Insertion torque, pull-out strength and cortical bone thickness in contact with orthodontic mini-implants at different insertion angles

Effects of exposure length, cortical and trabecular bone contact areas on primary stability of infrazygomatic crest mini-screws at different insertion angles

BACKGROUND

The infrazygomatic crest mini-screw has been widely used, but the biomechanical performance of mini-screws at different insertion angles is still uncertain. The aim of this study was to analyse the primary stability of infrazygomatic crest mini-screws at different angles and to explore the effects of the exposure length (EL), screw-cortical bone contact area (SCA), and screw-trabecular bone contact area (STA) on this primary stability.

METHODS

Ninety synthetic bones were assigned to nine groups to insert mini-screws at the cross-combined angles in the occlusogingival and mesiodistal directions. SCA, STA, EL, and lateral pull-out strength (LPS) were measured, and their relationships were analysed. Twelve mini-screws were then inserted at the optimal and poor angulations into the maxillae from six fresh cadaver heads, and the same biomechanical metrics were measured for validation.

RESULTS

In the synthetic-bone test, the LPS, SCA, STA, and EL had significant correlations with the angle in the occlusogingival direction (rLPS = 0.886, rSCA = -0.946, rSTA = 0.911, and rEL= -0.731; all P < 0.001). In the cadaver-validation test, significant differences were noted in the LPS (P = 0.011), SCA (P = 0.020), STA (P = 0.004), and EL (P = 0.001) between the poor and optimal angulations in the occlusogingival direction. The STA had positive correlations with LPS (rs = 0.245 [synthetic-bone test] and r = 0.720 [cadaver-validation test]; both P < 0.05).

CONCLUSIONS

The primary stability of the infrazygomatic crest mini-screw was correlated with occlusogingival angulations. The STA significantly affected the primary stability of the infrazygomatic crest mini-screw, but the SCA and EL did not.

The effect of different orthodontic mini-implant brands and geometry on primary stability (an in vitro study)

Background

In orthodontic procedures, mini-implants are routinely used as temporary anchorage devices. Early failure is primarily attributed to a variety of issues, which are mostly connected to the quality and geometry of the screw that lead to insufficient primary stability.

Objectives

To evaluate the primary stability of different sizes and brands of orthodontic mini-implants by optimizing the insertion torque value (ITV) and to clear out which one has the greatest primary stability among the most widely used mini-implants by orthodontists.

Methods

Eighty-two self-drilling mini-implants from three different brands with different sizes were used (Optimus Ortho System (Osteonic made in Korea), Smart anchor (GNI made in Korea) (1.4 × 6, 1.6 × 8 and 1.8 × 10mm) and Morelli (made in Brazil) (1.5 × 6, 1.5 × 8 and 1.5 × 10mm), made from (Ti 6Al 4V). All were drilled at a 60° angle on Sixty artificial bone blocks made from polyurethane foam with a digital torque meter device (Orthonia, Jeil made in Korea), pullout strength (tensile force) was measured with a universal testing machine to find out the best brand and size in the mean of primary stability. Data were analyzed using SPSS Version 25 and JMP Pro Version 16 software using the One-way ANOVA test, the Post hoc and Tukey HCD tests.

Results

There were significant differences between the pullout strength of different sizes for the GNI and OSTEONIC brands, while for the MORELLI brand there were no significant differences between the three different sizes considering ITV (10Ncm) whereas for ITV (20Ncm) there was a significant difference between the different sizes for the pullout of all three brands. GNI was the best brand for all the selected sizes with ITV (10Ncm) and size 1.4 × 6 for ITV (20Ncm), whereas OSTEONIC sizes 1.6 × 8 and 1.8 × 10 were the best for ITV (20Ncm) in term of primary stability.

Conclusion

GNI screws were demonstrated higher primary among the three widely used brands followed by OSTEONIC for size 1.6 × 8 and 1.8 × 10 while MORELLI was the least resistant to dislodgement for the two torque insertion values 10 N/cm and 20 N/cm.

The Relationship Between Vertical Facial Type and Maxillary Anterior Alveolar Angle in Adults Using Cone-Beam Computed Tomography

Background

Cone-beam computed tomography (CBCT) imaging provides detailed and thorough information about the dentofacial complex. However, not all aspects have been yet explored among different types of malocclusion. The maxillary anterior alveolus is one of the components of the maxillary bone which affects the upper lip position and the esthetics of the smile. The inclination of this alveolus may vary between the different vertical growth patterns of patients who may seek orthodontic treatment. The objective of this study was to investigate possible differences in maxillary anterior alveolar angle (MAAA) among orthodontically untreated adults with different vertical facial types in a Syrian sample.

