ORIGINAL ARTICLE

Influence of orthodontic mini-implant

penetration of the maxillary sinus in
the infrazygomatic crest region
Xueting Jia, Xing Chen, and Xiaofeng Huang
Beijing, PR China

Introduction: Mini-implants are widely used for predictable tooth movements, but insertion is often restricted by
anatomic structures. The aims of this study were to investigate the incidence of penetration of mini-implants into
the sinus and the relationship between penetration depth and sinus tissue. Methods: Data from 32 patients who
received mini-implants in the infrazygomatic crest were collected from a data base. The success rate of mini-
implants was determined by clinical retrospective analysis. The incidence of penetration, penetration depth,
and sinus configuration were investigated and compared between cone-beam computed tomography scans
obtained immediately after insertion and before mini-implant removal. Results: The overall success rate of
mini-implants in the infrazygomatic crest was 96.7%, and 78.3% penetrated into the sinus. In the group in
which penetration exceeded 1 mm, the incidence of membrane thickening was 88.2%, and the mean value of
thickening was 1.0 mm; however, the variable values of penetration in the 1-mm group were only 37.5% and
0.2 mm, respectively (P \0.05). Conclusions: The incidence of penetration of infrazygomatic crest mini-
implants into the sinus may be high. Penetration through double cortical bone plates with limitation of the
penetration depth within 1 mm is recommended for infrazygomatic crest mini-implant anchorage. (Am J
Orthod Dentofacial Orthop 2018;153:656-61)

