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Almashraqi AA, Sawady M, Beleges EM, Khadhi AH, Halboub E, Alhammadi MS. Comprehensive qualitative and quantitative assessment of the most suitable levels for maxillary and mandibular miniscrew insertion sites: A cross-sectional comparative study. Int Orthod 2025; 23:101007. [PMID: 40245596 DOI: 10.1016/j.ortho.2025.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 03/27/2025] [Accepted: 04/03/2025] [Indexed: 04/19/2025]
Abstract
INTRODUCTION To analyse the quality and quantity of inter-radicular buccal and palatal cortical bone in the maxillary and mandibular regions at the most recommended levels for miniscrew insertion sites in both sexes. METHODS This retrospective, cross-sectional comparative study utilized Cone Beam Computed Tomography (CBCT) scans from 60 adult patients meeting the selection criteria. The analysis focused on Cortical Bone Thickness (CBT), Inter-radicular Space (IRS), and Relative Cortical Bone Density (RCBD) at eleven maxillary and six mandibular miniscrew insertion sites, measured at 4, 6, and 8mm from the cemento-enamel junction. RESULTS CBT on the maxillary buccal side ranged from 0.85±0.13 to 1.32±0.14mm, with all palatal sites measuring at least 1mm. Palatal areas showed greater IRS than buccal sites, with no significant sex differences. RCBD indicated significant differences at 6mm (P=0.004) and 8mm (P=0.008), where females had higher density than males. In the mandible, CBT ranged from 1.20±0.22 to 2.63±0.36mm, with the lowest IRS in the canine-premolar region at 4mm and the highest in the molar area at 8mm. High densities were observed across levels without sex preference. CONCLUSION It is advisable to position orthodontic miniscrews as far as possible in the attached gingiva of the maxillary buccal and mandibular canine-premolar regions. For maxillary palatal miniscrews, preferred insertion depths are 6mm in the premolar and 4mm in the molar regions, and predrilling at 6mm is recommended in the mandibular molar region. Limited sex differences were noted.
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Affiliation(s)
- Abeer A Almashraqi
- Department of Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Mohammed Sawady
- Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Essa Mohammed Beleges
- Saudi Board of Orthodontics and Dentofacial Orthopedics, Saudi Commission for Health Specialties, Jeddah, Saudi Arabia
| | - Ahmed Hassan Khadhi
- Saudi Board of Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Maged S Alhammadi
- Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Son CH, An JS, Yi WJ, Ahn SJ. Bone mineral density and anatomic limitations of miniscrew placement at buccal interradicular sites: A quantitative computed tomography study. Am J Orthod Dentofacial Orthop 2025:S0889-5406(25)00051-4. [PMID: 40029233 DOI: 10.1016/j.ajodo.2025.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 01/09/2025] [Accepted: 01/13/2025] [Indexed: 03/05/2025]
Abstract
INTRODUCTION This study aimed to evaluate the bone mineral density (BMD) and anatomic limitations of miniscrew placement at buccal interradicular sites. METHODS Virtual miniscrews were placed at the interradicular sites from the canines to the second molars of 139 patients who underwent quantitative computed tomography. Mixed-effects modeling and logistic regression were used to test the differences in BMD and the odds of root proximity, sinus invasion, and bicortical perforation according to sex, growth status, and interradicular site. RESULTS No significant interradicular BMD differences were observed between the sexes. Adults had higher interradicular BMDs than adolescents only in the mandible. There were no significant BMD differences among the maxillary interradicular sites, whereas the mandibular interradicular BMD tended to increase from the anterior to the posterior regions. All interradicular bones belonged to the same category according to Misch's classification, and BMD differences of <0.05 g/cc were observed in most sites except between mandibular molars. The interradicular BMD measurements were unavailable for 41.9% and 24.6% of the maxilla and mandible, respectively, mostly because of root proximity. The most anatomically favorable site was between the mandibular premolars, whereas the most unfavorable site was between the maxillary molars. The odds of anatomic limitations were not significantly affected by growth state or sex. CONCLUSIONS Regarding BMD, all interradicular sites from the canines to the second molars may be adequate candidates for miniscrew placement, regardless of growth state and sex. Anatomic limitations should be carefully considered when placing miniscrews, specifically between the maxillary molars.
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Affiliation(s)
- Chang-Han Son
- Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Jung-Sub An
- Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, South Korea; Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Won-Jin Yi
- Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, South Korea; Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Sug-Joon Ahn
- Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, South Korea; Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea.
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Zhu Z, Zhong L, Zhao Y, Wang X, Qian W, Ye N. Mapping optimal orthodontic implant sites in the palate using cone-beam computed tomography. FRONTIERS IN ORAL HEALTH 2024; 5:1453665. [PMID: 39416888 PMCID: PMC11480054 DOI: 10.3389/froh.2024.1453665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 09/06/2024] [Indexed: 10/19/2024] Open
Abstract
Objective To measure the palatal soft tissue thickness and cortical bone density to determine safe regions for the placement of orthodontic mini-implants and to examine the influence of sex and age on soft tissue thickness and cortical bone density. Materials and methods Cone-beam computed tomography images of 42 patients (22 males and 20 females), including 21 adults and 21 adolescents, were examined in this study. The palatal soft tissue thickness and cortical bone density were measured at the coronal planes between the premolars (P4-5), between the second premolars and first molars (P5-6), and between the first molars and second molars (P6-7). Results The thickness of the soft tissue revealed similar coronal planes, but the bone density varied. The mean thickness was 3.8 mm at 0°-60° and 1.5 mm at 60°-90°. P4-5 had the highest bone density (>600 HU), decreasing toward P6-7 (<600 HU). Bone density decreased from 90° to 0° coronally, whereas the soft tissue thickness increased. Age, sex, and their interaction affected bone and soft tissues. Conclusions In general, areas with a high bone density tended to have thin soft tissue coronally, thus the preferred implant site tends to be more anterior to the P4-5 plane and closer to 60°-90°. Considering individual variances, mapping of the recommended regions for palatal mini-implants is suggested.