Methods

CBCT images of 84 orthodontically untreated adult patients were included. Three groups of vertical facial type (n=28 for each group; 14 males, 14 females) were created using disproportionate multi-stratified random sampling. CBCT-derived lateral cephalograms were used to categorize the patients into three groups. Measurements were made at three regions (region 1 (R1), region 2 (R2), and region 3 (R3)), located in the maxillary anterior alveolar bone using OnDemand3D™ software (Cypermed Inc., Seoul, South Korea).

Results

No significant differences in the mean MAAA were detected between females and males for the three measured regions in all groups. Analysis of variance showed significant inter-group differences in the MAAA (p<0.05) for all measured regions. The hyperdivergent facial type group had the greatest MAAA mean value of 68.72° (± 6.01), 67.30° (± 4.15), and 68.01° (± 5.12) at R1 in the female, male, and the entire sample of both sexes respectively. Whereas the hypodivergent facial type group had the least mean MAAA values of 58.47° (± 5.34) at R3, 59.83° (± 6.23) at R2, and 59.23° (± 5.75) at R3 in the female, male, and the entire sample of both sexes respectively.

Conclusions

The maxillary anterior alveolar bone was more buccally inclined in the hypodivergent facial type. The MAA bone inclination did not differ between females and males in the same vertical facial type group.

Buccal bone thickness of posterior mandible for microscrews implantation in molar distalization

BACKGROUND

This study explored the inter-radicular space and buccal bone thickness of the posterior mandibular region to provide an appropriate miniscrew insertion site for lower dentition distalization.

METHODS

The cone-beam computed tomographic (CBCT) records of 63 subjects were collected. Buccal bone thickness (BBT) was measured at four sections: (I) the root of the second premolar(P₁); (II) the mesial root of the first molar(P₂); (III) the distal root of the first molar(P₃); (IV) the mesial root of the second molar(P₄). The narrowest inter-radicular space of the four sections was also detected. Both BBT and inter-radicular space were measured at 4 height levels, 2, 4, 6 and 8mm from the alveolar ridge.

RESULTS

The largest BBT was observed at the mesial root of the second molar at 6 and 8mm, demonstrating a thickness of 6.77±2.50mm and 7.46±1.94mm, respectively. It provided sufficient coverage for mini-implants inserted 10°-30° oblique to the root. Therefore, during distalization of the mandibular dentition, roots have sufficient space to bypass the inclined mini-implants on the lingual side, avoiding miniscrew-root contact. The width between the mesiodistal roots of the first molar was the smallest, showing 1.53±0.69mm and 2.13±0.65mm at 4 and 6mm. Miniscrews implanted in this region had an increased risk of root proximity.

CONCLUSIONS

The most appropriate insertion site at the mandibular buccal shelf was the mesial point of the second molar at 6-8mm from the alveolar ridge, and an insertion angle of 10°-30° was recommended to avoid miniscrew-root contact. CBCT analysis is recommended before implantation due to individual differences.

Effect of placement angle, diameter, length and bone density on the pull-out strength of orthodontic mini-implants: An in vitro study

OBJECTIVE

To evaluate the effect of the placement angle, diameter, length and bone density on the mechanical stability of orthodontic mini-implants by measuring their pull-out strengths.

DESIGN

A total of 120 mini-implants of four different dimensions made from titanium were used. They measured 1.3 × 6.0mm, 1.3 × 8.0 mm, 1.5 × 6.0 mm and 1.5 × 8.0 mm. Synthetic polyurethane bone blocks (Saw Bones, USA) in two different densities were used.

SETTING

Each size of mini-implant was inserted equidistantly into synthetic bone blocks of two different densities, in three different insertion angles of 30°, 60° and 90°. This resulted in 24 test groups with five mini-implants allocated to each group.

METHODS

The pull-out strength was measured using an Instron Universal Testing Machine exerting a vertical force parallel to the long axis of the mini-implant until removal or failure occurred. Peak load at failure of the mini-implant was recorded in kN.

RESULTS

Showed that mini-implants placed at an insertion angle of 30° offered least resistance to pull-out. Mini-implants 6.0 mm in length showed less pull-out strength compared to the longer 8.0-mm mini-implants. Mini-implants 1.3 mm in diameter provided similar pull-out values as 1.5-mm mini-implants. Bone densities of 0.20 g/cc and 0.32 g/cc did not affect the pull-out strength of mini-implants.

CONCLUSION

From the study, it was concluded that a logical choice of mini-implant dimension and prudent use of placement technique can help achieve the treatment goals with a reduced hazard of mini-implant failure.

