Use Of Mini-implants Research Articles

Comparative Study of Mini-implants versus Standard Implants in Orthodontic Anchorage for Space Closure

ABSTRACT Background: In order to obtain satisfactory treatment outcomes, orthodontic space closure frequently requires trustworthy anchoring devices. Because they are easier to install and smaller than regular implants, mini-implants have become a viable option. The purpose of this study was to evaluate the effectiveness of regular implants versus mini-implants as orthodontic anchoring devices for closing gaps in a tertiary care context. Methods: A total of 100 patients who needed space closure were split into two groups at random and given regular implants (group B, n = 50) or mini-implants (group A, n = 50). The rate of space closure, anchoring loss, and patient pain were measured using visual analog scales as the primary end measures. Resonance frequency analysis was used to assess implant stability. Based on implant survival and the lack of peri-implant problems, success rates were calculated. Findings: Mini-implants showed much lower rates of patient pain (P < 0.001) and anchoring loss (P < 0.05) than normal implants; however, they did show comparable rates of space closure (P = 0.42). In addition, mini-implants had comparable success rates (P = 0.78) and greater implant stability (P < 0.01) when compared to normal implants. Conclusion: In conclusion, mini-implants have benefits in anchorage preservation, patient comfort, and implant stability over regular implants when used as orthodontic anchoring devices for space closure. They also offer equivalent effectiveness. These results provide credence to the use of mini-implants as practical substitutes in orthodontic practice.

Redefining the Envelope of Discrepancy in Contemporary Orthodontics: A Narrative Review

Abstract Redefining the envelope of discrepancy with temporary anchorage devices (TADs) refers to the use of mini-implants, miniplates, or miniscrews in orthodontics to expand the range of possible tooth movements and correct complex dental discrepancies. By strategically placing TADs in specific locations, orthodontists can create an augmented anchorage system that enables them to move teeth in ways that were previously not feasible. This expanded envelope of discrepancy allows for more efficient and effective treatment of complex malocclusions, including retraction of teeth, correction of severe crowding, open bites, deep bites, and cases with missing teeth. TADs allow orthodontists to have greater control over tooth movements, as they provide stable and reliable anchorage points. Orthodontists can tackle more challenging cases that were considered difficult or even impossible to treat. TADs minimize the dependence on patient cooperation since they provide additional anchorage independent of patient compliance. They can accelerate treatment by allowing orthodontists to move teeth more efficiently and effectively. Thus, treatment duration can be shortened, reducing the overall time patients spend in braces or aligners. Overall, redefining the envelope of discrepancy with TADs has significantly expanded the possibilities in orthodontic treatment, allowing for more precise and efficient correction of complex dental discrepancies.

Unilateral mesialisation using Temporary anchorage device and segmental T loop – A case report

A temporary anchorage device is a device that is temporarily fixed to bone for the purpose of enhancing orthodontic anchorage either by supporting the teeth of the reactive unit or by obviating the need for the reactive unit altogether, and which is subsequently removed after use. Use of mini implants is one of the innovative approach for complex tooth movements such as mesialisation. Space closure from distal to mesial is one of the most difficult orthodontic tasks. Tooth-borne anchorage limits the scale of tooth movement. Extraoral or intraoral appliances are used especially for unilateral space closure. As an alternative to conventional mesialization appliances, osseointegrated implants may be used for maximum anchorage in orthodontic treatment. The use of direct anchorage in the form of installed mini-implant that is connected to the teeth requiring horizontal movement causes low levels of strains on anchor unit comparing to the results that were registered during indirect anchorage with one or two anchor teeth. This report presents the case of removal of mesiodens and blocked out and fractured premolar and the space closure by unilateral mesialisation with the help of mini implants and loops.

