ORIGINAL ARTICLE

Healing of the roots and surrounding

structures after intentional damage
with miniscrew implants
Carmen E. Brisceno,a P. Emile Rossouw,b Roberto Carrillo,c Robert Spears,d and Peter H. Buschange
South Miami, Fla, and Dallas Tex

Introduction: In this study, we evaluated the healing potential of the roots and surrounding periodontium
(cementum, periodontal ligament [PDL], and bone) after intentional damage during miniscrew implant (MSI)
placement. Methods: A randomized split-mouth design was used to evaluate healing 6 and 12 weeks after
intentional root damage. Seven skeletally mature male beagle dogs had MSIs placed into the roots of 8 man-
dibular teeth (6 premolars, 2 first molars). After root contact had been verified by using insertion torques and
radiographs, the MSIs were immediately removed, and the sites were allowed to heal for 6 or 12 weeks.
Sequential point labeling was performed at 6-week intervals with tetracycline and calcein. Demineralized
and undemineralized sections were stained, and healing was histologically evaluated. Results: The placement
torque was twice as high with root contact than without contact (23.8 vs 50.7 Ncm). Damage to the roots and
periodontium ranged from cementum interruption to pulp invasion. New bone, PDL, and cementum were ob-
served in 64.3% of the teeth, with significant (P \0.05) increases in the percentages of cementum over time.
Sequential labeling confirmed healing at both 6 and 12 weeks. Abnormal healing was found in 35.7% of teeth;
it included lack of PDL and bone regeneration, bone degeneration in the furcation area, ankylosis, and no heal-
ing associated with inflammatory infiltrate or pulpal invasion. Conclusions: Under favorable conditions (no
inflammatory infiltrate or pulpal invasion), healing can occur when root damage caused by MSIs is limited
to the cementum or the dentin. Increased resistance should be used as an indicator of possible root contact
during MSI placement. (Am J Orthod Dentofacial Orthop 2009;135:292-301)

