129 temporary anchorage devices in orthodontics-miniscrews-mini-implants-oussama sandid-awatef shaar-orthodontist-orthodontiste

129-Temporary Anchorage Devices in
Orthodontics Miniscrews
Biomechanics
Awatef SHAAR (BAU-LB), Orthodontist.
Mohamad ABOULNASER- Orthodontist, BAU, Connecticut, USA.
Oussama SANDID- Orthodontist, D.C.D., D.U.O, C.E.S.B.B, C.E.S.O.D.F ,
S.Q.O.D.F, Paris. France.
Contact: dr.aboualnaser@hotmail.com
www.orthofree.com

Plan
• Introduction
• Definition
• 1-Conventional anchorage in orthodontics
• 2-Advantages And Disadvantages Of Miniscrews
• 3-Clinical Applications of Miniscrews
• 4-Descriptions types of miniscrews
• 5-Common sites of placement
• 6-CBCT - Planning of TAD placement
• 7-Case report
• 8-Risks and complications of miniscrew anchorage
• 9-Surgical procedures for placement of orthodontic miniimplants
• 10-Biomechanics
• Conclusions
Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR

The success of orthodontic treatment depends on the anchorage protocol planned for a particular
case.
-Implants have become one of the best sources of reliableanchorage
-Use of extraoral anchorage devices such as headgears requires full patient
cooperation, which is sometimes not possible and is unpredictable. ,
Introduction of implants in orthodontics have solved thisproblem.
- Maximum Anchorage
- SkeletalAnchorage
- Relatively predictable outcomes
- Favorable esthetics
- Reduction of orthodontic appliances
- Incomplete osseointegration represents a distinct advantage in orthodontic applications, allowing
for effective anchorage with easy insertion and removal of thescrew
Introduction
Awatef SHAAR , Mohamad ABOUALNASER , Oussama SANDID

Definition
Mini-implants, also called mini-screws or temporary anchorage devices
(TAD), are very small screw-like gadgets used more widely in orthodontic
tooth movement and anchorage.

1-

Protraction mask J Hook Headgear
Headgear Orthopedic chin cup
1a-Conventional extra-oral Anchorage in orthodontics

1- Provide comfort for the patient; Minimal dependence on patient cooperation.
2-24 X 7 Force delivery, Continuous forces, simplified mechanics ,
3Remarkable reduction (upto 40%) in treatment timing
4 Reduction in number of extractions, minimize the risk of surgery
5The major advantage of these implants is that they make it possible to move multiple teeth
without loss of anchorage, strong anchorage
6can be placed in areas where natural anchorage or conventional orthodontic appliances are
impractical, including the edentulous spaces in the alveolus of either arch, the palate, the
zygomatic process, the retromolar regions, and the ramus.
- Easy insertion and removal, improved results, Incomplete osseointegration allowing for
effective anchorage with easy insertion and removal of the screw.
http://pocketdentistry.com/
2-Advantages Of Miniscrews

1The need for an invasive surgical procedure, Irritation of mucous membrane, Injury
to roots or neurovascular bundles. Root proximity is a major factor for screw
2The limitations on placement sites imposed by the implants’ 10mm length.
3The time required for osseointegration prior to force application.
4- Cost.
5Mobility of screw fracture after removal;
6Different insertion sites that have different anatomical features;
7-Problem in site selection in patients with poor Bonequality
2-Disadvantages Of Miniscrews
Awatef SHAAR ,Mohamad ABOUALNASER , Oussama SANDID

3-Clinical Applications Miniscrews
1- Closure of extraction space
2-Retraction of Incisors and canines
3-For symmetric incisor intrusion, Deep bite
4- Molar intrusion, Open bite
5 -Molar distalization,
6-Molar meliazilation
7-Correction of canted occlusal plane,
8-Dental midline corrections
9-Extrusion of impacted canines
10-intermaxillary anchorage.
11- En Masse Retraction
http://iosrjournals.org/iosr-jdms/papers/Vol15-Issue%2010/Version-9/K1510095562.pdf

3a-TADS- Closure of extraction space
• Between maxillary 1st molar and 2nd premolar buccally.
• Purpose: Retraction of the maxillary anterior teeth, Intrusion of maxillary buccal teeth
• Diameter: 1,2 mm and 1,3 mm, Length; 7-8 mm .
• The mesio-buccal root of the maxillary 1st molars are curved mesialy. to avoid root injury drill
the bone somewhat mesial to the contact point between the 2nd premolar and 1st molar .

