Miniscrew Anchorage Research Articles

Diagnosis and Treatment Planning for Primary Molar Ankylosis along with Un-erupted Maxillary Premolar: Case Report

Background: Dentoalveolar ankyloses of the deciduous tooth may lead to collapse of the dental arch complicating eruption and development of the succedaneous permanent dentition. The early interceptive orthodontic treatment is recommended to avoid complications on the eruptive process of the successor tooth. Objective: The aim of this article is to report the orthodontic treatment of a patient with dentoalveolar ankylosis of the deciduous upper molar and impaction of the succeeding permanent teeth. Materials and methods: A 15 year-old female patient presented with a complaint about severely intruded maxillary left second deciduous molar and inclination of the adjacent tooth. Computed tomography scam (CT) showed that the premolars were found to be ankylosed and were extracted. The extraction spaces were closed by moving the posterior teeth mesially through NiTi closed springs with miniscrew anchorage. Results: In the maxillary arch, the first molars were positioned in the place of the second premolars. The occlusal posttreatment evaluation revealed a Class II molar and Class I canine relationship on the sides, normal overjet and overbite, and good intercuspation. Ideal functional occlusion was obtained. Panoramic radiography revealed good positioning and good periodontal health of the teeth, and the parallax of the roots of the teeth. The patient’s skeletal pattern was not altered by the mechanics and the facial esthetics was not compromised. Conclusion: It is important to diagnose the dental ankyloses or impaction problems as early as possible in order to treatment planning achieve better results with a great long-term stability.

Fractured Miniscrew Retrieval through Flapless Vibration Technique: A Mini Review and Case Report

ABSTRACT Nowadays, miniscrew anchorage system is encouraged to obtain better results in orthodontic treatment. This system also brings emergency complications like fractures during insertion of these miniscrews. According to protocol flap-raising technique, a periodontist should be consulted during retrieval of the fractured miniscrew. Here, we propose a new technique that can retrieve the fractured implant with uneventful healing by the vibration of micromotor blunt burs or ultrasonic scaler tips with reinsertion in 7 days. How to cite this article Rath SK, Swain CS, Panda SM. Fractured Miniscrew Retrieval through Flapless Vibration Technique: A Mini Review and Case Report. Int J Oral Implantol Clin Res 2017;8(1):31-33.

Quantitative and qualitative assessment of anchorage loss during en-masse retraction with indirectly loaded miniscrews in patients with bimaxillary protrusion.

This study provides vital insight in assessing anchorage loss when miniscrews are indirectly loaded. The study sample comprised 18 patients with bimaxillary protrusion (14 girls, 4 boys; mean age, 17.3±4.6years) selected from a database of 89 patients treated with miniscrews. All subjects who were selected required extraction of all first premolars and maximum anchorage. After initial leveling and aligning, miniscrews were placed between the first molar and the second premolar in all 4 quadrants and loaded by the indirect method at 3weeks after placement with 200-g nickel-titanium alloy closed-coil springs for en-masse retraction. Mean treatment duration was 29.7±6.8months. Pretreatment and posttreatment lateral cephalograms were analyzed to measure the amount of anchorage loss, incisor retraction, and the incisors' angular change in reference to the pterygoid vertical reference line and were evaluated by the structural superimposition method. The ratio of incisor retraction to molar protraction was 4.2 in the maxilla and 4.7 in the mandible. The first molars showedmean extrusion of 0.20mm in the maxilla and 0.57mm in the mandible; these were statistically insignificant. The mean angular change of the first molars was -2.43° in the maxilla and -0.03° in the mandible. The mean anchorage loss in reference to the pterygoid vertical was 1.3mm in the maxilla and 1.1mm in the mandible; these were statistically significant. Structural superimpositions showed mean change in molar position of 0.83mm in the maxilla and 0.87mm in the mandible, and 5.77mm in the maxillary incisor and 5.43mm in the mandibular incisor. These results were compared with the direct anchorage method reported in the literature. Indirect miniscrew anchorage can be a viable alternative to direct anchorage.

