Mini Implants Research Articles

Immediate loading of ø 2,4 mm narrow-diameter implants in the edentulous maxilla and mandible

A 61-year-old healthy patient was referred for prosthetic rehabilitation in the maxilla and mandible. The primary wish of the very anxious patient was to improve the masticatory function and his aesthetic appearance with the least invasiveness and as efficiently as possible. Furthermore, he desired to receive a reliable long-term solution. The patient had no general medical restrictions and was a non-smoker. At the time of the first clinical examination, the patient presented nearly edentulous, with a few root remnants in the mandible and remaining wisdom teeth in the maxilla. The main objective of the treatment, hence, was to improve both his chewing function and the stability of the prostheses without invasive surgeries. After the removal of the root remnants and one of the two wisdom teeth (18), two new complete dentures were fabricated. Thereafter, 6 diameter reduced mini implants (SLA® one-piece self-tapping Straumann® Mini Implants made of Roxolid®, with a diameter of 2.4 mm and a length of 10 mm) were inserted in the maxilla, and 4 mini implants (SLA® one-piece self-tapping Straumann® Mini Implants made of Roxolid®, with a diameter of 2.4 mm and a length of 10 mm) were inserted in the mandible. After the implant insertion with good primary stability, the two new complete dentures were transferred into two implant-supported removable dental prostheses and retained by means of the transmucosal integrated attachment system of the mini implants (Optiloc®). At the 3-month follow-up visit, the patient was very satisfied with the outcomes, both from a functional and aesthetic point of view.

Evaluation of Thickness of Attached Gingiva at Common Mini Implant Insertion Sites

Evaluation of Thickness of Attached Gingiva at Common Mini Implant Insertion Sites

Managing Unexpected Iatrogenic Opening of Anterior Bite During Active Orthodontic Treatment: A Case Report

Introduction: Orthodontic treatment even though managed and properly controlled , on some remote occasion may lead to presence of unwanted movement. Anterior open bite is one such example of an iatrogenic outcome. This article describes the management of an iatrogenic anterior open bite case that occurred in active orthodontic treatment in the early stage of leveling and aligning. A few modalities had been employed to manage the open bite through some artistic bends followed by the use of modified low transpalatal arch with extended looped arms with loops as well as orthodontic mini implants for distalisation and some intrusion mechanics. This case report is aimed to share authors’ anecdotal experience on overcoming the open bite.

Marginal Bone Level Changes and Oral Health Impact Profile (14) Score of Smokers Treated by Mandibular Mini Implant Overdentures: A 5-Year Follow-up Study.

Objectives Studies considered edentulous patients having smoking habit as a compromised oral condition. This research examined the value of using mini implant mandibular overdenture to maintain long-term satisfactory levels of oral health quality of life and marginal vertical bone loss. Materials and Methods Twenty-nine edentulous patients with smoking habit received four mini implants in the mandible loaded by overdentures. The present study monitored patients radiographically for vertical bone loss after (1 month, 1, 3, and 5 years) of treatment. Patients were also evaluated by oral health impact profile 14 (OHIP-14) pretreatment and at 1 and 5 years of treatment. Statistical Analysis Repeated measure analysis of variance with Bonferroni’s test as a post-hoc test was used to see the difference among time points. Independent sample t -tests were used to compare between anterior and posterior mini implant positions after 5 years of follow-up. OHIP-14 questionnaire was analyzed by Wilcoxon signed ranks for pairwise comparisons at different evaluation times. A Holm-Bonferroni correction method was used to control the familywise error rate. Results The mean of the bone height changes showed a significant difference between 1-month data and all other evaluation intervals while no significance was calculated among other evaluation intervals. Bone loss of the mini implants placed anteriorly was less than those placed posteriorly with a statistically significant difference. A significant reduction in the OHIP-14 score levels was observed between pretreatment and both 1 and 5 years of treatment. No significance was seen between the first and fifth year after treatment. Conclusion Mini implant overdenture could maintain satisfactory marginal bone level changes and oral health quality of life for patients with smoking habit after 5-year follow-up period.

Influence of nano-hydroxyapatite coating implants on gene expression of osteogenic markers and micro-CT parameters. An in vivo study in diabetic rats.