U
nwanted loss of anchorage because of biome-
chanical side effects and lack of a full dentition
have contributed to the recent increase in the
use of fixed anchorage devices, such as miniscrew im-
plants (MSIs), in orthodontics. The ability to obtain ab-
solute anchorage through bone-anchored devices has
enabled orthodontists to eliminate the unwanted side ef-
fects normally associated with conventional approaches
and has made it possible to correct malocclusions previ-
ously treated with maxillofacial surgery or complicated
a
Private practice, South Miami, Fla.
b
Professor and chairman, Orthodontic Department, Baylor College of Dentistry,
Texas A&M Health Science Center, Dallas, Tex.
c
Doctoral student, Department of Biomedical Sciences, Baylor College of
Dentistry, Texas A&M Health Science Center, Dallas, Tex.
d
Associate professor, Biomedical Science Department, Baylor College of
Dentistry, Texas A&M Health Science Center, Dallas, Tex.
e
Professor and director of orthodontic research, Orthodontic Department,
Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Tex.
Partially funded by the Robert E. Gaylord Endowed Chair in orthodontics.
Reprint requests to: Peter H. Buschang, Orthodontic Department, Baylor Col-
lege of Dentistry, Texas A&M Health Science Center, 3302 Gaston Avenue,
Dallas, TX 75246; e-mail, phbuschang@bcd.tamhsc.edu.
Submitted, February 2008; revised and accepted, June 2008.
0889-5406/$36.00
Copyright Ó 2009 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2008.06.023
292
orthodontic biomechanics. However, the possibility of
irreversible damage to the roots during MSI placement
and use is as a major problem. Current studies on
MSIs focus primarily on their use1-8; limited informa-
tion is available regarding the histologic sequence of
events after root damage.9,10
Damage to a root can occur from an MSI due to im-
proper placement, MSI movement after loading, and
tooth movement into contact with the MSI.1 MSIs
used as direct or indirect anchorage are usually placed
between the roots of teeth. Although there are general
guidelines for safe zones during the placement of
MSIs, the risk of root damage remains.11,12 Guidelines
aid clinicians, but they do not take into account individ-
ual differences in root morphology. Only a few clinical
studies have addressed damage to the root either during
or after placement.9,10,13 The best information on root
damage pertains to the use of small screws for the fixa-
tion of mandibular fractures and osseous segments
placed during orthognathic surgery.14-18 For such
screws, the incidence of root damage has been reported
to range between 0.47%15 and 43.3%.19 Although fixa-
tion screws are similar to the MSIs used for orthodontic
treatment, they are usually not placed in interradicular
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 135, Number 3
spaces and might be expected to underestimate the like-
lihood of root damage with MSIs used in orthodontic
treatment. Because they do not remain stationary after
loading, Liou et al13 proposed a minimum distance of
2.0 mm between the MSI and the root. Damage to
a root can also occur if a tooth moved into contact
with MSIs.10
The periodontal literature demonstrates that repair
can occur after damage to the cementum of roots and
the surrounding periodontium.20-23 A timeline for
humans has been proposed after root damage, with the
appearance of cementoid tissue after approximately 23
days and cellular cementum by 40 days.22 Hellden,22
who purposefully damaged teeth after flap exposure
and cut lesions into the dentin on the middle third of
the root, showed that bone regenerated faster than did
the cementum and that the periodontal ligament (PDL)
regenerated 2 to 3 months after damage. When infection
was evident, histologic sections showed ingrowths of
epithelium, which totally or partially prevented reat-
tachment. Jahangiri et al10 found that a partial transfer
of PDL-like structures occurred after 6 weeks of direct
contact with an implant. When fixation screws contact
teeth, they usually remain vital, show normal mobility
throughout follow-up, and only rarely become infected
or require extraction.14-16 Asscherickx et al9 showed
