Effect of miniscrew placement torque on resistance to miniscrew movement under load

Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA 52242, USA.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (Impact Factor: 1.38). 09/2011; 140(3):e93-8. DOI: 10.1016/j.ajodo.2011.04.017
Source: PubMed


The primary stability of orthodontic anchorage miniscrews is believed to result from mechanical interlock, with success based upon a number of variables, including screw diameter, angle of placement, monocortical vs bicortical placement, placement through attached or unattached soft tissue, presence or absence of a pilot hole, periscrew inflammation, and maximum placement torque. The purpose of this ex-vivo study was to further explore the relationship between maximum placement torque during miniscrew placement and miniscrew resistance to movement under load.
Ninety-six titanium screws were placed into 24 hemi-maxillae and 24 hemi-mandibles from cadavers between the first and second premolars by using a digital torque screwdriver. All screws were subjected to a force parallel to the occlusal plane, pulling mesially until the miniscrews were displaced by 0.6 mm. The Spearman rank correlation test was used to evaluate whether there was an increasing or a decreasing relationship between maximum placement torque of the screws, miniscrew resistance to movement, and bone thickness. A paired-sample t test and the nonparametric Wilcoxon signed rank test were used to compare maximum placement torque, bone thickness, and miniscrew resistance to movement between coronally positioned and apically positioned screws in the maxilla and the mandible, and between screws placed in the maxilla vs screws placed in the mandible. Additionally, 1-way analysis of variance (ANOVA) with the post-hoc Tukey-Kramer test was used to determine whether there was a significant difference in miniscrew resistance to movement for screws placed with maximum torque of <5 Ncm, 5 to 10 Ncm, and >10 Ncm.
The mean difference in miniscrew resistance to movement between maximum placement torque groupings, <5 Ncm, 5 to 10 Ncm, and >10 Ncm, increased throughout the deflection range of 0.0 to 0.6 mm. As deflection increased to 0.12 to 0.33 mm, the mean resistance to movement for miniscrews with maximum placement torque of 5 to 10 Ncm was statistically greater than for screws with maximum placement torque <5 Ncm (P <0.05). As deflection increased to 0.34 to 0.60 mm, the mean resistance to movement for miniscrews with maximum placement torque of 5 to 10 Ncm and >10 Ncm was significantly greater than for screws with maximum placement torque <5 Ncm (P <0.05). At no deflection was there a significant difference in resistance to movement between the 2 miniscrew groups with higher placement torque values of 5 to 10 Ncm and >10 Ncm.
Ex vivo, the mean resistance to movement of miniscrews with higher maximum placement torque was greater than the resistance to movement of those with lower maximum placement torque.

5 Reads
    • "Using conical OMIs, especially Nos. 3,7 and 8, a pilot drill is recommended to decrease the IT for better secondary stability (3) because high placement torques although they increase primary stability may are not favorable in the clinical setting (23). Bone remodelling was shown to counteract the OMI primary stability already 3 weeks after the OMI placement (15). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Orthodontic mini-implants (OMIs) are increasingly used in orthodontics but can fail for various reasons. This study investigates the effects of OMI design characteristics on the mechanical properties in artificial bone. Material and Methods: Twelve self-drilling OMIs (2 small, 6 medium, 4 large) from 8 manufacturers were tested for their primary stability in simulated medium-high cancellous bone and the risk to fracture in high-density methacrylate blocks. For the assessments of the maximum insertion torque (IT) and torsional fracture (TF) 5 of each OMI were used and for the pull-out strength (POS) 10. The OMIs were inserted with a torque screwdriver (12 sec/360°) until the bottom at 8 mm depth was reached. OMI designs were analyzed with a scan electron microscope (SEM). Results: SEM images revealed a great variation in product refinement. In the whole sample, a cylindrical OMI shape was associated with higher POS (p<0.001) but lower IT (p=0.002) values. The outer and inner OMI diameters were design characteristics well correlated with POS, IT and TF values (ranging from 0.601 to 0.961). Greater thread depth was related to greater POS values (r= 0.628), although OMIs with similar POS values may have different IT values. Thread depth and pitch had some impact on POS. TF depended mainly on the OMI inner (r= 0.961) and outer diameters (r=0.892). A thread depth to outer diameter ratio close to 40% increased TF risk. Conclusions: Although at the same insertion depth the OMI outer and inner diameters are the most important factors for primary stability, other OMI design characteristics (cylindrical vs. conical, thread design) may significantly affect primary stability and torsional fracture. This needs to be considered when selecting the appropriate OMI for the desired orthodontic procedures. Key words:Orthodontic mini-implants, primary stability, insertion torque, pullout strength, torsional fracture.
    Medicina oral, patologia oral y cirugia bucal 05/2013; 18(5). DOI:10.4317/medoral.18674 · 1.17 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To compare the clinical performance and the survival rate of two mini-implant systems with different surface characteristics under immediate orthodontic loading. Seventeen machined titanium (MT) mini-implants and 15 sandblasted, large grit, acid-etched (SLA) mini-implants were placed in 10 patients. The mini-implants were immediately loaded and the patients seen at 7, 14, 30, 60, and 150 days. Clinical parameters such as anatomical location, character of the soft tissue at the screw head emergence, type of mini-implant system, diameter, and length were analyzed. In addition, the insertion torque recorded at the time of insertion was also assessed. Survival rate and clinical parameters were evaluated by the chi-square exact tests using the SAS version 9.1. The overall survival rate was 87.5%. Over the four failing mini-implants, three were MT and one SLA resulting in an individual survival rate of 82.4% and 93.4%, respectively. In the failure group, all the fixtures had their screw emergence at the oral mucosa and recorded a torque range of less than 15 Ncm. The insertion torque statistically influenced the survival rate of the mini-implants (P < .05). Surface treatment, anatomical location, as well as soft tissue emergence were not statistically significant. Surface characteristics did not appear to influence survival rates of immediately loaded mini-implants.
    The Angle Orthodontist 01/2008; 78(1):107-13. DOI:10.2319/100206-401.1 · 1.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to evaluate the correlations between bone characteristics, orthodontic miniscrew designs, and primary stability. 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. 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). In this in-vitro experimental study, strong correlations were observed among miniscrew geometry, bone characteristics, and primary stability.
    American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 08/2012; 142(2):228-34. DOI:10.1016/j.ajodo.2012.03.029 · 1.38 Impact Factor
Show more

Similar Publications