A prospective, split-mouth, clinical study of orthodontic titanium miniscrews with machined and acid-etched surfaces

The effect of surface roughening on the success of orthodontic mini-implants: A systematic review and meta-analysis

INTRODUCTION

Orthodontic mini-implants are a widely accepted treatment modality in orthodontics; however, the failure rate is moderately high. Surface roughening is the golden standard in conventional oral implantology, and this may prove beneficial for orthodontic mini-implants as well. The objective of this systematic review is to assess the effect of surface roughening on the success rate of orthodontic mini-implants in both adolescent and adult patients undergoing orthodontic treatment.

METHODS

Randomized studies comparing the success of surface-roughened and smooth, machined-surface orthodontic mini-implants were included. A literature search was conducted for 6 electronic databases (Pubmed/Medline, Embase, Cochrane, CINAHL, Web of Science, and Scopus), Clinical trial registry (https://www.

CLINICALTRIALS

gov), and grey literature (Google Scholar). A manual search of the reference lists of included studies was performed. Two authors independently performed the screening, data extraction, risk of bias, and quality assessments. The risk of bias was assessed with the Cochrane risk-of-bias 2.0 Tool. Data were synthesized using a random effect model meta-analysis presented as a forest plot. The certainty in the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation tool.

RESULTS

A total of 4226 unique records were screened, and 6 of these were included in the quantitative analysis. Four additional articles were selected for a secondary outcome. A total of 364 orthodontic mini-implants were included in the primary outcome analysis. There was no statistically significant effect of surface roughening on the success of orthodontic mini-implants (odds ratio = 0.63 favoring roughened orthodontic mini-implants; 95% confidence interval, 0.35-1.14). The secondary outcome (ie, the overall failure rate of roughened orthodontic mini-implants) was 6% based on studies with high heterogeneity. Limitations of this study were the risk of bias, study imprecision, and possible publication bias, leading to a very low certainty in the body of evidence.

CONCLUSIONS

There is very low-quality evidence that there is no statistically significant effect of surface roughening on the success of orthodontic mini-implants in humans. The overall failure rate of surface-roughened orthodontic mini-implants was 6%.

FUNDING

No funding was received for this review.

REGISTRATION

This study was preregistered in the Prospective Register of Systematic Reviews (CRD42022371830).

Functionality testing of an innovative biomechanically optimized and surface-modified orthodontic mini-screw-a comparative study

PURPOSE

The failure rate of orthodontic mini-screws depends strongly on primary stability and, thus, on insertion torque. Further improvement regarding the failure rate might be achieved by modifying the surface coating. Therefore, the aim of the study was to investigate the stability of a newly designed and surface-modified orthodontic mini-screw in beagle dogs.

METHODS

Newly designed mini-screws coated either with DOTIZE® or DOTIZE®-copper (DOT GmbH, Rostock, Germany; each: n = 24) were inserted in the mandibles of eight beagle dogs for a duration of 8 months. Insertion and removal torque were measured. These data were compared to values generated by using the artificial bone material Sawbones® (Sawbones Europe AB, Malmö, Sweden). Experiments with and without torque limitation (each: n = 5) were run. The bone-to-implant contact rate and the amount of bone between the threads were examined. Statistical significance was set at P < 0.05.

RESULTS

The success rates of the in vivo study reached high levels with 95.3% for the DOTIZE-coated and 90.5% for the DOTIZE-copper-coated screws, whereas the insertion and removal torque did not differ between the coatings. During insertion, a torque limitation of 20 Ncm was necessary to ensure that the recommended limit was not exceeded. The insertion in Sawbones without torque limitation revealed a significantly higher torque compared to torque-limited insertion (18.2 ± 1.3 Ncm, 23.6 ± 1.3 Ncm). Bending occurred (n = 5) in the thread-free part of the mini-screw.

CONCLUSIONS

Surface coating might be able to improve the performance of orthodontic mini-screws. The study showed high success rates and stable mini-screws until the end of observation. Further investigations are necessary.

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

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.

How Does Orthodontic Mini-Implant Thread Minidesign Influence the Stability?—Systematic Review with Meta-Analysis

Background: Clinical guidelines are lacking for the use of orthodontic mini-implants (OMIs) in terms of scientific evidence referring to the choice of proper mini-design. Thus, the present study aimed to investigate to what extent orthodontic mini-implant thread design influences its stability. Methods: Search was conducted in five search engines on 10 May. Quality assessment was performed using study type specific scales. Whenever possible, meta-analysis was performed. Results: The search strategy identified 118 potential articles. Twenty papers were subjected to qualitative analysis and data from 8 papers—to meta-analysis. Studies included were characterized by high or medium quality. Four studies were considered as low quality. No clinical studies considering the number of threads, threads depth, or TSF have been found in the literature. Conclusions: Minidesign of OMIs seems to influence their stability in the bone. Thread pitch seems to be of special importance for OMIs retention—the more dense thread—the better stability. Thread depth seems to be of low importance for OMIs stability. There is no clear scientific evidence for optimal thread shape factor. Studies present in the literature vary greatly in study design and results reporting. Research received no external funding. Study protocol number in PROSPERO database: CRD42022340970.

A Scoping Review about the Characteristics and Success-Failure Rates of Temporary Anchorage Devices in Orthodontics

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.

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

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.

