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VARIOUS METHODS TO LOCATE

IDEAL SITE FOR MINI IMPLANT


PLACEMENT
Vishnu kantham mula
pg
Contents
• Introduction
• Historical back ground
• Mini implant design
• Classification
• Methods to locate ideal site for placing mini implant
• Placement sites and safe zones in the maxilla
• Placement sites and safe zones in the mandible
• Applications
• Complications
• Conclusion
• References
Introduction
• Traditionally, anchorage in orthodontics has been reinforced by various intraoral
and extraoral methods.
• With the advent and introduction of mini-implants as anchorage system, several
disadvantages, including complicated appliance design and the need for patient
cooperation, have been almost eliminated.
• The mini-implant anchorage system is less invasive, easy to place and remove,
allows immediate loading, cost-effective and has few anatomic limitations when
compared with conventional implants.
• With our improved understanding of the biomechanics, an array of tooth
movements are possible with mini-implants.
Historical back ground
• Basal bone anchorage was suggested more than 60 yrs ago as an alternative to
increasing the number of teeth to achieve conventional anchorage.
• Orthopedists have used stainless steel bone screws for leg lengthening since
1905.
• 1945- concept of using pin or screw to the ramus was initiated not only for
moving teeth, but also for exerting a pull on the mandible.
• vitallium screws-study on dogs- more susceptible to infection
• Taken 60 yrs to progress- stainless steel – vitallium – titanium
• Type v titanium( 6% aluminium and 4% vanadium) – material of choice for bone
screws.
• The first use of a surgical screw as anchorage was described by Creekmore in a
case report of a single patient but this did not immediately attract a lot of
attention (Creekmore and Eklund1983).
• Kanomi demonstrated the use of a small screw as anchorage for the
displacement of the lower incisors
• Costa et al., also used a surgical screw, primarily as an easier alternative of the
zygoma wire.
• Development of the Aarhus Mini-implant system was initiated in 1996 by
Professor Birte Melsen at the University of Aarhus, based on her prior studies of
the use of skeletal anchorage for orthodontic treatment.
• Orthodontic purpose- standard implants of 3.25-7mm in diameter were less than
ideal
-require multiple stage surgical procedures
-require waiting period of 4-6 months for osseointegration
-lack of adequate bone to place
-anatomic limitations
-invasive, expensive and uncomfortable
• So a variety of small titanium screws were developed
-less expensive
-few anatomic limitations
-easy to place and remove
-allow for immediate loading since osseointegration is
not prerequisite
-less expensive
-improve orthodontic treatment result while improving
patient complience
Mini implant design
Head:
-provide twisting torque to the core and helix
-act as an application point force
Bone screw:
-generally used for closed implants, so they require less prominent head
shape
-a female type means of engaging a screw driver is preferable
Orthodontic screw:
-used for open implants, prominent head shape
-a male type means of engaging a screw driver favourable
Core:
-forms support
-cross sectional area determines torsional strength
Helix or thread:
-shape of thread is related to insertion methods and stress distribution
Improvements in design

• Linkow 1970- proposed use of blade implant as anchorage for class II elastics
• Creekmore and eklund 1983- used bone screw to intrude maxillary incisors
• Block-”onplant’’ palatal anchorage device and
wehrbein et al- orthosystem(straumann), both of which require osseointegrated
interface
• Kanomi 1997- used mini screw in intrusion case
• 1998- zygoma ligatures were introduced as an option for anchorage
classification
• Depending on the area of implantation:

subperiosteal endosseous transosseous


• Depending on their shape:
-screw type: dentos absoanchor implant system, aurhus
implant, spider screw, OMAS system and leone
mini implant
-blade type: SAS, graz implant supported system and
zygoma anchorage system
-cylinder type: root form implants
• Depending on condition of exposure:
-closed implants
-open implants
• According to the method of insertion:
-pretapped
-self tapping
-self drilling
Pretapped:
-used in harder and less compressible materials such as in metal or in
cortical bone
-because the screw threads cannot readily compress these firm
materials, pretapped screws require the use of a tap to precut the
thread
-not suitable for thin bone such as maxilla
• Self tapping:
-used in softer and less compressible materials and forms threads by
compressing and cutting through surrounding materials
- have fluted leading edge and require only a predrilling procedures

• Self drilling screws:


- have a corkscrew - like tip
-therefore, neither predrilling nor tapping procedures are
needed
Methods to locate ideal site for mini implant
placement
• Success with mini-implant anchorage system depends on factors related to the
clinician, patient and the screw itself.

