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Orthodontics mini implants – A brief review

Article in International Dental Journal of Students' Research · January 2022

DOI: 10.18231/j.idjsr.2021.033

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Review Article
Orthodontics mini implants – A brief review

Gejo Johns1, *
1 Dept. of Orthodontics, Annoor Dental College and Hospital, Muvatupuzha, Kerala, India

ARTICLE INFO ABSTRACT

Article history: In routine orthodontics practice anchorage is a critical factors that determining the success of an orthodontic
Received 09-12-2021 treatment. For many years’ anchorage has been a strenuous factor. Many modalities have been tried for
Accepted 05-01-2022 preventing the anchorage loss by using the extra oral and intraoral devices according to various scientific
Available online 27-01-2022 literature, yet the orthodontists did not find any convenient solutions to solve this problem until the
mini- implants were emerged to the speciality. During the early 20t h century introduction of various
skeletal anchorage devices which includes prosthetic implants, palatal implants, mini-plates and screws.
Keywords: The implants used in orthodontics for the purpose of effective treatment are also known as Temporary
Orthodontic mini implants Anchorage Devices (TADs), which helps in bringing down the strenuous efforts employed to prevent
Temporary anchorage devices
anchorage loss and they are easy and small and can be insert and remove without stenos efforts, they can
Anchorage
be immediately loaded after insertion, and they can provide absolute anchorage for orthodontic treatment,
which require minimal need patient compliance there by increasing its popularity. This article gives a brief
reviews of indications, contraindications, safety zones for TADs, their insertion procedure, complications,
failures and medico legal aspects.

This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons
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For reprints contact: [email protected]

1. Introduction Orthodontic mini-implants, maximum anchorage is possible

which will reduces the unwanted side-effects. 1
For a success of orthodontic treatment anchorage is one
of the main factors. Conservation of orthodontic anchorage Mini-screws are also known as TAD’S (Temporary
has been a one of the perennial problem for orthodontist. Anchorage Device) or Micro-implants or Ortho-implant, by
Conventional techniques use either intra-oral sites or the advent of TADS there is a significant revolution in the
extra oral means. For optimum treatment results various field of clinical Orthodontics.
approaches have been employed which includes using In 1945, Gainsforth & Higley conducted a study in
implants for anchorage with varying success. Extra oral which Vitallium screws & SS wires in the Ramal area
anchorage is cumbersome to use and it usually requires of the dog’s mandible so as to bring about retraction of
patient’s compliance and may cause injury during their use. upper canines. This was considered to be the first published
The term ‘Absolute anchorage’ can be defined as when the case where implants are used for orthodontic anchorage. 2
anchorage unit remains completely stable. In 1984, Robert & fellow researchers collaborated with
The skeletal Anchorage used in orthodontics are of the findings of Branemark where they placed titanium
absolute anchorage which is achieved with the use of implants in rabbits. The study concluded that titanium
orthodontic mini- implants. With the appropriate use of endosseous implants provides firm osseous anchorage. 3
* Corresponding author. In 1988, Vitallium implant were used by Creekmore for
E-mail address: [email protected] (G. Johns). anchorage for the purpose of intruding upper anterior teeth. 4

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 Johns / International Dental Journal of Student’s Research 2021;9(4):176–180 177

2. Classification of Orthodontic Mini Implant. 5,6

Orthodontic implant are alloplastic material devices which
are surgically inserted into or onto jaw bone and it is
classified as:

1. Based on the Location

(a) Subperiosteal they lies over the bony ridge.
Onplants are the subperiosteal design that are
used for orthodontic purposes.
(b) Transosseous; These implant body penetrates the
mandible completely.
(c) Endosseous/ Endosteal are those implants that
are partially submerged and are anchored within
bone.
2. Based on the form
(a) Solid
(b) Hollow
(c) Vented
3. According to the composition
(a) Stainless steel,
(b) Cobalt-Chromium-Molybdenum, Fig. 1: Parts of orthodontic mini implants
(c) Titanium,
(d) Ceramic Implants.
(e) Miscellaneous such as Vitreous carbon and Body – It is parallel in shape and self- drilling with
composites wide diameter and have deep thread pitches. It provides
better anchorage, good mechanical retention, less loosening
4. According to the surface structure
breakage. It is the part of mini implant which get embedded
(a) Threaded or Non-threaded inside bone.
(b) Porous or Non Porous.
5. 5) Based on head type –
2.3. Ideal requirements for implant biomaterial