Biomechanical comparison of different framework materials in mandibular overdenture prosthesis supported with implants of different sizes: a finite element analysis

BackgroundThe aim of this study is to evaluate the stresses on the supporting bone, implants, and framework materials under masticatory forces in mandibular overdenture prostheses modeled with different framework materials and different implant types, using the Finite Element Analysis (FEA).MethodsFor the finite element modeling, two identical mandibular jaw models were created; one with two standard (diameter:4.1 mm/12 mm length) and the other with two mini-implants (diameter:2.4 mm/12 mm length) were placed in the canine teeth area. The polymethylmethacrylate (PMMA) denture was modeled upon them, supported by Cobalt Chromium alloy (CoCr), Poly-ether ether ketone (PEEK), and Zantex materials with framework. No framework was added as a control model; only PMMA overdenture prosthesis was modeled.ResultsRegardless of the framework materials of the overdenture prostheses, the stress values ​​on mini-implants in all models yielded approximately two times higher results comparing to standard implants. More stress transmission was observed in the supporting bone and implants in the control prostheses and overdenture prostheses supported with respectively PEEK, Zantex, CoCr alloy frameworks, respectively. In the framework materials, more stress occurred on CoCr, Zantex and PEEK in that order.ConclusionIn the light of this study, the use of mini-implants as an alternative to standard implants is not promising in terms of distribution and transmission of chewing stresses. As a framework material, standard rigid metal alloys were found to be more advantageous than polymer materials in terms of stress distribution.

High degree of consensus amongst an expert panel regarding focal resurfacing of chondral and osteochondral lesions of the femur with mini-implants.

The rationale for the use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions is still under debate. The evidence supporting best practise guidelines is based on studies with low-level evidence. A consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence. The purpose of this article is to report the resulting consensus statements. Twenty-five experts participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted via an online survey of two rounds, for initial agreement and comments on the proposed statements. An in-person meeting between the panellists was organised during the 2022 ESSKA congress to further discuss and debate each of the statements. A final agreement was made via a final online survey a few days later. The strength of consensus was characterised as: consensus, 51-74% agreement; strong consensus, 75-99% agreement; unanimous, 100% agreement. Statements were developed in the fields of patient assessment and indications, surgical considerations and postoperative care. Between the 25 statements that were discussed by this working group, 18 achieved unanimous, whilst 7 strong consensus. The consensus statements, derived from experts in the field, represent guidelines to assist clinicians in decision-making for the appropriate use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions. Level V.

Evaluation of the Patient-Reported Outcome Measures (PROMs) With Temporary Skeletal Anchorage Devices in Fixed Orthodontic Treatment: A Systematic Review.

Analysis of patient-reported outcome measures(PROMs) is essential to ensure that the skeletal and traditional anchoring methods are appropriately and effectively utilized in the context of patient acceptance and satisfaction. This review's objective was to assess the available data on the levels of discomfort, soft-tissue irritation, functional impairment, and other patient-reported outcomes related to the usage of mini-implants in the context of fixed orthodontic treatment for adult patients. A total of seven electronic bibliographic databases were searched between January 1995 and February 2022. Moreover, a manual search was done in the selected orthodontic journals. This systematic review (SR) covered cohort studies, retrospective studies, randomized clinical trials (RCTs), and controlled clinical trials (CCTs) that studied the use of mini-implants, mini-plates, or onplants as anchorage devices on patients receiving orthodontic treatment. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2 tool). Three RCTs and two cohorts were included in this SR with a total of 468 patients. Three of the four included studies were at high risk of bias. The pain level was in the "mild-to-moderate" category on the first day following the insertion of mini-implants, then decreased to a mild level from the fifth day to the seventh day of insertion (mean values are 36.61, 16.36, and 11.33, respectively). The levels of functional impairments were found to be located between the "mild-to-moderate" and "moderate" categories after the placement of mini-plates and intermaxillary fixation screws, while they experienced a mild level with mini-implants. The greatest pain levels were found after the insertion of the temporary anchorage devices (TADs) and then decreased until they became mild or disappeared completely after one month. Speaking, chewing, and cleaning difficulties were more problematic when using TADs compared to conventional anchorage. To obtain good evidence in this area, more high-quality RCTs are needed.