This study evaluated the response of a nano-hydroxyapatite coating implant through gene expression analysis (runt-related transcription factor 2 (Runx2), alkaline phosphatase (Alp), osteopontin (Opn), osteocalcin (Oc), receptor activator of nuclear factor-kappa B (Rank), receptor activator of nuclear factor-kappa B ligand (Rank-L), and osteoprotegerin (Opg)). Three-dimensional evaluation (percent bone volume (BV/TV); percent intersection surface (BIC); bone surface/volume ratio (BS/BV); and total porosity (To.Po)) were also analyzed. Mini implants were surgically placed in tibias of both healthy and diabetic rats. The animals were euthanized at 7 and 30 days. Evaluating all factors the relative expression of Rank showed that NANO surface presented the best results at 7 days (diabetic rats). Furthermore the levels of Runx2, Alp, Oc, and Opn suggest an increase in osteoblasts proliferation, especially in early stages of osseointegration. %BIC in healthy and diabetic (7 days) depicted statistically significant differences for NANO group. BV/TV, BS/BV and To.Po demonstrated higher values for NANO group in all evaluated time point and irrespective of systemic condition, but BS/BV 30 days (healthy rat) and 7 and 30 days (diabetic rat). Microtomographic and gene expression analyses have shown the benefits of nano-hydroxyapatite coated implants in promoting new bone formation in diabetic rats.

Rationale for Mini Dental Implant Treatment.

Mini dental implants can be used to support crowns and partial and complete dentures in compromised edentulous sites. Lack of bone width or site length may be treated with mini implants. Mini implants have less percutaneous exposure and displacement that may reduce complications. Nonetheless, mini implants transmit about twice the load to the supporting bone, and thus, control of occlusal loading is important. In fixed prosthetics, rounded flat cusps, splinting, implant protective occlusal schemes, and placement only in dense bone sites are features of successful mini implant treatment. With removable prosthetics, multiple mini implants may be needed for appropriate retention and load resistance. Maxillary lateral incisor and mandibular incisor sites may be best suited for mini implant treatment. However, past research on dental implants has been directed at standard sized implants. While mini implants are indeed dental implants, they behave somewhat differently under functional load, and the clinician should be circumspect and very judicious in their use. This article is a mini review and not a systematic review. The topics covered are not pervasive because each would require a monograph or textbook for a complete discussion.

Comparative Evaluation of Cortical Bone Anatomy of Mandibular Buccal Shelf for Mini Implant Placement in Different Facial Divergence: A Cone Beam Computed Tomography Study

Aim: The purpose of this study was to use measurements from cone beam computed tomography scans to quantify the cortical bone thickness of mandibular buccal shelf region and preferable site for buccal shelf implant placement in 10 hyperdivergent and 10 hypodivergent patients. Method: 20 cone beam computed tomographies were equally divided based on divergence. 6 sites were examined: mesial of first molar (6M), middle of first molar (6Mi), interdental between the first and second molar (Id), mesial of second molar (7M), middle of second molar (7Mi), and distal of second molar (7D). The study quantified the mandibular buccal shelf relative to its angle of slope, the cortical bone thickness measured perpendicular to the bone surface, the amount of cortical bone 30° angle to the bone surface. The cortical bone thickness was measured perpendicular and at a 30° angle at 3, 5, and 7 mm from the alveolar crest. Result: Significant change is seen at the buccal shelf slope at 6M ( P = .001) and further increase in this angle till 7D ( P = .003). Mean amount of cortical bone for hyperdivergent group at 7D is 4.77 ± 0.68 mm and for hypodivergent group is 3.86 ± 0.70 mm. Statistically significant differences were noted at insertion site at 90° and 30° for both groups at 3, 5, and 7 mm from the alveolar crest. Conclusion: Preferable site for buccal shelf implant placement is distal to the mandibular second molar. The maximum amount of cortical bone is found distal to the second molar 7 mm vertically from alveolar crest when the buccal shelf implant is placed at 30° angulation for hyperdivergent group.

Meta-analysis dataset comparing orthodontic mini-implants and conventional anchorage reinforcement for maximum orthodontic anchorage.

The present article describes data from systematic review and meta-analysis investigating the efficacy and safety outcomes comparing mini-implants (MIs) and conventional anchorage reinforcement in patients with maximum dentoalveolar protrusion. All relevant RCTs and non-RCTs published up to 2018 were collected from PubMed, Embase and Cochrane database. Thirteen studies assessing the effect of mini-implants were included, of which 4 were randomized controlled trials (RCTs) and 9 observational studies. The efficacy parameters include mesiodistal movements of molars and incisors and vertical movements of molars and incisors. Whereas, the safety parameters were angular and linear measurement of soft tissue change. Subgroup analysis data was provided in terms of patients average age (<18 years and ≥18 years) at the initiation of treatment. This dataset is suitable for research purpose in the field of orthodontics and also helps dental doctors to determine their treatment preferences in the choice of anchorage reinforcement.