Effect of Microimplant Neck Design with and without Microthread on Pullout Strength and Destruction Volume

The microthread neck concept has been applied to dental implants. This study investigated the pullout strength and destruction volume of orthodontic microimplants with and without the microthread neck design. Fifteen microimplants (diameter: 1.5 × 10 mm) of three types (Types A and B: without microimplant neck; Type C: with microimplant neck) were tested. The insertion torque (IT), Periotest value (PTV), horizontal pullout strength (HPS), and horizontal destruction volume (HDV) of each type were measured. Kruskal–Wallis H test and Dunn’s post-hoc comparison test were performed to compare the measured values of the three types of microimplants. The correlations of the measured values were used to perform the Spearman’s correlation coefficient analysis. The ITs of Types B (8.8 Ncm) and C (8.9 Ncm) were significantly higher than those of Type A (5.2 Ncm). Type B yielded the lowest PTV (4.1), and no statistical differences in PTV were observed among the three types. Type A had a significantly lower HPS (158.8 Ncm) than Types B (226.9 Ncm) and C (212.8 Ncm). The three types did not exhibit any significant differences in the HDV. The results of the Spearman’s correlation coefficient test revealed that HDV (ρ = 0.710) and IT (ρ = 0.813) were strongly correlated with HPS, whereas for PTV and HPS, it was not. HPS was strongly and significantly correlated with HDV. The orthodontic microimplant with a microimplant neck design did not perform better than that without a microthread in the mechanical strength test.

The correlation among gripping volume, insertion torque, and pullout strength of micro-implant

Background/purpose

The fixation stability is the key factor for orthodontic micro-implant to succeed. This study evaluated the mechanical properties of three types of micro-implants by analyzing their structural configurations.

Materials and methods

Thirty micro-implants of three types (diameter 1.5 mm, Types A, B, C) were assessed. All micro-implants were manually driven into artificial bones at an 8-mm depth. The insertion torque (IT), pullout strength (PS), and gripping volume (GV) of each type were measured. The indexes of mechanical properties denoted as the PS/IT, GV/IT and PS/GV ratios. Intergroup comparisons and intragroup correlation were examined using statistical analysis.

Results

Type B had the greatest inner–outer diameter ratio (0.67), and Type A had the smallest (0.53). The IT of Type A (5.26 Ncm) was significantly (p = 0.038) lower than that of Type C (8.8 Ncm). There was no significant difference in the pullout strength. The GV of Type A (9.7 mm³) was significantly greater than Type C (8.4 mm³). Type C was significantly greater than Type B (7.2 mm³). The ratios of mechanical properties (PS/IT, PS/GV, and GV/IT) were found significant in intergroup comparison. The PS/GV ratio was in order: Type B (26.5) > Type A (23.0) > Type C (20.2). Spearman's rho rank correlation test showed that PS of Type B was correlated significantly with GV.

Conclusion

The design of thread and gripping volume were the important factors that contributes to the mechanical strengths of micro-implant.

Effects of size and insertion angle of orthodontic mini-implants on skeletal anchorage

INTRODUCTION

The primary aim of this in vitro study was to compare the insertion torque (IT) and anchorage force (AF) values of 4 different sizes of orthodontic mini-implants with 2 different angles. The second aim was to evaluate the relationship between IT and AF values under different diameter, length, and insertion angle variables.

METHODS

A total of 160 mini-implants, including 20 implants in each group, with 4 different sizes (1.6 × 8 mm, 1.6 × 10 mm, 2.0 × 8 mm, and 2.0 × 10 mm) at 2 different angles (70° and 90°), were inserted into bovine iliac bone segments. The IT and AF values leading to 1.5 mm deflection were compared. The correlations between IT and AF values under different variables were also analyzed.

RESULTS

The mini-implants with greater diameter and length showed greater IT and AF values (P <0.05). The IT and AF values of mini-implants inserted at 70° angle were significantly greater than those of mini-implants inserted at 90° angle (P <0.001). Significant correlations were found between IT and AF values in all variables.

CONCLUSIONS

The diameter, length, and insertion angle of orthodontic mini-implants have significant effects on IT and AF values. Insertion angle and diameter of mini-implants are more effective than implant length on skeletal anchorage. Significant correlations are present between IT and AF values of mini-implants regardless of their diameters, lengths, and insertion angles.

Effect of vertical placement angle on the insertion torque of mini-implants in human alveolar bone

Objective:

The aim of the present ex-vivo study was to evaluate the effect of the vertical placement angle of mini-implants on primary stability by analyzing maximum insertion torque (MIT).