True intrusion of maxillary first molars with zygomatic and palatal miniscrew anchorage: a case report

Abstract The intrusion of the maxillary first molar is indicated when occlusal clearance is needed for prosthetic rehabilitation. Maxillary molar intrusion may be undertaken using skeletal anchorage systems to avoid complicated mechanics delivered by conventional intra-oral fixed appliances. In the present case report, the efficient use of orthodontic miniscrew anchorage by applying simple mechanics for true maxillary first molar intrusion is described. This was followed by the rehabilitation of the mandibular first molar spaces with implant prostheses. A 16-year-old female patient had masticatory difficulty due to the bilateral overeruption of the maxillary first molars and carious mandibular first molars. True intrusion of each maxillary first molar was achieved using zygomatic and palatal paramedian miniscrews placed in line with the central axis of the teeth. Simultaneously, alignment of the upper arch was achieved via fixed appliance therapy. Using two orthodontic miniscrews to intrude each maxillary molar, orthodontic treatment was simplified by eliminating the need for miniplate placement by extensive surgery and the creation of intra-oral multiunit anchorage. Masticatory efficiency was improved by increasing the occlusal table with prosthetic rehabilitation of the mandibular first molar spaces with dental implant prostheses.

Evaluation of effects of mini screw anchorage during leveling and alignment phase of fixed orthodontic treatment

Evaluation of effects of mini screw anchorage during leveling and alignment phase of fixed orthodontic treatment

Correction of severe deep bite and gummy smile using mini-screw anchorage: A case report

The patient was a 23-year-old girl who had an Angle Class II Division 1 malocclusion, severe overjet, and deep bite with a gummy smile. She had both impacted mandibular canine teeth. The objectives were to correct deep bite, gummy smile, accentuated overjet, alignment of impacted canine and to achieve adequate overbite and overjet. The treatment involved extraction of maxillary first premolars proceeding with retraction and intrusion of the upper anterior teeth with mini-screw implants as the orthodontic anchorage. After treatment, adequate overbite and overjet and a satisfactory maxillary gingival exposure in the smile were obtained. The mini-screw implant anchorage method is useful for correction of severe overjet and a deep bite with a gummy smile.

Prevalence of the use of anchorage miniscrews among French orthodontists.

Since always, anchorage has raised frequent problems for orthodontists. Since the early 2000s, the use of anchorage miniscrews has spread on a vast scale among practitioners. For the first time, a broad epidemiological survey (733exploitable responses) has looked into the habits of French orthodontists regarding the use of anchorage miniscrews. The survey reveals that the majority of French practitioners have adopted miniscrews in their daily practice (66%), particularly among those using the lingual technique. However, the number of patients concerned still remains small for most practitioners (fewer than 10patients for 65% of users). Seventy-four percent of users are satisfied with their experience with miniscrews although a majority uses them exclusively in adults (64%). The movements most sought by miniscrew users are mesialization/distalization and intrusion/extrusion. Among non-users, 60% have never placed an anchorage miniscrew but are thinking about doing so, whereas 20% of practitioners have used them but have since abandoned them. Finally, 20% of non-users have never used anchorage miniscrews and do not intend to do so.

Clinical application of a 3-dimensional morphometric apparatus for diagnosis and treatment of a Class III patient with facial asymmetry: A pilot study

This article demonstrated the usefulness of a non-contact 3-dimensional (3D) morphometric apparatus in orthodontic diagnosis and treatment evaluation. A female patient, 23 years 6 months of age, had a Class III malocclusion with mandibular deviation. The 3D images taken by a 3D morphometric apparatus figured out her protrusive chin of 6mm on the deviation side compared to the non-deviation side, and showed a possibility of orthognathic surgery. Before starting of orthodontic treatment, a diagnostic splint was used for 2 months to determine her proper mandibular position. The 3D images retaken for quantitative evaluation showed decrease of the mandibular protrusion by approximately 3mm, and improvement of facial asymmetry. Then, we decided to treat the patient without orthognathic surgery. After 18 months of active orthodontic treatment with miniscrew anchorage, the mandibular deviation was improved and an acceptable occlusion was achieved. The 3D images at posttreatment demonstrated significant decrease of chin protrusion on the deviation side, and improvement of facial asymmetry. In conclusion, a 3D morphometric apparatus could provide quantitative data of facial asymmetry and chin protrusion and contributed decision making process of treatment planning in a patient with facial asymmetry.