(a) Small head type The following are the ideal requirements for implant
(b) Long head type biomaterial –
(c) Circle head type
1. Biological properties
(d) Fixation head type
2. Physical properties
(e) Bracket head type
6. According to March 2005 classification – Biological properties –
(a) Biocompatible TADS
1. Provide effective Osseo integration.
(b) Biological TADS
2. Shouldn’t cause any harm to soft tissue and hard
tissue.
2.1. Parts of orthodontic implant 3. Should not contain the toxic diffusible substance.
2.2. Orthodontic mini implant screw/plate has three 4. Should be free agents that may cause an allergic
parts reaction.
5. Should have no carcinogenic potential.
Implant head, this is the part where the implant is attached 6. Should be tasteless and odourless.
to the driver and the head of the implant serves as the
abutment and could be the source of attachment for elastics/ Physical properties –
coil-springs
Neck –It is the junction between head of the implant and 1. Should be dimensionally stable.
platform for attachment of an elastic, NiTi coil spring or 2. Should possess adequate strength and resilience
other accessories. 3. Should able to resist biting or chewing forces.
178 Johns / International Dental Journal of Student’s Research 2021;9(4):176–180

The osseointegrating orthodontic / dental implants / screws the orthodontic mini-implant and it is noted that delayed
are composed of 99% titanium. The medical grade titanium or inadequate tissue healing and poor osseointegration is
used are of grade I to IV. noted.
Commercially pure titanium (C P Ti) is used widely
for implants fabrication because it possesses excellent 3.4. Radiographic analysis
biocompatibility and suitable mechanical properties. Use
of Ti grades I to IV in for the manufacturing of non During placement of orthodontic mini implants
–osseointegrated / mechanical retentive miniscrews showns careful observation of Periapical pathology and
failures as screw were thinner. Radiopaque/radiolucent should be examined and diagnosed
Therefore, the titanium alloy (Ti - 6Al - 4V) (grade V) in the regions above the inferior alveolar region, the
is the material for orthodontic miniscrews / mini implants. maxillary sinus, adequate space above IAN or below
Titanium alloy (Ti - 6Al - 4V) increases the modulus of maxillary sinus are to be taken care, During placement
elasticity to six times that of bone so that long and thin of mini-implant a minimum of 2mm from the inferior
alveolar canal or below the maxillary sinus with adequate
interradicular area should be there.
2.4. Indications for implant in orthodontics
Indications for implants in orthodontics are as follows 3.5. Safe zones for implant placement

1. Retract and align anterior teeth The most commonly used placement sites for miniscrews in
2. In first molar extraction sites they are used for closing maxilla and mandible are as follows
the edentulous spaces In Maxilla: Inter radicular alveolar –as the buccal
3. Intrude or extrude teeth, cortical bone on the entire maxillary alveolar process is
4. Protract or retract teeth of one arch, about 3mm to 4mm, so longer screws are needed. Most
5. Stabilizing the teeth with less bone support, commonly used sites are –

1. Between second premolar and first permanent molar

2.5. Contraindication for implant placement
2. Between the first and second permanent molar
There is no absolute contraindication for orthodontic 3. Between the two central incisors, used for intrusion
mini implant placement the placement of implant are 4. Infrazygomatic region – zygomatic buttress
contraindicated in cases of Psychiatric diseases (psychoses 5. Palatal areas.
dysmorphobia severe systemic disorder like osteoporosis, 6. Maxillary tuberosity region
blood disorders ,alcoholics ,drug abusers. Patients with poor 7. Mid palatal area
bone quality and diabetic patients.
In Mandible: In the mandible dense cortical bone on the
3. Treatment Considerations 6–8 buccal area is present, so the screws of smaller in size should
be used, so the possibility of root contact is remote. Most
3.1. Age of the patient common sites are –
The age of the patients is an important consideration for
implant placement in growing children the use of implant 1. Between second premolar and first permanent molar
in the anterior maxilla is contraindicated due to opened mid 2. Between first and second permanent molar
palatal suture Resorption in the posterior part of the maxilla 3. Between two central incisors
resulting to the exposure of the implants due to growth 4. Between mandibular canine and premolar buccally
changes..= 5. Retromolar area
6. Mandibular symphysis facially
3.2. Periodontal status
Some of the anatomical and vital structures that should
Patients with satisfactory periodontal status with adequate be kept care of during micro-implant placement includes-
amount of bone support and thick compact cortical bone are inferior alveolar nerve, artery, vein, mental foramen,
indicated or mini care should be taken to maintain good oral maxillary sinus and nasal cavity. 9
hygiene.
3.6. Implant placement angulation
3.3. Systemic manifestations
In Maxilla: micro- implant is placed at an angulation of 30-
One of the predisposed factor for delayed wound healing degree to 40 -degree angle to the long axis of the teeth in the
in case of diabetics are destructive habits like smoking. In maxilla, it will keep the screw in the widest space available
case of chronic smokers it is contraindicated to placement between the roots apically.
 Johns / International Dental Journal of Student’s Research 2021;9(4):176–180 179