3b-TADs- Retraction of anterior teeth
• Increased overjet and/or anterior crowding, Normal or increased overbite, Buccal mini-
implants (1.5mm diameter, 9mm length, short neck) inserted in U5-6 areas bilaterally.
• Powerarms (on a 19x25 steel archwire) to assist bodily incisor retraction and limit
intrusive effects on maxillary molars.
http://www.infinitas-miniimplant.co.uk/incisor-retraction/incisior-retraction.html

3c-TADs-Intrusion-Mandibular symphysis
facially
• Purpose: Intrusion of mandibular anterior teeth.
• Diameter: 1,2mm and 1,3mm, Length :4-6 mm.
• Microimplants Placed in the Mandibular symphysis
O SANDID

• Burstone lingual arch with lingual crown torque + buccaly mini-implamts
• Diameter 1,6 mm Length 6mm
• Miniscrew Placement in Posterior Mandibular Sites: insertion angles of 45, 60, and 90 .
Tae-Woo kim ,
http://laboratorioceosa.com/cursos-de-ortodoncia/modulos/modulo-7-
biomecanica-avanzada-y-autoligado/mini-implantes-como-alternativa-de-anclaje/
3d-TADs-Intrusion of lower molar- open bite

3e-TAD's- Molar intrusion
• 2 mini-implants from the buccal and palatal sides on one tooth will exert intruding force
without tipping
• Dimension: Diameter 1,6mm Length 6-8 mm

3f-TAD's - Open Bite
• Anterior openbite with an increased mandibular plane angle.
• Anchorage and intrusion by TPA.
• Palatal mini-implants (1.5mm diameter, 9mm length, long neck) inserted U6-7s (or U5-6s if
U7s not fully erupted) , TPA d'intrusion rigide fabriqué avec 5mm de dégagement au milieu
du palais.
http://www.infinitas-miniimplant.co.uk/anterior-open-bite/anterior-open-bite.html

3g-Maxillary tuberosity Area
Molar Distalization
• Purpose: Retraction of the maxillary posterior teeth
• Diameter: 1,3 -1,5 mm, Length 7-8 mm.
• Microimplants placed on the maxillary tuberosity area in lingual orthodontic treatment
https://www.ortodoncia.ws/publicaciones/2014/art31.asp
O SANDID

• Purpose: Uprighting of tilted mandibular molar.
Retraction of the mandibular teeth or the whole dentition
Diameter: 1,3-1,6mm., length: 6-10 mm.
3h-Microimplamts in the Retromolar area

3i-Miniscrew Applications in Orthodontics Mesialization
• Examples of miniscrew-supported mechanics for predictable unilateral space
closure. Miniscrews prevented the typical reactive side effect of midline shift or
anterior anchorage loss that would have occurred with traditional orthodontic
mechanics
BjÖrn Ludwig, ; Bettina Glasl, http://www.orthodonticproductsonline.com/2008/04/miniscrews-2008-04-02/

Mesialization of molars using miniscrews
3j-TADs- Molar mesialization
O Sandid
By Yuly Mycaza

3k-TADs-Molar Mesialization
• Upper Molar Mesialisation

Correction of Occlusal Plane inclination
3l-TADs -Correction of canted occlusal plane
O SandidOussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR

3m- TAD's - Centre line Corrections
• Centre line displacement and/or anterior crowding,
• Buccal mini-implants
• (1.5mm diameter, 9mm length, short neck) inserted UR5-6, and LR5-6
http://www.infinitas-miniimplant.co.uk/centreline-corrections/centreline-corrections.html

3n-TADs-Extrusion of impacted canines
• TADs

3p- Inter-maxillary Fixation / Traction
• Buccal mini-implants (1.5mm diameter, 6 or 9mm length) are inserted at interproximal sites according
to required tractionlocations.
• Upper labial frenectomy may berequired.
• Indications:
• Inadequate root length and/or periodontal support for elastictraction.
• Orthognathic cases treated without full labial fixedappliances.
http://www.infinitas-miniimplant.com/fixed-appliance2.html

3q-Correction of Deepbite and Bilateral en
masse distalization
Correction of Deepbite and Bilateral en mass
distalization of maxillary teeth
O Sandid

3s-Microimplants in between the maxillary 1st
and 2nd molarsbuccaly
• Purpose: Molar distalization
• Retraction of the maxillary anterior teeth ,
• Intrusion of maxillary molars
• Diameter: 1,2 and 1,3mm, Length 7-8mm
• Placement: Vertical
• The hook of 1st molar tube is used to prevent gingival impingement of coil spring

3t-Microimplants Between mandibular 1st and 2nd molars
buccaly
• Purpose: Retraction of mandibular anterior teeth, en masse retraction
Intrusion and distalization of the mandibular molar
Diameter; 1,2-1,4 mm . Length: 5-7 mm.