• Incorrect mini-implant insertion technique has been identified as a primary cause


of failure in this system.

• Precise positioning of the implants requires a careful assessment of clinical and


radiographical implant site to maximize the available bone volume and avoid
important anatomical structures like roots,nerves, blood vessels, etc.
• To maximize the depth of implant into the bone, the clinician must consider three
major parameters:
-topographical entry point of the implant
-anteroposterior angle of entry
- vertical inclination of entry

• Recommended angles of the implant to the long axes of the teeth have ranged
from 10-20° in the mandible and from 30-40° in the maxilla.
• The use of a guidance device can facilitate accurate mini-implant placement.
Safe zones for mini implant placement
• A minimal clearance of 1 mm of alveolar bone around the screw has been
recommended to preserve the periodontal health.
• Therefore, when the diameter of the miniscrew and the minimum clearance of
alveolar bone are considered, interradicular space larger than 3 mm is needed for
safe miniscrew placement.
• Several studies have been performed to assess the safe locations in the
interradicular spaces for miniscrew placement, the so-called ‘‘safe zones”.
Safe zones
Paola Maria Poggio et al.. (Angle 2006)
• Provides an anatomical map to assist the clinician in miniscrew placement in a
safe location between dental roots.
• Volumetric tomographic images of 25 maxillae and 25 mandibles taken with the
NewTom SystemT were examined.
• For each interradicular space, the mesiodistal and the buccolingual distances
were measured at 2, 5, 8, and 11 mm from the alveolar crest.
Mesiodistal measurements

Posterior maxilla Anterior maxilla Mandibular arch


Buccolingual measurements
maxilla
• Mesiodistal dimension
• Palatal side:
• The greatest amount of mesiodistal bone was on the palatal side
between the first molar and the 2nd premolar (5.5 mm SD 1.3, at five-
mm depth); and the least amount of bone was at the
tuberosity(0.2mm at 11mm depth).
• Buccal side:
• The greatest amount of mesiodistal bone was between the first and
second premolars(3.5mm) and between the canine and first
premolar(4.3mm)
• Less mesiodistal space is available on the buccal side than on the
palatal side. This indicates that more sites for a safe screw insertion
are available on the palatal side than on the buccal side.
Buccopalatal dimension:
• In the buccopalatal dimension, the greatest amount of space is
between the first and second molars (14.3 mm SD 1.1, at five mm
from the alveolar crest).
mandible
• Mesiodistal dimension:
• The greatest amount of bone in the mesiodistal dimension was
between first and second premolars (4.9 mm SD 1.0, at 11-mm depth)
and the least amount of bone was between the first premolar and the
canine(2.7mm SD 0.7 at 2mm depth)
• Buccolingual dimension:
• The greatest amount of bone was between the first and second
molars (13.4mm SD 1.5, at eight- and 11-mm depth), and the least
between the first premolar and canine (6.8 mm SD 1.0, at two-mm
depth).
• Both in the maxilla and in the mandible, the mesiodistal interradicular
measurements are less than the buccolingual ones and, therefore,
they represent the key parameter to define an interradicular space
suitable for miniscrew insertion.
• The order of the safer sites available in the interradicular spaces of
the posterior maxilla is as follows:
• On the palatal side: the interradicular space between the maxillary first molar
and second premolar, from 2 to 8 mm from the alveolar crest.

• On the palatal side: the interradicular space between the maxillary second and
first molars, from 2 to 5 mm from the alveolar crest.