that healing in beagles takes place approximately 12
weeks after root damage with MSIs. However, the study
was limited to 6 screws inadvertently placed close to
roots, 3 of which became loose and had to be removed.
In the only study designed to evaluate healing of PDL
structures intentionally damaged with MSIs over vary-
ing time periods, Chen et al24 found higher failure rates
with root contact. They also reported repair of roots by
cementum deposition and bone regeneration if the MSIs
were removed and allowed to heal.
The purpose of this split-mouth study was to estab-
lish the healing potential of the roots and surrounding
periodontium (cementum, PDL, and bone) after inten-
tional root damage during MSI placement. The specific
aims were to evaluate whether healing takes place after
root damage with MSIs and to determine healing differ-
ences after 6 and 12 weeks.
MATERIAL AND METHODS
The sample included 7 skeletally mature male bea-
gles weighing 15 to 30 lbs and between 20 and 24
months of age. The animals were housed at the Animal
Resource Unit at Baylor College of Dentistry at Texas
A&M Health Science Center (Dallas). The housing,
care, and experimental protocol were according to the
guidelines of the Institutional Animal Care and Use
Brisceno et al 293
Committee. After their arrival at the facilities (day –17,
Fig 1), the animals were quarantined per USDA
regulations for 10 days.
Before the experiment, detailed procedures were de-
veloped by using a fresh pig mandible to ensure damage
to the roots of the teeth during MSI placement. A stent
with stainless steel metal loops was fabricated to guide
the MSI into the root. The procedures were then per-
formed on a pilot animal for standardization and to en-
hance efficiency. All remaining animals were started 4
weeks after the pilot animal. The procedures and time-
line of the investigation were the same for each dog (Fig
1). At each intervention and record procedure, the teeth
were cleaned with a cavitron (Dentsply Int, York, Pa).
Photographs and radiographs were taken initially and
every 3 weeks thereafter until the dogs were killed. Be-
fore each intervention and each record-taking session,
the animals were sedated with ketamine (2.2 mg/kg/
IM) and xylazine (0.22 mg/kg/IM). While anesthetized,
the animals’ vital signs were monitored and recorded.
The MSIs used were self-tapping, 1.8 mm in diam-
eter and 8 mm long (IMTEC, Ardmore, Okla). They
were placed after drilling a pilot hole through the
bone cortex by using only a slow-speed drill (1.1 mm di-
ameter) and copious irrigation. The MSIs were placed
interradicularly to damage the distal or mesial roots of
the mandibular second, third, and fourth premolars
and the first molar (Fig 2, A). The right and left sides
of the mandibles were randomly allocated to evaluate
either 6 or 12 weeks of healing (Fig 2, B). Eight MSIs
were used per animal, for a total of 56 MSIs.
The initial records were obtained on day –7. While
sedated, the animals received dental cleaning, and in-
traoral right and left photographic images were taken
with a digital camera (Digital Rebel XT, Canon, Lake
Success, NY). Impressions of the mandibular arch
were taken by using polyvinylsiloxane material (Aqua-
sil VPS, Dentsply, York, Pa). The impressions were
poured, and the models were used to fabricate an acrylic
mold. This mold was used as a radiographic tray guide
(Fastray, Bosworth, Skokie, Ill) fitted to the canine and
the first molar. The guide allowed for standardization of
the radiographic technique and was made to hold 1 in-
dicator arm, 1 aiming ring, and 1 film holder (Dentsply)
(Fig 3, A). Periapical radiographs (27 3 54 mm; Kodak
Ultra-Speed film, Eastman Kodak, Rochester, NY) were
then taken of each quadrant to determine the placement
of the MSIs. By using a stone model, a removable vac-
uum-formed tray of thermoplastic copolyester was fab-
ricated with Essix ACE (Dentsply Raintree Essix,
Metairie, La; 125 mm square, 7.62 mm thickness).
With the radiographs as a guide, a 0.46-mm
diameter stainless steel wire was used to make loops
294 Brisceno et al American Journal of Orthodontics and Dentofacial Orthopedics
March 2009