T
he adoption of the mini-implant as the
“absolute” stable skeletal anchorage has become
an effective treatment strategy for orthodontic
patients, enabling precise control of tooth move-
ment.1-3 One frequently-selected insertion site for an
orthodontic mini-implant is the infrazygomatic crest
region, a bony ridge running along the curvature be-
tween the alveolar and zygomatic processes of the
maxilla.4 Due to the relatively long distance from the
root region, an infrazygomatic crest mini-implant
will not interfere with tooth movement, and the risk
of contact with the natural tooth root may be reduced.
In the clinic, the infrazygomatic crest anchorage sys-
tem has been used successfully for space closure,
From the Department of Stomatology, Beijing Friendship Hospital, Capital Med-
ical University, Beijing, PR China.
All authors have completed and submitted the ICMJE Form for Disclosure of Po-
tential Conflicts of Interest, and none were reported.
Supported by the Capital Health Research and Development of Special Project
(2018-2-1102) and the achievement promotion project of the Natural Science
Foundation of Beijing Municipality (7162053).
Address correspondence to: Xiaofeng Huang, Department of Stomatology,
Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road,
Xicheng District, Beijing, PR China; e-mail, huangxf1998@163.com.
Submitted, May 2017; revised and accepted, August 2017.
0889-5406/$36.00
! 2018 by the American Association of Orthodontists. All rights reserved.
https://doi.org/10.1016/j.ajodo.2017.08.021
656
anterior retraction, posterior intrusion, and molar
and even maxillary dental arch distalization.5-8
However, placement of a mini-implant in the infrazy-
gomatic crest is often limited by vital anatomic struc-
tures, especially the maxillary sinus. Although the
approximate mean bone thickness in the infrazygomatic
crest site was found in a previous study4 to vary between
5 and 8 mm, which could be considered adequate
for mini-implant insertion, a major factor associated
with primary stability and placement torque of a mini-
implant is the quantity of cortical bone.9-11
Farnsworth et al9 reported that the average cortical
thickness of the infrazygomatic crest is only 1.44 to
1.58 mm. As generally accepted, cortical bone thickness
of more than 1 mm is required for good stability and a
high success rate with orthodontic mini-implants.10,11
That means that, to obtain adequate primary stability,
the mini-implant may have to penetrate through double
cortical bone plates with the potential risk of invading
the maxillary sinus. However, whether the cortical plate
of the maxillary sinus floor is perforated during mini-
implant insertion into the infrazygomatic crest has not
been widely recognized until now.
The impact of dental implant penetration of the
maxillary sinus has been investigated.12-15 It was
reported that sinus infection and implant failure might
Jia, Chen, and Huang
be potential complications in cases with large
perforations. However, few studies have provided
information regarding orthodontic mini-implants in-
serted in the infrazygomatic crest site.16 Considering the
common application of infrazygomatic crest mini-
implants and their close proximity to the maxillary sinus,
the incidence of mini-implant penetration into the sinus
should be determined. In addition, the relationship be-
tween penetration status and sinus tissue reaction should
also be investigated.
Cone-beam computed tomography (CBCT) can pro-
vide accurate 3-dimensional and high-resolution images
of hard and soft tissues in the infrazygomatic crest
and maxillary sinus, with a relatively low radiation
dose and low cost.17,18 The aims of this study were
to determine with CBCT the incidence of the
infrazygomatic crest mini-implant penetration into the
maxillary sinus in clinical practice and to investigate
the irritation caused by penetration of the sinus tissue.
MATERIAL AND METHODS
This retrospective study was registered and approved
by the biomedical ethics committee (approval ID: 2016-
P2-089-01) of Capital Medical University, Beijing, PR
China. All preexisting clinical data and CBCT scans per-
formed from January 2014 to November 2016 in the
department of orthodontics of Beijing Friendship Hospi-
tal were screened for further evaluation. Appropriate
methodology and sample size were determined by a pilot
study. The sample size was calculated based on an alpha
of 0.05, a sample rate of 87%, and an allowable error of
10 percent of the sample rate. It was determined that a
sample of 60 mini-implants was needed to represent a
reasonable overall incidence of mini-implant penetra-
tion into the maxillary sinus.
Subjects selected for this study had to fulfill the
following inclusion criteria: (1) Chinese patients with
mini-implants inserted in the infrazygomatic crest as
anchorage for distalization of the maxillary dental
arch, (2) completion of the fixed orthodontic procedure,
(3) CBCT performed just before removal of the mini-
implant anchorage (with or without CBCT scans imme-
diately after mini-implant insertion), and (4) images of
the infrazygomatic crest and maxillary sinus floor com-
plete and clear. Mini-implants in contact with a tooth
root after insertion were excluded.
A total of 60 mini-implants placed in the infrazygo-
matic crests in 32 subjects (10 men, 22 women) were
available for this study, with a mean age of
28 6 6 years. The mean length of the mini-implant
was 14 mm, and the mean embedded angulation was
29.6! . The interobserver and intraobserver agreements
were 0.852 and 0.898, respectively (P .0.05).
American Journal of Orthodontics and Dentofacial Orthopedics
657
Commercial self-drilling mini-implants (A1, Pen-
ghua, Taiwan; stainless steel, 2 mm in diameter, 12-
17 mm in length according to the individual anatomic
variation) were inserted by a skilled orthodontist (X.H.)
with more than 20 years of clinical experience, in accor-
dance with recommended guidelines for the insertion
procedure. CBCT scans were carefully observed before
mini-implant placement to select the preferred insertion
site and direction in the infrazygomatic crest. After local
anesthesia, an incision in the buccal keratinized gingiva
near the mucogingival junction of the maxillary first
molar was made and limited to less than 2 mm. A