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Affiliation(s)
- Zhengxian Zhu
- Department of Orthodontics, Shanghai Xuhui District Dental Center, Shanghai, China
| | - Lin Zhong
- Department of Stomatology, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Yicheng Zhao
- Department of Oral Prothodontics, Stomatological Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoting Wang
- Department of Orthodontics, Shanghai Xuhui District Dental Center, Shanghai, China
| | - Wenhao Qian
- Department of Implantology, Shanghai Xuhui District Dental Center, Shanghai, China
| | - Niansong Ye
- Department of Orthodontics, Shanghai Hua Guang Private Practice, Shanghai, China
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Matschke J, Farahzadi S, Sembdner P, Holtzhausen S, Kroschwald L, Korn P, Schröder TA, Keil C, Paetzold-Byhain K, Lauer G, Franke A. A cross-sectional study of the anatomy of the jaws of a central-European caucasian population using cone beam computer tomography as a prerequisite for designing pre-formed calcium phosphate cement scaffolds. Ann Anat 2024; 254:152270. [PMID: 38679148 DOI: 10.1016/j.aanat.2024.152270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/04/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE This study aims to measure the cortical and cancellous bone thickness in the upper and lower jaws, serving as a data template for developing pre-defined calcium phosphate cement primary implant forms. These measurements are crucial for creating a biphasic scaffold. METHODS Forty complete jaws were assessed for cortical bone shape and thickness using statistical analysis and specific software tools. Sex and age were considered, and four groups were created. RESULTS The cumulative thickness of the cortical layer varied from region to region. In both the upper and lower jaws, the cortical layer in the molar region was significantly thicker than in the frontal region. Within the alveolar process, cortical thickness increases with distance from the alveolar crest on both sides. The oral side of the lower jaw is significantly thicker than the vestibular side. For the upper jaw, no significant differences between the oral and vestibular sides were found in this study. Additionally, it is noteworthy that men have a significantly thicker cortical layer than women. Regarding age, no significant overall differences were found. CONCLUSION Mathematical analysis of anatomical forms using polynomial functions improves understanding of jaw anatomy. This approach facilitates the design of patient-specific scaffold structures, minimizing the need for costly and time-consuming planning and enabling more efficient implementation of optimal therapy.
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Affiliation(s)
- Jan Matschke
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus" Dresden, Technische Universität Dresden, Dresden 01307, Germany.
| | - Samaneh Farahzadi
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus" Dresden, Technische Universität Dresden, Dresden 01307, Germany
| | - Philipp Sembdner
- Institute of Machine Elements and Machine Design, Chair of Virtual Product Development, Technische Universität Dresden, Dresden 01062, Germany
| | - Stefan Holtzhausen
- Institute of Machine Elements and Machine Design, Chair of Virtual Product Development, Technische Universität Dresden, Dresden 01062, Germany
| | - Lysann Kroschwald
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus" Dresden, Technische Universität Dresden, Dresden 01307, Germany
| | - Paula Korn
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus" Dresden, Technische Universität Dresden, Dresden 01307, Germany
| | - Tom Alexander Schröder
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus" Dresden, Technische Universität Dresden, Dresden 01307, Germany
| | - Christiane Keil
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus" Dresden, Technische Universität Dresden, Dresden 01307, Germany; Department of Orthodontics, University Hospital "Carl Gustav Carus" Dresden, Technische Universität Dresden, Dresden 01307, Germany
| | - Kristin Paetzold-Byhain
- Institute of Machine Elements and Machine Design, Chair of Virtual Product Development, Technische Universität Dresden, Dresden 01062, Germany
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus" Dresden, Technische Universität Dresden, Dresden 01307, Germany
| | - Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus" Dresden, Technische Universität Dresden, Dresden 01307, Germany
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Abstract
The objective of this study was to evaluate the effect of bone–miniscrew contact percentage (BMC%) and bone quality and quantity on orthodontic miniscrew stability and the maximum insertion torque value (ITV). Orthodontic miniscrews of five different dimensions and several bovine iliac bone specimens were used in the evaluation. Miniscrews of each dimension group were inserted into 20 positions in bovine iliac bone specimens. The experiment was divided into three parts: (1) Bone quality and quantity were evaluated using cone-beam computed tomography (CBCT) and microcomputed tomography. (2) The 3D BMC% was calculated. (3) The ITVs during miniscrew insertion were recorded to evaluate the stability of the orthodontic miniscrews. The results indicated that longer and thicker miniscrews enabled higher ITVs. CBCT was used to accurately measure cortical bone thickness (r = 0.939, P < 0.05) and to predict the bone volume fraction of cancellous bone (r = 0.752, P < 0.05). BMC% was significantly influenced by miniscrew length. The contribution of cortical bone thickness to the ITV is greater than that of cancellous bone structure, and the contribution of cortical bone thickness to BMC% is greater than that of cancellous bone structure. Finally, the higher is BMC%, the greater is the ITV. This study concludes that use of CBCT may predict the mechanical stability of orthodontic miniscrews.
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Keo P, Matsumoto Y, Shimizu Y, Nagahiro S, Ikeda M, Aoki K, Ono T. A pilot study to investigate the histomorphometric changes of murine maxillary bone around the site of mini-screw insertion in regenerated bone induced by anabolic reagents. Eur J Orthod 2021; 43:86-93. [PMID: 32202621 DOI: 10.1093/ejo/cjaa018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the histomorphometric changes around the site of mini-screw insertion in the regenerated bone which was induced by an anabolic-injection method using both anabolic peptide and bone morphogenetic protein 2 (BMP-2). METHODS Twenty-seven eight-week-old C57BL/6J male mice were used. Some mice received submucosal co-injections of anabolic peptide and BMP-2 just in front of the maxillary first molar. Screw insertion was then performed 4 weeks after injection. All mice underwent a weekly in vivo micro-focal X-ray computed tomography (µCT) analysis before being sacrificed at week 8. The bone formation activity was evaluated using fluorescent labelling in the undecalcified sections. The analyses, including screw insertion, were performed in the frontal plane, in front of the site of screw insertion. RESULTS Reconstructed µCT images revealed that the co-injection of anabolic reagents could lead to a gradual increase in the bone mineral density (BMD) of the injection-induced thickened bone by week 8. Both radiological and histomorphometric analyses indicated that screw insertion did not have any deleterious effects on either the BMD or the bone formation activity of the induced bone. Furthermore, the injection of anabolic reagents also led to an increase in the BMD of the underlying maxillary bone at the injection site. CONCLUSION Our histomorphometric analyses suggest that performing such anabolic injection to thicken bone could stimulate bone formation in the basal bone as well as in the induced bone. Similar augmentation of bone formation could be obtained even after subsequent screw insertion at the site of the induced bone.
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Affiliation(s)
- Preksa Keo
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiro Matsumoto
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Shimizu
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeki Nagahiro
- Department of Pediatric Dentistry/Special Needs Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaomi Ikeda
- Department of Oral Prosthetic Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuhiro Aoki
- Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Sana S, Reddy R, Talapaneni AK, Hussain A, Bangi SL, Fatima A. Evaluation of stability of three different mini-implants, based on thread shape factor and numerical analysis of stress around mini-implants with different insertion angle, with relation to en-masse retraction force. Dental Press J Orthod 2021; 25:59-68. [PMID: 33503126 PMCID: PMC7869798 DOI: 10.1590/2177-6709.25.6.059-068.oar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 02/03/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives: Assess the stability of three different mini-implants, based on thread shape
factor (TSF), and evaluate stresses at the mini-implant site and surrounding
cortical bone on application of retraction force, at two different insertion
angles. Methods: Mini-implants of three different diameters (M1 - Orthoimplant, 1.8mm), (M2 -
Tomas, 1.6mm) and (M3 - Vector TAS, 1.4mm) and length of 8mm were used.
