Professional Documents
Culture Documents
• 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:
• 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
• 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:
• 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
• 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..
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):
• 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)
• 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:
• 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.
• 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
• 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.
• 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