hand screwdriver was used for mini-implant insertion.
Favorable primary stability was achieved. Each patient
was instructed to take analgesics postoperatively, but
no antibiotics were prescribed. After 1 month, an ortho-
dontic force of 400 to 500 g was applied to the mini-
implant using an elastic power chain (Ormco, Glendora,
Calif).19,20 The patient was instructed to clean the
implant area gently and was scheduled for regular
periodontal maintenance every 3 months.
All images were acquired with a CBCT machine (5G,
version FP; NewTom, Verona, Italy) by experienced radi-
ologists using standardized procedures. The imaging pa-
rameters were set at 110 kV, 5 mA, scan time of
3.6 seconds, and field of view of 18 3 16 cm. The
observer filtered the CBCT images using a liquid crystal
display with a resolution of 1280 3 1024 pixels under
room lighting. The data were reconstructed with cross-
sectional slices at an interval of 0.3 mm. Clear CBCT
views were obtained by adjusting the luminance and
gray scale. The midimplant cross-sectional view was
chosen for the variable measurement.
The distance and angulation measurement tool in the
software (NNT viewer; NewTom) was used to measure
the following variables (Fig 1): (1) embedded angulation,
the angulation between the long axis of the mini-
implant and the sagittal plane; and (2) penetration
depth, the distance between the mini-implant apex
and the sinus floor cortical bone plate following the
long axis of the mini-implant. The value was labeled
as positive if the mini-implant penetrated the interior
wall of the sinus.
The configuration of the sinus tissue around the
mini-implant (Fig 1) included (1) membrane thickness,
the maximum thickness value of the sinus membrane
measured at the insertion site; (2) palatal bone thickness,
the thickness of the bone plate palatal to the existing
mini-implant following the direction parallel to the
axis of the mini-implant; (3) palatal cortical bone thick-
ness, the value of palatal bone thickness minus the thick-
ness of cancellous bone palatal to the mini-implant; (4)
buccal bone thickness, the thickness of the bone plate
May 2018 " Vol 153 " Issue 5
658
Fig 1. Description of the maxillary sinus floor region
around the mini-implant: a, penetration depth; b, membrane
thickness; c, palatal bone thickness; d, palatal cancellous
bone thickness; e, buccal bone thickness; f, buccal cancel-
lous bone thickness; g, embedded angulation.
buccal to the existing mini-implant following the direc-
tion parallel to the axis of the mini-implant; and (5)
buccal cortical bone thickness, the value of buccal
bone thickness minus the thickness of cancellous bone
buccal to the mini-implant.
All measurements were made by 2 examiners (X.J.,
X.C.). The interobserver and intraobserver agreements
were determined by comparing the 2 repeated measure-
ments on 10 randomly selected CBCT images taken
1 week apart.
Mini-implant success was defined as (1) no discom-
fort, (2) no clinically detectable mobility, and (3) stable
anchorage function until the end of the maxillary dental
arch distalization.21 Any mini-implant that did not fulfill
any of these criteria was presumed to have failed.
Statistical analysis
All variable values were analyzed using the SPSS sta-
tistical package (version 19.0; IBM, Armonk, NY). The
interobserver and intraobserver agreements were deter-
mined by a paired-samples t test. The incidences of
mini-implant success and penetration were presented
as the percentages of the number of related sites divided
by the total number of sites. All measurements are pre-
sented as means and standard deviations. The chi-
square test was used to compare the success rates
May 2018 " Vol 153 " Issue 5 American Journal of Orthodontics and Dentofacial Orthopedics
Jia, Chen, and Huang
between the penetration and nonpenetration groups,
and the incidence of membrane thickening or bone
resorption in relation to penetration depth and primary
membrane thickness. The Mann-Whitney U-test was
used to evaluate the configuration change after place-
ment of the mini-implant. A significant difference was
defined as P \0.05.
RESULTS
Forty-seven of the 60 mini-implants penetrated into
the maxillary sinus, equivalent to 78.3% of the total
mini-implants. No patient complained of clinical symp-
toms. Two mini-implants were removed during the or-
thodontic procedures because of mobility, both in the
penetration group. The overall success rate was 96.7%.
Table I shows the results comparing the success rates.
The success rate did not have a statistically significant
difference in relation to penetration, side, or sex
(P .0.05).
A detailed description of the maxillary sinus tissue is
presented in Table II. In 25 of the 60 mini-implants, the
CBCT images obtained immediately after insertion and
before mini-implant removal were available, and they
were used for further evaluation of irritation of the
mini-implant to the sinus tissue. The time interval be-
tween the 2 CBCT scans was 13 months on average.
Twenty-two mini-implants penetrated into the maxillary
sinus, with a mean depth of 2.6 mm. After placement of
the mini-implant, the mean membrane thickness
increased by 0.6 mm (P 5 0.001). In addition, the
mean buccal bone thickness and mean palatal bone
thickness values decreased by 0.1 and 0.4 mm, respec-
tively (P 5 0.019; P 5 0.002).
The changes of sinus tissue configuration after mini-
implant placement were compared between subjects
grouped by penetration depth (Table III). The incidence
of sinus membrane thickening was significantly higher
around the mini-implants that penetrated by more
than 1 mm into the sinus (88.2%) than around those
that penetrated less than 1 mm (37.5%) (P 5 0.017).
In addition, compared with the group in which penetra-
tion was less than 1 mm, the mean value of membrane
thickening was significantly greater by 0.8 mm in the
group with penetration exceeding 1 mm (P 5 0.033).
The typical reaction of the maxillary sinus membrane
to different depths of penetration is illustrated in
Figure 2. The incidence and value of buccal bone resorp-
tion were also greater in sites with penetration exceeding
1 mm, although the difference was not statistically sig-
nificant (P .0.05).
The effects of primary membrane thickness on mem-
brane thickening, buccal bone resorption, and palatal
Jia, Chen, and Huang 659

