Int. J. Oral Maxillofac. Surg.

2006; 35: 704–707

doi:10.1016/j.ijom.2006.02.018, available online at http://www.sciencedirect.com

Clinical Paper
Oral Surgery

The application of mini-implants Y.-C. Tseng1, C.-H. Hsieh2,

C.-H. Chen3, Y.-S. Shen3,
I.-Y. Huang3, C.-M. Chen3

for orthodontic anchorage

1
Department of Orthodontics, Kaohsiung
Medical University, Taiwan; 2Graduate
Institute of Dental Sciences, College of Dental
Medicine, Kaohsiung Medical University,
Taiwan; 3Department of Oral and Maxillofacial
Surgery, Kaohsiung Medical University,
Y.-C. Tseng, C.-H. Hsieh, C.-H. Chen, Y.-S. Shen, I.-Y. Huang, C.-M. Chen: The Taiwan
application of mini-implants for orthodontic anchorage. Int. J. Oral Maxillofac. Surg.
2006; 35: 704–707. # 2006 International Association of Oral and Maxillofacial
Surgeons. Published by Elsevier Ltd. All rights reserved.

Abstract. The aim of this study was to explore the use of mini-implants for skeletal
anchorage, and to assess their stability and the causes of failure. Forty-five mini-
implants were used in orthodontic treatment. The diameter of the implants was
2 mm, and their lengths were 8, 10, 12 and 14 mm. The drill procedure was directly
through the cortical bone without any incision or flap operation. Two weeks later, a
force of 100–200 g was applied by an elastometric chain or NiTi coil spring. Risk
factors for the failure of mini-implants were examined statistically using the Chi-
square or Fisher exact test as applicable. The average placement time of a mini-
implant was about 10–15 min. Four mini-implants loosened after orthodontic force
Key words: mini-implant; orthodontic ancho-
loading. The overall success rate was 91.1%. The location of the implant was the rage; skeletal anchorage.
significant factor related to failure. In conclusion, the mini-implants are easy to
insert for skeletal anchorage and could be successful in the control of tooth Accepted for publication 24 February 2006
movement. Available online 9 May 2006

In 1989, ARTHUR & BERNARDO1 reported a
simplified technique of intermaxillary
fixation. They suggested the use of 2.0-
mm self-tapping bone screws, secured into
both jaws and linked by loops of wire.
Hence, the idea of the mini-implant was
introduced to substitute for the conven-
tional method involving arch bars and
eyelet wires. The advantages of the
mini-implant include easy placement,
reduced operating time, increased patient
comfort and easier maintenance of gingi-
val health6. In 1983, CREEKMORE &
EKLUND4 inserted bone screws just below
the anterior nasal spine for intrusion of
maxillary incisors. The maxillary central
incisors were intruded 6 mm after 1 year
of orthodontic treatment and the bone
screw was not mobile at the time that it
was removed. The authors suggested that
skeletal anchorage be validated as a safe
and effective clinical procedure in ortho-
dontics. The purpose of the present study
was to investigate the stability of mini-
implants, and to identify risk factors for
their failure.
Patients and methods
From June 2002 to December 2003, a retro-
spective review was conducted of the charts
of 25 patients who received 45 mini-
implants (Stryker–Leibinger, Germany)
for skeletal anchorage in orthodontic treat-
ment. The mini-implants were designed
originally for the purpose of achieving
intermaxillary fixation. Of the 25 patients,
14 were women and 11 were men. The
mean age of the patients was 29.9 years.
Before implants were selected, measure-
ments were taken to determine the amount
of bone available for placement. Special
attention was required during mini-implant
placement to reduce the chance of injury to
delicate anatomic structures such as ves-
sels, nerves and dental roots. All patients
were under local anaesthesia for insertion
of the mini-implants. A twist drill (diameter
1.5 mm) under a Stryker handpiece was
used to drill only to the cortical bone level.
The mini-implants were then inserted by
screwdriver, all by the same operator. They
were made of titanium alloy and their screw
surfaces were machined and smooth. The
diameter of the mini-implants was 2 mm,
and the lengths were 8 and 14 mm. In this
study, the 14-mm mini-implant could be