Dental implants survival rates among ectodermal dysplasia patients: aggregation and synthesis of literature data

Background. Consensus statements of several international congresses and conferences include option of using dental implants as a potentially effective treatment alternative for ectodermal dysplasia patients. So far ectodermal dysplasia seems to be the most common disorder which arguments need for using dental implants among growing patients
 Objective. To assess survival rates of dental implants placed among patients with ectodermal dysplasia based on previous literature data.
 Materials and Methods. Bibliographic search of publications potentially related with the objective of present study was held through PubMed database (https://pubmed.ncbi.nlm.nih.gov/), while also via Google Scholar (https://scholar.google.com/) search engine to increase the probability for identification of corresponding scientific articles. Data extraction was provided in selective manner in terms to collect specific rates of dental implants survival observed among ectodermal dysplasia patients.
 Results. Provided analysis revealed that in the majority of studies approximated conventional implants survival rate exceeds 90% for the first five years. Due to the data extracted from systematic reviews implants survival rates among ectodermal dysplasia patients varied in the range of 35.7-98.7%; due to the data extracted from retrospective studies – in the range of 35.7-98.7%; due to the data extracted from prospective studies – in the range of 76-100%; due to the data extracted from critical review of literature – in the range of 88.5-97.6%.
 Conclusion. Provided analysis revealed that dental implants remain reliable treatment option for patients with ectodermal dysplasia. Placement of dental implants among pediatric patients with ectodermal dysplasia characterized with decreased survival rates compare to intraosseous fixtures placed among adult ED patients. Use of mini-implants helps to overcome some complications and shortcomings related with placement of conventional implants among patients with confirmed ectodermal dysplasia diagnosis.

Mini-Implant Rejection Rate in Teenage Patients Depending on Insertion Site: A Retrospective Study.

Mini-implants have undeniable advantages in Orthodontics. However, the use of mini-implants shows some limitations and disadvantages related to patient age, the quality of the bone tissue, the characteristics of the oral mucosa, implant site, the state of health of the organism and the quality of oral hygiene. The aim of this paper was to analyze the rejection rate of mini-implants in teenage patients, depending on their insertion site, and examine their stability up to three months after insertion. This retrospective study was conducted on dental charts belonging to patients aged between 12 and 17 years, from Oradea, Romania. The mini-implants were placed for various therapeutic reasons and were inserted in the following sites: buccal maxillary area, the infrazygomatic region, palatal area, buccal mandibular area and lingual area; they had a diameter of 1.6 mm (inter-radicular spaces) and of 2 mm (nonbearing tooth areas), and a length of 6–8 mm (mandible) or 8–10 mm (maxilla). The rejection rate was checked in the first month, second month, third month and after the third month from insertion. A total of 432 patients were included in the study, and they had a total of 573 mini-implants. Most implants were placed in the buccal region of the maxilla (27.7%), and most patients had one mini-implant placed (65.7%). The highest rejection rate was obtained in the first month (15.2%). The rejection rate between genders was similar. The mini-implants from the buccal mandibular region had a significantly higher rate of rejection in the first month (M1) in comparison to the mini-implants from the palatal region (24.4% vs. 8.3%). The mini-implants from the lingual region of the mandible had a significantly higher rate of rejection in the second month (M2) in comparison to the mini-implants from the infrazygomatic or the palatal region (10.5% vs. 0%/0%). Mini-implants are very useful for carrying out various orthodontic treatments, but their stability should be enhanced.

Dentofacial asymmetry: non-surgical orthodontic treatment using extra-alveolar miniscrews

Asymmetric malocclusions have been always a challenge to orthodontists, with different dental, skeletal or dentoskeletal factors being probable causes for the condition. It is key to distinguish between dental and skeletal asymmetry before determining a predictable force system for corrective treatment. The use of mini-implants (MIs) to address anchorage needs in modern orthodontic practice has become an important tool for orthodontists. They have been widely used for anchorage reinforcement purposes and placed in the dentoalveolar region, especially between tooth roots (inter-radicular miniscrews). However, placement sites other than root areas allow more versatility of orthodontic movement since tooth roots do not interfere in tooth displacement, such as the extra-alveolar miniscrews.Objective The objective of the present paper is to present biomechanical concepts in which extra-alveolar mini-implants are placed in the infrazygomatic crest (IZC) and buccal shelf (BS) areas for correction of dento-facial asymmetries allowing predictable outcomes to be achieved with minimal need for patient's compliance and minor mechanic side effects.