between sinus perforation with primary membrane

Table I. Success rate and comparison results (n 5 60)
thickness of more than 3 mm and loosening of
Mini-implant Successful Success rate the mini-implant was also mentioned in a study by
Group (n) (n) (%) P Motoyoshi et al.16
Penetration status The high success rate of infrazygomatic crest mini-
Penetration 47 45 95.7
Nonpenetration 13 13 100 0.449
implant anchorage in this study may be related to the
Side penetration through double cortical plates. It is generally
Left 28 27 96.4 accepted that cortical bone thickness is 1 critical factor
Right 32 31 96.9 0.923 affecting primary stability and the success rate of
Sex mini-implants.10,11 A cortical bone thickness of 1 mm
Male 20 20 100.0
Female 40 38 95.0 0.309
is recommended around the mini-implant in clinical
practice. In 2011, Farnsworth et al9 assessed the cortical
bone thickness at common mini-implant insertion sites
and reported that the infrazygomatic crest region had
Table II. Changes in maxillary sinus tissues after mini-
the thickest cortical bone of 1.44 mm. However, whether
implant placement (n 5 25) (mm)
the cortical plate of the maxillary sinus floor was added
Variable After insertion Before removal P to the cortical bone thickness of the infrazygomatic crest
PD 1.8 6 1.7 1.7 6 1.7 0.060 was not described in detail, and the direction of mea-
MT 1.4 6 0.9 2.0 6 1.1 0.001 surement was different from the usual embedded angu-
BT 2.3 6 1.1 2.2 6 1.1 0.019 lation in clinical application. In our study, the
BCT 2.0 6 0.8 2.0 6 0.7 0.267
PT 5.1 6 1.5 4.7 6 1.7 0.002
preexisting mini-implant was used as a reference, and
PCT 1.5 6 0.5 1.4 6 0.5 0.494 the total thickness of 2 layers of cortical bone palatally
PD, Penetration depth; MT, membrane thickness; BT, buccal bone
adjacent to the mini-implant was only 1.5 mm
thickness; BCT, buccal cortical bone thickness; PT, palatal bone (Table II). That means, when the mini-implant ran
thickness; PCT, palatal cortical bone thickness. through enough cortical bone for the required primary
stability, the apex of the mini-implant may have already
penetrated into the maxillary sinus. Penetration of 2
bone resorption are also illustrated in Table III. However, layers of cortical bone in the infrazygomatic crest guar-
no statistically significant difference was found between anteed more than 1.0 mm thickness of cortical bone and
different primary membrane thicknesses (P .0.05). primary stability for the mini-implant.
The reaction of the maxillary sinus to the penetration
DISCUSSION has been evaluated in a few studies. In 2013, Zhong
Mini-implant insertion has become part of routine et al14 investigated the effect of a dental implant with
practice in orthodontic treatment. When the infrazygo- a diameter of 3.75 mm on the sinus health at different
matic crest is involved, the location of the maxillary sinus penetration depths. The results showed no signs of
should be considered before mini-implant placement. inflammation, and the apices of dental implants with
We investigated the incidence of mini-implant penetra- penetration depths of 1 and 2 mm were found to be fully
tion into the maxillary sinus and the effects of penetra- covered with newly formed membrane and partially
tion on the sinus tissue when a mini-implant is placed in covered with new bone. However, the implant diameter,
the infrazygomatic crest. surrounding bone quality, blood supply, and loading
This study showed that 78.3% of mini-implants in- pattern differed significantly between dental implants
serted in the infrazygomatic crest penetrated into the and mini-implants. Thus, these results may not apply
maxillary sinus. The incidence was much higher than to orthodontic anchor screws. In 2015, Motoyoshi
the sinus perforation rate of 9.8% after insertion of in- et al16 reported that 8 orthodontic miniscrews pene-
terradicular orthodontic anchorage screws.16 The overall trated into the maxillary sinus, and 1 of the 8 perforated
success rate in this study was 96.7%, which was higher miniscrews failed. However, the sample size was rela-
than that reported in previous studies, which varied tively small, and comparative information was absent.
from approximately 78% to 86%.22-24 Two mini- Considering the high incidence of penetration in the in-
implants failed in this study, and both of them were frazygomatic crest site, we investigated the irritation
inserted into the sinus in contact with a primary mem- caused by penetration into the maxillary sinus in 25 sub-
brane thickness of more than 3 mm. Since the thickened jects. At baseline, the mean sinus membrane thickness in
membrane might imply existing inflammation, sinusitis the study was 1.4 mm, which was similar to the value of
may be a cause of failure. This possible correlation 1.33 mm reported in a meta-analysis of Schneiderian