• Both on buccal or palatal side between the second and first premolar, between 5
and 11 mm from the alveolar crest.
• Both on buccal or palatal side between the first premolar and canine, between 5
and 11 mm from the alveolar crest.
• On the buccal side, in the interradicular space between the first molar and
second premolar, from 5 to 8 mm from the alveolar crest.
• In the maxilla, the more anterior and the more apical, the safer the location
becomes.
• The order of the safer sites available in the interradicular spaces of the posterior
mandible:

• Interradicular spaces between the second and first molar.


• Interradicular spaces between the second and first premolar.
• Interradicular spaces between the first molar and second premolar at 11 mm
from alveolar crest.
• Interradicular spaces between the first premolar and canine at 11 mm from the
alveolar crest.
• In the palatal area safer zones for placement of miniscrew determined
based on bone density.
• Bone density is classified into 4 types D1, D2, D3 and D4.
• D1, D2, D3 are optimal for self-drilling miniscrews and Implant
placement in D4 not recommended.
• Based on bone density mid palatal suture (D1&D2) in the hard
palate considered as safer zone in palate.
• D3 bone density seen in paltal slopes at region of 1st, 2nd and 1st
molar area.
• D4 bone density is seen at the most posterior palate.
• Based on Soft tissue considerations, Thin and keratinized mucosa is
the preferred area for implant placement.
Optimal sites assesd by CBCT
Mona Mohamed Salah Fayeda et al…(2010)
• The optimal sites for mini-implant placement in the maxilla and the
mandible based on dimensional mapping of the interradicular spaces
and cortical bone thickness
• The effect of age and sex on the studied anatomic measurements.
• The cone beam computed tomography images of 100 patients (46
males, 54 females) divided into two age groups (13–18 years), and
(19–27 years) were used. The
• following interradicular measurements were performed:
• (1) Buccolingual bone thickness
• (2) Mesiodistal spaces both buccally and palatally/lingually; and
• (3) Buccal and palatal/lingual cortical thicknesses.
• Anterior Maxilla:
• The highest buccolingual thickness was found between the right
central and lateral incisor at the 6- mm level, which decreased the
more cervical the measurements were taken.
• The lowest buccolingual thickness was between the central incisors at
the 2-mm and 4-mm level.
• The highest mesiodistal distance from the buccal side between the
central incisors at the 6-mm level was, and the lowest was between
the left central and lateral incisor.
• The highest mesiodistal distance from the palatal side and buccal cortical
thickness was between the lateral incisor and canine at the 6-mm level (3.73 6
1.28), and (1.24 6 0.53), respectively.
• The greatest palatal cortical thickness was at the 6-mm level between the central
and lateral incisor (1.85 6 0.64) and the lateral incisor and canine (1.75 6 0.59)
and was greater in the anterior region than in the posterior region
Posterior maxilla
• The highest buccolingual thickness was found at the 6-mm level between the first
and second molars.
• The highest mesiodistal distances, both buccally and palatally, were found
between the second premolar and the first molar
• A certain pattern was found in the thickness of the buccal cortex: at the 2-mm
level, the thickness was 1.35 0.35 between first and second molars, but it
increased to 1.36 6 0.31 at 4 mm and then decreased to 1.32 6 0.3214 at 6 mm.
• The highest palatal cortical bone thickness was found between the canine and
the first premolar at the 6-mm level
Anterior Mandible

• The highest buccolingual thickness, mesiodistal distances labially and lingually,


and cortical thicknesses both labially and lingually were found between the
lateral incisor and canine at the 6-mm level
• The lowest measured dimensions were found between the central incisors.
Posterior Mandible

• The highest buccolingual thickness and buccal cortical thickness were between
the first and second molars
• The highest mesiodistal distance from the buccal side was found between the
second premolar and the first molar and the highest mesiodistal distance from
the lingual side was between the first and second premolars .
• The thickest lingual cortex was found between the canine and the first premolar
• The males and the age group older than 18 years had a significantly higher
buccolingual, palatal, and buccal cortical thickness at specific levels and sites in
the maxilla and the mandible.
Safe Zones’’ in different dentoskeletal patterns

