preformed C-wire group had a shorter retraction period (by 3.2 months). Furthermore, the maxillary molars in this group showed no significant mesialization, mesial tipping, or extrusion; some mesialization and mesial tipping occurred in the conventional C-wire group. CONCLUSIONS: Preformed C-wires combined with maxillary TSADs enable simultaneous leveling and space closure from the beginning of the treatment without maxillary posterior bonding. This allows for faster treatment of dentoalveolar protrusion without unwanted side effects, when compared with conventional C-wire, evidencing its clinical expediency.

Enhanced compatibility and initial stability of Ti6Al4V alloy orthodontic miniscrews subjected to anodization, cyclic precalcification, and heat treatment / 대한치과교정학회지

OBJECTIVE: To evaluate the bioactivity, and the biomechanical and bone-regenerative properties of Ti6Al4V miniscrews subjected to anodization, cyclic precalcification, and heat treatment (APH treatment) and their potential clinical use. METHODS: The surfaces of Ti6Al4V alloys were modified by APH treatment. Bioactivity was assessed after immersion in simulated body fluid for 3 days. The hydrophilicity and the roughness of APH-treated surfaces were compared with those of untreated (UT) and anodized and heat-treated (AH) samples. For in vivo tests, 32 miniscrews (16 UT and 16 APH) were inserted into 16 Wistar rats, one UT and one APH-treated miniscrew in either tibia. The miniscrews were extracted after 3 and 6 weeks and their osseointegration (n = 8 for each time point and group) was investigated by surface and histological analyses and removal torque measurements. RESULTS: APH treatment formed a dense surface array of nanotubular TiO2 layer covered with a compact apatite-like film. APH-treated samples showed better bioactivity and biocompatibility compared with UT and AH samples. In vivo, APH-treated miniscrews showed higher removal torque and bone-to-implant contact than did UT miniscrews, after both 3 and 6 weeks (p < 0.05). Also, early deposition of densely mineralized bone around APH-treated miniscrews was observed, implying good bonding to the treated surface. CONCLUSIONS: APH treatment enhanced the bioactivity, and the biomechanical and bone regenerative properties of the Ti6Al4V alloy miniscrews. The enhanced initial stability afforded should be valuable in orthodontic applications.

Effectiveness of en-masse retraction using midpalatal miniscrews and a modified transpalatal arch: Treatment duration and dentoskeletal changes / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to compare the treatment duration and dentoskeletal changes between two different anchorage systems used to treat maxillary dentoalveolar protrusion and to examine the effectiveness of en-masse retraction using two miniscrews placed in the midpalatal suture. METHODS: Fifty-seven patients (9 men, 48 women), who had undergone level anchorage system treatment at Aichi-Gakuin University Dental Hospital (Nagoya, Japan) were divided into two groups according to the method of maxillary posterior anchorage reinforcement: midpalatal miniscrews (25 patients, mean age 22 years) and conventional anchorage (32 patients, mean age 19 years). The en-masse retraction period, overall treatment duration, pre-treatment effective ANB angle, and change in the effective ANB angle were compared with an independent-samples t-test. RESULTS: Compared to the headgear group, the duration of en-masse retraction was longer by approximately 4 months in the miniscrew group (p < 0.001). However, we found no significant difference in the total treatment duration between the groups. Moreover, a greater change in the effective ANB angle was observed in patients treated with miniscrews than in those treated with the conventional method (p < 0.05). CONCLUSIONS: The level anchorage system treatment using miniscrews placed in the midpalatal area will allow orthodontists more time to control the anterior teeth during en-masse retraction, without increasing the total treatment duration. Furthermore, it achieves better dentoskeletal control than does the conventional anchorage method, thereby improving the quality of the treatment results.

Quantitative evaluation of alveolar cortical bone density in adults with different vertical facial types using cone-beam computed tomography / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to quantitatively evaluate the cortical bone densities of the maxillary and mandibular alveolar processes in adults with different vertical facial types using cone-beam computed tomography (CBCT) images. METHODS: CBCT images (n = 142) of adult patients (20-45 years) were classified into hypodivergent, normodivergent, and hyperdivergent groups on the basis of linear and angular S-N/Go-Me measurements. The cortical bone densities (in Hounsfield units) at maxillary and mandibular interdental sites from the distal aspect of the canine to the mesial aspect of the second molar were measured on the images. RESULTS: On the maxillary buccal side, female subjects in the hyperdivergent group showed significantly decreased bone density, while in the posterior region, male subjects in the hyperdivergent group displayed significantly decreased bone density when compared with corresponding subjects in the other groups (p<0.001). Furthermore, the subjects in the hyperdivergent group had significantly lower bone densities on the mandibular buccal side than hypodivergent subjects. The maxillary palatal bone density did not differ significantly among groups, but female subjects showed significantly denser palatal cortical bone. No significant difference in bone density was found between the palatal and buccal sides in the maxillary premolar region. Overall, the palatal cortical bone was denser anteriorly and buccal cortical bone was denser posteriorly. CONCLUSION: Adults with the hyperdivergent facial type tend to have less-dense buccal cortical bone in the maxillary and mandibular alveolar processes. Clinicians should be aware of the variability of cortical bone densities at mini-implant placement sites.