0901-5027/080704 + 04 $30.00/0 # 2006 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Fig. 1. Different lengths (8, 10, 12, 14 mm) of mini-implants.
shortened to 12 or 10 mm (Fig. 1). A sum-
mary of mini-implant placement is given in
Table 1.
The application of orthodontic force
was started 2 weeks after mini-implant
placement. A force of 100–200 g was
loaded with an elastometric chain or NiTi
coil spring. Clinical evaluation included
(1) the amount of time needed for mini-
implant insertion; (2) the location of the
mini-implant and (3) the appearance of
inflammation or infection. The criteria
for successful insertion of mini-implants
were as follows: (1) the mini-implant
could resist orthodontic force until com-
Table 1. Summary of mini-implant placement
Gender (m)*
Male (11)
Female (14)
Age (years)
Mean (29.9)
Range (22–44)
Location of mini-implants inserted (n)**
Maxilla
Anterior teeth (9)
Posterior teeth (18)
Mandible
Anterior teeth (6)
Posterior teeth (7)
Ramus (5)
Total mini-implants (n = 45)
*
m = number of patients.
**
n = number of mini-implants.
Mini-implants in orthodontic treatment 705
Table 2. Characteristics of mini-implants
Incision and flap required (n)* 0
Insertion time (min) 10–15
Mean follow up (months) 16
Diameter of mini-implant (mm) 2
Length of mini-implant in mm (n = 45)
8 15
10 10
12 12
14 8
*
n = number of mini-implants.
Results
Twenty-seven mini-implants were placed
in the buccal side of the maxilla (anterior:
9; posterior: 18) and 18 in the buccal side
of the mandible (anterior: 6; posterior: 7;
ramus: 5). Insertion time for mini-
implants was about 10–15 min. The char-
acteristics of the mini-implants are shown
in Table 2. The majority of mini-implants
were 8 mm in length. No patient needed an
incision and flap to insert the mini-
implant. The mean follow-up time was
16 months (Figs. 2–4). Failures of mini-
pletion of the orthodontic treatment and
implants occurred after orthodontic force
(2) there was no persistent inflammation or
loading. Two mini-implants were dis-
infection. Screw failure, which resulted in
lodged within 2 weeks of loading. The
the removal of the mini-implant, occurred
other 2 failed mini-implants had caused
when there was significant mobility of a
persistent inflammation that did not sub-
mini-implant that could not sustain the
side after local cleaning and antibiotic
orthodontic force, or when there was per-
treatment. These 2 mini-implants were
sistent infection or inflammation that did
removed and the inflammation resolved
not subside after local cleaning and anti-
completely. The overall success rate was
biotic treatment. The timing of mini-
thus 91.1% (41/45). The length of the
implant failure was classified as (1) before
mini-implant was related to success rate:
loading: removal of the mini-implant
80% for 8 mm, 90% for 10 mm and 100%
before orthodontic force loading and (2)
for 12 mm and 14 mm. Location was
after loading: removal of the mini-implant
found to be the only significant risk factor
after orthodontic force loading. Observed
for failure of the mini-implant (Table 3).
risk factors for failure of mini-implants
Success rates were 100% in anterior teeth
were statistically analysed using the Chi-
of the maxilla, 95% in posterior teeth of
square or Fisher exact test as appropriate.
the maxilla, 100% in anterior teeth of the
Statistical significance was considered to
mandible, 85.7% in posterior teeth of
be reached when P was 0.05 or less.
mandible and 60% in the ramus.
Fig. 2. The over-erupted left maxillary second premolar and first molar before treatment.
706 Tseng et al.