Using scanning electronic microscopy, the mean thread depth, pitch and
relationship between the two (TSF) were calculated. The mini-implants were
loaded into a synthetic bone block and the pull-out strength was tested. One
way ANOVA and Tukey post-hoc tests were used to compare the
pull-out strength of mini-implants. P values < 0.05 were considered
statistically significant. Finite element models (FEM) were constructed with
insertion angulation at 90° and 60°, with retraction force of 150 g. The
results were analyzed using ANSYS software. Results: Statistically significant difference was found among all the three
mini-implants for thread depth and pitch (< 0.001). Statistically
significant higher pull-out force value was seen for Orthoimplant. The
stress distribution level in mini-implant and surrounding bone was observed
to be smaller for Orthoimplant. Conclusion: Orthoimplant mini-implants have more favorable geometric characteristics
among the three types, and less stress with 90°angulation.
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Affiliation(s)
- Safiya Sana
- Al-Badar Rural Dental College & Hospital, Department of Orthodontics & Dentofacial Orthopaedics (Gulbarga/KA, India)
| | - Rekha Reddy
- Al-Badar Rural Dental College & Hospital, Department of Orthodontics & Dentofacial Orthopaedics (Gulbarga/KA, India)
| | - Ashok Kumar Talapaneni
- Al-Badar Rural Dental College & Hospital, Department of Orthodontics & Dentofacial Orthopaedics (Gulbarga/KA, India)
| | - Arshad Hussain
- Al-Badar Rural Dental College & Hospital, Department of Orthodontics & Dentofacial Orthopaedics (Gulbarga/KA, India)
| | - Sayeeda Laegue Bangi
- Al-Badar Rural Dental College & Hospital, Department of Orthodontics & Dentofacial Orthopaedics (Gulbarga/KA, India)
| | - Asma Fatima
- Al-Badar Rural Dental College & Hospital, Department of Orthodontics & Dentofacial Orthopaedics (Gulbarga/KA, India)
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Hayek E, Aoun G, Geha H, Nasseh I. Image-based Bone Density Classification Using Fractal Dimensions and Histological Analysis of Implant Recipient Site. Acta Inform Med 2020; 28:272-277. [PMID: 33627929 PMCID: PMC7879433 DOI: 10.5455/aim.2020.28.272-277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Success of dental implants is affected by the quality and density of the alveolar bone. These parameters are essential for implant stability and influence its load-bearing capacity. Their assessment is usually based on preoperative radiographs used as a tool prior to implant procedures. OBJECTIVE The aim of the study was to compare the bone density of surgically harvested bone specimens at implant recipient sites in the maxillary and mandibular posterior region using histological analysis to the radiographic bone density using fractal dimension for reliability and determining an image based classification of bone density prior surgery. METHODS Fifty implants were placed in the posterior region of male patients, (twenty five implants in the maxilla and twenty five in the mandible). The edentulous regions were presurgically assessed using Photo Stimulable Phosphor Plate (PSP) intra-oral radiographs and the fractal dimension box counting of region of interest was calculated at the implant recipient site. During surgery, bone core specimens were trephined, and bone densities and minerals parameters were evaluated based on histological analysis using SEM (Scanning Electron Microscopy), and atomic absorption spectrometry. RESULTS Fractal dimensions (FD) values for the same region of interest (ROI) selected on the radiographs of bone blocks and edentulous sites were different but showed a proportional variation in molar and premolar region of the maxilla and mandible. Bone density results, calculated by the ratio of bone mass (BM) to the bone volume (BV) of the bone core specimen (D=M/V), increased in the mandibular bone blocks, and decreased in the maxilla specimens. Moreover, fractal dimension values of preoperative radiographs at implant recipient sites and bone density of trephined showed a statistically similar distribution. However, no significant difference was shown in the percentage of minerals contents and mass of calcium phosphate of each bone specimen between maxilla and mandible based on scanning electron microscopy analysis. Four types of bone densities were classified according to the distribution of FD values based on preoperative radiographs and on the densities of bone cores calculations. CONCLUSION Radiographic estimation of bone quality calculated with fractal dimension could be a useful, non-invasive tool when using preoperative intra-oral radiographs to predict bone density at implant recipient sites with caution and limits concerning the kind of digital radiographs and size of region of interest, especially when these results were based with bone specimens harvested from implant site as an absolute reference.
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Affiliation(s)
- Elie Hayek
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Georges Aoun
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Hassem Geha
- Department of Comprehensive Dentistry, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Ibrahim Nasseh
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
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Limeres Posse J, Abeleira Pazos MT, Fernández Casado M, Outumuro Rial M, Diz Dios P, Diniz-Freitas M. Safe zones of the maxillary alveolar bone in Down syndrome for orthodontic miniscrew placement assessed with cone-beam computed tomography. Sci Rep 2019; 9:12996. [PMID: 31506517 PMCID: PMC6737031 DOI: 10.1038/s41598-019-49345-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/21/2019] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to quantify the available maxillary alveolar bone in a group of individuals with Down syndrome (DS) to determine the best areas for orthodontic miniscrew placement. The study group consisted of 40 patients with DS aged 12-30 years. We also selected an age and sex-matched control group. All measurements were performed on cross-sectional images obtained with cone-beam computed tomography. The selected areas of interest were the 4 interradicular spaces between the distal wall of the canine and the mesial wall of the second molar, in both maxillary quadrants. We measured the vestibular-palatine (VP) and mesiodistal (MD) dimensions to depths of 3, 6 and 9 mm from the alveolar ridge. We also measured the bone density in the same interradicular spaces of interest to 6 mm of depth from the alveolar crest. VP measurements were longer in the more posterior sectors and as the distance from the alveolar ridge increased. MD measurements also increased progressively as the distance from the alveolar ridge increased. In general, both the VP and MD measurements in the DS group were similar among the male and female participants. As age increased, the MD distance increased, while the VP distance decreased. The VP distance was ≥6 mm in at least 75% of the DS group in practically all assessed interdental spaces. The MD distance was ≥2 mm in at least 75% of the DS group only between the first and second molar, to 9 mm of depth from the alveolar ridge. The safe area for inserting orthodontic miniscrews in DS patients is restricted to the most posterior and deepest area of the maxillary alveolar bone.
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Affiliation(s)
- Jacobo Limeres Posse
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - María Teresa Abeleira Pazos
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - María Fernández Casado
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Mercedes Outumuro Rial
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Pedro Diz Dios
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Márcio Diniz-Freitas
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain.