Immediate versus delayed loading of strategic mini-implants under existing removable partial dentures: patient satisfaction in a multi-center randomized clinical trial.

The purpose of this study was to evaluate and compare the effects of the immediate and delayed loading of strategic mini-implants (MIs) on the satisfaction of patients with removable partial dentures (RPDs). In this multi-center randomized clinical trial, strategic MIs were inserted under 79 RPDs in 76 participants. Two questionnaires, one for the upper jaw and one for the lower jaw, were given before surgical intervention and 2 weeks, 4 months, 4.5 months, 1 year, 2 years, and 3 years after implant insertion. To estimate the loading effect (immediate vs. delayed) in terms of the odds ratio, an ordinal logistic regression model was used. The Wilcoxon matched-pairs signed-rank test, which was corrected for clusters in the patient population, was used to evaluate changes in patient satisfaction. After 4 months, a statistically significant difference in favor of the immediate loading group was recognized in terms of the overall satisfaction score. The patient satisfaction scores recorded after 4.5 months and 1, 2, and 3 years showed substantial improvements compared with the scores recorded before implant insertion in both groups. At the item level, substantial improvements were noted in the following domains: general satisfaction, RPD retention, stability, support, eating, speaking, and aesthetics. Strategic MIs improved the satisfaction of patients with RPDs during the medium-term follow-up period. An earlier improvement in the satisfaction of patients with RPDs was seen after immediate loading of the MIs as compared with delayed loading. Inserting MIs under existing RPDs can improve patients' satisfaction with their RPDs in several domains.

Is one dental mini-implant biomechanically appropriate for the retention of a mandibular overdenture? A comparison with Morse taper and external hexagon platforms

Statement of problemLimited information is available to clinicians on the use of dental mini-implants (MI) as opposed to standard-diameter implants (SDIs) for the stabilization of implant-retained mandibular overdentures (MOs). PurposeThe purpose of this in vitro and finite element analysis study was to analyze and compare the biomechanical behavior of MOs with either 1 or 2 implants with external hexagon (EH), Morse taper (MT) SDIs, and MIs. Material and methodsThirty photoelastic models (n=30) of each group (n=5) of SDIs (EH-1, EH-2, MT-1, MT-2) and MI (MI-1, MI-2) were fabricated for posterior, peri-implant, and total maximum shear stress evaluation by quantitative photoelastic analysis. One specimen of each group was further used to create the 6 computational models to be analyzed by finite element analysis. The maximum von Mises values and stress maps were plotted for each ductile component. Two types of load were applied to the overdenture: a150-N load bilaterally and simultaneously on the first molar and a 100-N load on the incisal edge of the central incisors at a 30-degree angle. The data were subjected to the 2-way ANOVA test and the Tukey honestly significant difference test (α=.05). ResultsThe EH-2 and MT-2 showed the lowest posterior (P<.001) and total (P<.05) mean shear stress values. For peri-implant shear stress, no difference was found among all groups (P>.05). Regardless of the loading area, the MI-1 and MI-2 groups showed the lowest von Mises stress values. However, for implant housing, the MI-1 group, under incisor loading, presented greater stress, followed by MT-1, EH-1, EH-2, MI-2, and MT-2. The attachment was the most overloaded structure, with high values under incisor loading, especially for the groups with 2 implants (MT-2, EH-2) as compared with the other models. ConclusionsBiomechanically, regardless of the implant number, MI is a promising rehabilitation method with similar peri-implant shear stress and lower von Mises stress on the implant when compared with SDIs for MOs.

Stainless steel or titanium mini-implants?

To investigate whether there was a difference in success rates when stainless steel (SS) was compared to titanium mini-implants (MIs) in orthodontic patients. PubMed, Cochrane, Scopus, Web of Science, Lilacs, Google Scholar, Clinical Trials, and OpenGray were searched without restrictions. A manual search was also performed in the references of the included articles. Studies comparing the success rate between SS and titanium MIs were included. Risk of bias (RoB) was assessed using the ROBINS-I (Risk of Bias in Non-randomized Studies-of Interventions) Tool or RoB 2.0 according to the study design. The level of evidence was assessed through GRADE (Grading of Recommendation, Assessment, Development, and Evaluation). Six studies met the eligibility criteria. One study was a randomized clinical trial that evaluated extraalveolar MIs, and nonrandomized trials examined interradicular MIs. The RCT presented a low RoB, two nonrandomized trials presented a moderate risk, and three presented a high risk. The quality of the evidence was high for the randomized clinical trial and moderate for the nonrandomized trials. Most studies found no difference between materials, with good success rates for both (SS, 74.6%-100%; titanium: 80.9%-100%) and only one study, with a high RoB, showed a higher success rate with titanium MIs (90%) when compared with SS (50%). A quantitative analysis was not because of the great heterogeneity among the studies. Although limited, the current evidence seems to show that the material used is not a major factor in the success rate of MIs. Because it has a lower cost than titanium and presents similar clinical efficiency, SS is a great material for orthodontic MIs.