• Design characteristics
1- Length 6 – 10 mm- 12mm
2 - Diameter 1.3 – 2 mm
3- Shape – Conical, cylindrical, mixed – Tip – Thread forming vs thread
cutting
4- Surface – Smooth or roughened
4-Selection of Miniscrwes

Orthodontic Miniscrwew Description

• Size ranges in –
 Length : 4-12 mm
 Diameter : 1.2- 2.7 mm
4a-Miniscrew length and diameter

•A diameter less than 1.1 mm is associated with a higher failure rate (Miyawaki et al., 2003, Park et al., 2006).
•A diameter greater than about 1.6 mm seems to confer no advantage and clearly wider screws run an extra
risk of contact with tooth roots. This consideration is now largely of historic interest because almost all screws
are currently between 1.4 and 1.8 mm in maximum diameter (Park et al.,2006).
•2.0 mm screws are suitable for sites such as the zygomatic ridge or retromolar pad, where avoidance of roots is
not an issue (Park et al., 2006
4b-Mini-screw Diameter

• This usually refers to the intraosseous threaded part of the screw.
• The range of available body lengths is typically 6 – 10-12 mm.
• This length does NOT seem to be a factor in stability if the screw
is more than 5 mm long (intraosseous length) (Miyawaki et al., 2003, Park et al.,
2006).
4c-Mini-screw length

•Animal research results indicate that self-drilling techniques result in higher
primary stability and better preserve the original bone (histologically) around mini
implant threads (Chen et al., 2008).
•However, pre-drilling, may be valuable in avoiding excessive torque generation in
thick/dense cortex sites e.g. the posterior mandible Wilmes et al., 2008).
4d-Mini-screw Shape

• Titanium Alloy, Stainless Steel, for general coil spring. for power chain, bracket,
Torque Screw , etc…
4f-Type of Screw

• Determine the optimum mini implant body size (length and
diameter):
• The 1.5mm diameter is selected for interproximal insertions while
the 2.0mm size is reserved for sites with good root clearance.
• A long (9mm) body length is ideal for posterior maxillary sites
whereas the shorter (6mm) length is better suited where less
cancellous bone depth and/or higher cortical depth occurs e.g.
anterior.
• Determine the optimum mini implant neck length.
• The short neck versions are preferred except where the mucosa is
thick e.g. edentulous and palatal sites. The tissue thickness may
be checked using a periodontal probe
http://www.infinitas-miniimplant.com/implant-selection-sub.html
4g-Selecting the correct mini implant

• MINISCREWS
MAXILLA:
• Infrazygomatic crest area.
• Tuberosity area.
• Between 1st and 2nd molars buccally.
• Between 1st molar and 2nd premolar buccally.
• Between canine and premolar buccally.
• Between incisors facially.
• Mid palatal Area.
• MANDIBLE:
• Retromolar Area.
• Between 1st and 2nd molars buccally.
• Between 1st molar and 2nd premolar buccally.
• Between canine and premolar buccally.
http://www.dentistrytoday.info/content/microimplant-screws-anchorage-orthodontics
5-COMMON SITES OF PLACEMENT

Zone Length Base diameter
Anterior labial Ms or Mi 6 -7 mm 1,3 mm
Labial Lateral Ms or Mi 6 -7 mm 1,3 mm – 1,6 mm
Midpalatine suture 6 mm 1,3 mm – 1,6 mm
Lateral to the midpalatine
suture
6 mm 1,3 mm
Lateral palatine 8 -12 mm 1,3mm – 1,6 mm
Tuberosity 7 -8 mm 1,3mm – 1,6 mm
Lower retromolar zone 8 -12 mm 1,3mm – 1,6 mm
Alveolar bone Ms or Mi 6 -8 mm 1,3mm – 1,6 mm
Mandibular torus 6 mm 1,3 mm
5a-Relationship between the insertion zone and the most used
microimplant dimensions

Implant Selection
http://www.infinitas-miniimplant.com/implant-selection-sub.html
5b-Selecting the correct mini implant