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Villela HM, Vedovello Filho M, Valdrighi HC, Santamaria-Jr M, Menezes CCD, Vedovello SAS. Evaluation of miniscrew angulation in the posterior maxilla using cone-beam computed tomographic image. Dental Press J Orthod 2018; 23:46-55. [PMID: 29791691 PMCID: PMC5962247 DOI: 10.1590/2177-6709.23.1.046-053.oar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/01/2017] [Indexed: 11/29/2022] Open
Abstract
Objective: This study aimed at evaluating whether changes in the insertion angle is a determining factor in the positioning of the miniscrews body in a region with larger interradicular space in the posterior maxilla. Methods: Analysis of 60 posterior maxillary quadrants were made using images obtained by means of cone-beam computed tomographic image (CBCT), with 0.076-mm voxel, which presented a real miniscrew inserted in the mesial region of the maxillary first molars, serving as reference point for the placement of the virtual miniscrews. Measurements of the distances between roots were made in three points on the body of the virtual miniscrews (A, B and C), at four different angulations, 70o, 60o, 50o and 40o (T1 to T4), in relation to the long axis of the second premolar. This evaluation was made in four groups, selected in accordance with the disposition of the roots of the second premolars and first molars: Group 1 (all types of roots), Group 2 (convergent roots), Group 3 (divergent roots) and Group 4 (parallel roots). Results: There were no statistically significant differences in the measurements of points A, B and C, at the different angles (70o, 60o, 50o and 40o) and in the different groups (p > 0.05). Conclusions: Changes in the insertion angle is not a determinant factor in the positioning of miniscrews body in regions with larger interradicular space in posterior maxilla.
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Affiliation(s)
- Henrique M Villela
- Programa de Pós-graduação em Ortodontia, Fundação Hermínio Ometto, Uniararas, Araras, SP, Brazil
| | - Mario Vedovello Filho
- Programa de Pós-graduação em Ortodontia, Fundação Hermínio Ometto, Uniararas, Araras, SP, Brazil
| | - Heloísa C Valdrighi
- Programa de Pós-graduação em Ortodontia, Fundação Hermínio Ometto, Uniararas, Araras, SP, Brazil
| | - Milton Santamaria-Jr
- Programa de Pós-graduação em Ortodontia, Fundação Hermínio Ometto, Uniararas, Araras, SP, Brazil
| | | | - Silvia A S Vedovello
- Programa de Pós-graduação em Ortodontia, Fundação Hermínio Ometto, Uniararas, Araras, SP, Brazil
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Radwan ES, Montasser MA, Maher A. Influence of geometric design characteristics on primary stability of orthodontic miniscrews. J Orofac Orthop 2018; 79:191-203. [PMID: 29637214 DOI: 10.1007/s00056-018-0131-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/07/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Aim of the present study was to investigate the influence of geometric design characteristics on primary stability of orthodontic miniscrews. MATERIALS AND METHODS Forty self-drilling miniscrews with different geometric design characteristics were divided into the following groups (n = 10): group I-Tomas® (Dentaurum, Germany), group II-AbsoAnchor® (Dentos, Korea), group III-HUBIT® miniscrew (HUBIT, Korea), group IV-Creative® (China). The four types were conical miniscrews with 1.6 mm diameter and 6.0 mm length. The miniscrews were manually inserted perpendicular to cow ribs until the full thread length was reached with the help of a 1.3 mm predrilled pilot hole. Each miniscrew was evaluated using scanning electron microscope. Linear and angular measurements were taken using Photoshop CS3 software. Miniscrew stability was measured by the Periotest® and pullout test. RESULTS All linear and angular measurements of the geometric characteristics showed significant differences between the four groups (p ≤ 0.001). Results of the pullout test showed significant differences between the four groups (p ≤ 0.001), while the Periotest® values showed no significant differences (p = 0.122). A multiple linear regression analysis revealed the significant predictors for higher pullout: a larger flank, a higher value for the thread angle, lead angle, and apical face angle (p ≤ 0.001). CONCLUSIONS Orthodontic miniscrews' geometric design characteristics significantly affected the primary stability. Larger pitch width, flank, thread angle, apical face angle, and/or lead angle led to higher primary stability. Smaller a thread shape factor (TSF) also improved primary stability. Varying these characteristics may enhance miniscrew design.
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Affiliation(s)
- Eman Saad Radwan
- Orthodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Mona A Montasser
- Orthodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.
| | - Ahmed Maher
- Orthodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Rossi M, Bruno G, De Stefani A, Perri A, Gracco A. Évaluation CBCT quantitative des variations d’épaisseur et de densité de l’os cortical maxillaire et mandibulaire en vue du placement de miniplaques orthodontiques. Int Orthod 2017; 15:610-624. [DOI: 10.1016/j.ortho.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rossi M, Bruno G, De Stefani A, Perri A, Gracco A. Quantitative CBCT evaluation of maxillary and mandibular cortical bone thickness and density variability for orthodontic miniplate placement. Int Orthod 2017; 15:610-624. [PMID: 29113844 DOI: 10.1016/j.ortho.2017.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether cortical bone thickness and density vary in relation to age, sex and skeletal pattern at the maxillary and mandibular areas suitable for miniplates placement for orthodontic purposes. MATERIALS AND METHODS CBCT of 92 subjects (42 males and 50 females) with skeletal class I, II or III malocclusion, divided between adolescents and adults, were examined. InVivoDental® software (Anatomage Inc, USA) was used to measure 34 maxillary areas and 40 mandibular areas per side. Values obtained were then compared between the groups of subjects. Statistical analysis was performed using the non-parametric Wilcoxon-Mann-Whitney rank-sum test for independent samples. RESULTS No significant differences were found in the cortical bone thickness values between the three skeletal patterns, and according to sex and age. Both maxilla and mandible showed an increase in cortical bone thickness from the anterior towards the posterior regions, and from the alveolar boneto the basal bone. Cortical bone density significantly varied in relation to the subject's age, with adults always showing higher values. Slight clinically significant differences were found between the three skeletal patterns and sex. CONCLUSION In terms of cortical bone thickness, age, sex and skeletal pattern do not represent valid decision criteria for the evaluation of the best insertion areas for miniplates, while in terms of cortical bone density, only age is useful as a decision criterion.