12 wks
Healing 6 wks
Tray
Quarantine Healing
Fabrication

Day -17 -7 0 21 42 63 83 84
IR R, FI, L R R,SI, L R R, L, N

IR = Initial Records L = Labels (tetracycline or calcein IV)

R = Records SI = Second Intervention
FI= First Intervention N = Sacrifice/Necropsy

Fig 1. Timeline of the investigation: MSIs were placed and removed at the first (FI) and second (SI)
interventions. Periods of 6 and 12 weeks of healing were allowed before the dogs were killed (N).

A B M3

M2

M1

PM 4

PM 3
PM 2
PM 1
C
I3
I2
I1

= MSI 6 weeks healing

= MSI 12weeks
healing

Fig 2. A, MSIs were placed interradicularly to damage either the distal or the mesial root of the sec-
ond, third, and fourth premolars and the first molar. B, The right and left mandibles of 7 beagles were
randomly allocated to 6 or 12 weeks of healing.

that were stabilized on the tray with acrylic resin (Figs 3,
B, and 4). Another set of radiographs was then taken to
verify loop positioning; adjustments were made if nec-
essary to ensure root damage (Fig 4, A).
At the first intervention, on day 0, the animals were
sedated, and local anesthetic (2% lidocaine with
1:100,000 epinephrine) was administered for MSI
placement. The radiographic stent was placed, and peri-
apical radiographs were taken to verify positions. Four
MSIs were placed in 1 mandibular quadrant (randomly
allocated) to intentionally damage the roots. The MSIs
were placed by using a digital torque tester (D1-5N-
RL2, CEDAR, Sugisaki Meter Co, Ltd, Ibaraki, Japan)
and a custom miniscrew implant adaptor, calibrated to
an accuracy of 0.5%. This device was used to determine
resistance in bone and, more importantly, resistance
when the MSI contacted the root. Torque measurements
of the control MSIs were taken in areas adjacent to the
roots, but not contacting them. Early in the study, 5 of the
56 MSIs (8%) broke during placement or removal. Be-
cause their placement torque values were over 60 Ncm,
the remaining screws were placed up to, but not beyond,
a torque of 55 Ncm (indication of root contact). Both ra-
diographs (Fig 4, B) and torque measurements were used
to verify root contact. After root contact was established,
the MSIs were immediately removed.
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 135, Number 3
Fig 3. A, Radiographic tray guide used to standardize radiographs; B, removable vacuum-formed
tray with .018-in stainless steel loops to direct placement of MSIs.
The animals were then dosed with tetracycline
(25 mg/kg/IV) to label the tissues for histologic exami-
nation. Intraoral photographs and periapical radiographs
were taken before and after MSI removal (Fig 4, C).
Postoperative analgesics (torbugesic, 0.2 mg/kg/IM;
banamine, 1 mg/kg/IM) and antibiotics (penicillin and
benzathine, 300,000 IU/10 lbs/IM) were administered
after the surgery.
At the second intervention on day 42, each animal
was anesthetized with ketamine (2.2 mg/kg/IM) and xy-
lazine (0.22 mg/kg/IM). Local anesthetic (2% lidocaine
with 1:100,000 epinephrine) was administered in the
contralateral quadrant, and an additional 4 MSIs were
placed as previously described and immediately re-
moved after root contact had been verified.
After all procedures, the animals were dosed with
calcein (10 mg/kg/IV) to label the tissues for histologic
examination. A set of intraoral photographs and radio-
graphs was taken, and postoperative analgesics and
antibiotics were administered, as previously described.
On day 83, a day before they were killed, the ani-
mals were dosed with tetracycline (25 mg/kg/IV) to
label the tissues for histologic examination. On day
84, full final records were taken, including radiographs
and photographs. The animals were killed with Beutha-
nasia-D (Schering-Plough, Kenilworth, NJ) at a dosage
of 1 cc intracardiac, and the tissues were then prepared
for histologic examination.
At necropsy, 1 L of 70% ethanol was perfused
through each animal. The mandibles were resected en
bloc and then hemi-sected. Each hemi-jaw was cut
into individual blocks, with each block including a sin-
gle tooth. The blocks were fixed for 7 days in 70%
ethanol.
The second and third premolars of each animal were
decalcified in 0.5 mol/L of EDTA. Radiographs of the
Brisceno et al 295
tissues were taken every 2 weeks to monitor decalcifica-
tion. The blocks were subsequently embedded in paraf-
fin and sectioned sagittally at thicknesses of 6 to 8 mm.
The tissues were stained with hematoxylin and eosin for
histologic examination.
The fourth premolars and first molars were evalu-
ated by using undecalcified tissues. The tissues were
embedded in methylmethacrylate, sectioned sagittally
at a thickness of 100 to 120 mm, and polished to approx-
imately 75 mm. Images of the sections were obtained
with a fluorescence microscope (Eclipse 80i, Nikon,
Melville, NY) to evaluate the vital stains (tetracycline
and calcein labels) incorporated in mineralizing hard
tissues.25 The sections were then stained with Steven-
ol’s blue with van Gieson picro-fuchsin for histologic
examination of the healing by using a light microscope
(Axiophot, Zeiss, Thornwood, NY).
Normal healing was defined as a cementum layer,
normal PDL attachment, and bone regeneration. Abnor-
mal healing was the absence of PDL or bone regenera-
tion, root ankylosis, or pulp invasion. To evaluate the
effects of time on the amount of healing after MSI re-
moval, the groups were separated into 6 and 12 weeks
of healing. The area of root damage filled by cementum,
PDL, and bone was quantified by using MetaMorph
(Downingtown, Pa) software. The Mann-Whitney U
test was used to compare the percentages of surface-
area healing between the 6- and 12-week times.
Descriptive statistics included means, standard devia-
tions, and ranges.
RESULTS
No animal exhibited significant changes in eating
habits or other behaviors indicating pain. The average
maximum placement torque of the control MSIs
296 Brisceno et al American Journal of Orthodontics and Dentofacial Orthopedics
March 2009

Fig 4. Intraoral periapical radiographs: A, removable vacuum-formed tray with .018-in stainless steel
loops to direct placement of MSIs; B, MSIs in place (note the proximity of the roots and the implants);
C, immediately after MSI removal, damage to the root is evident radiographically.