Geometrical design characteristics of orthodontic mini-implants predicting maximum insertion torque / 대한치과교정학회지

OBJECTIVE: To determine the unique contribution of geometrical design characteristics of orthodontic mini-implants on maximum insertion torque while controlling for the influence of cortical bone thickness. METHODS: Total number of 100 cylindrical orthodontic mini-implants was used. Geometrical design characteristics of ten specimens of ten types of cylindrical self-drilling orthodontic mini-implants (Ortho Easy(R), Aarhus, and Dual Top(TM)) with diameters ranging from 1.4 to 2.0 mm and lengths of 6 and 8 mm were measured. Maximum insertion torque was recorded during manual insertion of mini-implants into bone samples. Cortical bone thickness was measured. Retrieved data were analyzed in a multiple regression model. RESULTS: Significant predictors for higher maximum insertion torque included larger outer diameter of implant, higher lead angle of thread, and thicker cortical bone, and their unique contribution to maximum insertion torque was 12.3%, 10.7%, and 24.7%, respectively. CONCLUSIONS: The maximum insertion torque values are best controlled by choosing an implant diameter and lead angle according to the assessed thickness of cortical bone.

Effect of bite force on orthodontic mini-implants in the molar region: Finite element analysis / 대한치과교정학회지

OBJECTIVE: To examine the effect of bite force on the displacement and stress distribution of orthodontic mini-implants (OMIs) in the molar region according to placement site, insertion angle, and loading direction. METHODS: Five finite element models were created using micro-computed tomography (microCT) images of the maxilla and mandible. OMIs were placed at one maxillary and two mandibular positions: between the maxillary second premolar and first molar, between the mandibular second premolar and first molar, and between the mandibular first and second molars. The OMIs were inserted at angles of 45degrees and 90degrees to the buccal surface of the cortical bone. A bite force of 25 kg was applied to the 10 occlusal contact points of the second premolar, first molar, and second molar. The loading directions were 0degrees, 5degrees, and 10degrees to the long axis of the tooth. RESULTS: With regard to placement site, the displacement and stress were greatest for the OMI placed between the mandibular first molar and second molar, and smallest for the OMI placed between the maxillary second premolar and first molar. In the mandibular molar region, the angled OMI showed slightly less displacement than the OMI placed at 90degrees. The maximum Von Mises stress increased with the inclination of the loading direction. CONCLUSIONS: These results suggest that placement of OMIs between the second premolar and first molar at 45degrees to the cortical bone reduces the effect of bite force on OMIs.

Biologic stability of plasma ion-implanted miniscrews / 대한치과교정학회지

OBJECTIVE: To gain basic information regarding the biologic stability of plasma ion-implanted miniscrews and their potential clinical applications. METHODS: Sixteen plasma ion-implanted and 16 sandblasted and acid-etched (SLA) miniscrews were bilaterally inserted in the mandibles of 4 beagles (2 miniscrews of each type per quadrant). Then, 250 - 300 gm of force from Ni-Ti coil springs was applied for 2 different periods: 12 weeks on one side and 3 weeks contralaterally. Thereafter, the animals were sacrificed and mandibular specimens including the miniscrews were collected. The insertion torque and mobility were compared between the groups. The bone-implant contact and bone volume ratio were calculated within 800 microm of the miniscrews and compared between the loading periods. The number of osteoblasts was also quantified. The measurements were expressed as percentages and analyzed by independent t-tests (p < 0.05). RESULTS: No significant differences in any of the analyzed parameters were noted between the groups. CONCLUSIONS: The preliminary findings indicate that plasma ion-implanted miniscrews have similar biologic characteristics to SLA miniscrews in terms of insertion torque, mobility, bone-implant contact rate, and bone volume rate.

Orthodontic treatment of gummy smile by maxillary total intrusion with a midpalatal absolute anchorage system / 대한치과교정학회지

This article describes the orthodontic treatment of a 31-year-old Korean female patient with gummy smile and crowding. The patient showed excessive gingival display in both the anterior and posterior areas and a large difference in gingival heights between the anterior and posterior teeth in the maxilla. To correct the gummy smile, we elected to intrude the entire maxillary dentition instead of focusing only on the maxillary anterior teeth. Alignment and leveling were performed, and a midpalatal absolute anchorage system as well as a modified lingual arch was designed to achieve posterosuperior movement of the entire upper dentition. The active treatment period was 18 months. The gummy smile and crowding were corrected, and the results were stable at 21 months post-treatment.