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Affiliation(s)
- Margherita Rossi
- University of Padua, Department of Orthodontics, Via Giustiniani 2, 35010 Padua, Italy
| | - Giovanni Bruno
- University of Padua, Department of Orthodontics, Via Giustiniani 2, 35010 Padua, Italy.
| | - Alberto De Stefani
- University of Padua, Department of Orthodontics, Via Giustiniani 2, 35010 Padua, Italy
| | - Alessandro Perri
- University of Padua, Department of Orthodontics, Via Giustiniani 2, 35010 Padua, Italy
| | - Antonio Gracco
- University of Padua, Department of Orthodontics, Via Giustiniani 2, 35010 Padua, Italy
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Maya RR, Pinzan-Vercelino CRM, Gurgel JDA. Effect of vertical placement angle on the insertion torque of mini-implants in human alveolar bone. Dental Press J Orthod 2017; 21:47-52. [PMID: 27901228 PMCID: PMC5125170 DOI: 10.1590/2177-6709.21.5.047-052.oar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/20/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of the present ex-vivo study was to evaluate the effect of the vertical placement angle of mini-implants on primary stability by analyzing maximum insertion torque (MIT). Methods: Mini-implants were placed in 30 human cadavers, inserted at either a 90° or 60° angle to the buccal surface of the maxillary first molar. Out of 60 self-drilling mini-implants used, half were of the cylindrical type and half were of the conical type. Primary stability was assessed by means of measuring the MIT. Data were subjected to analysis of variance (ANOVA) and Newman-Keuls tests. A significance level of 5% was adopted. Results: The MIT was higher for both mini-implant types when they were placed at a 90° angle (17.27 and 14.40 Ncm) compared with those placed at a 60° angle (14.13 and 11.40 Ncm). Conclusions: MIT values were differed according to the vertical mini-implant placement angle in the maxillary posterior area. Regardless of the type of mini-implant used, placement at a 90° angle resulted in a higher MIT.
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Affiliation(s)
- Rafael Ribeiro Maya
- MSc in Orthodontics, Universidade Ceuma (UNICEUMA), São Luís, Maranhão, Brazil
| | | | - Julio de Araujo Gurgel
- Professor, Universidade Ceuma (UNICEUMA), Masters Program in Dentistry, São Luis, Maranhão, Brazil
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Almasoud NN, Tanneru N, Marei HF. Alveolar bone density and its clinical implication in the placement of dental implants and orthodontic mini-implants. Saudi Med J 2017; 37:684-9. [PMID: 27279516 PMCID: PMC4931651 DOI: 10.15537/smj.2016.6.14274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the bone density in maxilla and mandible in dentate and edentulous patients in Saudi population. METHODS This study involved a retrospective analysis of cone beam CT images of 100 patients (50 male and 50 female) who have come to College of Dentistry, University of Dammam, Dammam, Kingdom of Saudi Arabia between January 2014 and 2015. Using the bone density option in the Simplant software, the Hounsfield unit (HU) was calculated at the edentulous sites. While for dentate sites, a region of interest was selected coronally at 3-5 mm to the root apex using I-CAT vision software. The densities of the buccal bone and cancellous bone were measured at interradicular areas of a specific teeth. RESULTS The highest bone density at the edentulous sites was at the mandibular anterior region (776.5 ± 65.7 HU), followed by the mandibular posterior region (502.2 ± 224.2 HU). Regarding the dentate sites, the highest bone density was at the buccal cortical plate of the lower incisor teeth (937.56 ± 176.92 HU) and the lowest bone density was at the cancellous bone around the posterior maxillary teeth (247.12 ± 46.75 HU). CONCLUSION The alveolar bone density at dentate and edentulous sites in our population is generally lower than the norm reference density of other populations, which dictates the need for quantitative assessment of bone density before implants and mini-implants placement.
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Affiliation(s)
- Naif N Almasoud
- Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Kingdom of Saudi Arabia. E-mail.
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Avelar JC, da Silva Campos MJ, Mota Júnior SL, Fraga MR, Vitral RWF. Evaluation of the position of maxillary incisors with and without apical root resorption. J World Fed Orthod 2017. [DOI: 10.1016/j.ejwf.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lee MY, Park JH, Kim SC, Kang KH, Cho JH, Cho JW, Chang NY, Chae JM. Bone density effects on the success rate of orthodontic microimplants evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2016; 149:217-24. [PMID: 26827978 DOI: 10.1016/j.ajodo.2015.07.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effect of bone densities on the success rate of orthodontic microimplants with cone-beam computed tomography images. METHODS We examined 127 orthodontic microimplants implanted into the maxillary buccal alveolar bone of 71 patients (53 female, 18 male; mean age, 19.2 years) with malocclusion. The cortical, cancellous, and total bone densities were measured with Simplant Pro 2011 software (version 13; Materialise, Leuven, Belgium), and the correlations between these measurements and the orthodontic microimplant success rates were evaluated with cone-beam computed tomography. RESULTS The overall success rate was 85.0% (108 of 127). Sex, age, and side of placement were not significant factors for success in the results (P >0.05). The density of the cortical bone increased apically (3, 5, and 7 mm) from the alveolar crest, but in the cancellous bone it decreased. Whereas the orthodontic microimplant success rates significantly increased as cancellous bone density and total bone density increased (P <0.01), cortical bone density did not have a significant effect on the success rate (P >0.05). CONCLUSIONS The success rate of orthodontic microimplants significantly increased with higher cancellous and total bone densities, whereas cortical bone density did not have a significant effect.
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Affiliation(s)
- Mi-Young Lee
- Graduate student, Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Jae Hyun Park
- Professor and chair, Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A. T. Still University, Mesa, Ariz; adjunct professor, Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Sang-Cheol Kim
- Professor, Department of Orthodontics, School of Dentistry, Wonkwang Dental Research Institute, Wonkwang University, Iksan, Korea
| | - Kyung-Hwa Kang
- Professor, Department of Orthodontics, School of Dentistry, Wonkwang Dental Research Institute, Wonkwang University, Iksan, Korea
| | - Jin-Hyoung Cho
- Professor, Department of Orthodontics, School of Dentistry, Wonkwang Dental Research Institute, Wonkwang University, Iksan, Korea
| | - Jin-Woo Cho
- Clinical associate professor, Department of Orthodontics, School of Dentistry, Wonkwang University, Daejeon Dental Hospital, Daejeon, Korea
| | - Na-Young Chang
- Assistant professor, Department of Orthodontics, School of Dentistry, Wonkwang Dental Research Institute, Wonkwang University, Iksan, Korea
| | - Jong-Moon Chae
- Professor, Department of Orthodontics, School of Dentistry, Wonkwang Dental Research Institute, Wonkwang University, Iksan, Korea; visiting scholar, Postgraduate Orthodontic Program, Arizona School of Dentistry and Oral Health, A. T. Still University, Mesa, Ariz; instructor, The Charles H. Tweed International Foundation, Tucson, Ariz.
