European Journal of Orthodontics 36 (2014) 550–556 © The Author 2013.

r 2013. Published by Oxford University Press on behalf of the European Orthodontic Society.
doi:10.1093/ejo/cjt023 All rights reserved. For permissions, please email: journals.permissions@oup.com
Advance Access publication 18 April 2013

Finite element analysis of mono- and bicortical mini-implant

stability
Christof Holberg, Philipp Winterhalder, Ingrid Rudzki-Janson and Andrea Wichelhaus

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Department of Orthodontics, University of Munich, Bavaria, Germany

Correspondence to: Christof Holberg, Department of Orthodontics, University of Munich, Goethestrasse 70, 80336
Munich, Germany. E-mail: cholberg@med.lmu.de

SUMMARY
Objectives  Loosening and loss rates of monocortical mini-implants are relatively high, therefore the fol-
lowing null hypothesis was tested: ‘The local bone stress in mono and bicortically-anchored mini-implants
is identical’.
Material and Methods Anisotropic Finite Element Method (FEM) models of the mandibular bone,
including teeth, periodontal ligaments, orthodontic braces, and mini-implants of varying length, were
created. The morphology was based on the Computed Tomography data of an anatomical preparation.
All mini-implants with varying insertion depths (monocortical short, monocortical long, bicortical) were
typically loaded, and the induced effective stress was calculated in the cervical area of the cortical bone.
The obtained values were subsequently analysed descriptively and exploratively using the SPSS 19.0
software.
Results  The null hypothesis was rejected, since the stress values of each anchorage type differed sig-
nificantly (Kruskal–Wallis Test, P < 0.001). Therefore, the lowest effective stress values were induced in
bicortical anchorage (mean  =  0.65 MPa, SD  =  0.06 MPa) and the highest were induced in monocortical
(short) anchorage of the mini-implants (mean = 1.79 MPa, SD = 0.29 MPa). The Spearman rank correlation
was 0.821 (P < 0.001).
Conclusions  The deeper the mini-implant was anchored, the lower were the effective stress values in
the cervical region of the cortical bone. Bicortical implant anchorage is biomechanically more favourable
than monocortical anchorage; therefore, bicortical anchorage should be especially considered in chal-
lenging clinical situations requiring heavy anchorage.

Introduction
To avoid undesired effects on the adjacent teeth, sufficient
anchorage should be ensured during orthodontic tooth
movement (Angle, 1899). In addition to dental anchorage,
where multiple teeth can be assembled to anchor blocks,
skeletal anchorage is a proven method, particularly in
challenging clinical situations (Feldmann and Bondemark,
2006). For example, the anchorage system is strongly
loaded during mandibular molar mesialization, as in such
cases either an extraoral (Benauwt, 1974) or a skeletal
anchorage system is strongly recommended (Freudenthaler
et al., 2001). For skeletal anchorage, dental implants (Gallas
et al., 2005), mini-plates (Sato et al., 2007; Cornelis et al.,
2008), palatal implants (Gedrange et  al., 2005; Wehrbein
and Gollner, 2007), and mini-implants (Kanomi, 1997)
are used. Mini-implants have been particularly favoured
for skeletal anchorage in recent years (Reynders et  al.,
2009). However, the loss and loosening rates of these
usually monocortically inserted mini-implants is relatively
high at 10–30% (Crismani et  al., 2010). Many factors
impact on the success rate (Stahl et al., 2009; Chang et al.,
2012). These include the direction (Pickard et  al., 2010)
and the magnitude of the applied force, the thread design
(Wiechmann et  al., 2007), the thread diameter (Morarend
et al., 2009), and above all, the length of the mini-implant
(Mortensen et  al., 2009). The chosen screw length of the
mini-implant determines the kind of anchorage (mono- or
bicortical). Thus monocortical anchorage obviously reduces
the risk of injury to the adjacent anatomic structures such as
periodontal ligaments (PDLs) (Lemieux et al., 2011).Longer
mini-implants, however, could probably enhance primary
stability, leading to a reduced risk of loosening or loss (Wu
et al., 2007), even if the injury risk to adjacent anatomical
structures may be increased (Lemieux et  al., 2011). Thus
the factors of required anchorage and injury risk should be
considered when choosing a specific mini-implant length
(Sung et al, 2010; Çifter and Saraç, 2011). In challenging
clinical situations requiring heavy anchorage, the insertion
of bicortically anchored mini-implants comes into
consideration. Since a detailed biomechanical comparison
between mono- and bicortical anchorage systems is not
available in literature as yet; this will be the subject of the
present study. In particular, the following questions will be
answered. Are there biomechanical differences between a
MONO- OR BICORTICAL MINI-IMPLANTS 551