5c-Sites of the implants-Maxilla
• Tuberosity area
• Between 1st and 2nd molarsbuccally
• Between 1st molar and 2nd premolarbuccally
• Between canine and premolar buccally
• Bellow nasal spine
• Palate
• Infrazygomatic crest
O SANDID
BIRTE MELSEN

• Vertical, oblique
5d-Sites of the implants-MaxillaAwatef SHAAR ,Mohamad ABOUALNASER , Oussama SANDID

5e-Sites of the implants-Mandible
BIRTE MELSEN
Awatef SHAAR ,Mohamad ABOUALNASER , Oussama SANDID O SANDID
• Retromolar area and molar area
• Alveolar process
• Symphysis
• Between 1st molar and 2nd premolar buccally
• Between Canine and premolar buccally
• Between Incisors facially

• (a) Green areas represent recommended places in the vestibular area to place mini-
implants (Courtesy B. Ludwig).
• (b) Green areas represent recommended places in the palatal area (third palatal rugae) to
place mini-implants (Courtesy B. Ludwig)
http://pocketdentistry.com/orthodontic-implants-and-orthodontic-implant-surfaces/
5f-Sites of the implantsAwatef SHAAR ,Mohamad ABOUALNASER , Oussama SANDID

5g-The optimal position for insertion of orthodontic
miniscrews
Red areas indicate dangerous sites, yellow areas show sites of average
risk and green areas are the most favorable.
O Sandid
Luiza Paiva Bittencourt , Melissa Vasconcellos Raymundo , José Nelson Mucha, Rev Odonto Cienc 2011;26(2):133-138 1

• 3D anatomical mapping for safe and danger zones based on the mesiodistal distance in the
maxilla and mandible.
Purmal K, Alam MK, Pohchi A, Abdul Razak NH (2013) 3D Mapping of Safe and Danger Zones in the Maxilla and Mandible for the Placementof
Intermaxillary Fixation Screws. PLOS ONE 8(12): e84202. doi:10.1371/journal.pone.0084202
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0084202
5h-3D anatomical mapping

• 3D anatomical mapping for safe and danger zones based on the buccopalatal distance in
the maxilla and buccolingual distance in the mandible.
Purmal K, Alam MK, Pohchi A, Abdul Razak NH (2013) 3D Mapping of Safe and Danger Zones in the Maxilla and Mandible for the Placementof
Intermaxillary Fixation Screws. PLOS ONE 8(12): e84202. doi:10.1371/journal.pone.0084202
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0084202
5i- 3D anatomical mapping

6-CBCT - Planning of TAD
placement

6a-CBCT -Planning of TAD placement
• Anatomical guidelines for miniscrew placement
Genevive L. Machado⁎, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273277/

6b-CBCT -Planning of TAD placement
• LE MAY Jules – Graham J.

• CBCT - Intrusion By Miniscrews
https://www.orthodontisteenligne.com/appareils/mini-vis-dancrage-exemples-cliniques/
6c-CBCT -Planning of TADs placement
Dr JulesLemay

6d-CBCT- TADs
• 3D reformat showing the 3d positioning of a mini screw
Dr Alexandre Khairallah

• Mini Screw positioned in a wrong direction
6f-CBCT- TADs

• 3D reformat showing the wrong tipping of the left canine
AlexandreKhairallah
Private collection
Property of CLIR
6g-CBCT- TADs

6h-CBCT- TADs
• Demonstrations of the lines of traction force by cone-beam computed tomography (CBCT) images.
A, Right sagittal view; B, left sagittal biew; C, coronal view. In right and left sagittal views of the
CBCT scan, the angle between the lines of traction from the helix to the minscrews relative to the
occlusal plane clearly indicate the apical direction of distal driving force. The coronal view shows
the divergent distal driving force as the expansion component of applied force
https://openi.nlm.nih.gov/detailedresult.php?img=PMC4593868_kjod-45-236-g004&req=4

• CT evaluation of interradicular bone between maxillary first molars and second premolars
in 21 patients, 2mm, 4mm, 6mm, and 8mm apical to alveolar crestal margin (CP = contact
point; AC = alveolar crest).
Ludwig, Glasl, Bowman, Wilmes, Kinzinger, and Lisson
https://www.jco-online.com/archive/article-view.aspx?year=2011&month=08&articlenum=433
6i-CBCT Evaluation - TADs