RANK/RANKL/OPG gene polymorphisms and loss of orthodontic mini‐implants

To investigate the association of genetic polymorphisms (tagSNPs type) of RANK/RANKL/OPG genes with the loss of orthodontic mini-implants (MIs). One hundred and thirty-five patients of both sexes, with mean age of 48.7±10 (20-76years), were studied. The control group was composed of 104 patients, with no MI lost and functioning for at least 6months and the case group, of 31 patients with at least one MI lost. Cells were obtained by mouthwash with 3% glucose solution for 1minute and scraping the buccal mucosa with sterilized spatula. DNA was extracted from buccal epithelial cells with 10M ammonium acetate and 1mM EDTA. Genotyping was performed by the real-time polymerase chain reaction (PCR) technique. Univariate and multivariate analyses were performed (P<.05). No markers were associated with MI loss after Benjamini and Hochberg false discovery rate correction of Univariate tests. In the multivariate analysis, the variables that associated with MI loss were the number of MIs installed (P<.000) and the polymorphism rs8086340 in the RANK gene (P=.018). A higher number of MIs installed (P<.000) and polymorphism rs8086340 in the RANK gene (P=.018) were associated with loss of orthodontic MIs after multivariate analysis.

Use of fixed individual micro-implant supported orthodontic appliance in children with bilateral cleft lip and palate

Improving the effectiveness of treatment of children with bilateral orthodontic and surgical training. Under the supervision were 80 children with cleft lip and palate, with an age of up to 3 years. Of these 56 patients, 28 patients are the 2nd group prepared for surgery according to the developed technique. Preoperative orthodontic preparation of 28 children with bilateral cleft and an indicator that 22 (78.6%) patients should not have fully achieved results between the interhuman and fragmentary alveolar process of the upper jaw. In the second group of patients, 27 (96.4%) patients showed a normal ratio of the intermaxillary bone and lateral fragments. The use of the developed orthodontic design with active elements and mini implants in 96.4% of cases requires the presence of pre-spiral orthodontic preparation, normalization of the position of the intercellular bone and shape, followed by primary chelorinoplastics and in relation to additional uranoplastics, as well as the periodic stages of rehabilitation of patients with bilateral cleft lip and achieved thereby a stable aesthetic and functional result.

Clinical Evaluation of the Biting Force of the Mandibular Implant Supported Overdenture by Two Conventional and Two Mini Implants

Clinical Evaluation of the Biting Force of the Mandibular Implant Supported Overdenture by Two Conventional and Two Mini Implants

Intrusion Effects on Maxillary Anteriors using Mini Implant Anchorage and K-Sir Loop in Subjects with Deep Overbite- A Cohort Study

Introduction: Various options to treat deep bites nonsurgically involve extrusion of posterior teeth or intrusion of anterior teeth. Intrusion of anterior teeth is required in patients with excessive incisal display and to correct deep bite in adult patients when extrusion of posterior teeth is not desirable. Aim: To compare the rate of intrusion and dento-alveolar effects on maxillary anterior teeth by Kalra-Simultaneous Intrusion and Retraction loop (K-SIR loop) and Mini implant anchorage in subjects with deep overbite. Materials and Methods: This prospective cohort study included 12 patients with Class I or Class II Div 1 malocclusion having an overbite and overjet of &gt;4 mm treated with therapeutic extractions of upper first premolars. Group A included six subjects treated using orthodontic Mini implants, while Group B had six subjects treated with K-SIR loop. Lateral cephalograms were taken before intrusion and retraction (T1) and at the end of six months (T2) into intrusion and retraction. Independent t-test and paired t-test was done for intergroup and intragroup comparison respectively. Results: The rate of intrusion was 0.38 mm/month and 0.31 mm/month for Group A and Group B, respectively. The amount of intrusion was significantly more in Temporary Anchorage Devices (TAD) group (p-value &lt;0.01). Conclusion: In the TAD group, rate and amount of intrusion was significantly higher. There is no difference in vertical control between the two modalities statistically significant amount of molar extrusion was seen with the K-SIR loop group.