monocortical short, a monocortical long, and a bicortical

insertion of the mini-implants? Are the biomechanical
differences of importance? Do the differences affect the
quality of the primary stability? Thus, the null hypothesis
was, ‘The load of the peri-implant bone in mono or bicortical
anchorage is identical’.

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Material and methods
An anatomical preparation of a mandibular segment
(18  year old man) with tooth 46 missing served as the
morphological basis for the Finite Element Method (FEM)
models (Figure 1). This anatomical specimen was scanned
using Computed Tomography (CT), and the morphological
data were acquired by manual segmentation of the axial CT
layers using the Amira™ software (Visage Imaging GmbH,
Berlin, Germany). Segment models of the compact and can-
cellous mandible, complete models of tooth 44, 45, and 47,
and models of the corresponding PDLs resulted after cross-
linking the point cloud (Delauney Triangulation) to three-
dimensional polygon meshes. The surface structure of the
polygon meshes was subsequently post-processed and opti-
mized using the Rapidform™ software (INUS Technology
Inc., Seoul, Korea).

Pre-processing
Using Polytrans™ software (Okino Inc., Ontario,
Canada), the polygon meshes were converted into
analytical solid models (IGES format). All constructible
elements (brackets, powerarm and mini-implant)
were designed virtually using established Computer
Aided Design (CAD) tools in the Inventor™ software
(Autodesk GmbH, Munich, Deutschland). The resulting
solid models could be combined to three compound
models (Figure  2) using Boolean operations of addition
Figure 1  CAD model consisting of various materials (cortical bone, can-
cellous bone, teeth with enamel, dentin and periodontal ligament, brackets,
powerarm, and a mini-implant with a variable length).
Figure 2  Cross-section of the CAD models showing the variable length
of the mini-implant that was anchored mono- or bicortically.
and subtraction in the Mechanical Desktop™ software
(Autodesk GmbH, Munich, Germany). The first CAD
model represented short monocortical anchorage by using
a mini-implant with a diameter of 1.6 mm and a length
of 5 mm. The mini-implant in the second model (7 mm
length) was also inserted monocortically but reached the
region of the cancellous bone. Finally, in the third CAD
model bicortical anchorage was performed by using
a mini-implant with a diameter of 1.6 mm and a length
of 10 mm. The resulting CAD models could now be
cross-linked three-dimensionally to FEM models using
the ANSYS™ 11.0 simulation software (Ansys Inc.,
Canonsburg, Pennsylvania, USA). The finite elements
used were parabolic tetrahedrons with one node at
each corner and one additional node in the middle of
each edge. Accordingly, this tetrahedral element was a
nonlinear, 10-noded three-dimensional finite element.
Loading and boundary conditions (Tables 1 and 2) were
defined corresponding to the standard values found in the
literature. A force and a counterforce each of 1.5 N was
applied to all simulation models. The orientation of the
force vector corresponded to the closed coil depicted in
Figure 1. As a boundary condition, multiple nodes could
be fixed in the simulation model as far away as possible
from the region of interest (ROI). The contact conditions
552 C. HOLBERG ET AL.