Orthodontic mini-implant success–Analysis and review

Successful orthodontic treatment demands the need for adequate anchorage reinforcement. The growing need for minimum compliance and maximum curative effects has made the mini-implants more acceptable as an excellent substitute to traditional orthodontic anchorage. Mini-implants as skeletal anchorage sources can be used to carry out intrusion, extrusion, anterior retraction, molar protraction and distalization, and correction of midline and occlusal canting etc. Endosseous dental implants have begun to be more reliable sources of anchorage. However, because of complicated surgical procedure, long healing time, and limited implant sites—their use as routine clinical anchorage has remained subtle till date. Also, patient acceptability, rate and severity of adverse effects of miniscrews, and variables that influenced success remain unanswered. In the present article, we systematically reviewed some of the available and unswerving literature to quantify success and complications encountered with the use of mini-implants for orthodontic anchorage, to evaluate factors associated with success or failure.

Comparison of Biomechanical Properties of Surface-Treated and Untreated Machined Orthodontic Mini-Implants: An In Vitro Study

Background and Objectives: The use of mini-implants has become more popular, and there has been a heightened focus on factors that contribute to their success. The purpose of the study is to compare the effects of various surface treatment methods of mini-implants on their bone cutting capacity, insertion torque required, and fracture resistance when compared with the untreated machined mini-implants. Materials and Methods: The study included 4 groups. Each group consisted of 10 orthodontic mini-implants (OMIs). The first experimental group contains titanium oxide coated mini-implants, the second group contains grit-blasted implants with aluminum oxide, the third group consists of mini-implants coated with hydroxyapatite crystals, and the control group is formed by untreated machined mini-implants. Each group is evaluated for cutting efficiency, maximum insertion torque, and fracture resistance using a customized torque testing gauge. Results: The results showed that surface treating OMIs with hydroxyapatite particles increases the surface roughness, thereby enhancing their stability without decreasing the bone cutting ability compared with OMIs without surface treatment. Conclusion: Roughened surface of OMIs with hydroxyapatite particles exhibited maximum fracture resistance without decreased corresponding bone cutting efficiency.

Photobiomodulation stimulates surrounding bone formation and increases stability of titanium alloy miniscrews in ovariectomized rats.

The number of older individuals (> 60years) treated in orthodontic dental practice is constantly growing, and osteoporosis is a common disease within this age range. Orthodontic treatment for this group tends to be challenging, often requiring the use of mini-implants. Mini-implants are important accessories in orthodontic treatment that provide solutions to complex cases. Despite the high level of success, these devices are prone to failure if insufficient bone stability is achieved. This study aimed to evaluate the effects of photobiomodulation on bone neoformation around mini-implants using fluorescence analysis in ovariectomized rats. A total of 12 female rats (Wistar) were ovariectomized and divided into three groups: two groups of low-level laser therapy irradiation in two different protocols, as follows: in the PBM1 group, applications were performed using 2J, for 20s each for 48h, 6 irradiations in total, and in the PBM2 group, a single application of 4J was performed for 40s, and the third group represented the control group, and no laser therapy was applied. Each rat received two mini-implants placed immediately behind the upper incisors, and 0g of force was applied using a NiTi spring. All rats received two bone markers, tetracycline (days 0-4) and alizarin (days 7-10), for 5days each. Both markers were bound to calcium, allowing visualization of bone neoformation through fluorescence microscopy. After 12days, euthanasia was performed; the results revealed that both irradiated groups showed significantly greater bone neoformation compared to the control group (p < 0.05). Mini-implant stability was measured in all animals using the Periotest device on day 0 and on the day of euthanasia. A significant increase in stability was observed in the group that received more laser application (p < 0.05). Photobiomodulation had a positive effect on bone neoformation around mini-implants in ovariectomized rats, with an increase in stability when more irradiation was performed.

Orthodontic management of skeletal Class II malocclusion using three mini-implants- A case report

Vertical dimension issues are frequently regarded as the most difficult dentofacial problems to treat in clinical practice. The difficulty level increases when vertical dysplasia is paired with sagittal discrepancy. The use of mini-implants in Orthodontics has broadened the scope of orthodontic treatment options. The treatment of a 14-year-old female patient with skeletal Class II malocclusion, slight hyperdivergent profile, and enhanced incisor visibility with four premolar extraction followed by comprehensive orthodontic treatment to correct the convex profile and increased incisor visibility, with two posterior implants for retraction and a midline mini implant for intrusion of the anterior maxillary dentoalveolar segment is described in this case report. The active therapy period was 25 months long.