Comparison of the Amount of Anchorage Loss of the Molars with and without the Use of Implant Anchorage during Anterior Segment Retraction Combined with Alveolar Corticotomies

Purpose: The purpose of this study was to evaluate the effect of alveolar corticotomies on anchorage loss by comparing and measuring the amount of anchorage loss with titanium mini-screws and conventional molar anchorage during anterior segment retraction. Materials and methods: In this study, we compared treatment outcomes of patients with severe class ІІ malocclusions treated using mini screw anchorage (n = 8) or traditional orthodontic mechanics of inclusion of the second molars (n = 8). Both methods were combined with alveolar corticotomies before retracting the anterior segment. Pretreatment and post treatment lateral cephalograms were analyzed. Results: Both treatment methods achieved acceptable results as indicated by the reduction of overjet. The mesiodistal position of the maxillary molars in group2 showed a small change (+1.5mm). Conclusion: Alveolar corticotomies on the anterior teeth combined with inclusion of second molars proved to be efficient for intraoral anchorage reinforcements for en-masse retraction of the maxillary anterior teeth.

RE: response to: treatment effects of the Forsus Fatigue Resistant Device used with miniscrew anchorage. The Angle Orthodontist. 2014;84:76-87.

RE: response to: treatment effects of the Forsus Fatigue Resistant Device used with miniscrew anchorage. The Angle Orthodontist. 2014;84:76-87.

Risks and complications of miniscrew anchorage in clinical orthodontics

Summary Miniscrew anchorage has greatly expanded the limit of clinical orthodontics. Even without patient compliance, miniscrews can provide stationary anchorages for various tooth movements and even make it possible to move the tooth in directions which have been impossible with traditional orthodontic mechanics. On the other hand, the clinical use of miniscrew anchorage includes some risks. Screw fracture might be one of the most undesirable side effects in clinical use of miniscrew anchorage, which occurs in not only the placement but also the removal. A lot of factors are suggested to relate with screw failure, but screw-root proximity and the mandible are considered as two common factors. Damages of soft tissues are temporary in most cases, but damages of hard tissues are irreversible and should be avoided. We have to understand these risks and complications of miniscrew anchorage, and pay attention for their safety-conscious use.

Dental Class III Camouflage Treatment Using Miniscrew Anchorage

ABSTRACT In this case report, the treatment of a moderate Class III malocclusion by miniscrews is presented. A 17-year-old female patient with a chief complaint of crowding had Class III dental relationship. Cephalometric analysis demonstrated a Class II skeletal relationship with a high angle vertical pattern. The aim was to correct the skeletal and dental relationships with orthognathic surgery; however, the patient refused the operation. So it was decided to perform camouflage treatment, which consisted of lower posterior stripping and uprighting of the same teeth by the help of miniscrews placed into the interdental spaces between the mandibular first and second molars. At the end of the treatment, Class I molar and canine relationships were achieved, and the crowding was eliminated. The patient's profile was not negatively affected. The outcome was stable after 1 year of retention. This case report shows that miniscrew anchorage successfully aided in the correction of a dental Class III malocclusion ...

Indirect miniscrew anchorage: biomechanical loading of the dental anchorage during mandibular molar protraction—an FEM analysis

While there are many studies in the literature addressing direct miniscrew anchorage, the biomechanical effects of indirect miniscrew anchorage remain unknown. The aim of the present study was to biomechanically analyze the load on the anchor teeth during mandibular molar protraction using different types of anchorage. Four finite element method (FEM) models of the right mandible were created using the morphological CT data of a 21-year-old male. All models were morphologically identical, but they differed in anchorage type (dental anchorage, direct miniscrew anchorage, indirect miniscrew anchorage with one anchor tooth, indirect miniscrew anchorage with two anchor teeth). To analyze the load on the dental anchorage during mandibular molar protraction, we measured the induced effective strain (µstrain) at specific control points on the alveolar bone. With indirect miniscrew anchorage, we observed that the effective strain at an average of 7.21 μstrain (one anchor tooth) or 6.57 μstrain (two anchor teeth) was almost as high as in pure dental anchorage where no miniscrew was used (mean 8.38 µstrain). In contrast, we noted significantly lower strain values in conjunction with direct miniscrew anchorage. We observed highly significant differences between direct and indirect simulated miniscrew anchorage (p=0.008). Our FEM results reveal relatively high loads on the dental anchorage when using indirect miniscrew anchorage. This may carry an increased risk of anchorage loss during mandibular molar protraction; however, further studies are necessary to confirm this.

