Evidence-based selection of orthodontic miniscrews, increasing their success rate in the mandibular buccal shelf. A randomized, prospective clinical trial

Michał Sarul, Joanna Lis, Hyo-Sang Park, Kornelia Rumin, Michał Sarul, Joanna Lis, Hyo-Sang Park, Kornelia Rumin

Abstract

Background: Skeletal anchorage has made it possible to perform complex orthodontic tooth movements that are difficult or even impossible to achieve with conventional orthodontic treatment. Mandibular buccal shelf miniscrews, used for distalization, play a particularly important role in treatment of Class III malocclusion. Unfortunately, stability of the miniscrews placed in the mandible is still considered at higher risk of failure compared to other intraoral locations. The aim of our study was to determine the influence of the miniscrew size on their long-term stability, occurrence of oral mucosa inflammation and pain lasting over 48 h after implantation.

Methods: 184 Absoanchor® miniscrews (Dentos, South Korea) in two sizes: SH2018-10 (length 10 mm, ø 1.8-2.0 mm) and SH1514-08 (length 8 mm, ø 1.4-1.5 mm) were inserted in the mandibular buccal shelf in 92 Caucasians aged 20-50 years, diagnosed with Class III malocclusion that required en-masse distalization of the mandibular dentition. Data was statistically analyzed with the level of significance set at p = .05.

Results: 91.3% of the SH2018-10 and 75% of the SH1514-08 miniscrews were stable, and this difference was statistically significant (p < .05). Inflammation of the oral mucosa was noticed around both types of miniscrews and affected 50% of the SH2018-10 and 26.09% of the SH1514-08 group (p < .05). Pain lasting longer than 48 h after implantation was related to 60.87% and 20.65% of the SH2018-10 and the SH1514-08 miniscrews (p < .05), respectively. Inflammation associated with larger SH2018-10 miniscrews did not affect their stability (p > .05), contrary to the SH1514-08 ones (p < .05). When inflammation was present, the overall success rate declined to 64.29%, from 94.74% noted for TADs without inflammation. According to the log-rank test, smaller TADs failed significantly sooner than the larger ones (p = .002).

Conclusion: Larger SH2018-10 miniscrews are the anchorage of choice for the mandibular buccal shelf, despite triggering inflammation and long-lasting pain significantly more often than the smaller ones. Therefore, this issue should be discussed with every patient prior to miniscrew use. Trial registration ID: ClinicalTrials.gov Identifier: NCT05280678 Date of Registration: 15/03/2022. Retrospectively registered.

Keywords: Mandible; Orthodontic anchorage procedures; Orthodontics.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT participant flow diagram
Fig. 2
Fig. 2
Mini-implants used in the study (from left to right): SH 1514-08 and SH 2018-10
Fig. 3
Fig. 3
TADs allocation securing randomization. captions: R–right side, L–left side
Fig. 4
Fig. 4
TAD insertion area
Fig. 5
Fig. 5
Frontal cross-section of mandibular buccal shelf illustrating axial inclination of the TAD (extra-alveolar approach)
Fig. 6
Fig. 6
Survival distribution of the mini-implants with respect to their size: SH1514-08 and SH2018-10.