Table 1  Material properties of the mini-implant and other materials used in the present study; Young´s modulus specifies the elasticity
and Poisson´s ratio the transverse contraction characteristics of the material. 

Young´s modulus Poisson´s ratio References

Mini-implant 110 000 MPa 0.35 (Motoyoshi et al., 2009)

Brackets 210.0 MPa 0.30 (Chen et al., 2008)

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Adhesive 8.823 MPa 0.25 (Lin et al., 2011)
Powerarm (Stainless Steel) 193.0 MPa 0.30 (Chen et al., 2008)
Enamel 80 000 MPa 0.25 (He et al., 2006)
Dentin 24 400 MPa 0.43 (Xu et al., 1998; Kinney et al., 2004)
PDL 50 MPa 0.49 (Rees and Jacobsen, 1997; Fill et al., 2011)
Nerve tissue 0.58 MPa 0.42 (Ichihara et al., 2001; Borschel et al., 2003)

between the structures were defined as fixed—only the

Table 2  Anisotropic material properties of cortical and
cancellous bone used in the present study (Dechow et al., 1993;
O’Mahony et al., 2000; O’Mahony et al., 2001). 
contact between the bone and the mini-implant was
friction dependent with non-linear lifting (coefficient
µ = 0.3).

Compact Bone Cancellous Bone Stress calculation

Ex 12 600 MPa 1148 MPa An ROI was defined, where the effective stress (in MPa)
Ey 19 400 MPa 1148 MPa should be calculated. This ROI was formed by the buccal
Ez 12 600 MPa 210 MPa
part of the cortical bone surrounding the head of the mini-
Gxy 5700 MPa 434 MPa
Gyz 5700 MPa 68 MPa implant by a diameter of 8 mm (Figure  3). In this region
Gxz 4850 MPa 68 MPa the effective stress (in MPa) was calculated at all nodes.
vxy 0.253 0.322 Following this, the values were sorted by their size, and the
vyz 0.390 0.055
vxz 0.300 0.055 top 1000 highest stress values were considered for further
statistical analysis, as these peak loads could be responsible

Figure 3  Comparison of induced stress values (in MPa) in the region of interest (cortical bone around the head of the mini-implant). The implant body
itself was removed for a better view. Cross-section (left row) showing the distribution of the induced effective stresses (in MPa).
MONO- OR BICORTICAL MINI-IMPLANTS 553

for possible mini-implant complications such as loss of the
primary stability, loosening, or even loss of the mini-implant.
Statistical analysis
The obtained values were analysed descriptively and explora-
tively using the SPSS™ 15.0 software. The Kolmogorov–
variant of the monocortical mini-implant showed somewhat
lower stress values. The mean effective stress was 1.55 MPa
(SD 0.28 MPa). The median was 1.48 MPa, the maximum
2.43 MPa, and the minimum 1.22 MPa (Table 3).
Bicortical anchorage

Smirnov test was performed to check the variables for normal
distribution. The Kruskal–Wallis test was used to find sig-
nificant differences between the samples; following this, the
Mann–Whitney U-test was used in pairs. The correlation
coefficient according to Spearman was calculated to quantify
the correlation between the length of the mini-implant and
the induced effective stress in the peri-implant bone.
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After applying a force of 1.5 N perpendicular to the axis
of the monocortical short-inserted mini-implant, the mean
effective stress in the cortical bone was 0.65 MPa (SD
0.09 MPa). The median was 0.64 MPa, the maximum value
0.90 MPa, and the minimum 0.57 MPa (Table 3). The box
plots in Figure 5 illustrate the statistical differences between
the three mini-implant anchorage variants.

