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Xin Y, Wu Y, Chen C, Wang C, Zhao L. Miniscrews for orthodontic anchorage: analysis of risk factors correlated with the progressive susceptibility to failure. Am J Orthod Dentofacial Orthop 2022; 162:e192-e202. [PMID: 35987884 DOI: 10.1016/j.ajodo.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Yilin Xin
- State Key Laboratory of Oral Diseases, and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yeke Wu
- Department of Stomatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chenjou Chen
- State Key Laboratory of Oral Diseases, and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chen Wang
- State Key Laboratory of Oral Diseases, and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lixing Zhao
- State Key Laboratory of Oral Diseases, and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Quantitative Assessment of Posterior Maxillary Arch for Orthodontic Miniscrew Insertion Using Cone Beam Computed Tomography: A Cross-Sectional Analysis. Int J Dent 2022; 2022:8257256. [PMID: 35662891 PMCID: PMC9162861 DOI: 10.1155/2022/8257256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Methods and Materials Cone beam computed tomography records of 35 patients (70 quadrants) from maxilla were evaluated. The images were analyzed using the NNT viewer software (version 23). The measurements were made on axial sections at 2, 4, 6, and 8 mm from CEJ. The optimal sites were defined in terms of mesiodistal palatal or buccal interradicular distance, alveolar cortical bone thickness, and palatal or buccal safe depth of the bone for miniscrew insertion. Descriptive statistics, paired t-test, and repeated measure ANOVA were used to analyze the data. Results The mean buccal interradicular distance was the lowest between first and second molar (2.44 mm) and the highest between first and second premolar (3.28 mm). The mean palatal interradicular distance was the lowest between first and second premolar (3.64 mm) and the highest between second premolar and first molar (5.30 mm). The mean buccal safe depth was the lowest between canine and first premolar (1.96 mm) and the highest between first and second molar (2.61 mm). The mean palatal safe depth was the lowest between second premolar and first molar (3.35 mm) and the highest between first and second molar (3.56 mm). The thinnest and thickest buccal cortical thicknesses were detected on canine and first molar (1.04 mm) and on the second premolar and second molar (1.56 mm). Conclusion The quantity and quality of the maxillary alveolar process is an important factor to decide where to insert the orthodontic miniscrews, necessitating careful preoperative evaluation.
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Jaramillo-Bedoya D, Villegas-Giraldo G, Agudelo-Suárez AA, Ramírez-Ossa DM. A Scoping Review about the Characteristics and Success-Failure Rates of Temporary Anchorage Devices in Orthodontics. Dent J (Basel) 2022; 10:78. [PMID: 35621531 PMCID: PMC9139455 DOI: 10.3390/dj10050078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 02/05/2023] Open
Abstract
This study synthesized the scientific evidence concerning the main characteristics of the Temporary Anchorage Devices (TADs) used in orthodontics and reported the success-failure rates during treatment. For that means, this scoping review collected articles from previous research. A complementary search was carried out in the databases PubMed-MEDLINE, Scopus, LILACS, and EMBASE, focusing on original studies published from 2010 to 2020. We analyzed the main characteristics of the publications. As a result, 103 articles were included. Most of the research was conducted among different groups, who needed TADs principally in the maxilla and an interradicular location between the second premolar and first molar. AbsoAnchor, Dentos Inc., Daegu, Korea, was the most used brand of TADs. The most common characteristics of the devices and biomechanics were a diameter and length of 1.6 mm and 8 mm, a self-drilled system, a closed technique for placement, immediate loading, and forces that ranged between 40 and 800 g. Of the studies, 47.6% showed success rates ≥90%. In conclusion, high success rates were found for TADs, and differences were found according to sociodemographic and clinical variables. The studies showed variability in methodological design, and scientific publications were concentrated in certain countries. We recommend further scientific research on TADs using more standardized designs.
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Effect of a digital guide on the positional accuracy of intermaxillary fixation screw implantation in orthognathic surgery. J Plast Reconstr Aesthet Surg 2022; 75:e15-e22. [PMID: 35367159 DOI: 10.1016/j.bjps.2022.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/27/2022] [Accepted: 02/17/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intermaxillary fixation screw (IMFS) implantation is a common procedure in orthognathic surgery (OGS) performed to the temporary maxillary-mandibular fixation and stable bite relationships. The study aims to assess the accuracy of IMFS implantation with a digital guide to reduce the occurrence of root damage. METHODS This prospective study involved 40 patients undergoing OGS at the Affiliated Hospital of Qingdao University from August 2017 to May 2021. The patients were randomly divided into two groups according to whether the IMFS implantation was with or without digital guide (20 patients in the experimental group and 20 controls). The digital guides used in the experimental group were designed according to a virtual implantation plan and printed using stereolithography. In the control group, IMFSs were directly implanted by a surgeon based on clinical experience. Postoperatively, cone-beam computed tomography was performed to compare root proximity of IMFSs between the two groups and verify the accuracy of IMFS placement. RESULTS In the experimental group, there was no case of root damage, the incidence of the periodontal ligament (PDL) injured was 22.1%, and 77.9% IMFSs were placed without contacting adjacent anatomic structures. In the control group, the incidence of root damage had been up to 20.8%, 31.7% IMFSs injured the PDL, and only 47.5% IMFSs were placed between the roots (P < 0.001). CONCLUSION IMFSs can be placed more accurately with surgical guides, reducing the incidence of root and PDL damages.