The effect of sandblasting and acid etching on survival rate of orthodontic miniscrews: a split-mouth randomized controlled trial

Background

The aim of this study was to investigate the effect of surface roughening and acid etching on clinical success rate and removal and insertion torque of orthodontic miniscrews.

Materials and methods

Sixty-two orthodontic miniscrews (Jail Medical Corporation, Seoul, Korea) with the same design and dimensions (10-mm length, 2-mm diameter) are divided into two (sandblasted and acid-etched versus control) groups. The sample of the study was 31 patients whose miniscrews were needed for en masse retraction of the upper six anterior teeth. In this split-mouth study, the miniscrews were placed in the attached gingiva between the second premolar and the first molar. The side (left or right) was selected randomly. The miniscrews were loaded 6 weeks after insertion, and the patients were followed up after 3, 6, 10, 14, and 18 weeks and then for 4 weeks interval. Chi-square, correlation, and independent t tests were done using SPSS ver24 to interpret the data.

Results

The survival rate was 90.3% and 83.9% for the sandblasted and acid-etched versus the control group, respectively. The difference in survival rate was not statistically significant (p > 0.05). Removal torque was higher for the sandblasted group (p < 0.05). Younger patients showed less survival rate (p < 0.05) in both groups. Insertion side, namely, left or right, was not statistically significant.

Conclusions

Although sandblasting increased removal torque, it did not influence the survival rate of orthodontic miniscrews significantly.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40510-020-00347-z.

Characteristics and Dynamics of Full Arch Distalization Using Transpalatal Arches with Midpalatal and Interradicular Miniscrews as Temporary Anchorage Devices: A Preliminary Finite Element Analysis

INTRODUCTION

Miniscrews have proved quite effective in fixed orthodontic treatment. They can be placed in areas like palatal interradicular zones or midpalatal suture. Despite the value of these methods and their ever-increasing use, their characteristics are not assessed before when implanted in palatal interradicular areas or in the midpalatal suture. We aimed to assess, for the first time, the dynamics of full arch distalization using such miniscrews.

METHODS

A 3D model of maxilla with all permanent dentition was created from a CT scan volume. Tissues were segmented and differentiated. Afterward, miniscrews and appliances were designed, and the whole model was registered within a finite element analysis software by assigning proper mechanical properties to tissues and orthodontic appliances. The full arches were distalized using transpalatal arches with miniscrews as anchorage devices (in two different models). The extents of stresses and patterns of movements of various elements (teeth, miniscrews, appliances, tissues) were estimated. Results and Conclusions. Comparing the two models, it is obvious that in both models, the stress distribution is the highest in the TPA arms and the head of the miniscrew where the spring is connected. In comparison with the displacement in the X-axis, the "mesial in" rotation is seen in the first molar of both models. But there is one exception and that is the "mesial out" rotation of the right second molar. In all measurements, the amount of movement in Model 2 (with palatal interradicular miniscrews) is more than that in Model 1 (with midpalatal miniscrew). In the Y-axis, more tipping is seen in Model 2, especially the anterior teeth (detorque) and the first molar, but in Model 1, bodily movement of the first molar is more evident. Along the Z-axis, the mesial intrusion of the first molar and the distal extrusion of this tooth can be seen in both models. Again, the displacement values are higher in the second model (with interradicular miniscrews). In comparison with micromotion and stress distribution of miniscrews, in Model 1, maximum stress and micromotion is observed at the head of the miniscrew where it is attached to the spring. Of course, this amount of micromotion increases over time. The same is true for Model 2, but with a lower micromotion. As for the amount of stress, the stress distribution in both miniscrews of both models is almost uniform and rather severe.

Maximum insertion torque loss after miniscrew placement in orthodontic patients: A randomized controlled trial

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.

Evaluation of success rate and biomechanical stability of ultraviolet-photofunctionalized miniscrews with short lengths

INTRODUCTION

The aim of this research was to verify that ultraviolet light (UV)-photofunctionalization improves the success rate and biomechanical stability of miniscrews regardless of length, and to evaluate the comparability of biomechanical stability between UV-photofunctionalized miniscrews with short lengths and untreated miniscrews with conventional lengths.

METHODS

Eight male beagles (age, 12-15 months; weight, 10-13 kg) received a total of 64 miniscrews, including 7-mm and 4-mm untreated and UV-photofunctionalized, acid-etched miniscrews with the use of a random block design. The cumulative success rates were examined in all studied groups. The insertion and removal torques and screw mobility were measured. Microcomputed tomographic scans and histomorphometric analyses were performed at 8 weeks postoperatively.

RESULTS

The success rates of 7-mm UV-untreated and UV-photofunctionalized miniscrews were 87.5% and 100%, respectively, vs 43.8% for the 4-mm UV-untreated and 4-mm UV-photofunctionalized miniscrews. The rates were significantly different in accordance with the length (P <0.001). There were no differences in the insertion and removal torque and screw mobility between groups according to the length or UV treatment. However, the 4-mm UV-untreated miniscrews yielded a mean bone area ratio of 6.35 ± 7.43%, whereas the 7-mm UV-photofunctionalized miniscrew yielded a mean ratio of 32.17 ± 8.34% (P = 0.037).

CONCLUSIONS

The UV-photofunctionalization significantly increased the biomechanical stability and led to increased bone and miniscrew contact area in dogs with miniscrews of the same length. However, the most important factor that affected the success rate of the miniscrew was the length.