Statistical analysis
Results
The variable of effective stress was not normally distributed
The samples for the anchorage variants ‘monocortical
in all types of anchorage. The hypothesis of a normal dis-
short’, ‘monocortical long’, and ‘bicortical’ differed with
tribution could be rejected in the Kolmogorov–Smirnov test
regard to their descriptive statistics. The mean effective
stress (in MPa) was clearly higher in mono than in bicortical
anchorage (Figure 3). The peri-implant stress values in the Table 3  Descriptive statistics of effective stress values (n=1000)
cortical bone for the monocortical variant were more than calculated in the cervical region of the cortical bone close to the
twice those for the bicortical variant. The individual values, mini-implant. 
which were sorted in a descending order, are depicted in
Figure 4 to give a comparison between the anchorage types. Parameter Unit Monocortical Monocortical Bicortical
(short) (long)
Monocortical anchorage
n — 1000 1000 1000
After applying a force of 1.5 N perpendicular to the axis Mean MPa 1.79 1.55 0.65
of the monocortical short-inserted mini-implant, the mean Median MPa 1.71 1.48 0.64
effective stress in the cortical bone was 1.79 MPa (SD Std.-Dev. MPa 0.29 0.28 0.06
Minimum MPa 1.43 1.22 0.57
0.29 MPa). The median was 1.71 MPa, the maximum value Maximum MPa 2.76 2.43 0.90
2.76 MPa, and the minimum value 1.43 MPa. The long