References

    1. Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent. 1983;50(3):399–410. doi: 10.1016/S0022-3913(83)80101-2.
    1. Kanomi R. Mini-implant for orthodontic anchorage. J Clin Orthod. 1997;31(11):763–7.
    1. Costa A, Raffainl M, Melsen B. Miniscrews as orthodontic anchorage: a preliminary report. Int J Adult Orthodon Orthognath Surg. 1998;13(3):201–9.
    1. Park HS, Bae SM, Kyung HM, Sung JH. Micro-implant anchorage for treatment of skeletal class I bialveolar protrusion. J Clin Orthod. 2001;35(7):417–22.
    1. Wahabuddin S, Mascarenhas R, Iqbal M, Husain A. Clinical application of micro-implant anchorage in initial orthodontic retraction. J Oral Implantol. 2015;41(1):77–84. doi: 10.1563/AAID-JOI-D-12-00227.
    1. Antoszewska J, Raftowicz-Wójcik K, Kawala B, Matthews-Brzozowska T. Biological factors involved in implant-anchored orthodontics and in prosthetic-implant therapy: a literature review. Arch Immunol Ther Exp. 2010;58(5):379–83. doi: 10.1007/s00005-010-0088-8.
    1. Tan JM, Liu YM, Chiu HC, Chen Y. Molar distalization by temporary anchorage devices (TADs)–a review article. Taiwan J Orthod. 2017;29(1):8–15.
    1. Hu H, Chen J, Guo J, Li F, Liu Z, He S, Zou S. Distalization of the mandibular dentition of an adult with a skeletal Class III malocclusion. Am J Orthod Dentofacial Orthop. 2012;142(6):854–62. doi: 10.1016/j.ajodo.2011.03.030.
    1. Alharbi F, Almuzian M, Bearn D. Miniscrews failure rate in orthodontics: systematic review and meta-analysis. Eur J Orthod. 2018;40(5):519–30. doi: 10.1093/ejo/cjx093.
    1. Papageorgiou SN, Zogakis IP, Papadopoulos MA. Failure rates and associated risk factors of orthodontic miniscrew implants: a meta-analysis. Am J Orthod Dentofacial Orthop. 2012;142(5):577–95. doi: 10.1016/j.ajodo.2012.05.016.
    1. Park HS, Jeong SH, Kwon OW. Factors affecting the clinical success of screw implants used as orthodontic anchorage. Am J Orthod Dentofacial Orthop. 2006;130(1):18–25. doi: 10.1016/j.ajodo.2004.11.032.
    1. Antoszewska J, Papadopoulos MA, Park HS, Ludwig B. Five-year experience with orthodontic miniscrew implants: a retrospective investigation of factors influencing success rates. Am J Orthod Dentofacial Orthop. 2009;136(2):158.e1–158.e10.
    1. Chang C, Liu SSY, Roberts WE. Primary failure rate for 1680 extra-alveolar mandibular buccal shelf mini-screws placed in movable mucosa or attached gingva. Angle Orthod. 2015;85(6):905–10. doi: 10.2319/092714.695.1.
    1. Hong SB, Kusnoto B, Kim EJ, BeGole EA, Hwang HS, Lim HJ. Prognostic factors associated with the success rates of posterior orthodontic mini-screw implants: a subgroup meta-analysis. Korean J Orthod. 2016;46(2):111–26. doi: 10.4041/kjod.2016.46.2.111.
    1. Sarul M, Minch L, Park HS, Antoszewska-Smith J. Effect of the length of orthodontic mini screw implants on their long term stability: a prospective study. Angle Orthod. 2015;85(1):33–8. doi: 10.2319/112113-857.1.
    1. Liu TC, Chang CH, Wong TY, Liu JK. Finite element analysis of miniscrew implants used for orthodontic anchorage. Am J Orthod Dentofacial Orthop. 2012;141(4):468–76. doi: 10.1016/j.ajodo.2011.11.012.
    1. Lu YJ, Chang SH, Ye JT, Ye YS, Yu YS. Finite element analysis of bone stress around micro-implants of different diameters and lengths with application of a single or composite torque force. PLoS ONE. 2015;10(12):e0144744. doi: 10.1371/journal.pone.0144744.
    1. Barros SE, Vanz V, Chiqueto K, Janson G, Ferreira E. Mechanical strength of stainless steel and titanium alloy mini-implants with different diameters: an experimental laboratory study. Prog Orthod. 2021;22(1):9. doi: 10.1186/s40510-021-00352-w.
    1. Nicholson JW. Titanium alloys for dental implants: a review. Prosthesis. 2020;2(2):100–16. doi: 10.3390/prosthesis2020011.