6j-CBCT Evaluation - TADs
• TADs
http://www.ijdr.in/articles/2012/23/1/images/IndianJDentRes_2012_23_1_49_99038_f2.jpg

6k-CBCT Evaluation – TADs
• Stress distributions in peri-miniscrew areas from cylindrical and tapered miniscrews
inserted at different angles
https://synapse.koreamed.org/DOIx.php?id=10.4041/kjod.2016.46.4.189&vmode=PUBREADER

Evaluation of mini-implant sites in the Posterior maxilla using traditional
radiographs and cone-beam computed tomography
• Panoramic radiograph used to determine the mini-implant position (A). Cone-beam computed
tomography images for the same mini-implant where the apex of the mini-implant was
determined on the sagittal plane (B), coronal plane (C), and horizontal plane (D).
Mona A. Abbassy, Hanady M. Sabban, , Ali H. Hassan, , Khalid H. Zawawihttp://www.smj.org.sa/index.php/smj/article/view/12462/7745

Evaluation of mini-implant sites in the Posterior maxilla using
traditional radiographs and cone-beam computed tomography
• Periapical radiograph used to determine the mini-implant position (A). Cone-beam computed
tomography images for the same mini-implant where the apex of the mini-implant was
determined on the sagittal plane (B), coronal plane (C), and horizontal plane (D).
Mona A. Abbassy, Hanady M. Sabban, , Ali H. Hassan, , Khalid H. Zawawihttp://www.smj.org.sa/index.php/smj/article/view/12462/7745

CBCT -TADs
• A, Frontal view of a clear model showing the inclination of the microimplant; B, bottom
view of a clear model showing the relationship of the apex of the microimplant and the
roots; C, buccal view of the 3D image of the CT scans; D, bottom view of the 3D image of CT
scan. Arrows indicate the microimplant
https://www.researchgate.net/figure/50363068_fig10_Fig-11-Biomechanics-for-the-palatal-root-movement-of-the-maxillary-anterior-teeth-with

7- TADs - CASE REPORT

• Diameter: 1,2 mm and 1,3 mm, Length; 7-8 mm .
• The mesio-buccal root of the maxillary 1st molars are curved mesialy. to avoid root injury
drill the bone somewhat mesial to the contact point between the 2nd premolar and 1st
molar .
http://pocketdentistry.com/chapter-2-miniscrews-and-biomechanics-in-orthodontics/
7a-Anterior retraction (Canine Incisors)

7b-Clinical Applications Miniscrews are used in
closure of extraction space
• Diameter: 1,2 mm and 1,3 mm, Length; 7-8 mm.
• The mesio-buccal root of the maxillary 1st molars are curved mesialy. to avoid root injury drill the bone
somewhat mesial to the contact point between the 2nd premolar and 1st molar .

7c-Retraction Incisors canines
• Diameter: 1,2 mm and 1,3 mm, Length; 7-8 mm.
• The mesio-buccal root of the maxillary 1st molars are curved mesialy. to avoid root injury drill the bone
somewhat mesial to the contact point between the 2nd premolar and 1st molar .

7d-Retraction of anterior teeth
• Increasedoverjet and/or anterior crowding, Normal or increased overbite.
• Buccal mini-implants (1.5mm diameter, 9mm length, short neck) inserted in U5-6 areasbilaterally.
• Powerarms (on a 19x25 steel archwire) to assist bodily incisor retraction and limit intrusive effects on
maxillary molars.

• Anterior retraction (Canine Incisors)- en-masse retraction
By YonOrthodontics
7e- TADs- Retraction (Canine Incisors)

7f-For symmetric incisor intrusion, Deep bite
BY Skander ELLOUZE
• Incisor intrusion, Deep bite, Gummysmile

7g-Miniscrews for upper incisor intrusion
Gummy smile
• Intrusion By Miniscrews – Dr Jules Lemay
• Types , Diameter, length, Angulation, Activation, duration…
https://www.orthodontisteenligne.com/appareils/mini-vis-dancrage-exemples-cliniques/
O SANDID

7h-Miniscrews for upper incisor intrusion
Gummy smile
• Gummy smile
O SANDID

• Between Maxillary incisors facially
• Purpose: Intrusion and Torque control of maxillaryIncisors.
• Diameter : 1,3 mm-1,6 mm, Length; 6-7 mm.
7i-Miniscrews for upper incisor intrusion
O SANDIDOussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR

7k-Mini-screw Application For Gummy Smile
Correction
• Types, Diameter, length, Angulation, Activation, duration…
O SANDID

