The effect of varying healing times on orthodontic mini-implant stability: a microscopic computerized tomographic and biomechanical analysis

The impact of immediate versus delayed mini-screw placement on alveolar bone preservation and bone density following tooth extraction: evidence from a canine model

The aim of this study was to evaluate the impact of mini-screw placement on the alveolar ridge using a split-mouth design. Twelve beagles underwent bilateral extraction of their lateral teeth. In the immediate group, a mini-screw was unilaterally placed approximately 3-4 mm below the alveolar crest of the extraction site on the experimental side. The delayed group received mini-screws six weeks after tooth extraction. On average, the dogs were sacrificed after 11 weeks, and the maxillary bones were excised and scanned using cone-beam computed tomography (CBCT). Histopathological examinations were conducted to assess inflammation and bone formation scores. The results showed that in the immediate group, bone height was significantly greater on the intervention side compared to the control side (p < 0.05), whereas there was no significant difference in the delayed group. In both groups, there was a significant increase in bone density around the mini-screws compared to the control sides (p < 0.05). Mini-screw insertion led to a significant enhancement of bone growth in both groups (p < 0.05), with no notable differences between the two groups. The mini-screws did not have any impact on bone inflammation or width. Overall, both immediate and delayed mini-screw placement in the extraction socket positively influenced bone dimensions, density, and histological properties. However, immediate insertion was more effective than delayed placement in preserving vertical bone height, despite delayed insertion resulting in higher bone density.

Miniscrews for orthodontic anchorage: analysis of risk factors correlated with the progressive susceptibility to failure

INTRODUCTION

The phenomenon of orthodontic anchorage miniscrews loosening after being implanted several times happens in daily clinical practice, and the reasons need to be traced. This study aimed to investigate the underlying risk factors influencing the progressive susceptibility of orthodontic miniscrews to failure.

METHODS

Overall, 889 miniscrews were successively inserted into 347 patients because some loosened or fell off once, twice, or more before achieving their purposes. The number of miniscrew failures (ie, once, twice, or more) was defined as progressive susceptibility to failure. The clinical indicators were assessed via univariate analysis, multicollinearity diagnosis, and Poisson log-linear regression model with stepwise calculation to screen out.

RESULTS

The progressive susceptibility of miniscrews to failure was proved to be affected by the age of patients, the onset of force application, site of placement, and appliance type. Age and onset of force application presented a negative relationship with susceptibility. Miniscrews inserted in the palatal region appeared to be more stable than the forepart of the arch. In contrast, the retromaxillary and retromandibular areas obtained the lowest stability. The patients with fixed appliances were more unlikely to suffer progressive failure than removable appliances. In addition, the larger number of screws inserted in each patient, the greater probability of failure.

CONCLUSIONS

Younger people with removable appliances that miniscrews inserted in the retromaxillary or retromandibular regions and earlier onsets of loading had a higher progressive susceptibility to loosening. Meanwhile, the failure rate was elevated with the increasing number of screws per patient received.

Crystalline Biomimetic Calcium Phosphate Coating on Mini-Pin Implants to Accelerate Osseointegration and Extend Drug Release Duration for an Orthodontic Application

Miniscrew implants (MSIs) have been widely used as temporary anchorage devices in orthodontic clinics. However, one of their major limitations is the relatively high failure rate. We hypothesize that a biomimetic calcium phosphate (BioCaP) coating layer on mini-pin implants might be able to accelerate the osseointegration, and can be a carrier for biological agents. A novel mini-pin implant to mimic the MSIs was used. BioCaP (amorphous or crystalline) coatings with or without the presence of bovine serum albumin (BSA) were applied on such implants and inserted in the metaphyseal tibia in rats. The percentage of bone to implant contact (BIC) in histomorphometric analysis was used to evaluate the osteoconductivity of such implants from six different groups (n=6 rats per group): (1) no coating no BSA group, (2) no coating BSA adsorption group, (3) amorphous BioCaP coating group, (4) amorphous BioCaP coating-incorporated BSA group, (5) crystalline BioCaP coating group, and (6) crystalline BioCaP coating-incorporated BSA group. Samples were retrieved 3 days, 1 week, 2 weeks, and 4 weeks post-surgery. The results showed that the crystalline BioCaP coating served as a drug carrier with a sustained release profile. Furthermore, the significant increase in BIC occurred at week 1 in the crystalline coating group, but at week 2 or week 4 in other groups. These findings indicate that the crystalline BioCaP coating can be a promising surface modification to facilitate early osseointegration and increase the success rate of miniscrew implants in orthodontic clinics.