    1. Kuroda S, Sugawara Y, Deguchi T, Kyung HM, Takano-Yamamoto T. Clinical use of mini-screw implants as orthodontic anchorage: success rates and postoperative discomfort. Am J Orthod Dentofacial Orthop. 2007;131(1):9–15. doi: 10.1016/j.ajodo.2005.02.032.
    1. Tseng YC, Hsieh CH, Chen CH, Shen YS, Huang IY, Chen CM. The application of mini-implants for orthodontic anchorage. Int J Oral Maxillofac Surg. 2006;35(8):704–7. doi: 10.1016/j.ijom.2006.02.018.
    1. Chen CH, Chang CS, Hsieh CH, Tseng YC, Shen YS, Huang IY, et al. The use of micro-implants in orthodontic anchorage. J Oral Maxil Surg. 2006;64:1209–13. doi: 10.1016/j.joms.2006.04.016.
    1. Miyawaki S, Koyama I, Inoue M, Mishima K, Sugahara T, Takano-Yamamoto T. Factors associated with the stability of titanium screws placed in the posterior region for orthodontic anchorage. Am J Orthod Dentofacial Orthop. 2003;124(4):373–8. doi: 10.1016/S0889-5406(03)00565-1.
    1. Manni A, Cozzani M, Tamborrino F, De Rinaldis S, Menini A. Factors influencing the stability of miniscrews. A retrospective study on 300 miniscrews. Eur J Orthod. 2011;33(4):388–95. doi: 10.1093/ejo/cjq090.
    1. Beltrami R, Sfondrini Mf, Confalonieri L, Carbone L, Bernardinelli L. Miniscrews and mini-implants success rates in orthodontic treatments: a systematic review and meta-analysis of several clinical parameters. Dentistry. 2015;5(12):346. doi: 10.4172/2161-1122.1000346.
    1. Zitzmann NU, Berglundh T, Ericsson I, Lindhe J. Spontaneous progression of experimentally induced peri-implantitis. J Clin Periodontol. 2004;31(10):845–9. doi: 10.1111/j.1600-051X.2004.00567.x.
    1. Sharma P, Valiathan A, Sivakumar A. Success rate of microimplants in a university orthodontic clinic. ISRN Surg. 2011;2011:982671. doi: 10.5402/2011/982671.
    1. Luzi C, Verna C, Melsen B. Guidelines for success in placement of orthodontic mini-implants. J Clin Orthod. 2009;43(1):39–44.
    1. Kravitz ND, Kusnoto B. Risks and complications of orthodontic miniscrews. Am J Orthod Dentofacial Orthop. 2007;131(Suppl 4):43–51. doi: 10.1016/j.ajodo.2006.04.027.
    1. Tezel A, Orbak R, Canakci V. The effect of right or left-handedness on oral hygiene. Int J Neurosci. 2001;109(1–2):1–9. doi: 10.3109/00207450108986521.
    1. Andrucioli MCD, Matsumoto MAN, Fukada SY, Saraiva MCP, Bergamo AZN, Romano FL, et al. Quantification of pro-inflammatory cytokines and osteoclastogenesis markers in successful and failed orthodontic mini-implants. J Appl Oral Sci. 2019;27:e20180476. doi: 10.1590/1678-7757-2018-0476.
    1. Zhu J, Guo B, Fu M, Guo W, Yuan Y, Yuan H, et al. Interleukin-6-174G/C polymorphism contributes to periodontitis susceptibility: An updated meta-analysis of 21 case-control studies. Dis Markers. 2016;2016:9612421.
    1. Narazaki M, Kishimoto T. The two-faced cytokine IL-6 in host defense and diseases. Int J Mol Sci. 2018;19(11):3528. doi: 10.3390/ijms19113528.
    1. Baxmann M, McDonald F, Bourauel C, Jäger A. Expectations, acceptance, and preferences regarding microimplant treatment in orthodontic patients: a randomized controlled trial. Am J Orthod Dentofacial Orthop. 2010;138(3):250.e1–250.e10.
    1. Lee TCK, McGrath CPJ, Wong RWK, Rabie ABM. Patients’ perceptions regarding microimplant as anchorage in orthodontics. Angle Orthod. 2008;78(2):228–33. doi: 10.2319/040507-172.1.
    1. Wiechmann D, Meyer U, Büchter A. Success rate of mini- and micro-implants used for orthodontic anchorage: a prospective clinical study. Clin Oral Implants Res. 2007;18(2):263–7. doi: 10.1111/j.1600-0501.2006.01325.x.
    1. Garfinkle JS, Cunningham LL, Jr, Beeman CS, Kluemper GT, Hicks EP, Kim MO. Evaluation of orthodontic mini-implant anchorage in premolar extraction therapy in adolescents. Am J Orthod Dentofacial Orthop. 2008;133(5):642–53. doi: 10.1016/j.ajodo.2006.04.053.

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