• Gummy smile Deep Bite
7l-Mini-screw Application For Gummy Smile Correction

7n- Molar intrusion, Open bite
For intruding lower molars, an elastomer can be connected to the buccal TAD and the wire. This
photo shows the simultaneous A-P retraction and vertical intrusion from a single buccal TAD
Types Miniscrews….. Dimensions ….. Angulation…. Location….
Cheol-Ho Paik, https://www.aaoinfo.org

7p-Molar intrusion
• TPA with crown lingual torque and buccal mini-implants to intrude the molars
• Dimension: Diameter 1,6mm Length 6mm
Tae –Woo Kim
http://www.slideshare.net/marwanmouakeh/anterior-open-bite-treatment-in-the-permanent-dentition-part-2-63901035?qid=c179a1bc-7522-48b4-8bc0-fce9926f5e93&v=&b=&from_search=9

7q-Molar intrusion
• 1 Midpalatal and 2 buccal mini-implants with TPA to intrude molars
• Dimension: Diameter 1,6 and Length 6-8mm
Tae –WooKim

7r-Temporary Anchorage Devices in
Orthodontics
Occlusal Plan
O Sandid

7s-Dental midline corrections
e-kjo.org/ ,, Jong-Moon Chae, Na-Young Chang, , Jin-Hyoung Cho, ,a Kyung-Hwa Kang, ang-Cheol Kim

7t-Temporary Anchorage Devices in
Orthodontics O Sandid

7q-Microimplants Between mandibular 1st and
2nd molarsbuccaly
• Purpose: Retraction of mandibular anterior teeth, En masse retraction
Intrusion and distalalization of the mandibularmolar
• Diameter; 1,2-1,4 mm . Length: 5-7 mm.

7v-En masse retraction
• En masse retraction

7w-En masse retraction
• Missing maxillary lateral incisors

7x-En masse retraction
• En masse retraction

• Canted occlusal plane
7y-Correction of canted occlusal plane
O SANDID

• Tooth transposition, translation movement
7aa-TADs - Tooth transpositionO SANDID

7bb- TADs -Molar Mesialization
Molar Mesialization

7cc-TADs-Molar Intrusion
• Molar Intrusion

7dd- TADs- Retraction
Retraction

http://www.scielo.br/pdf/dpjo/v19n2/2176-9451-dpjo-19-02-00018.pdf
8-Reasons for mini-implants failure

• Mini-implant loss due to placement in recent extraction site.
Alberto Consolaro , Fábio Lourenço Romano:http://dx.doi.org/10.1590/2176-9451.19.2.018-024.oin
8a-Reasons for mini-implants failure

• Mini-implant loss.
Alberto Consolaro , Fábio Lourenço RomanoDOI: http://dx.doi.org/10.1590/2176-9451.19.2.018-024.oin
8b-Reasons for mini-implants failure

• Mini-implant loss.
http://www.scielo.br/pdf/dpjo/v20n1/2176-9451-dpjo-20-01-00023.pdf
8B-placement failure in area of recent extraction

• Mini-implant near the dental root
8c-Reasons for mini-implants failure

• Food debris around a mini-implant
8d-Reasons for mini-implants failure

• Mini-implant placed in the periodontal ligament.
8e-Reasons for mini-implants failure

• Mucositis around a mini-implant.
8f-Reasons for mini-implants failure

• Mini-implant fracture during placement.
8g-Reasons for mini-implants failure

• Inappropriate mini-implant placement.
8h-Reasons for mini-implants failure

• Mini-implant placed in the periodontal ligament.
8i-Reasons for mini-implants failure

• Mini-implant placed in free gingiva.
8j-Reasons for mini-implants failure

• Mini-implant placed in inappropriate alveolar bone.
8k-Reasons for mini-implants failure

• Maxillary sinus perforation by orthodontic anchor screws
https://www.researchgate.net/publication/278042696_Maxillary
_sinus_perforation_by_orthodontic_anchor_screws
8l-Reasons for mini-implants failure

• Stats
8m-Reasons for mini-implants failure

Incomplete osseointegration allowing for effective anchorage
with easy insertion and removal of the screw.
TADs-Osseointegration

9-Surgical procedures for placement of
orthodontic miniimplants

9-Surgical procedures for placement
of orthodontic miniimplants
Surgical procedures for placement

• A) Choosing ideal mini-implant placement site with the aid of a millimeter periodontal probe;
• B) Infiltrative anesthesia;
• C) Lancing procedures;
• D) Implant placement onset;
• E) Mini-implant in place.
by Prof. Dr. Antônio Carlos Ruellas
Major steps for mini-implant placement.