American Journal of Orthodontics and Dentofacial Orthopedics May 2018 " Vol 153 " Issue 5
660 Jia, Chen, and Huang

Table III. Comparison of results from different penetration depths and primary membrane thickness (n 5 25)
Membrane thickening Buccal bone resorption Palatal bone resorption

Group Total n (%) Value (mm) n (%) Value (mm) n (%) Value (mm)
Primary penetration depth
#1 mm 8 3 (37.5) 0.2 6 0.7 4 (50.0) 0.2 6 0.3 5 (62.5) 0.4 6 0.8
.1 mm 17 15 (88.2) 1.0 6 0.9 11 (64.7) 0.2 6 0.4 14 (82.4) 0.5 6 0.7
P 0.017 0.033 0.667 0.791 0.344 0.883
Primary membrane thickness
#1 mm 10 7 (70.0) 0.5 6 0.8 5 (50.0) 0.1 6 0.3 9 (90.0) 0.6 6 0.7
.1 mm 15 11 (73.3) 0.9 6 0.9 10 (66.7) 0.2 6 0.4 10 (66.7) 0.4 6 0.7
P 1.000 0.304 0.442 0.575 0.345 0.154

Fig 2. Typical reactions of maxillary sinus membrane to different depths of penetration: A and C are the
CBCT images obtained immediately after insertion. The penetration depths were 1.9 mm in A and
0.4 mm in C. B and D are the images obtained at the end of mini-implant placement, corresponding
to A and C, respectively.

membrane thickness.25 During mini-implant placement,
no patient complained of any clinical symptoms, but the
comparative CBCT images showed a slight membrane
thickening of 0.6 mm and bone resorption of 0.1 to
0.4 mm as shown in Table II.
The depth of penetration may be significant for sinus
health. The occurrence and mean value of membrane
thickening were 88.2% and 1.0 mm with the penetration
depth exceeding 1 mm, whereas the occurrence and
mean value decreased to 37.5% and 0.2 mm if the
penetration depth was within 1 mm (Table III). Conse-
quently, practitioners should consider primary stability
as much as sinus health. Penetrating through double
cortical bone plates and limiting the penetration depth
within 1 mm are recommended for infrazygomatic crest
mini-implant anchorage. To meet this requirement, full