Cementum Dentin Pulp Table I. Teeth with normal and abnormal healing
80 71.4 6 weeks 12 weeks Total
67.9
70 64.3
n % >n % n %
60
Percent (%)

50 Normal healing 18 64.3 18 64.3 36 64.3

40 New cementum, but no 4 14.3 2 7.1 6 10.7
evidence of PDL or
30 21.4
17.9 19.6 bone regeneration
20 10.7 14.3
12.5 Major bone loss or 3 10.7 2 7.1 5 9.0
10 destruction in the
0 furcation
6 Weeks 12 Weeks Total Spot ankylosis 0 0 2 7.1 2 3.6
Pulp damage, with 3 10.7 4 14.3 7 12.5
Fig 5. Percentages of teeth with defects into cementum, inflammatory infiltrate
dentin, and pulp.

(without root contact) was 23.8 Ncm (range, 16.6-31
Ncm), and the average maximum placement torque of
the experimental MSIs (with root contact) was 50.7
Ncm (range, 36.4-65.2 Ncm).
The 56 teeth evaluated histologically had variable
amounts of damage, ranging from damage to the cemen-
tum layer to invasion of the pulp. Seven (12.5%) MSIs
were placed into the pulp; 3 of them broke during the
procedure and had to be surgically removed (Fig 5).
The remaining 49 (87.5%) MSIs showed evidence of
damage into the root cementum (19.6%) or the dentin
(67.9%) .
Most teeth (64.3%) showed normal healing when
damage was limited to the dentin or the cementum
(Table I). Healed teeth had a new cementum layer,
PDL attachment, and bone regeneration at both 6 and
12 weeks (Fig 6). The fluorescent labels showed both
short- and long-term healing of the cementum and the
bone (Fig 7). About 10.7% of the teeth showed a layer
of cementum, but no evidence of PDL or bony
American Journal of Orthodontics and Dentofacial Orthopedics Brisceno et al 297
Volume 135, Number 3

Fig 6. Undemineralized (top) and demineralized (bottom) sections of normal healing, with new ce-
mentum (C), PDL, and bone (B) formed in the area of the dentin (D) defect (arrows): A and C, after
6 weeks of healing; B and D, after 12 weeks of healing (magnification: left, 2.5 times; right, 10 times).