Installation procedures for mini-
implants
• Installation procedures for mini-implants using the graded
radiographic-surgical guide
Mariana Pracucio Gigliotti, Guilherme J, Sérgio Estelita Cavalcante, Kelly Chiqueto****, Marcos Roberto de Freitas http://www.scielo.br/pdf/dpjo/v16n2/en_a05v16n2.pdf

• Surgical guide
TADs-Radiographic-surgical guide

TADs-Radiographic-surgical guide
Template bent from rectangular wire and affixed with light-cured acrylic.
B. Periapical radiograph of template.
C. Mini-implant insertion.
BIRTEMELSEN

Miniscrews and biomechanics in
orthodontics

10-TADs-Biomechanics
Ravindra Nanda, Madhur Upadhyay, https://academic.oup.com/ejo/article/35/5/634/495624/Skeletal-and-dental-considerations-inorthodontic
Biomechanical design of the force system involved: (A) during en-masse retraction of the anterior
teeth with mini-implant anchorage. Here, F >> r > i. (B) After space closure. Note the increase in the
angulation of the total force relative to the occlusal plane. Here, F >> r ≈ i) (F, total force; I, intrusive
component; r, retractive component; M, moment on the anterior segment; m, moment on the entire
arch)

• A) Illustration of the moment generated by both forces due to the
archwire torsion in the 6-mm hook group; B) Illustration of the moment
generated by the retraction force applied to the 6-mm hook group.
Antônio Carlos de Oliveira Ruellas1 , Matheus Melo Pithon2 , Rogério Lacerda dos Santos3http://www.scielo.br/pdf/dpjo/v18n2/a21v18n2.pdf
10 a-TADs-Biomechanics

10 b -TADs-Biomechanics
https://www.hindawi.com/journals/crid/2011/475638/fig1/
• (a) Effect of space closure with conventional sliding mechanics without miniscrew. Anterior and posterior
segments rotate around CR of each segment, archwire forced to bend near rotation of entire arch. These
changes can easily be prevented with precurved archwires. (b) Retraction force from miniscrew anchorage
with continuous archwire produces rotation of entire arch around Cres of dentition. (c) Rotationof anterior
segment around Cres of anteriorteeth.

Intrusive force on posterior teeth causing posterior open bite and anterior deepbite.
10 c-TADs-Biomechanics

(a) Right lateral views of biomechanics of space closure with MSPA. (c) Transverse view of
miniscrew biomechanics.
10 d -TADs-Biomechanics

Biomechanics for the palatal root movement of the maxillary anterior teeth with microimplants
https://www.researchgate.net/figure/50363068_fig10_Fig-11-Biomechanics-for-the-palatal-root-movement-of-the-maxillary-anterior-teeth-with
10 e -TADs-Biomechanics

10 f-Miniscrews for upper incisor intrusion
• Force vectors for the intrusion of the six-tooth anterior segment (green box). Black and
white circles, miniscrew heads; red arrows, load vectors.
https://synapse.koreamed.org/DOIx.php?id=10.4041/kjod.2016.46.5.310&vmode=PUBREADER
O SANDIDAwatef SHAAR , Mohamad ABOUALNASER , Oussama SANDID

• A. Denture preparation : An .022 × .028″ edgewise appliance is sequentially placed. .017 × .022″ maxillary
and .018 × .025″ mandibular archwires are inserted. Maxillary and mandibular posterior micro-implants,
and elasto‐ mers are applied to the canine brackets and mandibular archwire just mesial to omega stop
loop. B. End of denture preparation : The arches are leveled, the rotations are corrected, the canines have
been retracted, and the mandibular terminal molar has been tipped to an anchorage prepared position
10 g -TADs-Biomechanics

• This is the combined intrusion and retraction force system suggested for the high angle
protrusion cases
Johnny Joung-Lin Liaw1, Daniel Wei-Yee Wang2, http://www.apospublications.com/article.asp?issn=2321
1407;year=2015;volume=5;issue=2;spage=56;epage=62;aulast=Liaw
10 h -TADs-Biomechanics

10 I -TADs-Biomechanics
Tae-Woo Kim
• Openbite: 2 mini-implants from the buccal and palatal sides on one tooth will exert intruding
force without tipping.
• Midpalatal and 2 buccal mini-implants with TPA to intrude molars
•