Impact of anchorage miniscrews in multibracket treatments without extractions

Over the past decade, the interest for miniscrews is continuously growing as confirmed by the amount of recent published studies. In particular, their use allows to make corrections in a single phase and avoids extractions of premolars, while keeping usual goals of treatment. Main results of pilot studies and some clinical examples are presented here to illustrate our therapeutic approach for the treatment of tooth discrepancy in Class I, Class II and Class III situations.

Intrusion of overerupted maxillary molars with miniscrew implant anchorage: A radiographic evaluation

The aim of this retrospective study was to quantitatively evaluate the treatment effects of intrusion of overerupted maxillary molars using miniscrew implant anchorage and to investigate the apical root resorption after molar intrusion. The subjects included 30 patients whose average ages were 35.5±9.0 years. All patients had received intrusion treatments for overerupted maxillary molars with miniscrew anchorage. There were 38 maxillary first molars and 26 maxillary second molars to be intruded. Two miniscrews were inserted in the buccal and palatal alveolar bone mesial to the overerupted molar. Force of 100-150 g was applied by the elastic chains between screw head and attachment on each side. Lateral cephalograms and panoramic radiographs taken before and after intrusion were used to evaluate dental changes and root resorption of molars. Only 6 of the 128 miniscrews failed. The first and second molars were significantly intruded by averages of 3.4 mm and 3.1 mm respectively (P<0.001). The average intrusion time was more than 6 months. The crown of the molars mesially tilted by averages of 3.1 degrees and 3.3 degrees (P<0.001) for first and second molars. The amounts of root resorption were 0.2-0.4 mm on average. The intrusion treatment of overerupted molars with miniscrew anchorages could be used as an efficient and reliable method to recover lost restoration space for prosthesis. Radiographically speaking, root resorption of molars was not clinically significant after application of intrusive forces of 200 to 300 g.

Treatment effects of the Forsus Fatigue Resistant Device used with miniscrew anchorage

To evaluate the dentofacial effects of the Forsus Fatigue Resistant Device (FRD) used with miniscrew anchorage (FRDMS) and compare them with those of conventional FRD and an untreated Class II control group. The sample consisted of 48 Class II subjects. Sixteen patients (13.68 ± 1.09 years of age) were treated with FRDMS, whereas 17 subjects (14.64 ± 1.56 years of age) were treated with only FRD. Also, a control sample of 15 untreated Class II subjects (14.13 ± 1.50 years of age) was constructed. Angular and linear measurements were made on 96 lateral cephalograms. Paired t, one-way analysis of variance, and Tukey tests were used for statistical analysis. Class I molar relationship and overjet correction were achieved in an average period of 6.5 ± 1.97 and 5.5 ± 1.80 months in the FRDMS and FRD groups, respectively. No skeletal effect was determined in both treatment groups. Greater overbite correction was found in the FRD group. Retrusion and extrusion of maxillary incisors, distalization of maxillary molars, and extrusion of mandibular molars were significant in both treatment groups. Labial tipping of mandibular incisors was significantly greater in the FRD group than in the FRDMS group. Overjet and molar correction was totally dentoalveolar. Unfavorable labial tipping of mandibular incisors was effectively minimized with the usage of miniscrews.

Endodontic and Surgical Treatment of Root Damage Caused by Orthodontic Miniscrew Placement

IntroductionMiniscrews are being increasingly used for anchorage control in orthodontics. Despite the concern over root damage caused by miniscrews, there are few reports of precise clinical evaluations and appropriate management of that damage. In the case presented herein, the root damage caused by the placement of miniscrews was repaired by root canal treatment and surgical intervention. MethodsA 44-year-old man received orthodontic treatment for intrusion of the left maxillary first molar with a miniscrew anchorage system. During that treatment, the miniscrews had fallen out and had to be reinserted more than 6 times in the same area. Two years later, the patient complained of a spontaneous pain in the maxillary left molar region. Although the patient received root canal treatment, intraoral sinus tracts could still be detected, and the patient's discomfort persisted. Periradicular surgery revealed that the persistent infection was related to root surface damage caused by orthodontic miniscrew placement. Healing was achieved by a combination of root canal treatment and surgical intervention. ResultsScanning electron microscopy of the damaged distobuccal root apex revealed a mature biofilm consisting of a network of matrix that contained mostly rod-like and spherical bacteria. At a 12-month recall checkup, the patient was free of pain. A repeat periapical radiograph revealed reduction of the pretreatment radiolucent lesion. ConclusionsMore careful planning of miniscrew placement is necessary to lessen the danger of root damage. Furthermore, a precise evaluation of both root and pulpal damage and careful consideration of the choice of optimal treatment modality are needed.