regeneration (Fig 8, A). Nine percent showed bony de-
generation in the furcation area (Table I), with little or
no regeneration of bone or PDL adjacent to the damage
in the furcation (Fig 8, B). Fluorescence labeling
showed no mineralized tissues in these areas of abnor-
mal healing (Fig 9). Evidence of bone-to-dentin contact
(spot ankylosis) was seen in 2 teeth from the 12-week
group (Table I, Fig 10). All teeth that had pulp damage
(12.5%) showed unspecified inflammatory tissues with
no evidence of cementum or PDL lining (Table I, Fig
11), confirmed by fluorescence microscopy (Fig 12).
Significant differences in the percentages of cemen-
tum, PDL, and bone were found between the 6- and 12-
week groups (Table II). The percentages of bone and
PDL in the defect decreased significantly (P \0.05)
over time as the percentage of cementum filling the
area of the defect increased (P \0.001). This was evi-
dent for defects in the dentin and the cementum. The
amount of cementum approximately doubled between
the 6- and 12-week healing periods (Table II).
DISCUSSION
Under favorable conditions, root healing occurs af-
ter damage with MSIs. Most teeth (64.3%) in this study
showed normal healing after 6 and 12 weeks when the
defect was limited to the cementum or the dentin.
This agrees with the literature pertaining to fixation
screws, showing that most teeth with screw-to-root con-
tact remained vital and without abnormal mobility
throughout the follow-up.14-16 In this study, normal
healing, reattachment of the PDL, regeneration of the
bone, and new cementum layers on exposed dentin
were all evident by day 42. Hellden22 also reported
healing after defects were drilled into the dentin,
with the first cementum deposition occurring after
298 Brisceno et al
Fig 7. Undemineralized sections of normal healing in-
cluding fluorescence after 12 weeks of healing. A new
layer of cementum (C), PDL, and bone (B) formed near
the dentin (D) defect (arrows). Under fluorescence, or-
ange represents tetracycline, and green represents cal-
cein. A, 2.5 times magnification (2 times for
fluorescence); B, 10 times magnification.
approximately 25 days and most teeth showing cellular
cementum by day 40. Chen et al24 showed bone healing
and cementum repair after longer periods.
The teeth with normal healing had significant and
substantial increases in the percentages of cementum
in the defects between 6 and 12 weeks. Hellden22
showed that the deposition of cementoid tissue starts
at the periphery of the experimental cavity and, over
time, extends to cover the entire defect, with the new
cementum layers becoming thicker. Similar patterns
of increase in the thickness of cementum during healing
were reported to be associated with root damage into
dentin.9,21,23,26 Additionally, regeneration of the PDL
and the bone after root surface damage was evident in
all specimens, with normal healing at both 6 and 12
weeks. Although the width of the PDL did not change,
the relative percentages of PDL and bone decreased
between 6 and 12 weeks, because of the increased ce-
mentum in the area of the defect; this was similar to
Hellden’s data.22
American Journal of Orthodontics and Dentofacial Orthopedics
March 2009
Abnormal healing occurred in approximately 36%
of the teeth; this might have been due to infection or in-
corporation of epithelial tissues during placement. Stud-
ies involving replantation suggest that inhibition of
epithelial down-growth and no bacterial stimulus are
key in the regeneration of the attachment apparatus.27
Approximately 20% of the teeth showed no bone forma-
tion or PDL regeneration in furcation areas or in regions
adjacent to the MSI damage. This might have been due
to ingrowths of epithelium, which can totally or par-
tially prevent reattachment.22 An additional 3.6% of
the teeth showed evidence of spot ankylosis. Ankylosis,
or root resorption, has been shown to occur with large
dentin defects and when the cementum layer is removed
in replantation.28,29
In this study, 12.5% of the teeth showed evidence of
pulpal invasion with infiltration of inflammatory tissues
and no evidence of healing. Invasion of the pulp cham-
ber produces a periodontal-endodontal bony lesion that
can lead to external inflammatory root resorption.27
Pulp invasion allows access of the pathogens into the
PDL space; this can result in devitalization and bony
destruction. Although such a defect might heal after
adequate endodontic treatment, extractions can be re-
quired if treatment fails.14,17,18,27 Although the animals
showed no significant changes in behavior or eating pat-
terns, it was not possible to know whether they experi-
enced minor pain. Extractions or root canal treatment
might have been required in such instances.
To date, there is only limited information on the
likelihood of root damage during the placement of
MSIs. In our study, the MSIs were intentionally placed
to contact the roots; this overestimates the incidence of
damage. Studies on surgical fixation screws reported
that the incidence of root damage is between 0.47%15
and 43.3%,19 but these studies probably underestimated
the likelihood of root damage with MSIs used by ortho-
dontists. Since the risk of damage is substantial if roots
are contacted, care should be taken during placement.
The average placement torque was significantly
higher (approximately twice as much) when a root
was contacted and can be used to judge the possibility
of root contact. Some authors have suggested that a cli-
nician can feel when the implant touches the root and
then back out and redirect the screw.30-33 Motoyoshi
et al34 recommended placement torque values of 5 to
10 Ncm for humans; these values are substantially lower
than the average maximum placement torque (50.7
Ncm) in this study. However, the maximum torque of
the control MSIs, averaging 23.8 Ncm, was also higher,
perhaps reflecting differences in bone density between
regions and species. In a study by Wilmes et al,35 the
high percentage of implant fractures was attributed to
American Journal of Orthodontics and Dentofacial Orthopedics Brisceno et al 299
Volume 135, Number 3

Fig 8. A, Demineralized section showing a new layer of cementum (C) but no PDL or bone (B) regen-
eration around the dentin (D) defect (arrows); B, demineralized section showing bone (B) degenera-
tion in the furcation area. Note the inflammatory infiltrate (I) in both A and B (magnification: left, 2.5
times; right, 10 times).

