Cementum and dentin repair following root damage caused by the insertion of self-tapping and self-drilling miniscrews

Evaluation of root repair using an environmental scanning electron microscope after intentional contact with microscrew

Objective:

The purpose of this study was to evaluate the amount of root repair that took place at varying intervals of 1 day, 2 weeks, 4 weeks and 8 weeks after intentional contact with microscrews. The results were evaluated by an environmental scanning electron microscope study (E-SEM).

Material and Methods:

Ten orthodontic patients with 2 maxillary and 2 mandibular first premolars (40 premolars) to be extracted as part of the orthodontic treatment were included in this study (age 18–25 years). The position of the roots of the 4 premolars to be extracted was clinically determined and under local anesthesia, microscrew implants were placed in such a way that they directly hit the root from the buccal aspect. Implants were removed immediately after the above-mentioned procedure was performed. On the same day, premolar of the 1st quadrant (Group I) was extracted. Premolar of the 2nd quadrant (Group II) was extracted 2 weeks later. Premolar of the 3rd quadrant (Group III) was extracted 4 weeks later and premolar of the 4th quadrant (Group IV) was extracted 8 weeks later, from the day of intentional damage.

Results:

Significant changes were observed in the deposition of cementum over 8 weeks which were analyzed using ESEM under magnifications of × 50, × 200, × 500, and × 5000.

Conclusion:

The damaged root surfaces due to intentional contact with microscrews showed swift repair and healing within 8 weeks. In case, the root is damaged due to improper placement technique or wrong biomechanics which may result in the implant touching the root surface, a minimum healing period of 8–10 weeks is advocated before commencing further tooth movement.

Tooth Complications after Orthodontic Miniscrews Insertion

Orthodontic miniscrews (OM) are widely used in modern orthodontic clinical practice to improve skeletal anchorage and have a high safety profile. A complication at the time of OM insertion is tooth root perforation or periodontal ligament trauma. Rarely, OM injury can cause permanent damage, such as ankylosis, osteosclerosis, and loss of tooth vitality. The aim of this work was to analyze potential risks and dental complications associated with the use of OMs. A search of the PubMed, Cochrane, Web of Science, and Scopus databases was conducted without a time limit using the keywords "orthodontic mini-screw" and "dental damage", resulting in 99 studies. After screening and eligibility, including articles obtained through a citation search, 13 articles were selected. Four studies revealed accidental injuries caused by OM. Most of the damage was localized at the root level and resolved spontaneously with restorative cement formation after prompt removal of the OM, while the pain disappeared. In some cases, irreversible nerve damage, extensive lesions to the dentin-pulp complex, and refractory periapical periodontitis occurred, requiring endodontic and/or surgical treatment. The choice of insertion site was the most important element to be evaluated during the application of OMs.