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18
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Scheibel PC, Ramos AL, Iwaki LCV, Micheletti KR. Analysis of correlation between initial alveolar bone density and apical root resorption after 12 months of orthodontic treatment without extraction. Dental Press J Orthod 2016; 19:97-102. [PMID: 25715722 PMCID: PMC4296651 DOI: 10.1590/2176-9451.19.5.097-102.oar] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 03/10/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the correlation between initial alveolar bone density of upper central incisors (ABD-UI) and external apical root resorption (EARR) after 12 months of orthodontic movement in cases without extraction. METHODS A total of 47 orthodontic patients 11 years old or older were submitted to periapical radiography of upper incisors prior to treatment (T1) and after 12 months of treatment (T2). ABD-UI and EARR were measured by means of densitometry. RESULTS No statistically significant correlation was found between initial ABD-UI and EARR at T2 (r = 0.149; p = 0.157). CONCLUSION Based on the present findings, alveolar density assessed through periapical radiography is not predictive of root resorption after 12 months of orthodontic treatment in cases without extraction.
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19
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Hong SB, Kusnoto B, Kim EJ, BeGole EA, Hwang HS, Lim HJ. Prognostic factors associated with the success rates of posterior orthodontic miniscrew implants: A subgroup meta-analysis. Korean J Orthod 2016; 46:111-26. [PMID: 27019826 PMCID: PMC4807148 DOI: 10.4041/kjod.2016.46.2.111] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/26/2015] [Accepted: 07/29/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To systematically review previous studies and to assess, via a subgroup meta-analysis, the combined odds ratio (OR) of prognostic factors affecting the success of miniscrew implants (MIs) inserted into the buccal posterior region. METHODS Three electronic searches that were limited to articles on clinical human studies using MIs that were published in English prior to March 2015 were conducted. The outcome measure was the success of MIs. Patient factors included age, sex, and jaw of insertion (maxilla vs. mandible), while the MI factors included length and diameter. A meta-analysis was performed on 17 individual studies. The quality of each study was assessed for non-randomized studies and quantified using the Newcastle-Ottawa Scale. The meta-analysis outcome was a combined OR. Subgroup and sensitivity analyses based on the study design, study quality, and sample size of miniscrews implanted were performed. RESULTS Significantly higher success rates were revealed for MIs inserted in the maxilla, for patients ≥ 20 years of age, and for long MIs (≥ 8 mm) and MIs with a large diameter (> 1.4 mm). All subgroups acquired homogeneity, and the combined OR of the prospective studies (OR, 3.67; 95% confidence interval [CI], 2.10-6.44) was significantly higher in the maxilla than that in the retrospective studies (OR, 2.10; 95% CI, 1.60-2.74). CONCLUSIONS When a treatment plan is made, these risk factors, i.e. jaw of insertion, age, MI length, and MI diameter, should be taken into account, while sex is not critical to the success of MIs.
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Affiliation(s)
| | - Budi Kusnoto
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, IL, USA
| | | | - Ellen A BeGole
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, IL, USA
| | - Hyeon-Shik Hwang
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea.; Dental Science Reseach Institute, Chonnam National University, Gwangju, Korea
| | - Hoi-Jeong Lim
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea.; Dental Science Reseach Institute, Chonnam National University, Gwangju, Korea
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20
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Campos MJDS, de Souza TS, Mota Júnior SL, Fraga MR, Vitral RWF. Bone mineral density in cone beam computed tomography: Only a few shades of gray. World J Radiol 2014; 6:607-12. [PMID: 25170398 PMCID: PMC4147441 DOI: 10.4329/wjr.v6.i8.607] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/11/2014] [Accepted: 04/25/2014] [Indexed: 02/06/2023] Open
Abstract
Cone beam computed tomography (CBCT) has often been used to determine the quality of craniofacial bone structures through the determination of mineral density, which is based on gray scales of the images obtained. However, there is no consensus regarding the accuracy of the determination of the gray scales in these exams. This study aims to provide a literature review concerning the reliability of CBCT to determine bone mineral density. The gray values obtained with CBCT show a linear relationship with the attenuation coefficients of the materials, Hounsfield Units values obtained with medical computed tomography, and density values from dual energy X-ray absorciometry. However, errors are expected when CBCT images are used to define the quality of the scanned structures because these images show inconsistencies and arbitrariness in the gray values, particularly when related to abrupt change in the density of the object, X-ray beam hardening effect, scattered radiation, projection data discontinuity-related effect, differences between CBCT devices, changes in the volume of the field of view (FOV), and changes in the relationships of size and position between the FOV and the object evaluated. A few methods of mathematical correction of the gray scales in CBCT have been proposed; however, they do not generate consistent values that are independent of the devices and their configurations or of the scanned objects. Thus, CBCT should not be considered the examination of choice for the determination of bone and soft tissue mineral density at the current stage, particularly when values obtained are to be compared to predetermined standard values. Comparisons between symmetrically positioned structures inside the FOV and in relation to the exomass of the object, as it occurs with the right and left sides of the skull, seem to be viable because the effects on the gray scale in the regions of interest are the same.
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21
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Lai TT, Chen MH. Factors affecting the clinical success of orthodontic anchorage: Experience with 266 temporary anchorage devices. J Dent Sci 2014. [DOI: 10.1016/j.jds.2013.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Ozdemir F, Tozlu M, Germec Cakan D. Quantitative evaluation of alveolar cortical bone density in adults with different vertical facial types using cone-beam computed tomography. Korean J Orthod 2014; 44:36-43. [PMID: 24511514 PMCID: PMC3915175 DOI: 10.4041/kjod.2014.44.1.36] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 06/17/2013] [Accepted: 06/28/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose of this study was to quantitatively evaluate the cortical bone densities of the maxillary and mandibular alveolar processes in adults with different vertical facial types using cone-beam computed tomography (CBCT) images. METHODS CBCT images (n = 142) of adult patients (20-45 years) were classified into hypodivergent, normodivergent, and hyperdivergent groups on the basis of linear and angular S-N/Go-Me measurements. The cortical bone densities (in Hounsfield units) at maxillary and mandibular interdental sites from the distal aspect of the canine to the mesial aspect of the second molar were measured on the images. RESULTS On the maxillary buccal side, female subjects in the hyperdivergent group showed significantly decreased bone density, while in the posterior region, male subjects in the hyperdivergent group displayed significantly decreased bone density when compared with corresponding subjects in the other groups (p<0.001). Furthermore, the subjects in the hyperdivergent group had significantly lower bone densities on the mandibular buccal side than hypodivergent subjects. The maxillary palatal bone density did not differ significantly among groups, but female subjects showed significantly denser palatal cortical bone. No significant difference in bone density was found between the palatal and buccal sides in the maxillary premolar region. Overall, the palatal cortical bone was denser anteriorly and buccal cortical bone was denser posteriorly. CONCLUSION Adults with the hyperdivergent facial type tend to have less-dense buccal cortical bone in the maxillary and mandibular alveolar processes. Clinicians should be aware of the variability of cortical bone densities at mini-implant placement sites.