Pajongjit Chaimanee et al.. (2011)


• In the maxilla greatest interradicular space was between the second premolar
and the first molar. In the mandible, the greatest interradicular space was
between the first and second molars, followed by the first and second premolars.
• Significant differences in interradicular spaces among the skeletal patterns were
observed.
• Maxillary interradicular spaces, particularly between the first and second molars,
in the subjects with skeletal Class II patterns, were greater than those in the
subjects with skeletal Class III patterns.
• In contrast, in the mandible, interradicular spaces in the subjects with skeletal
Class III patterns were greater than those in the subjects with skeletal Class II
patterns.
• For all skeletal patterns, the safest zones were the spaces between the second
premolar and the first molar in the maxilla, and between the first and second
premolars and between the first and second molars in the mandible.

• The availability of interradicular space was mainly influenced by the axial


inclination of teeth due to dentoalveolar compensatory changes for variations in
sagittal skeletal discrepancies.

• Understanding the relationship between the skeletal pattern and the availability
of interradicular space may aid the clinician in planning appropriate surgical sites
for miniscrew implant placement.
Insertion sites for mini-implants
A micro-CT study-Morten G. Laursena et al..

• Assesed thickness of the cortical bone in insertion sites


• assessed the impact of a change in insertion angle on primary
cortical bone-to-implant contact
• evaluated the risk of maxillary sinus perforation.
• In the maxilla, the overall mean cortical
thickness at 90u was 0.7 mm buccally in the
lateral region, 1.0 mm buccally in the anterior
region, and 1.3 mm palatally.
• In the mandible, the mean cortical thickness
was 0.7 mm buccally and 1.8 mm lingually in
the anterior region; 1.9 mm buccally and 2.6
mm lingually in the lateral region.
• Changing the insertion angle from 90u to 45u
increased the cortical bone-to-implant contact
by an average of 47%.

The thickness of the buccal and lingual cortical bone was measured at mid-root level (red dotted line). Mini-
implant insertion was simulated with angulations of 45u and 90u to the long axis of the teeth.
• Perpendicular insertion at the mid-root level only rarely interfered
with the sinus, whereas apically inclined insertion increased the risk
of sinus perforation.
The various guides to locate ideal site for placing mini implants includes:
-surgical guides
-surgical stent
-CBCT guides
-3D radiographic guide
-wire or metal guides:
-cross bar
-jiffy jig
-tray grid guide
-wire jig
-2D placement positioning guide
-simple and efficient guide by dileep n kumar et al
-universal guide
surgical guides
Surgical guide by camillo morea et al..(jco 2005):

• a new surgical guide that provides three-dimensional surgical bur


control for accurate placement of non-selftapping orthodontic mini-
implants at the desired location and angle.
Surgical Guide Fabrication
• Retracted upper anteriors without loss of anchorage with help of this guide.
• This allows precise implant location to be conveyed from the orthodontist to oral
surgeon
Radiographic and surgical template
Jian-chao Wu et al.. INT J ORAL MAXILLOFAC IMPLANTS 2006;
• The radiographic and surgical template used in the placement of bicortical
miniscrews in the areas between dental roots invented by Freudenthaler and
associates is effective but has the disadvantages of requiring computerized
tomography (CT) and being more complicated to fabricate.
• An effective radiographic and surgical template for the placement of
microimplants in interradicular regions without contacting the dental roots has
been developed.
• They retracted upper anteriors with help of this guide.
Fabrication of a Radiographic Template
Fabrication of a Surgical Template
• Advantages :
• This surgical template can assist the surgeon in determining the amount of bone
available for microimplant placement between the roots and the direction in
which to drill.
• It can be used successfully to place orthodontic microimplants in the correct
position.
Surgical guide
Seong-Hun Kim et al.. AJODO 2007
• A safe, accurate, and simple system for locating mini-implants with CBCT data has
been developed.