Dental implants and its use in children

Among the various congenital dental abnormalities in children, loss of tooth due to trauma and hypodontia are few that are most prevalent. A wide range of treatment modalities are available for these abnormalities, however, removable prosthesis is the most common treatment option to be used, but a pitfall of this method is that it may increase the residual alveolar bone resorption and other problems related to periodontal support of the remaining teeth. Dental implants, another treatment modality, are generally advocated in adults or young patients that are beyond their craniofacial growth potential. This comprehensive review will discuss the use of dental implants in normal growing patients and some special scenarios including orthodontic consideration and mini-implant use in pediatric population. This review sorted the literature in main themes of influence of growth on the usage of dental implants in children; use of dental implants in children suffering from ectodermal dysplasia; use of dental implants in traumatic dental injuries sustained in children; and for orthodontics intervention during childhood. The literature was searched using databases such as PubMed, Scopus, MEDLINE, and Google. The titles and abstracts were screened, and full text was retrieved for publications that studied the use of dental implants in children in any form of intervention. The results indicated that scientific studies have documented high functional and esthetic results in cases of prosthetic treatments on implants, min-implants in children. However, the use of implants in children is high restricted to anterior mandibular region, with most clinicians opting for growth completion before implant placements. The establishment of the mastication, speech function, and normal appearance is highly crucial for growth of the jaws and facial bones. However, isolated use of mini-implants in growing children has definitely broaden the idea of the use of implant modification in children, yet to achieve maturation.

Use of mini implants for the two-implant retained mandibular overdenture: A prospective study

BackgroundThe two-implant retained mandibular overdenture utilizing nonsplinted implants is a proven treatment modality for completely edentulous patients. However, a lacuna still exists regarding the suitability of mini dental implants for this purpose. The purpose of the study was to evaluate implant stability and crestal bone loss in single-piece mini dental implants loaded with immediate or conventional loading protocols to retain a mandibular overdenture. MethodTwenty-four completely edentulous patients were rehabilitated using conventional maxillary complete denture and a mandibular two-implant retained overdenture utilizing nonsplinted single piece mini implants. The implants were loaded with immediate or conventional loading protocols. Implant stability (with Periotest TM) and crestal bone loss (with radiovisiograph and radiographic grid) were evaluated at the time of loading and at one, two, and six months after loading. Statistical analysis was done with the Independent Samples “t” test and One-Way ANOVA. ResultsMean Periotest Values observed were significantly more negative in implants loaded with the conventional loading protocol. Crestal bone loss was significantly lesser in the immediate loading protocol but was still higher than the requisite 1.5 mm postulated by established criteria. ConclusionTwo single-piece nonsplinted mini implants may be sufficient to retain a mandibular overdenture utilizing the immediate loading protocol. Further studies with a longer duration of observation and larger sample size are required.

The efficiency of mandibular mini-implants in reducing adverse effects of class II elastics in adolescent female patients: a single blinded, randomized controlled trial

BackgroundExcessive proclination of lower incisors and other undesirable consequences usually result from the use of class II elastics during orthodontic treatment. The purpose of this study was to attempt to limit the adverse effects of class II elastics by the use of mini implants placed in the mandibular arch in adolescent class II female patients.MethodsThe sample comprised 28 patients, (a mean age of 15.66 ± 2 years for intervention group and 15.1 ± 2.2 years for conventional group) with one-fourth or one-half unit class II canine relationship. The sample was divided into two equal groups. Randomization was carried out by a computer sequence generator with a 1:1 allocation ratio. In the intervention group, the mini implants were inserted between the lower second premolar and first molar, while the conventional group underwent regular class II elastics therapy. The active elastics treatment time was 8 months for both groups. Results were assessed by measurements from pre- and post-elastics lateral cephalometric radiographs.ResultsThe change in L1 inclination (0.97 ± 0.92°) and L1 AP position (0.31 ± 0.63 mm) did not show a statistically significant difference between the two groups, but a statistically significant difference was found in the U1 retroclination (5.23 ± 1.92°) and U1 distal movement (4.05 ± 1.4 mm) [P ˂ 0.001] and [P ˂ 0.05] respectively in favor of the intervention group.ConclusionMini-implants in conjunction with class II elastics had no skeletal effect, mainly dentoalveolar and it did not prevent the proclination of lower incisors. There was more distal movement in the upper incisors in the skeletal anchorage group which helped in enhancing the camouflaging of class II malocclusion.Trial registrationTrial registered “FUE.REC (10)/10-2018” at the FUE registration council for clinical trials/IOP Orthodontic Program October 2018.