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Manni A, Drago S, Migliorati M. Success rate of surface-treated and non-treated orthodontic miniscrews as anchorage reinforcement in the lower arch for the Herbst appliance: A single-centre, randomised split-mouth clinical trial. Eur J Orthod 2022; 44:452-457. [PMID: 35028669 DOI: 10.1093/ejo/cjab081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Surface treatment of miniscrews was implemented to determine whether its application increased bone-to-surface contact and enhanced the interlock between the device and the surrounding bone. OBJECTIVES To compare the success rate of surface-treated and non-treated orthodontic miniscrews used as reinforcement of anchorage during treatment with the Herbst appliance. TRIAL DESIGN Split-mouth design with an allocation ratio of 1:1. METHODS Eligibility criteria to enrol patients were skeletal and dental class II patients with a retrusive chin, use of the Herbst appliance to correct malocclusion, need for skeletal anchorage using a miniscrew both in the left and right side of the mouth, absence of systemic diseases, absence of using drugs that alter bone metabolism, and good oral hygiene. Patients received self-drilling miniscrews without surface treatment and with surface treatment. Both types presented a 1.4 or 1.2 mm diameter. Miniscrews were inserted between the first molar and second premolars or between the two premolars. The force applied to the screws was an elastic chain from the head of the miniscrews to a direct button applied on the canines. The success rate of each type of miniscrew was considered the primary outcome, and the association of success with demographical, clinical, and geometrical characteristics was investigated. Differences were tested by the generalised linear mixed effects model for the split-mouth design. Differences with a P-value < 0.05 were selected as significant. RANDOMISATION A randomisation list was created for the mouth side assignment. BLINDING The study was single blinded with regard to the statistical analysis. RESULTS Thirty-nine miniscrews of the non-treated type and 39 miniscrews of the surface-treated type were inserted in 39 patients (23 female and 16 male, mean age: 15.55 ± 7.91) recruited between March 2018 and December 2020 with a split-mouth study design. The mean therapy duration was 9.3 months (SD = 1.31). No differences in failure rate were observed between miniscrew types. No serious harm was observed. CONCLUSIONS The success rate of surface-treated and non-treated miniscrews showed no significant differences. REGISTRATION This trial was not registered.
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Affiliation(s)
| | - Sara Drago
- Orthodontics Department, School of Dentistry, Univesity of Genova , Genova, Italy
| | - Marco Migliorati
- Orthodontics Department, School of Dentistry, Univesity of Genova , Genova, Italy
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Guided Insertion of Temporary Anchorage Device in Form of Orthodontic Titanium Miniscrews with Customized 3D Templates—A Systematic Review with Meta-Analysis of Clinical Studies. COATINGS 2021. [DOI: 10.3390/coatings11121488] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
(1) Background: Miniscrew insertion, using a surgical guide, aims to avoid possible adverse effects or complications. With the higher availability of both 3D imaging and printing, 3D surgical guides have been used more frequently in orthodontics. The aim of the present systematic review was to find scientific clinical evidence concerning the precision of the 3D guided insertion of miniscrews for temporary orthodontic anchorage. (2) Methods: Literature searches were performed in the following five search engines: Pubmed (Medline), Pubmed Central, Scopus, Web of Science and Embase on 10 September 2021 (articles from 1950 to 10 September 2021). A meta-analysis was performed using the random-effect model, with Standardized Mean Differences (SMD) and 95% confidence intervals (95% CI) calculated as effect estimates. The heterogeneity was assessed quantitatively. (3) Results: The search strategy identified 671 potential articles. After the removal of duplicates, 530 articles were analyzed. Subsequently, 487 papers were excluded, because they were not associated with the subject of the study. Of the remaining 43 papers, 34 were excluded because they did not meet the methodological criteria. Finally, only nine papers were subjected to a qualitative analysis. (4) Conclusions: The current literature concerning guided miniscrew insertion reveals, for the most part, a low methodological level. High-quality clinical trials are in the minority. The use of surgical guides increases insertion accuracy, stability and reduces the failure rate of orthodontic miniscrews. Tooth-borne insertion guides supported on the edges of the teeth ensure a higher insertion precision compared to mucosa-borne ones. The study protocol was registered in PROSPERO under the number CRD42021267248.