bracket appliance, extraoral anchorage by

headgear and an active corrector, cannot
effectively control anchorage, especially
in adult patients. The reinforcement of
anchorage requires complicated biome-
chanics and good patient compliance.
Application of the mini-implant as alter-
native anchorage for various types of tooth
movement has been demonstrated2,7,8,9.
MAINO et al.9 used mini-implants to pro-
vide anchorage when retracting the max-
illary first molar and canine. KYUNG et al.7
applied mini-implant anchorage to pro-
tract lower second molars into first molar
extraction sites. CARANO et al.2 used the
mini-implants to provide anchorage dur-
Fig. 3. Intrusion of left maxillary second premolar and first molar using elastic to mini-implant. ing incisor intrusion. LEE et al.8 reported
that midpalatal mini-implants could be
effectively used for intrusion of maxillary
molars.
The principle gateway of stability for
mini-implants is a mechanical lock within
the bone. Poor quality or an insufficient
quantity of available bone may cause lack
of retention of the mini-implant. In the
present study, the location and length of
the inserted mini-implants were the impor-
tant risk factors. Two of the mini-implants
that failed were inserted in the bilateral
anterior ramus; they loosened 2 weeks after
orthodontic force loading. Panoramic
radiographs revealed that both failed
mini-implants had only locked in the bone
about 3–4 mm due to very thick surround-
ing mucosa in the anterior ramus area.
Fig. 4. Patient after 8 months of treatment. Statistically, the location of the mini-
implant, especially in the ramus, was the
Table 3. Parameters related to success of mini-implants only significant risk factor for failure. Three
Success rate (%) P other mini-implants were successful in the
same location, but they were all 10 mm
Location of mini-implant (n)*
Maxilla (buccal side) long and inserted into the bone at least
Anterior teeth 100 — 6 mm. In the authors’ opinion, the depth
Posterior teeth (1) 95 — of insertion of the mini-implant was more
important than its location or length, the
Mandible (buccal side)
recommended depth being at least 6 mm.
Anterior teeth 100 —
Posterior teeth (1) 85.7 — Oral hygiene could also influence the
Ramus (2) 60 <0.05** success rate of mini-implants. The preo-
perative periodontal condition of all
Length of mini-implant in mm (n)* patients was acceptable. Unfortunately,
8 (3) 80 — 2 patients did not follow the instructions
10 (1) 90 — to maintain mini-implant cleaning. Poor
12 100 — attention to oral hygiene lead to inflam-
14 100 — mation in the tissues around the mini-
implants and hastened their loss.
Orthodontic force loading (n)*
In this study, 41 mini-implants showed
Before 100 —
After (4) 91.1 — enough stability to resist orthodontic
*
force. Of the 4 failed mini-implants, 3
n = number of mini-implant failures. were 8-mm long and 1 was 10-mm. The
**
Statistically significant (P < 0.05); —, statistically insignificant.
overall success rate was 91.1% (41/45).
Care must be taken to place the mini-
Discussion Various techniques have been devised and implant away from the root apices and the
used in orthodontic practice to reinforce inferior alveolar nerves. Improper place-
Anchorage control is the most important anchorage. Traditional biomechanical ment could lead to tooth damage or per-
factor in successful orthodontic treatment. techniques, such as the use of a multi- manent nerve injury. This has been

reported in recent papers3,5 where compli-
cations were examined retrospectively.
Complications included fracture of the
mini-implant on insertion, iatrogenic
damage to teeth causing loss, and bony
sequestra around the area of mini-implant
placement. We recommend a through clin-
ical and radiographic 3-dimensional
assessment of the teeth adjacent to the site
for mini-implant placement. Because of
wide variation in root morphology, post-
operative radiography must be used to
screen for any evidence of impingement
of the root or nerve.
In conclusion, the mini-implant can be
used as alternative anchorage in ortho-
dontic treatment. In its clinical applica-
tion, the mini-implant can be used
effectively as an anchor for tooth move-
ment. Evaluation of the relationship of the
insertion pathway with adjacent struc-
tures is needed to reduce iatrogenic
damage.
Mini-implants in orthodontic treatment
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Address:
Chun-Ming Chen
Department of Oral
Maxillofacial surgery
Kaohsiung Medical University
No.100, Shih-chuan 1st Road
Kaohsiung
807
Taiwan
Tel.: +886 7 3121101x7005
E-mail: komschen@seed.net.tw