• Illustration of the Class III mechanics employed in the vertical control, anchored
in mini-implants on the upper arch, between the first molars and second
premolars
Márcio Costa Sobral1 , Fernando A. L. Habib2 , Ana Carla de Souza Nascimento,http://www.scielo.br/pdf/dpjo/v18n2/a26v18n2.pdf
10 j -TADs-Biomechanics

• The line of force applied from the miniscrew to the hook prewelded tothe
archwire creates vertical components, favoring the correction of a deepoverbite.
10 k -TADs-Biomechanics

• The line of force action is parallel to the archwire, creating a resultant in the
same direction. This should be done in cases where the overbite is undercontrol
10 L-TADs-Biomechanics

10 m-Palatal Mini-implant- Open bite
• - Mid-palatal Mini-implant
• - Expanded TPA
• - Expanded main archwire 19 x 25 SS with slight crown buccal torque.
• - Diameter 1,6mm , Length 6mm
Tae –WooKim

• Burstone lingual arch with lingual crown torque + buccaly mini-implamts
• Diameter 1,6 mm Length 6mm
• Miniscrew Placement in Posterior Mandibular Sites: insertion angles of 45, 60, and 90 .
Tae-Woo kim ,
http://laboratorioceosa.com/cursos-de-ortodoncia/modulos/modulo-7-
biomecanica-avanzada-y-autoligado/mini-implantes-como-alternativa-de-anclaje/
10 n -TADs-Intrusion of lower molar- open bite

• Canted occlusal plane
10- o-Correction of canted occlusal plane
O SANDID

REFERENCES
• http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=162;epage=167;aulast=Vakil
• https://www.researchgate.net/figure/49657083_fig1_Fig-1-Pretreatment-extraoral-and-intraoral-photographs-show-
bidentoalveolar-protrusion
• https://www.researchgate.net/figure/6813775_fig4_Fig-4-Biomechancis-showing-closing-of-anterior-open-bite-after-
intrusion-force-at
• http://www.scielo.br/pdf/dpjo/v19n2/2176-9451-dpjo-19-02-00018.pdf
• http://pocketdentistry.com/chapter-2-miniscrews-and-biomechanics-in-orthodontics
• https://academic.oup.com/ejo/article/36/5/541/404446/Paramedian-vertical-palatal-bone-height-for-
minihttp://www.infinitas-miniimplant.com/implant-selection-sub.html
• https://wikisites.mcgill.ca/Dentalpedia/index.php?title=Project_10:Micro-
implants&redirect=no&printable=yes&printable=yes
• http://www.slideshare.net/indiandentalacademy/implants-in-orthodontics
• http://www.dental-bio-ray.com/
• http://www.jdionline.org/article.asp?issn=0974-6781;year=2011;volume=1;issue=2;spage=86;epage=92;aulast=Rastogi
• http://www.slideshare.net/khaledwafaie/temporary-anchorage-device-tad-or-mini-screw-implant
• http://www.sciencedirect.com/science/article/pii/S1607551X16303837?np=y
• http://www.dentistrytoday.info/content/microimplant-screws-anchorage-orthodontics
• https://books.google.com.lb/books?id=f9_TBQAAQBAJ&pg=PA17&lpg=PA17&dq=anchorage+by+distal+tipping+molars&sou
rce=bl&ots=rcTonBV_wa&sig=vHnKeuAGQiYSmvXGxtGdWQlkym0&hl=en&sa=X&ved=0ahUKEwjml-
3kprLRAhWG8RQKHdkkCdIQ6AEINDAD#v=onepage&q=anchorage%20by%20distal%20tipping%20molars&f=false
• http://www.slideshare.net/pdeshmukh1/tad-parag
• ++++http://pocketdentistry.com/chapter-2-miniscrews-and-biomechanics-in-orthodontics/
• https://progressinorthodontics.springeropen.com/articles/10.1186/s40510-014-0061-x
• https://www.researchgate.net/publication/6381206_Surgical_positioning_of_orthodontic_mini-
implants_with_guides_fabricated_on_models_replicated_with_cone-beam_computed_tomography
• http://www.writtenepisodes.com/watch-video/PaXNNQMj3t0/CC305.%20Forum%20Chris%20Chang%20Part%20A/

129 temporary anchorage devices in orthodontics-miniscrews-mini-implants-oussama sandid-awatef shaar-orthodontist-orthodontiste

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