Fig 9. A, Undemineralized section and B, fluorescence

after 6 weeks of healing. A new layer of cementum (C)
is evident, but no PDL or bone (B) regeneration around
the dentin (D) defect (arrows) (magnification: left, 2.5
times; right, 2 times). Under fluorescence, orange repre-
sents tetracycline, and green represents calcein. Note
the inflammatory infiltrate (I) in both A and B.
Fig 10. Demineralized section showing: A, lack of a layer
of cementum (C) and PDL with direct contact between
the bone (B) and dentin (D); B, magnified view spot anky-
losis indicated by arrows (magnification: left, 2.5 times;
right, 20 times).

high torquing values of placement. Therefore, we used
a pilot hole (limited to the cortical bone), as suggested
for prevention of implant fractures.14,34 However, 5
MSIs broke after root contact, suggesting that implant
breakage is possible even with a pilot hole.
Because of the high incidence of adverse effects af-
ter root damage, careful planning should be used when
placing MSIs. As shown by Hembree et al,36 significant
and extensive damage can occur to the teeth, periodon-
tium, and bone after MSI placement. Although most
teeth in this study regenerated their attachment appara-
tus, many showed partial or no regeneration. Under fa-
vorable conditions, regeneration of the attachment
apparatus is possible after immediate removal of the
MSI. In other words, if a significant increase in resis-
tance is felt during placement, removal of the screw
will most likely lead to healing of the root defect and
the adjacent tissues. On the other hand, if inflammatory
infiltrate or invasion of the pulp chamber occurs, the
normal healing sequence could be interrupted.
300 Brisceno et al American Journal of Orthodontics and Dentofacial Orthopedics
March 2009

Fig 11. A, Demineralized section showing unspecified inflammatory infiltrate (I) with no evidence of
cementum (C), PDL, or bone (B) healing; B, mineralized section with evidence of pulpal invasion,
showing unspecified inflammatory infiltrate (I) with no evidence of cementum (C), PDL, or bone (B)
healing (magnification: left, 2.5 times; right, 10 times).

Table II. Percentages of cementum, PDL, and bone in

the defects of normally healed teeth
6 weeks 12 weeks
Group
Mean SD Mean SD difference,
n (%) (%) n (%) (%) P value

Defects into cementum

Cementum 2 47.5 27.0 6 61.7 17.7 0.429
PDL 2 47.5 34.1 6 38.8 16.9 0.857
Bone NS NS NS 6 .74 1.81 0.857
Defects into dentin
Cementum 16 18.2 8.8 12 34.2 10.6 \0.001
PDL 16 61.8 15.0 12 54.0 9.7 0.064
Bone 16 20.7 18.5 12 10.8 15.6 0.121
Fig 12. Undemineralized section of pulp (P) invasion, in- Defects into cementum or dentin
cluding fluorescence, after 12 weeks of healing. Note the Cement 18 21.4 14.2 18 43.9 18.8 \0.001
unspecified inflammatory infiltrate (I) with no evidence of PDL 18 60.2 17.0 18 48.6 14.3 0.019
cementum (C), PDL, or bone (B) healing (magnification: Bone 18 18.4 18.6 18 7.3 13.4 0.045
left, 2.5 times; right, 2 times). Under fluorescence,
NS, Not significant.
orange represents tetracycline, and green represents
calcein.
4. The average placement torque was twice as high
when a root was contacted.
CONCLUSIONS
We thank IMTEC for its support.
1. Under favorable conditions (no infection or pulpal
invasion), root healing occurred in 64.3% of the
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