Figure 4  Comparison of the peak stress values with different types of

anchorage calculated at the nodes of the region of interest (cortical bone Figure 5  Boxplot visualization comparing the stress values in the region
around the head of the mini-implant). In the chart all presented nodes were of interest (cortical bone around the head of the mini-implant) with three
rearranged by their value size. different types of mini-implant anchorage.
554
with a very high significance (P < 0.001). Due to the lack of
normal distribution, non-parametric tests were used. In the
Kruskal–Wallis test the mean values of the samples differed
with high significance (P < 0.001). A  pairwise testing of
the samples using the Mann–Whitney U-test yielded highly
significant differences for each variant (P < 0.001). The
rank correlation according to Spearman was in the negative
range at −0.821 (P < 0.001), which corresponds to a high
correlation. When only including the 10 highest stress val-
ues in the samples, the correlation coefficient according to
Spearman was −0.943 (P < 0.001), which corresponds to a
very high correlation. The negative correlation coefficients
indicated that the peri-implant stress values were lower
when the mini-implant was longer and inserted deeper into
the alveolar bone.
Discussion
The FEM is a proven method to analyse mini-implant-
based anchorage systems biomechanically (Motoyoshi
et  al., 2005; Stahl et  al., 2009; Chatzigianni et  al., 2011;
Ammar et  al., 2011; Suzuki et  al., 2011; Woodall et  al.,
2011; Liu et al., 2012; Singh et al., 2012). In the present
study, three anchorage variants of mini-implants were
compared biomechanically using the FEM. As in other
FEM studies, the FEM models represented an idealization
and simplification of the reality (Cattaneo et  al., 2005;
Stahl et al., 2009; Pickard et al. 2010; Chatzigianni et al.,
2011). For example, the mechanical properties of the PDL
are very complex in reality (Poppe et al., 2002). Different
approaches are taken to consider this complexity in FEM
studies; for instance, sometimes the material properties of
the PDL are defined as linear (Rees and Jacobsen, 1997;
Poiate et  al., 2009; Fill et  al., 2011), but this approach
often seems to be an oversimplification. Often the material
properties are defined as ‘bilinear’, leading to an ‘ultimate
strain’ value between the linear ranges (Ziegler et al., 2005;
Cattaneo et al., 2009; Dong-Xu et al., 2011). This approach
is more accurate because both ‘curled’ and ‘uncurled’
PDL modes are taken into account (Ziegler et  al., 2005;
Dong-Xu et al., 2011). Another approach is the description
of the PDL by the hyper-elastic Ogden constitutive law
(Shibata et  al., 2006). In the present study, the material
properties of the PDL were defined as linear. This
simplification was acceptable, as the PDL was far away
from the ROI and had only a small effect on the results.
In the present study, the morphology of the bone was
differentiated into a cortical and cancellous segment, and
the corresponding anisotropic material properties could
be assigned. All the material properties used were taken
from the literature. In comparison to other FEM studies,
the morphological accuracy of the present FEM model
was relatively high, because the alveolar bone segments
were sometimes virtually constructed by the authors and
not transferred from individual patient data (Pickard et al.,
C. HOLBERG ET AL.
2010; Lombardo et al., 2010). This virtual design of organic
structures increases the methodical error. To keep this as
low as possible, the FEM models of the present study were
not constructed but rather generated from the CT data of
an anatomical preparation. To further reduce the systematic
error, no absolute values were considered to draw the
conclusion, only the differences between the simulations.
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Since all simulations were affected by the simplification
effects to the same extent, the analysis of the differences
resulted in an additional increase of validity.
Cortical stress
The null hypothesis (‘The local bone stress in mono and
bicortically-anchored mini-implants is identical’) could
be discarded since highly significant differences were
determined between the different anchorage types. Since
in bicortical anchorage the peak stresses induced in the
cortical bone were the lowest, this type of anchorage
seems to be superior according to a long-lasting primary
stability. Respectively, the risk of mini-implant loss or
loosening should be reduced in bicortical anchorage. The
present results are supported by the study of Brettin et al.
(2008) in which the deflection forces of mono or bicor-
tically anchored mini-implants were calculated using a
simplified FEM model and an anatomical preparation.
Here the bicortically anchored mini-implants underwent
less loosening than the monocortical ones. Additionally,
biomechanical differences between variants of monocor-
tical anchorage could be analysed in the present study.
Since the short monocortical anchorage is limited to the
outer cortex, the stresses were higher than with longer
mini-implants, which are extended into the cancellous
bone. The stress differences between these monocortical
variants were highly significant, but the extent of the dif-
ferences was much lower than between monocortical and
bicortical anchorage.
Monocortical anchorage
For a sustainable primary stability of orthodontic mini-
implants it is important to prevent loosening of the mini-
implant by overloading the peri-implant bone. In particular,
the stress induced in the cervical region of the peri-implant
bone is important here (Singh et al., 2012). The lower the
induced stress is here, the lower the risk of loosening of the
mini-implant (Florvaag et al., 2010). With short monocorti-
cal anchorage, however, relatively high stresses are induced
in the region of the cervical peri-implant bone. These were
somewhat higher than in long monocortical anchorage but
clearly higher than in bicortical anchorage. Not only was the
peri-implant bone in the distal region of the mini-implant
affected by stresses (where the tensile force was applied by
the closed coil) so too was the mesial region. Obviously,
the head of the short mini-implant was pulled in a distal
direction, causing stresses in the mesial region by a leverage
MONO- OR BICORTICAL MINI-IMPLANTS
effect of the implant body. This interesting effect was not
found in long monocortical anchorage, including anchor-
age in the cancellous bone. Apparently peri-implant stresses
caused by this leverage effect can be prevented by choosing
longer mini-implants.
Bicortical anchorage
The cervical bone stress was clearly lower in the bicortical
variant than in all variants of monocortical anchorage. The
reduction factor was 2–3, leading to low stresses of the cer-
vical bone in the direction of the applied force. In contrast
to monocortical anchorage, the mesial region of the peri-
implant bone did not show relevant stresses. Obviously, in
bicortical anchorage the mini-implant is completely fixed
by the opposite cortical bone, effectively preventing a lever-
age effect of the implant body. The overall stresses of the
cervical bone are very low in bicortical anchorage; thus the
risk of loosening or loss of the mini-implant is reduced in
comparison to monocortical anchorage.
Conclusion
From a biomechanical point of view bicortical mini-implant
anchorage is more favourable than monocortical anchorage,
because the induced stress in the peri-implant bone is less.
Therefore, bicortical anchorage should be especially con-
sidered in challenging clinical situations requiring heavy
anchorage. This implies a beneficial morphology, allowing
a bicortical insertion without increased risk of injury to the
adjacent structures.
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