Three-dimensional finite element analysis of the deformation of the human mandible: a preliminary study from the perspective of orthodontic mini-implant stability / 대한치과교정학회지

OBJECTIVE: The aims of this study were to investigate mandibular deformation under clenching and to estimate its effect on the stability of orthodontic mini-implants (OMI). METHODS: Three finite element models were constructed using computed tomography (CT) images of 3 adults with different mandibular plane angles (A, low; B, average; and C, high). An OMI was placed between #45 and #46 in each model. Mandibular deformation under premolar and molar clenching was simulated. Comparisons were made between peri-orthodontic mini-implant compressive strain (POMI-CSTN) under clenching and orthodontic traction forces (150 g and 200 g). RESULTS: Three models with different mandibular plane angles demonstrated different functional deformation characteristics. The compressive strains around the OMI were distributed mesiodistally rather than occlusogingivally. In model A, the maximum POMI-CSTN under clenching was observed at the mesial aspect of #46 (1,401.75 microstrain [microE]), and similar maximum POMI-CSTN was observed under a traction force of 150 g (1,415 microE). CONCLUSIONS: The maximum POMI-CSTN developed by clenching failed to exceed the normally allowed compressive cortical bone strains; however, additional orthodontic traction force to the OMI may increase POMI-CSTN to compromise OMI stability.

Management of acquired open bite associated with temporomandibular joint osteoarthritis using miniscrew anchorage / 대한치과교정학회지

This article reports the orthodontic treatment of a patient with skeletal mandibular retrusion and an anterior open bite due to temporomandibular joint osteoarthritis (TMJ-OA) using miniscrew anchorage. A 46-year-old woman had a Class II malocclusion with a retropositioned mandible. Her overjet and overbite were 7.0 mm and -1.6 mm, respectively. She had limited mouth opening, TMJ sounds, and pain. Condylar resorption was observed in both TMJs. Her TMJ pain was reduced by splint therapy, and then orthodontic treatment was initiated. Titanium miniscrews were placed at the posterior maxilla to intrude the molars. After 2 years and 7 months of orthodontic treatment, an acceptable occlusion was achieved without any recurrence of TMJ symptoms. The retropositioned mandible was considerably improved, and the lips showed less tension upon lip closure. The maxillary molars were intruded by 1.5 mm, and the mandible was subsequently rotated counterclockwise. Magnetic resonance imaging of both condyles after treatment showed avascular necrosis-like structures. During a 2-year retention period, an acceptable occlusion was maintained without recurrence of the open bite. In conclusion, correction of open bite and clockwise-rotated mandible through molar intrusion using titanium miniscrews is effective for the management of TMJ-OA with jaw deformity.

Influência do diâmetro, comprimento e angulação nos torques de inserção e remoção de mini-implantes autoperfurantes / Influence of diameter, length and angulation in the insertion and removal torque of self-drilling mini-implants

Objetivo: avaliar a influência da associação do diâmetro, comprimento e angulação do mini-implante sobre a estabilidade primária a partir da análise do torque de inserção e remoção. Material e método: foram instalados 120 mini-implantes autoperfurantes, cilíndricos, com 1,4 x 6mm, 1,4 x 8mm, 1,6 x 6mm e 1,6 x 8mm, em um bloco de osso artificial. Os mini-implantes foram instalados com o auxílio da chave de mão acoplada ao torquímetro digital, possibilitando a inserção e mensuração do torque com orientação perpendicular e com inclinação de 60° em relação à superfície do bloco de osso artificial. Os mini-implantes foram removidos da mesma forma como inseridos, porém girando-se a chave em sentido anti-horário. Os registros foram realizados através da conexão do torquímetro ao computador e os valores do torque de inserção e remoção foram obtidos pelos picos máximos dos gráficos, registrados pelo software Datalogger e compilados em tabelas. Realizou-se a análise descritiva para obter a média e desvio-padrão de cada grupo, e submeteram-se os resultados à análise de variância (ANOVA). Resultados: a média dos torques variou entre 19,2 a 23,6Ncm nos testes de inserção e entre 11 a 14,66Ncm nos testes de remoção. Conclusões: as variáveis diâmetro e comprimento não exerceram influência significativa nos valores dos torques de inserção e remoção. A angulação de instalação ocasionou aumento significativo desses torques no grupo 7. Os demais grupos, porém, não apresentaram diferença significante entre as angulações.

Objective: evaluate the influence of diameter, length and angulation of mini-implant on the primary stability through the analysis of insertion and removal torque. Material and Methods: were installed 120 self-drilling mini-implants, cylindrical, with 1.4 x 6mm, 1.4 x 8mm, 1.6 x 6mm and 1.6 x 8mm in a block of artificial bone. The screwdriver for mini-implants was connected to digital torquimeter, in order to allow the insertion and measurement of torque oriented perpendicular and slanting at 60° to the bone surface. Mini-implants were removed the using the same procedures, but turning the screw driver counterclockwise. The recordings were made by connecting the torquimeter to the computer and values of insertion and removal torque were obtained by the maximum peak of the graphics, collected by the Datalogger software and compiled into tables. We conducted a descriptive analysis for the mean and standard deviation of each group, and the results submitted to analysis of variance (ANOVA). Results: the mean torques ranged from 19.2 to 23.6Ncm for insertion tests and between 11 to 14.66Ncm for removal tests. Conclusions: the diameter and length did not influence significantly the values of insertion and removal torques. The angle of installation of these torques caused a significant increase in group 7. However, the other groups showed no significant difference between the angles.