• A presurgical 3D model of the patient’s teeth and underlying alveolar bone


anatomy was created; this allowed the clinician to place the mini-implants in
predetermined positions.
surgical guide fabrication

• Three-dimensional CBCT images were taken of the posterior maxilla by using a


new type of CBCT system (PSR 9000N, Asahi Roentgen, Kyoto, Japan) that delivers
0.1 mm in voxel size.
• Advantage of this model was improved reproducibility of anatomical structures
with acquisition of a 0.15-mm slice.
• A CBCT record that was transformed into DICOM format was changed into 3D
images.
• A replica model of the right posterior maxilla was fabricated by using the SLA
(steriolithographic apparatus) method
3D imaging for replica model construction Replica model using SLA method
Advantages:
• Low radiation dose
• High resolution in three dimensions
• Placement of implants easier and safer with CBCT guide
stereolithographic surgical guide
Kim et al..wjo 2008

• method of making a surgical guide on a model produced from data acquired in a


high-resolution CBCT.
• The orthodontist or surgeon can acquire the CBCT and plan the safe and accurate
placement of the device with software.
• Three-dimensional reconstruction view of CBCT data
using SimPlant software.
• The simulated position of the orthodontic miniimplant
in the panoramic mode.
Surgical guide fabrication
• The surgical guide was constructed with a rapid prototyping (RP) machine that
uses stereolithography, a layer-additive rapid prototyping process based on
photopolymer liquid resins that solidify when exposed to UV light.
• The RP machine reads the diameter and angulation of the simulated implant,
selectively polymerizes the resin around the implant, and forms a cylindrical
guide on the replica corresponding to each implant.
• The technician then removes the supporting resin and uses the cylindrical guide
to insert surgical grade stainless steel tubing to serve as the guide tube.
guide A for soft tissue
guide B for a 1.5 mm in
punching and
diameter guide drill
mini-implant placement
SurgiGuide procedure
• C-implants (Cimplant, Seoul, South Korea) were used as the skeletal anchorage
mini-implant.
• It is a 2-component (head and screw) sandblasted, large-grit, and acid-etched
(SLA) mini-implant.
• Stability is provided primarily by osseointegration and secondarily by mechanical
retention.
• The screw was 1.8 mm in diameter and 8.5 mm long.
CBCT view after insertion
Advantages:
• Simulation software for easy planning and placement
• Better accuracy than 2D IOPA’S
3-D radiographic-surgical guide: drill-free screws
Se´rgio Estelita et al.. AJODO 2009

• Drill-free screws (DFS) can be considered a significant advance in mini-implant


design.
• DFS prevents tooth root damage from surgical drill.
• DFS placement success depends on correct positioning in the interradicular
septum.
• If complications and failures increase because of improperly positioned screws in
the interradicular septum, an accurate surgical guide should be used to direct the
3-dimensional (3D) course of the screw regarding adjacent tooth roots.

• Graduated3D radiographic-surgical guide (G-RSG) used to predict the final DFS


position in the interradicular septum.
3D RADIOGRAPHIC SURGICAL
GUIDE WITH COAXIAL
RADIOGRAPHIC POSITIONER

• 0.040-in telescopic
tube with a graduated
scale
• horizontal arm is made
of a 0.021 × 0.025-in
stainless steel wire
• Advantages:
• Accuracy and risk index were evaluated
• Allows accurate prediction of the final DFS position
Crossbar
Anup Belludi et al..J of Ind Ortho Soc 2010;

21 × 25 stainless steel
rectangular crossbar
• This implant guide used for intrusion of maxillary anteriors after initial leveling
and aligning.
Advantages:
• Easy to fabricate
• Less chair time
• can be used on any tooth bracket
• easily interchangeable
• adjustable in vertical direction according to the desired position clinically
JIFFY JIG
A. nandakumar and Jeetinder kumarsingla (2011)

• A quick chair side micro implant guide


• Fabrication:

• Peri-apical radiograph of the area of implant placement


is taken using parallax technique.
• Radiograph is traced onto an OHP sheet.
• Point of implant placement is transferred to the traced OHP sheet and a
hole is punched in the OHP sheet.
• Brass wire piece attached to OHP sheet acts as guide for long axis of
the tooth.
• The OHP sheet is cut into the shape of teeth with a part extending
occlusally to stabilize the sheet intra-orally
• The “JIFFY JIG” is placed in the mouth with the tracing coinciding with the
natural teeth and the occlusal extension is stabilized using putty material
Advantages:

• limited time
• making the placement of implants simpler
• “JIFFY JIG” provides a short and accurate technique for micro implant placement
and can be used for day to day clinical practice.
AUSOM(Aleppo University Surgical Orthodontic Miniscrew)
Al-Suleiman and Shehadah (2011)

• 3D placement guide
• It is used to determine the ideal position and to place mini-implants in the
optimal recommended position.
Invented this by considering following conditions:
• Versatile
• 3D adjustable
• Universal
• Comfortable
• Simple design
• sterilizable
• The AUSOM consists of four pieces:

• The vertical part is a graduated stainless


steel round cogged wire 1.2 mm in diameter
• The horizontal part
• The placement guide is a vertical round wire
Rinn XCP 1 mm in diameter.
• The film-holding part
Procedure:
Advantages:
• works as a radiographic locator as well as a 3D surgical placement guide
• 3D adjustable guide, it can determine the point of implant insertion
• simple design and is easy to use
• Its design allows easy and rapid attachment at any position along a
maxillary or mandibular archwire, with either labial or lingual appliances.
• It saves time; there is no need to repeat radiographs to determe if the new
position is acceptable
• It is less expensive
• There is no need for laboratory fabrication, and it can be reused after
sterilization.
• can be used with self-drilling and predrilling mini-implants.
• Patient discomfort is minimal, and the guide can easily be removed from
the archwire after mini-implant placement and reused on the opposite
side, saving chair time and expense.
Tray-Grid Guide
Madhukar Reddy Rachala et al..(JIOS 2012)

• Tray- Grid Guide (TGG) using thermoplastic Erkodent sheets as tray and grid made
of 0.012“ ligature wire has been designed that provides an accurate guidance in
terms of both location and angulations with minimal complications.
Fabrication

0.012 ” ligature

Erkopress machine
TGG
Advantages:
• Flexibile, can use in any part of the arch.
• Erkodent transfer tray is easy to fabricate, rigid enough to withstand the muscular
forces, thereby giving support and minimizing any discomfort to the patient.
• allows precise and accurate placement both vertically and horizontally.

Disadvantage: extra laboratory work


3D Stent
A Sumathi Felicita (2013)

• A stent is a surgical guide which aids in the proper placement of the mini-implant
in the three dimensions of space, namely, sagittal (root proximity), vertical
(attached gingiva/alveolar mucosa), and transverse (angulation).
• The stent has been fabricated from 0.018 × 0.025 in. stainless steel wire
Stent design
Advantages:
• The stent can be placed at any site using wire of different cross
sections depending on the need of the case.
• simple, easy to fabricate
• cost effective, provides ease of insertion and removal
• provides three-dimensional orientation of the mini-implant.
Universal Wire Grid
Narendra S Sharmaet al.. (2013)

• 3D wire grid which is simple, reliable and accurate for placing implant
in a single step which improves the insertion success rate.
fabrication

Positioning grid Guide base


Advantages:
• universal.
• It can be used on any implant insertion site (upper/lower/
ant./post.)
• After proper sterilization, it can be used in other patients.
• The procedure described is easy to master.
• It can be also used for placement of prosthetic implant.
Guiding jig
Vimala Gnanasambandam et al.. (2014)