Severe open bite due to traumatic condylar fractures treated nonsurgically with implanted miniscrew anchorage

This case report illustrates the use of miniscrews to treat a patient with an open bite caused by mandibular condylar fractures. The patient was 36 years old when she visited our hospital with a chief complaint of difficulty with chewing. She had suffered condylar and maxillary bone fractures in a traffic accident 6 months before her visit. She had an anterior open bite and Angle Class II molar relationships. Her mandibular midline was deviated to the right relative to the maxilla. The cephalometric analysis showed a skeletal Class II relationship. Titanium miniscrews were implanted in the bilateral maxillary buccal areas. The maxillary dentition was retracted and intruded by using elastomeric chains and miniscrews. After this treatment, an Angle Class I molar relationship was achieved, her overjet and overbite became ideal, and a good facial appearance was obtained. The total active orthodontic treatment period was 33 months. Treating an open bite with molar intrusion often leads to counterclockwise rotation of the mandible; however, in this patient, the mandible was moved anteriorly and upward. We believe that this movement was caused by the patient's condylar fractures and the subsequent remodeling. Although there was some relapse, our results suggest that implant anchorage is useful for correcting anterior open bites originating from condylar fractures.

Indirect usage of miniscrew anchorage to intrude overerupted mandibular incisors in a Class II patient with a deep overbite

Vertical dentoalveolar discrepancies are a common problem in orthodontic patients but are often difficult to treat with traditional mechanics. This case report illustrates the successful treatment of overerupted mandibular incisors via the indirect use of miniscrew anchorage. A woman (age, 22 years 9 months) had chief complaints of maxillary incisor protrusion and crooked teeth. An excessive curve of Spee caused by elongation of the mandibular incisors was also found. The patient was diagnosed with a severe Class II Division 1 malocclusion and a deep overbite. After extraction of the mandibular first premolars and the subsequent leveling phase, the elongated incisors were intruded with a novel method, which involved the combined use of sectional archwires and miniscrews placed in the premolar areas. After the procedure, the mandibular incisors had been intruded by 6.5 mm with no undesirable side effects. The total active treatment period was 42 months. The resultant occlusion and satisfactory facial profile were maintained after 30 months of retention. Our novel intrusion approach shows potential for correcting a deep overbite.

Maxillary molar distalization with the Indirect Palatal Miniscrew for Anchorage and Distalization Appliance (iPANDA)

Distalization of the maxillary molars is an important treatment option for the correction of Class II malocclusions. The purposes of this study were to introduce the clinical application of the indirect Palatal miniscrew Anchorage and Distalization Appliance (iPanda) and to describe the dental and skeletal effects obtained with this innovative appliance. Pretreatment (TO), post-distalization (T1), and posttreatment (T2) lateral cephalometric radiographs and dental casts of 20 consecutively treated adult patients (mean age 23.2 ± 4.7 years) with Class II molar relationship were analyzed. All patients were treated with the iPanda for maxillary molar distalization. The iPanda was anchored on a pair of midpalatal miniscrew implants to deliver the distalizing force to the maxillary first molars. The iPanda was the only appliance used during the distalization phase of treatment. A paired t test analysis was used to statistically assess the effects of treatment. A Class I molar relationship was obtained in a mean period of 3.2 ± 0.6 months. Cephalometric analysis demonstrated that the maxillary first molars were significantly distalized by an average 4.5 ± 1.5 mm (P < .001) and were intruded by a mean of 1.0 mm ± 0.8 mm (P < .05). No significant change in the inclination of the first molars was observed. No significant change in the mandibular plane was observed. Dental model analysis demonstrated an asymmetric pattern of distalization between right (4.5 ± 2.2 mm) and left (3.1 ± 2.1 mm) first molars. The transverse width of the dental arch was maintained. No significant rotation of the first molars was observed. This study demonstrated that the innovative iPanda is effective to bodily distalize the maxillary molars into a Class I molar relationship and to provide maximum anchorage.