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Affiliation(s)
- Fulya Ozdemir
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Murat Tozlu
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Derya Germec Cakan
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
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Cassetta M, Sofan AA, Altieri F, Barbato E. Evaluation of alveolar cortical bone thickness and density for orthodontic mini-implant placement. J Clin Exp Dent 2013; 5:e245-52. [PMID: 24455090 PMCID: PMC3892271 DOI: 10.4317/jced.51228] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/26/2013] [Indexed: 11/07/2022] Open
Abstract
Objective: Mini-implant stability is primarily related to bone quality and quantity. This study evaluated alveolar cortical bone thickness and density differences between interradicular sites at different levels from the alveolar crest, and assessed the differences between adolescents (12-18 years of age) and adults (19-50 years of age), males and females, upper and lower arch, anterior and posterior region of jaws and buccal and oral side.
Study Design: In this retrospective study, 48 Computed Tomography scans, performed for oral surgery purposes were selected from dental records of 3,223 Caucasian orthodontic patients.
The SimPlant software (Materialise, Leuven, Belgium) was used to measure cortical bone thickness and density at 13 interradicular sites and four bone levels ( 2,4,6 and 8 mm ). For the statistical analysis descriptive statistics, Student’s t-test and Pearson correlation coefficient were used.
Results: Statistically significant differences in alveolar cortical bone thickness and density between age, gender, sites and sides were found (P<0.05). The Pearson correlation coefficient demonstrated a significant linear increasing of thickness and density from crest to base of alveolar crest (P≤0.05).
Conclusion. Adults show a thicker alveolar cortical bone than adolescents. Alveolar cortical bone thickness and density were greater in males than in females, in mandible than in maxilla, in the posterior region than the anterior, in oral than buccal side. There is an increase of thickness and density from crest to base of alveolar crest.
Key words:Orthodontics, cortical bone thickness, cortical bone density, mini-implant, computed tomography, temporary anchorage devices.
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Affiliation(s)
- Michele Cassetta
- DDS, PhD. Assistant Professor, Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Italy
| | - Aisha Aa Sofan
- DDS, PhD. Orthodontist, Department of Oral and Maxillofacial Sciences, Al- Thawra Modern General Hospital, Sanaa, Yemen
| | - Federica Altieri
- DDS. Assistant Researcher, Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Italy
| | - Ersilia Barbato
- DDS, MS. Professor, Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Italy
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Scheibel PC, Ramos AL, Iwaki LCV. Is there correlation between alveolar and systemic bone density? Dental Press J Orthod 2013; 18:78-83. [DOI: 10.1590/s2176-94512013000500014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: The present study assessed the correlation between maxillomandibular alveolar bone density and systemic bone mineral density (BMD). METHODS: Dual-energy X-ray absorptiometry of the anterior and posterior maxillomandibular alveolar bone, of the standard sites for the measurement of BMD (lumbar spine and femur) and the third cervical vertebra was performed on 23 middle-aged women. Periapical radiographs were also obtained, with an aluminum step-wedge as reference for the digital reading of apical bone density of the upper incisors. RESULTS: Spearman's correlations coefficients revealed that density in the apical region was correlated with that of the femoral neck (r = 0.433; p < 0.05); BMDs of the posterior regions of the mandible and maxilla were significantly correlated with that of the cervical vertebra (r = 0.554, p < 0.01 and r = 0.423, p < 0.05, respectively); and the anterior maxilla was correlated with the posterior mandible (r = 0.488, p < 0.05). CONCLUSION: Bone density of the maxillary alveolar bone was significantly correlated with that of the femoral neck. Among the bone densities of the alveolar regions, only the anterior maxilla and the posterior mandible were significantly correlated. The findings suggested that bone densitometry might be individually and locally evaluated.
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Meursinge Reynders R, Ronchi L, Ladu L, Van Etten-Jamaludin F, Bipat S. Insertion torque and orthodontic mini-implants: A systematic review of the artificial bone literature. Proc Inst Mech Eng H 2013; 227:1181-202. [DOI: 10.1177/0954411913495986] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This article systematically reviewed the literature to (1) identify variables that were associated with maximum insertion torque values during the insertion of orthodontic mini-implants into artificial bone, (2) quantify such associations and (3) assess adverse effects of this procedure. Computerized and manual searches were conducted up to 24 February 2012. Selection criteria included studies that (1) recorded maximum insertion torque during the insertion of orthodontic mini-implants into artificial bone, (2) used sample sizes of five screws or more, (3) assessed maximum insertion torque with electronic torque sensors, and (4) used orthodontic mini-implants with a diameter smaller than 2.5 mm. ASTM Standards F543-07ε1 and F1839-08ε1 and the Cochrane Handbook for Systematic Reviews were used as guidelines for this systematic review. Quality assessments were rated according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A total of 23 studies were selected, many of which were multiple publications of the same study. Many domains in the risk of bias assessments were scored as “high” or “unclear” risk of bias. A wide variety of implant, test block, and insertion procedure–related associations with maximum insertion torque were recorded. The quality of most outcomes was classified as “moderate.” Outcomes could not be combined in a meta-analysis because of high risk of bias, poor standardization, high heterogeneity, or inconsistency in direction of outcomes within or between studies. Adverse effects were only assessed in one study. Future studies should control publication bias, consult existing standards for conducting torque tests, and focus on transparent reporting.
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Affiliation(s)
| | | | | | | | - Shandra Bipat
- Departments of Radiology, Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Campos MJDS, de Albuquerque EG, Pinto BCH, Húngaro HM, Gravina MA, Fraga MR, Vitral RWF. The role of orthodontic tooth movement in bone and root mineral density: a study of patients submitted and not submitted to orthodontic treatment. Med Sci Monit 2013. [PMID: 23197239 PMCID: PMC3560800 DOI: 10.12659/msm.883604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Orthodontic force application to the teeth is responsible for a series of biological responses in the bone and dentin, which lead to some alterations of the mineral density of the tissues. Our objective was determine, through cone-beam computed tomography (CBCT), the mineral density of the apical third of the roots of the upper central incisors and of the periapical bone portion surrounding these teeth, in patients submitted to orthodontic treated and untreated individuals. Material/Methods 30 untreated individuals and 15 treated ones (treatment cessation at least 1 year before the study) underwent CBCT. Mineral density was assessed in the apical third of the root of the upper central incisors and in the alveolar bone in the periapical region of these teeth. In order to reduce CBCT-related mineral density variability, we standardized the cone-beam tomography device, the image-acquisition settings and the field of view positioning and size. Student’s t test was used for the analyses. Results bone mineral density (BMD) and root mineral density (RMD), in Hounsfield Units, were 674.84 and 1282.26 for the untreated group and 630.28 and 1370.29 for the treated group, respectively. The differences between the group means were statistically significant for RMD (p<0.05). Conclusions untreated individuals had a significant lower mean RMD in comparison with those submitted to orthodontic treatment.