• Guiding jig provides an easy way to accurately locate the ‘exact implant spot’.
• This wire frame work can be fabricated with ease, within few minutes of chair
side time and can be checked for its position immediately with an IOPA
fabrication
Advantages:
• Easy to fabricate
• Less chair side time
• No laboratory works
• Inexpensive
• Can be sterilizable
2D Mini Implant Positioning Guide
Arun kumar dasari et al.. (2014)

fabrication
• Advantages
• Grid can be sterilized and used any number of times.
• It is very reliable and accurate.
• Economical and cost effective to the patient.
• Saves lot of chair side time.
• Minimal radiation.
• Disadvantages
• It is a representation of 3D image and a 2D technique.
• Does not evaluate the bone thickness and density.
• Cannot be used for palatal implant placement.
simple grid
Dilip N. Kumar et al.. (2015)
• This is a unique one which is fabricated by the author using a regular orthodontic
wire which is very convenient and simple.

0.6mm round ss wire


Advantages:
• simple in design, easy to fabricate, economical
• Efficient, and provides accurate point of implant insertion
• can be used with different types of orthodontic implants.
• The grid is universal as it can be used in both maxillary and mandibular arch as
well as in anterior or posterior region.
Placement sites of maxilla
• Buccal alveolus
• Posterior palatal alveolus
• Mid palatal suture
• Anterior nasal spine
• Anterior alveolus
• Anterior rugae
• Infrazygomatic crest
• Maxillary tuberosity
Placement sites of mandible
• Buccal alveolus
• Retromolar area
• Buccal shelf area
• Anterior alveolus
• Lingual alveolus
Applications
• Indirect anchorage:
a.orthodontic:
-maxillary expansion
-maxillary protraction
-head gear like effects
b.dental:
-space closure
-intrusion of anterior and posterior teeth
• Direct anchorage: in conjunction with prosthetic rehabilitation
Complications

• During insertion:
-trauma
-screw slippage
-nerve involvement
-Air subcutaneous emphysemas
-nasal and sinus perforation
• Under orthodontic loading:
-stationary anchorage failure
-mini screw migration
• Soft tissue complications:
-tissue coverage
-peri implantitis
• During removal:
-mini screw fracture
-partial osseointegration
conclusion
• Mini implants are placed at any site in the oral cavity with the help of guiding
templates. Mini implants placed without guiding templates must have various
complications. Each template have its own advantages and disadvantages. So we
should always use guiding templates to place mini implants and to reduce risk of
failure and complications.
References
• Predictable drill-free screw positioning with a graduated 3-dimensional
radiographic-surgical guide: A preliminary report
Se´ rgio Estelita,a Guilherme Janson,b Kelly Chiqueto,a Marcos Janson,c and Marcos
Roberto de Freitasd Bauru, Brazil
(Am J Orthod Dentofacial Orthop 2009;136:722-35)
• A simple three-dimensional stent for proper placement of mini-implant
A Sumathi Felicita
Felicita Progress in Orthodontics 2013, 14:45
• clinical application of a stereolithographic surgical guide for simple positioning of
orthodontic mini-implants
• ‘‘Safe Zones’’: A Guide for Miniscrew Positioning in the Maxillary
and Mandibular Arch
Paola Maria Poggioaet al… (Angle 2006)
• Safe Zones for Miniscrews in Orthodontics: A Comprehensive Review
V Raghavendra1, Y Muralidhar Reddy2, C Sreekanth3, B
VishnuVardhan Reddy4, B.Lakshman Kumar5, G.Kranthi Praveen Raj
Int J Dent Med Res 2014
• ‘‘Safe Zones’’ for miniscrew implant placement in different
dentoskeletal patterns
Pajongjit Chaimaneea; Boonsiva Suzukib; Eduardo Yugo Suzukic
Angle 2011
• Optimal sites for orthodontic mini-implant placement assessed by
cone beam computed tomography
Mona Mohamed Salah Fayeda; Pawel Pazerab; Christos Katsarosc
Angle 2010
• An evaluation of insertion sites for mini-implants A micro-CT study of
human autopsy material
Morten G. Laursena; Birte Melsenb; Paolo M. Cattaneoc
Angle 2013

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