May 2018 " Vol 153 " Issue 5 American Journal of Orthodontics and Dentofacial Orthopedics
Jia, Chen, and Huang
analysis of the infrazygomatic crest region using CBCT,
taking into consideration individual differences, is
essential for mini-implant selection and insertion.
Virtual mini-implant placement in the CBCT scans is
suggested for choosing the preferred implant size and
embedded angulation, and if necessary, a computer-
guide template is recommended to improve the predict-
ability of the surgical procedure.
The results in this study are based on retrospective
single-center data. A further randomized controlled trial
with a larger sample size will be required in the future to
clarify our findings.
CONCLUSIONS
Taken together, it can be concluded that the incidence
of an infrazygomatic crest mini-implant penetrating into
the maxillary sinus may be high. Penetrating through
double cortical bone plates and limiting the penetration
depth within 1 mm are recommended for infrazygomatic
crest mini-implant anchorage.
REFERENCES
1. Ali D, Mohammed H, Koo SH, Kang KH, Kim SC. Three-dimen-
sional evaluation of tooth movement in Class II malocclusions
treated without extraction by orthodontic mini-implant
anchorage. Korean J Orthod 2016;46:280-9.
2. Ueno S, Motoyoshi M, Mayahara K, Saito Y, Akiyama Y, Son S, et al.
Analysis of a force system for upper molar distalization using a
trans-palatal arch and mini-implant: a finite element analysis
study. Eur J Orthod 2013;35:628-33.
3. Kuroda S, Sugawara Y, Tamamura N, Takano-Yamamoto T. Ante-
rior open bite with temporomandibular disorder treated with tita-
nium screw anchorage: evaluation of morphological and
functional improvement. Am J Orthod Dentofacial Orthop 2007;
131:550-60.
4. Liou EJ, Chen PH, Wang YC, Lin JC. A computed tomographic im-
age study on the thickness of the infrazygomatic crest of the
maxilla and its clinical implications for miniscrew insertion. Am J
Orthod Dentofacial Orthop 2007;131:352-6.
5. Wang YC, Liou EJ. Comparison of the loading behavior of self-
drilling and predrilled miniscrews throughout orthodontic loading.
Am J Orthod Dentofacial Orthop 2008;133:38-43.
6. Seres L, Kocsis A. Closure of severe skeletal anterior open bite with
zygomatic anchorage. J Craniofac Surg 2009;20:478-82.
7. Lin JC, Liou EJ, Yeh CL. Intrusion of overerupted maxillary molars
with miniscrew anchorage. J Clin Orthod 2006;40:378-83.
8. Cornelis MA, De Clerck HJ. Maxillary molar distalization with mini-
plates assessed on digital models: a prospective clinical trial. Am J
Orthod Dentofacial Orthop 2007;132:373-7.
American Journal of Orthodontics and Dentofacial Orthopedics
661
9. Farnsworth D, Rossouw P, Ceen RF, Buschang PH. Cortical bone
thickness at common miniscrew implant placement sites. Am J
Orthod Dentofacial Orthop 2011;139:495-503.
10. Motoyoshi M, Yoshida T, Ono A, Shimizu N. Effect of cortical bone
thickness and implant placement torque on stability of orthodon-
tic mini-implants. Int J Oral Maxillofac Implants 2007;22:779-84.
11. Motoyoshi M, Inaba M, Ono A, Ueno S, Shimizu N. The effect of
cortical bone thickness on the stability of orthodontic mini-
implants and on the stress distribution in surrounding bone. Int
J Oral Maxillofac Surg 2009;38:13-8.
12. Br!anemark PI, Adell R, Albrektsson T, Lekholm U, Lindstr€ om J,
Rockler B. An experimental and clinical study of osseointegrated
implants penetrating the nasal cavity and maxillary sinus. J Oral
Maxillofac Surg 1984;42:497-505.
13. Hern#andez-Alfaro F, Torradeflot MM, Marti C. Prevalence and
management of Schneiderian membrane perforations during
sinus-lift procedures. Clin Oral Implants Res 2008;19:91-8.
14. Zhong W, Chen B, Liang X, Ma G. Experimental study on penetra-
tion of dental implants into the maxillary sinus in different depths.
J Appl Oral Sci 2013;21:560-6.
15. Timmenga NM, Raghoebar GM, Boering G, van Weissenbruch R.
Maxillary sinus function after sinus lifts for the insertion of dental
implants. J Oral Maxillofac Surg 1997;55:936-40.
16. Motoyoshi M, Sanuki-Suzuki R, Uchida Y, Saiki A, Shimizu N.
Maxillary sinus perforation by orthodontic anchor screws. J Oral
Sci 2015;57:95-100.
17. White SC. Cone-beam imaging in dentistry. Health Phys 2008;95:
628-37.
18. Kobayashi K, Shimoda S, Nakagawa Y, Yamamoto A. Accuracy
in measurement of distance using limited cone-beam comput-
erized tomography. Int J Oral Maxillofac Implants 2004;19:
228-31.
19. Samuels RH, Rudge SJ, Mair LH. A clinical study of space closure
with nickel-titanium closed coil springs and an elastic module.
Am J Orthod Dentofacial Orthop 1998;114:73-9.
20. Buchmann N, Senn C, Ball J, Brauchli L. Influence of initial strain
on the force decay of currently available elastic chains over time.
Angle Orthod 2012;82:529-35.
21. Sharma P, Valiathan A, Sivakumar A. Success rate of microimplants
in a university orthodontic clinic. ISRN Surg 2011;2011:982671.
22. Uribe F, Mehr R, Mathur A, Janakiraman N, Allareddy V. Failure
rates of mini-implants placed in the infrazygomatic region. Prog
Orthod 2015;16:31.
23. Sch€atzle M, M€annchen R, Zwahlen M, Lang NP. Survival and fail-
ure rates of orthodontic temporary anchorage devices: a system-
atic review. Clin Oral Implants Res 2009;20:1351-9.
24. Papageorgiou SN, Zogakis IP, Papadopoulos MA. Failure rates
and associated risk factors of orthodontic miniscrew implants:
a meta-analysis. Am J Orthod Dentofacial Orthop 2012;142:
577-95.
25. Monje A, Diaz KT, Aranda L, Insua A, Garcia-Nogales A, Wang HL.
Schneiderian membrane thickness and clinical implications for
sinus augmentation: a systematic review and meta-regression
analyses. J Periodontol 2016;87:888-99.
May 2018 " Vol 153 " Issue 5