In the Mandible, Micro implants are placed at an levels are between 200- 300gms after achieving primary
angulation of 10- degree to 20- degree because the buccal stability. However, it may be better to wait approximately
cortex is of dense bone and curves out more buccally from 2-3 weeks for soft tissue healing.
gingival margins. So mini screws of shorter dimension can
be used than those used in the maxilla. Also the angle 3.8. Stability of orthodontic implants
is reduced to 10- degree to 20- degree with little risk of
touching the roots. In cases of orthodontic mini implant 2 types of stability are
seen they are Primary stability and the secondary stability.
Primary stability or initial stability is noted immediately
3.6.1. Methods of placing micro screws / micro implants
after the insertion of an orthodontic mini-implant. Which is
The method of placement of orthodontic miniscrew into the
the prime factor consideration for healing and loading. The
alveolar bone depends upon the type of screw chosen. There
factors that contributing and are responsible for achieving
are two different types of screws available –
the primary stability includes- Implant diameter, the length
of implant, and the number of flutes and design of threads,
1. Self-Tapping: First a tunnel is drilled into the bone
cortical bone thickness and also the bone density. Primary
with the help of pilot drill and then implant is driven
stability also depends on the placement technique and
into tunnel
location of implant placement. 10–14
(a) Tips: blunt, smooth and rounded Secondary stability is seen after implant placement and
(b) Threads: - thick rounded and blunt the bone regeneration and remodelling which contributes to
increasing the stability. 15
2. Self-Drilling: Here the implant itself acts as a drill and
it is directly inserted into bone Tips: - sharp, hooked
3.9. Complication of orthodontic implants
and pointed
3. Threads: - thin, pointed Complications can arise during the placement and after
orthodontic loading of TAD’s in regard to stability and
3.6.2. Procedure for microimplant placement patient safety.
The various steps for surgical implant placement are as
follows 1. Complications during Insertion includes
(a) Trauma to the dental root or to periodontal
1. Topical Anaesthesia: Soft local Infiltration usually ligament
adequate (b) Orthodontic implant slippage
2. Aseptic preparation – A disinfecting agent can be used (c) Nerve involvement
to prepare an intraoral or extra oral site for keeping the (d) Air subcutaneous emphysema
surgical area aseptic. (e) Nasal and maxillary sinus perforation
3. Drilling –Mini implants are loaded to the selected (f) Implants bending, fracture, and torsional stress
micro screw driver, and the screw is inserted at the
desired location. Guide bar can be use and placed 2. Complications under Orthodontic Loading
on the tooth before exposing the patient to IOPA. (a) Miniscrew migration
The guide is placed during micro implant insertion it (b) Soft-Tissue Complications
should be retained, so it can help in placement of a (c) Aphthous ulceration
micro- implant. The direction of insertion is first at 90 (d) Soft tissue inflammation, infection, and peri
degrees to occlusal plane and then angulated at 30 - implantitis
40 degree in the maxilla and in case of mandible at (e) There can be soft-tissue coverage on to the head
10- 20- degree. To ensure proper stability of implants of the mini implant and auxiliary
wobbling in the axis of a driver should be avoided.
3. Complications During Removal
During placement screw should be smooth alternating
between turns and stops (a) Screw fracture
(b) Partial osseointegration
3.7. Loading of implants
4. Conclusion
Two types of loading can be employed which includes
immediate loading and delayed loading in terms of The introduction of orthodontic mini implants on the field
orthodontic mini-implants, the primary stability is more of dentistry had a tremendous impact on dental treatment
important than the Osseo integration. Clinical studies have plans. Mini implants help the orthodontist to overcome
shown that there is no significant difference exists between the unwanted reciprocal tooth movement happening during
the immediate loading and delayed loading when the force routine dental treatment. The presently available implant
180 Johns / International Dental Journal of Student’s Research 2021;9(4):176–180

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