A Novel appliance for the correction of scissor bite

The transverse discrepancies of the occlusion are the common problems that are encountered in routine orthodontic practice. The most cited dental transverse discrepancies are the crossbite and scissor bite. Scissor bite is one of the toughest malocclusion to correct, and the appliances available for the effective correction are limited. one of the cause for scissor bite can be the expanded maxillary arch. The current manuscript demonstrates the effective correction of the expanded maxillary arch using the new TAS appliance. TAS appliance is an acronym for the authors (T-Tarulatha, A-Akashdeep, and S-Shyagali). The appliance construction is based on the sound biomechanical principles as well. The force was applied from the lingual side, and the applied force was nearer to the center of resistance of all the posterior teeth. Thus, the appliance produced less tipping of the molars. Unlike earlier mechanics used for the correction of scissor bite, the current appliance is not dependent on patient compliance, does not require archwire modification or the invasive procedure such as placement of mini implants or surgical intervention. The novel design of TAS appliance can help the clinician to correct the stubborn transverse discrepancy in an effective manner.

Clinical Tips of Successful Maxillary Expansion with Mini Implants

Clinical Tips of Successful Maxillary Expansion with Mini Implants

FUNCTIONAL OUTCOME OF MINI IMPLANTS IN CLOSED METACARPAL FRACTURES

Background: The incidence of Hand and Forearm fractures accounts for 1.5% of all Emergency cases. They are the 3rd commonest hand fractures next to distal forearm and phalanges. Closed multiple metacarpal fractures are found to be highly unstable and are more prone for poor functional outcome when they are managed conservatively. In this study we assessed the functional and radiological outcome of Mini Implants for closed metacarpal diaphyseal fractures. Patients And Methods: In our study we had 22 patients with closed metacarpal fracture which were treated with open reduction and internal fixation with mini screws and plates. Functional outcomes were assessed clinically using TAF (Total Active Flexion) and ASSH(American Society for Surgery of Hand) Scoring system and radiologically using RUST scoring system at 6 weeks, 3rd month and 6th month. Result: Union rates of 100% were achieved in all cases. The average time period of union in our study was 13.3 weeks. Functional outcomes were excellent in all cases with an active range of movement >220 degrees. Twocases developed infection, one was superficial and the another was deep infection. Infection got resolved for both the patients with adequate antibiotics and regular dressings. Conclusion: In this study we concluded that mini screws and plates is a good option for treating closed diaphyseal metacarpal fractures as it provided a rigid fixation for early mobilization and had a good functional outcome. Keywords: Hand, Metacarpal fracture, mini implants

Gummy smile - A dilemma

Gummy smile patients have always presented orthodontist with a huge dilemma. Gum tissue visible in the smile line should have balanced, even contour that are in harmony with upper lip. It is for this reason, that many people with a gummy smile /excessive gingival display feel their smile to be unattractive, often times feeling reluctant to smile at all. Gummy smile is usually characterized by overgrowth of anterior maxillary vertical excess, the outcome may not always be successful with conventional orthodontic therapy alone. In such cases, surgical therapy, lefort impaction/maxillary gingivectomies are often chosen to gain a good smile. However, the patient may not be willing to undergo surgical treatment, an alternative method must be considered to treat the gummy smile. This is a case report on non-surgical treatment for correction of gummy smile using mini-implants in which patient has achieved satisfactory results. Keywords: Gummy smile, Mini implants.

Evaluation and Comparison of Root Proximity of Maxillary and Mandibular Interradicular Sites for Mini Implant Placement Using Orthopantomogram and Cone Beam Computed Tomography

The purpose of this study is to evaluate and compare the root proximity of maxillary and mandibular inter radicular sites using orthopantomogram (OPG) and cone beam computed tomograph (CBCT) for the primary stability of mini implants. The cone beam computed tomographic images and orthopantomographic images of 70 subjects were taken. The interdental sites from distal of canine to mesial of second molar are examined for root proximity. The root proximity was measured at four levels from cementoenamel junction in 70 CBCT and OPG images. The results showed a statistically significant difference between the values obtained from CBCT and OPG images; the root proximity was least 6mm above the cementoenamel junction in maxilla and mandible in the range of 1.09–3.62mm, 1.45–4.17 mm respectively. The study concluded that CBCT images are more accurate and reliable. At 5mm from CEJ in the region between the first molar and second premolar in maxilla and in the area between first molar to first premolar in mandible the root proximity is least and adequate for mini implant placement.