A novel approach to retrieve fractured mini implants

Mini implant screws are accepted world wide as it provides a stable anchorage for the various types of orthodontic tooth movements. Use of mini screw implant includes risks such as screw fracture and screw failure. With the increased use of mini implants in dentistry, there is increase in cases of mini implant fracture. Reporting and management of fractured mini implant has not been given adequate importance. We are presenting a case of successful management of fractured mini implant using ultrasonic vibrations.

Class III malocclusion: a challenging treatment using miniscrews for extra anchorage

Abstract Aims This article presents the nonsurgical orthodontic treatment of a skeletal Class III malocclusion of an adult patient. Methods Because the patient refused an orthognathic surgical procedure, the mandibular first premolars were extracted and orthodontic camouflage using miniscrew anchorage was used to correct dental asymmetries and the occlusal relationship. Results The treatment strategy was successful and provided an acceptable aesthetic functional occlusion. Conclusion When appropriately indicated, the orthodontic camouflage of a class III malocclusion can avoid orthognathic surgery and, through the use of mini-implants as skeletal anchorage, enhance the results.

Intercorrência na instalação de miniparafuso buccal shelf – relato de caso

The use of dental support as orthodontic anchorage, used in conventional corrective orthodontic treatment, may interfere in the proper functioning of the applied mechanics, because the teeth that are used as support may suffer displacement. Nowadays, the use of miniimplants, among them buccal-shelf, has been increasingly used, as they reduce the chances of possible side effects resulting from the mechanics, because the support ceases to be dental and becomes skeletal. Despite low failure rate, according to the literature, difficulty of access and individual determination of the best area of installation of this type of miniscrew should be thoroughly evaluated, in addition to verification of bone conditions, thus avoiding the risk of poor insertion. This article presents a case of installation of an extra-alveolar miniscrew buccal-shelf type in which the device ended up being inserted in an inadequate trajectory, causing an acute inflammatory process. After removal of the extra-alveolar mini-screw, a new installation was performed guided by cone-beam computed tomography, and the orthodontic treatment was successfully concluded.

Different Interventions for Rehabilitation of the Edentulous Maxilla with Implant-Supported Prostheses: An Overview of Systematic Reviews.

To synthesize evidence derived from systematic reviews (SRs) on different interventions for rehabilitation of the edentulous maxilla with implant-supported restorations. A protocol-oriented search was established to address the PICO question: What is the current evidence regarding rehabilitation of the edentulous maxilla with different implant-supported prostheses in terms of implant and prosthesis survival? The primary outcomes were implant and prosthesis survival rates evaluated from SRs of clinical studies including adult patients with complete edentulism of the maxilla and comparing different implant-supported rehabilitation strategies. Methodologic quality of the SRs was assessed with the AMSTAR-2 tool. The final selection process led to the inclusion of 36 SRs that were grouped as: (1) addressing maxillae with sufficient bone to place implants; (2) addressing maxillae with insufficient bone to place implants; and (3) comparing different types of prosthesis, number of implants, patient-reported outcomes, and economic evaluations. The literature describes four or more implants as suitable for full-arch fixed prostheses and implant-supported overdentures; in both cases, the overall survival rate is > 95%. Mini-implants present very high short-term failure rates (> 30%). Poor description of technical complications, adjustments, and maintenance and corresponding costs precluded a cost-effectiveness analysis. No implant-supported rehabilitation of the edentulous maxilla (fixed or removable) should be supported on fewer than four implants. A one-piece full-arch fixed dental prosthesis can be supported by a minimum of two anterior axial plus two posterior distally tilted implants or by six to eight axial implants symmetrically distributed through the posterior and anterior regions of the arch. Four to six implants is the advised number to support an overdenture. The use of mini-implants in the maxilla is inadvisable.