Anodized Biomedical Stainless-Steel Mini-Implant for Rapid Recovery in a Rabbit Model

The study aimed to analyze the recovery period of the anodized 316L biomedical stainless steel (BSS) mini-implant through its implantation on femur of rabbit model. The 316L BSS mini-implant was modified by an electrochemical anodization approach with different voltages. The anodized samples were characterized via field-emission scanning electron microscopy, X-ray diffractometry, and X-ray photoelectron spectroscopy. The biocompatibility was assessed by cell culture assay. The anodized mini-implant was implanted on rabbit’s femur then evaluated histologically after 4 and 8 weeks. Analytical results indicated that the topography of the anodized mini-implant at 5 V for 5 min consisted of a dual (micro/nano) porous structure. Oxide film of Cr2O3 was formed on the surface of anodized mini-implant after anodizing with 5 V for 5 min. In vitro cell culture assay revealed that fibroblast cells (NIH-3T3) on the anodized samples were more firmly attached as compared with the control sample. Moreover, histological analysis demonstrated that the anodized mini-implant improved bone recovering at 4 weeks after implantation. Thus, this study suggests that the anodized 316L BSS mini-implant could be a potential choice as anchorage device for effective and efficient orthodontic treatment.

The effects of cortical bone thickness and miniscrew implant root proximity on the success rate of miniscrew implant: A retrospective study

OBJECTIVE

To investigate the effects of cortical bone thickness (CBT), miniscrew implant root proximity (MRP) and other related factors on the success rate of miniscrew implant (MSI).

MATERIALS AND METHODS

Four hundred and five MSIs placed in 171 patients were analysed in this retrospective study. The primary predictor variables were CBT and MRP at MSI insertion sites. The predictor variables also included patient, location, MSI design and procedure related factors. The outcome variable was the survival of MSI. The differences in measurement data between success group and failed group were evaluated by the analysis of variance and independent samples t tests. Patient, location, MSI design and procedure related factors associated with the MSI prognosis were analysed by survival analysis with Cox proportional hazard regression model. The P value was set at .05. And the survival curves of independent factors were plotted.

RESULTS

The overall success rate of MSI was 82.7%. The age of MSI host, CBT, interdental root distance (IRD) and MRP at MSI sites showed no significant differences between failed group and success group. CBT and insertion jaws were independent prognosis factors screened out by Cox proportional hazard regression model. Failure risk (hazard ratio) of MSI with CBT <1 mm was 4.72. The failure risk in the mandible was 3.80 times as high as that in the maxilla.

CONCLUSION

Inadequate CBT (<1 mm) contributed to the failure of MSI. MSI placed in the maxilla showed better prognosis compared to the mandible. MRP had no significant effect on the prognosis.

Implants for orthodontic anchorage: success rates and reasons of failures

INTRODUCTION

The aims of this study were to analyze the success rate of mini-implants and miniscrews and to report the reasons behind them.

MATERIALS AND METHODS

An electronic literature search from PubMed databases and a hand search in implant- and orthodontic-related journals were performed until December 31, 2011. Human clinical studies in English that reported temporary anchorage devices used for orthodontic purpose with at least 6 months follow-up were included. In addition, the minimal number of implants had to be at least 10. Implants placed in maxilla, mandible, and hard palate were included.

RESULTS

The initial search resulted in 847 articles, of which 46 were further evaluated. Finally, 29 studies were qualified and classified into 2 groups: implants placed in maxilla and mandible (group 1) and implants placed in hard palate (group 2). A meta-analysis performed for groups 1 and 2 showed 87.8% and 93.8% survival rate, respectively. In addition, the most common cause for implants failure was surgery-related factors.

CONCLUSION

Mini-implant survival rate is location dependent, with those placed in the palate showing higher success rates. In addition, failures most commonly occur because of surgery-related factors.

Immediate versus delayed loading: comparison of primary stability loss after miniscrew placement in orthodontic patients-a single-centre blinded randomized clinical trial

INTRODUCTION

The aim of this randomized clinical trial was to compare torque recordings at insertion time and 1 week post-placement between immediately loaded orthodontic miniscrews and an unloaded control group.