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Palone M, Darsiè A, Maino GB, Siciliani G, Spedicato GA, Lombardo L. Analysis of biological and structural factors implicated in the clinical success of orthodontic miniscrews at posterior maxillary interradicular sites. Clin Oral Investig 2021; 26:3523-3532. [PMID: 34837567 DOI: 10.1007/s00784-021-04321-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aims to evaluate success factors implicated in clinical orthodontic miniscrew stability after their interradicular placement in maxilla. MATERIALS AND METHODS Six hundred seventy-six miniscrews were inserted in maxillary interradicular sites in a sample of 276 patients (109 males and 167 females; mean age 19 ± 1.7 years) and immediately loaded. Percentage failure rate was recorded, and the influence of the following factors was investigated: structural (miniscrew length, diameter and body shape), operative (side of insertion site, pilot hole drilling or not) and biological (maximal insertion torque [MIT] and type of gingiva). A chi-square test with Monte Carlo correction was performed to detect the influence of these variables on the failure rate of orthodontic miniscrews. Then both multivariate logistic regression and post hoc analysis were performed, followed by classification and regression tree (CART) analysis. RESULTS The average success rate was 88%. The principal factors implicated in the failure rate were miniscrew length, MIT values and type of gingiva. Specifically, 8 mm miniscrew length, alveolar mucosa and 5-10 Ncm MIT values were linked to higher failure rates. According to CART, the main variable influencing failure is miniscrew length (≤ 8 mm for higher failure rates). For others, MIT values of 5-10 Ncm are linked to higher failure rates (p < 0.05). CONCLUSION Orthodontic miniscrews inserted in the maxilla display good success rates. However, clinicians should be discouraged from using miniscrews of length ≤ 8 mm and MIT values < 10 Ncm, even with longer miniscrews. CLINICAL RELEVANCE Information about factors related to failure rate of miniscrews placed at posterior maxillary interradicular sites is given.
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Affiliation(s)
- M Palone
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
| | - A Darsiè
- Private Practice, Treviso, Italy
| | - G B Maino
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - G Siciliani
- School of Dentistry, University of Ferrara, Via Luigi Borsari 46, 44121, FerraraFerrara, Italy
| | - G A Spedicato
- Faculty of Banking and Finance, Catholic University of Milan, Largo Agostino Gemelli, 1, 20123, Milano, Italy
| | - L Lombardo
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
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Migliorati M, Drago S, Amorfini L, Nucera R, Silvestrini-Biavati A. Maximum insertion torque loss after miniscrew placement in orthodontic patients: A randomized controlled trial. Orthod Craniofac Res 2020; 24:386-395. [PMID: 33274528 DOI: 10.1111/ocr.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare torque recordings of immediately loaded orthodontic miniscrews between insertion time and different post-placement timepoints (2 weeks, 4 weeks and removal time, respectively). SETTING AND SAMPLE POPULATION Parallel trial with an allocation ratio of 1:1. Eligibility criteria were needs of fixed orthodontic treatment, no systemic disease and absence of using drugs altering bone metabolism. MATERIAL AND METHODS Patients received miniscrews, 2.0 mm diameter and 10 mm length. All miniscrews underwent inter-radicular placement, and they were placed in the maxilla or in the mandible, palatally or buccally. No pre-drilling was performed. Miniscrews were loaded immediately after the insertion and were used for distalization, intrusion, extrusion, mesialization or indirect anchorage. Patients were randomly divided into three groups. For each patient, Maximum Insertion Torque (MIT) was evaluated at baseline. MIT was measured again after 2 weeks and after 4 weeks by tightening the screw a quarter of turn in Groups 1 and 2, respectively. At the end of the treatment, maximal removal torque was evaluated in Group 3. Torque variation with respect to insertion time was considered as the primary outcome. Baseline and longitudinal differences were tested using the linear mixed-effects (LME) model. RESULTS Forty seven patients and 74 miniscrews were followed up. An association existed between maximum insertion torque and the observation time. A torque decrease of 26.9% and 30% after 2 weeks was observed for mandibular and maxillary miniscrews, respectively. After 1 month, torque values were similar to the baseline records. The overall success rate was 79.7%. No serious harm was observed. CONCLUSIONS Maximum insertion torque undergoes a loss during the first 2 weeks, and its values may depend on the insertion site and the anchorage purpose. Removal torque value is almost the same as the initial torque after 1 month.
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Affiliation(s)
- Marco Migliorati
- Orthodontics Department, School of Dentistry, University of Genova, Genova, Italy
| | - Sara Drago
- Orthodontics Department, School of Dentistry, University of Genova, Genova, Italy
| | | | - Riccardo Nucera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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