Methods:

Mini-implants were placed in 30 human cadavers, inserted at either a 90° or 60° angle to the buccal surface of the maxillary first molar. Out of 60 self-drilling mini-implants used, half were of the cylindrical type and half were of the conical type. Primary stability was assessed by means of measuring the MIT. Data were subjected to analysis of variance (ANOVA) and Newman-Keuls tests. A significance level of 5% was adopted.

Results:

The MIT was higher for both mini-implant types when they were placed at a 90° angle (17.27 and 14.40 Ncm) compared with those placed at a 60° angle (14.13 and 11.40 Ncm).

Conclusions:

MIT values were differed according to the vertical mini-implant placement angle in the maxillary posterior area. Regardless of the type of mini-implant used, placement at a 90° angle resulted in a higher MIT.

Evaluation of mechanical strengths of three types of mini-implants in artificial bones

We investigates the effect of the anchor area on the mechanical strengths of infrazygomatic mini-implants. Thirty mini-implants were divided into three types based on the material and shape: Type A (titanium alloy, 2.0×12 mm), Type B (stainless steel, 2.0×12 mm), and Type C (titanium alloy, 2.0×11 mm).The mini-implants were inserted at 90° and 45° into the artificial bone to a depth of 7 mm, without predrilling. The mechanical strengths [insertion torque (IT), resonance frequency (RF), and removal torque (RT)] and the anchor area were measured. We hypothesized that no correlation exists among the mechanical forces of each brand. In the 90° tests, the IT, RF, and RT of Type C (8.5 N cm, 10.2 kHz, and 6.1 N cm, respectively) were significantly higher than those of Type A (5.0 N cm, 7.7 kHz, and 4.7 N cm, respectively). In the 45° test, the RFs of Type C (9.2 kHz) was significantly higher than those of Type A (7.0 kHz) and Type B (6.7 kHz). The anchor area of the mini-implants was in the order of Type C (706 mm²)>Type B (648 mm²)>Type A (621 mm²). Type C exhibited no significant correlation in intragroup comparisons, and the hypothesis was accepted. In the 90° and 45° tests, Type C exhibited the largest anchor area and the highest mechanical strengths (IT, RF, and RT) among the three types of mini-implants. The anchor area plays a crucial role in the mechanical strength of mini-implants.

A Comparison of the Mechanical Measures Used for Assessing Orthodontic Mini-Implant Stability

PURPOSE

Mechanical loosening remains a common complication associated with mini-implant failure. The purpose of this study was to compare common mechanical measures of mini-implant stability to determine their association and reliability.

MATERIALS AND METHODS

Ninety self-drilling orthodontic mini-implants from 6 manufacturers were inserted into artificial bone blocks. Insertion torques (ITs) and Periotest values (PVs) were measured. Subsequently, mini-implants underwent pull-out testing for measures of pull-out load (POL) and screw displacement (ScrD). Stability measurements were compared using one-way ANOVA, associations among them were assessed using correlation analyses, and reliability was evaluated using coefficients of variation (COVs).

RESULTS

Variations in stability of mini-implants were found, specific to the mechanical measure used for assessment (P < 0.05). The strongest correlations were found between IT and PV (r = -0.68) and between IT and POL (r = 0.66). Overall, PV showed the greatest variability (COV: 11%-100%) compared with IT (≤11%), POL (≤4%), and ScrD (≤19%).

CONCLUSIONS

IT, PV, and POLs only agreed moderately in their assessment of mini-implant stability, and Periotest showed the least reliability in predicting mini-implant stability. As such, independent and interchangeable use of these stability measures should be avoided.

Maxillary buccal cortical plate inclination at mini-screw insertion sites

OBJECTIVE

To evaluate whether buccal cortical bone inclination varies for the maxillary alveolar processes of adult patients with decreased, normal, and increased facial heights.

MATERIALS AND METHODS

Cone-beam computed tomography images of 135 adult patients, including 49 hypodivergent subjects (26 women, 23 men), 40 hyperdivergent subjects (24 women, 16 men), and 46 normodivergent (25 women, 21 men) were analyzed. Cortical bone inclination measurements were made relative to the occlusal plane. Cross-sectional slices of the maxilla were taken at interdental sites from the distal aspect of maxillary canine to the mesial aspect of maxillary second molar.

RESULTS

Analysis of variance indicated significant differences (P < .05) between the angles formed by the line tangent to the cortical bone and the occlusal plane among the vertical facial types for the regions between canine and first premolar and between second premolar and first molar at miniscrew insertion sites.

CONCLUSION

The results of this study indicate that vertical facial pattern should be taken into consideration when adjusting the insertion angle of miniscrews at the maxillary buccal region.