TRIAL DESIGN

This RCT was designed as parallel with an allocation ratio of 1:1.

METHODS

Eligibility criteria to enroll patients were: needs of fixed orthodontic treatment, no systemic disease, absence of using drugs altering bone metabolism. All patients were consecutively treated in a private practice and the miniscrews were placed by the same author. Patients received ORTHOImplant (3M Unitek) miniscrews and they were blindly divided in two groups: group 1 screws were unloaded between T0 and T1, group 2 received immediately loaded screws with NiTi coil. For each patient, maximum insertion torque (MIT) was evaluated at T0. After 1 week, without loading, the screw torque was measured again (T1) and at the end of the treatment maximal removal torque was evaluated (T2). Torque variation in the first week was considered as the primary outcome.

RANDOMIZATION

A randomization list was created for the group assignment, with an allocation ratio of 1:1.

BLINDING

The study was single blinded in regard of the statistical analysis.

RESULTS

Patients enrolled in the clinical trial were 51 for a total of 81 miniscrews. The recruitment started in November 2012 and the observation period ended in August 2014. Twenty-six and twenty-five patients were analysed in group 1 and 2, respectively. The MIT mean in each placement time was 18.25 Ncm (SD = 3.00), 11.41 Ncm (SD = 3.51) and 10.52 Ncm (SD = 5.14) at T0, T1, and T2 time, respectively. In group 1, the torque decrease between T1 and T0 was statistically higher compared to group 2 (P value = 0.003). Statistically significant effects of the placement times on MIT were found (P value <0.0001). No serious harm was observed.

LIMITATIONS

This study was performed using only direct force on the miniscrew and not using the miniscrew as an indirect anchorage. It was not possible to obtain quantitative data on bone quality or root proximity to miniscrews.

CONCLUSIONS

A significant stability loss was observed in the first week in both groups; Group 1 showed a statistically higher torque loss in the first week when compared to the immediately loaded group. There were statistically significant effects of the measurement times on MIT and of the miniscrew location on MIT. The overall failure rate was 7.4%.

TRIAL REGISTRATION

This trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

The impact of healing time before loading on orthodontic mini-implant stability: a histomorphometric study in minipigs

OBJECTIVE

To evaluate healing time before loading, areas compression and tension and location of insertion on mini-implant stability.

DESIGN

Six minipigs were used. Each animal received 3 mini-implants in each quadrant: 1 mini-implant was used as an unloaded control (G1, n=24); the other 2 were loaded with 150g-force at three time intervals (G2: immediate loading, G3: after 15 days and G4: after 30 days), with 16 mini-implant in each experimental group. After 120 days, tissue blocks of the areas of interest were harvested. Clinical analysis (exact Fisher test) determined the survival rate. Histological analysis (Kontron KS 300™, Zeiss) quantified the fractional bone-to-implant contact (%BIC) and bone area (%BA) at each healing time point, areas of interest, and insertion site (ANOVA and t tests for dependent and independent samples).

RESULTS

The mini-implant survival rates were G1: 71%, G2: 50%, G3: 75% and G4: 63%, with no statistical differences between them. The groups presented similar %BIC and %BA. There were no differences between the compression and tension sides or maxillary and mandibular insertion sites.

CONCLUSIONS

These results suggest that low-intensity immediate or early orthodontic loading does not affect mini-implant stability, because similar histomorphometric results were observed for all the groups, with partial osseointegration of the mini-implants present.

Influence of metal artifacts on in vivo micro-CT for orthodontic mini-implants

This study aimed to show the effects of metal artifacts on the in vivo micro-CT of mini-implants by measuring bone volume. We drilled a hole in the cortical bone of a rat tibia and embedded a titanium orthodontic mini-implant (diameter, 1.5 mm) in the hole. Twelve individually weighed hydroxyapatite grains (HA grains) were placed around the implant either by one dentist (method 1) or separately by 12 dentists (method 2). In vivo micro-CT was used to scan the model after placement of each grain to measure increases and decreases in bone volume voxel number. The subtracted bone voxel volume increased with HA weight in both methods. Simple linear regression analysis showed a significant correlation between weight and volume in both methods (method 1: regression coefficient: 516.502, P < 0.05; method 2: regression coefficient: 4837.432, P < 0.05). Metal artifacts did not appear to influence measurements of bone volume, although further studies are required to determine the effect of thicker implants.