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Song HN, Hong C, Banh R, Ohebsion T, Asatrian G, Leung HY, Wu BM, Moon W. Mechanical stability and clinical applicability assessment of novel orthodontic mini-implant design. Angle Orthod 2013; 83:832-41. [PMID: 23627420 DOI: 10.2319/111412-876.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the stability and clinical applicability of a novel orthodontic mini-implant design (N2) with the most widely used commercially available (CA) design. MATERIALS AND METHODS Two groups of mini-implants were tested: a CA design (1.5-mm diameter, 6-mm length) and N2 (3-mm diameter, 2-mm length, tapered shape). Implants were inserted in bone blocks of cortical bone simulation with varying densities (20 pounds per cubic foot [pcf], 30 pcf, and 40 pcf). A torque test was used to measure maximum insertion torque (MIT) and maximum removal torque (MRT). Compression and tension force vectors were applied at angles of 10°, 20°, 30°, and 40° using customized load pins to determine primary stability. RESULTS Mean MIT and MRT were higher in the N2 than the CA design at all three cortical bone densities except MRT in 20 pcf bone (not statistically significant). The mean compression force required to displace the N2 at all distances and angulations was greater for the N2 than the CA design. At all displacement distances, the highest mean tension force required for N2 displacement was at 10° angulation, whereas at 30° and 40°, the mean tension force required to displace the CA design was greater. CONCLUSIONS The primary stability of the N2 is superior to that of the CA design and is promising for both orthodontic and orthopedic clinical applicability, especially under compression force. The short length of the N2 reduces risk of damage to anatomic structures and root proximity during placement and orthodontic treatment. The stability of the N2 may be compromised in areas of high bone density and highly angulated tension force.
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Affiliation(s)
- Ha Na Song
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, Calif 90095, USA
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Migliorati M, Benedicenti S, Signori A, Drago S, Barberis F, Tournier H, Silvestrini-Biavati A. Miniscrew design and bone characteristics: an experimental study of primary stability. Am J Orthod Dentofacial Orthop 2012; 142:228-34. [PMID: 22858333 DOI: 10.1016/j.ajodo.2012.03.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the correlations between bone characteristics, orthodontic miniscrew designs, and primary stability. METHODS Four different miniscrews were placed in pig ribs. The miniscrews were first scanned with a scanning electron microscope to obtain measurable images of their threads. Subsequently, the maximum insertion torque of the screws and the maximum load value in the pullout force tests were measured; furthermore, bone specimen characteristics were analyzed by using cone-beam computed tomography. For each bone sample, the insertion site cortical thickness as well as both cortical and marrow bone density were evaluated. The nonparametric Kendall rank correlation (tau) was used to evaluate the strength of the associations among the characteristics measured. The nonparametric Kruskall-Wallis test was used to evaluate the differences among the groups, and post-hoc comparisons were assessed by using the Nemenyi-Damico-Wolfe-Dunn test. RESULTS A significant dependence was found between pitch and maximum insertion torque (tau, -0.49). Positive correlations were also found between pullout force and maximum insertion torque (tau, 0.64), cortical thickness (tau, 0.36), and marrow bone density (tau, 0.35). CONCLUSIONS In this in-vitro experimental study, strong correlations were observed among miniscrew geometry, bone characteristics, and primary stability.
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Affiliation(s)
- Marco Migliorati
- Department of Orthodontics, School of Dentistry, Genoa University, Genoa, Italy.
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Migliorati M, Benedicenti S, Signori A, Drago S, Cirillo P, Barberis F, Silvestrini Biavati A. Thread shape factor: evaluation of three different orthodontic miniscrews stability. Eur J Orthod 2012; 35:401-5. [PMID: 22267706 DOI: 10.1093/ejo/cjr145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The thread shape factor (TSF) to evaluate the relationships between geometrical characteristics and mechanical properties of the temporary anchorage devices (TADs) has recently been introduced. This in vitro experimental study evaluated in 30 different tests with three TADs: ORTHOImplant (1.8 mm diameter and 10 mm length; 3M Unitek), Tomas (1.6 mm diameter and 10 mm length; Dentaurum), and Orthoeasy (1.7 mm diameter and 10 mm length; Forestadent). Scanning electron microscopy images were acquired for each TAD to measure the TSF; afterwards, the maximum insertion torque (MIT) was evaluated and thereafter pull-out tests on two differently designed organic bone analogs were carried out using a testing machine with a crosshead speed of 2 mm/minute being applied. One-way analysis of variance with group as factor was performed. Post hoc multiple comparisons Bonferroni test was used. Rank-transformed data were used when asymmetry of data was shown. To assess correlation between characteristics, load, and MIT, Spearman's rank correlation coefficient was used. A P-value of 0.05 was considered statistically significant. Significant direct correlations were found between TSF and depth and both load and MIT. Particularly, a correlation of 0.90 (P < 0.001) was found between depth and MIT for 2.2 mm cortical thickness. The authors conclude that MIT and maximum load values of pull-out test are statistically related to depth of the thread of the screw and to TSF.
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Affiliation(s)
- Marco Migliorati
- Orthodontics Department, Genoa University School of Dentistry, Genova, Italy.
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Migliorati M, Signori A, Silvestrini-Biavati A. Temporary anchorage device stability: an evaluation of thread shape factor. Eur J Orthod 2011; 34:582-6. [PMID: 21367816 DOI: 10.1093/ejo/cjr026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The resistance to extraction of temporary anchorage devices (TADs) depends on various factors, including miniscrew design, shear strength, and bone density. This research introduces the thread shape factor (TSF) as a new factor for the evaluation of TAD mechanical properties. The authors evaluated three TADs for a total of 27 tests: Mini-impianto autoforante (Leone, 1.75 mm diameter and 8 mm length), Orthoscrew (Leader Ortodonzia, 1.65 mm diameter and 9 mm length), and MAS (Miniscrew Anchorage System, 1.3 mm diameter and 11 mm length). For each TAD, the images were acquired via a 20.00 kV scanning electron microscopy to measure their respective mean depth of thread (D), pitch (P), and the relationship between the two (TSF). Subsequently, pullout tests on organic bone analogue were carried out using a testing machine; a crosshead speed of 2 mm/minutes was applied. A two-way analysis of variance was performed to evaluate the interaction between the type of miniscrew and the cortical thickness. A post hoc analysis for single comparisons was subsequently employed. In addition, if homogeneity of variances was not rejected, Scheffè's test was performed, while Tamhane's test was carried out if the homogeneity of variance assumption was not met. Univariate linear regression models were fitted to evaluate the relationship between the outcomes and TSF, D, and P separately. A P value of 0.05 was considered statistically significant. From univariate linear regression, TSF, D, and P were statistically significant predictors of 'peak load'. The tests showed that TSF has a statistical significance for describing the mechanical competency of TADs.
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Affiliation(s)
- M Migliorati
- Orthodontics Department, Genoa University School of Dentistry, Italy.
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