Original Article

Comparison of the Effects of Varying Positions of Mini‑implants on

Intrusion of Maxillary Incisors‑an In vivo Study
Nikita Rajesh Tilekar1, Vinit Swami2, Anand Sabane3, Veera Bhosale2

1
Orthodontic Practitioner, Objective: To compare the amount and rate of maxillary incisor intrusion by varying

Abstract
2
Prof., 3Associate Prof.
position of mini-implants. Materials and Methods: Twenty four subjects having deep
Department of
1,2,3 bite were randomly allocated to two groups: Group I where a single mini-implant
Orthodontics and Dentofacial was placed in the alveolar region between the roots of maxillary central incisors and
Orthopedics, Bharati a force of 60 grams was applied with elastic chain tied from mini-implant to wire.
Vidyapeeth Dental College Group II where mini-implants were placed bilaterally in the alveolar region between
and Hospital, Pune,
Maharashtra, India
thee roots of maxillary lateral incisors and canines and a force of 30 grams (total 60
grams) was applied on each side. Lateral cephalograms taken before intrusion and 4
months after intrusion. Data was analyzed by means of independent sample ‘t’ test
and paired ‘t’ test. Results: The maxillary incisors showed a significant amount of
intrusion in both groups but there was no significant difference in the amount and rate
of intrusion between the two groups (P > 0.01). Minimal molar extrusion was seen in
both the groups but the difference was not statistically significant. Conclusions: Both
the methods for maxillary incisor intrusion are effective as there was no statistically
significant difference but two mini-implants are preferred as they cause relatively less
proclination of maxillary incisors.

Received: 07-10-2017
Keywords: Mini-implants, maxillary incisor intrusion, varying positions of mini-
Accepted: 03-12-2017 implants

Introduction However, use of mini‑implants to correct deep bite with

R ecently, orthodontics has experienced a “paradigm
shift” to focus more on esthetics, with specific
emphasis on the smile and soft tissues around the teeth.[1]
Thus, correction of a deep bite and a gummy smile is
one of the important objectives of orthodontic treatment.
A deep bite is a complex orthodontic problem that is a
common feature of many malocclusions.[2] Depending
on the diagnosis, a deep overbite can be corrected by
intruding the incisors, extruding the buccal segments,
or a combination of both. Extrusion of posterior
teeth drops the mandible downward and backward
because the condyle assumes a new position in the
temporomandibular joint articulation.[3] This treatment
option is, therefore, not acceptable in vertically growing
patients.
Most often the cause of gummy smile is vertical
maxillary excess needing an orthognathic surgery.
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gummy smile which fall in the category of borderline
surgical cases seems promising option.[4]
Conventional treatment modalities such as the utility arch,
J‑hook headgear (J‑HG), intrusion arches, Connecticut
intrusion arch, and K‑SIR arch cause undesirable side
effects like extrusion of posterior teeth and flaring of
anteriors. Some of these appliances require patient
compliance which is sometimes difficult to achieve.
Introduction of mini‑implants to orthodontics has greatly
revolutionized the orthodontic anchorage and helped
in simplifying the treatment. Some studies[4‑8] have
previously described intrusion of maxillary anteriors
Address for correspondence: Dr. Nikita Rajesh Tilekar,
2/A‑1/28, New Ajanta Avenue Soc, Mayor Colony, Kothrud,
Pune ‑ 411 038, Maharashtra, India.
E‑mail: nttilekar@gmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non-commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

How to cite this article: Tilekar NR, Swami V, Sabane A, Bhosale V.

DOI: Comparison of the effects of varying positions of mini‑implants on
10.4103/jios.jios_222_17 intrusion of maxillary incisors‑an in vivo study. J Indian Orthod Soc
2018;52:35-43.

© 2018 Journal of Indian Orthodontic Society | Published by Wolters Kluwer - Medknow 35

 Tilekar, et al.: Maxillary anterior intrusion with mini-implants
using a single mini‑implant placed between the two
maxillary central incisors, while some studies[3,6,7,9‑15]
have described intrusion of maxillary anteriors using two
mini‑implants placed bilaterally between the maxillary
lateral incisors and canines and both have reported
success. However, in these studies, there has been no
uniformity in terms of sample size and distribution,
force levels used, and duration of intrusion. Hence,
there cannot be a comparison as to which method is
more effective (one implant or two implants). Hence,
the purpose of this study is to measure and compare
the amount of intrusion of maxillary incisors using
single versus two mini‑implants by varying position of
mini‑implants.
Materials and Methods
This study was carried out on 24 patients for 4 months.
The sample size calculation was based on the effect sizes
through previously published studies. The minimum
sample size 12 in each study group (total 24) would
provide 80% power (type II error 20%) with 5% type I
error to detect the clinically significant difference in
the cephalometric parameters studied between two
study groups. The ethical (Ortho IV-I/2014-15) was
obtained from the research ethical committee of Bharati
Vidyapeeth University, Pune.
The inclusion criteria were:
1. Patients having deep bite requiring maxillary incisor
intrusion as part of the orthodontic treatment
2. Patients undergoing orthodontic treatment with
fixed appliances  (3M Unitek 0.018  ×  0.025 MBT
preadjusted edgewise appliance)
3. Patients in the age group of 15–30 years.
The exclusion criteria were:
1. Periodontally compromised cases
2. Partial anodontia in maxillary arch
3. Abnormal root morphology, root resorption, or any
trauma with maxillary incisors
4. Patients with periapical pathology with maxillary
incisors
5. Presence of any systemic disease.
The samples were divided into 2 groups by simple
random sampling procedure as follows:
• Group  I: Twelve patients  (5  males; 7  females)  –  a
single midline mini‑implant (mean age‑18.5 years)
• Group  II: Twelve patients  (5  males;
7 females) – 2 mini‑implants placed distal to
maxillary lateral incisors (mean age‑17.3 years). The
patients were assigned randomly in both the groups.
After leveling and aligning, 0.017” ×0.025” Stainless
Steel archwire section was placed in the anterior segment
36 Journal of Indian Orthodontic Society  ¦  Volume 52  ¦  Issue 1  ¦  January-March 2018
in maxillary arch to minimize flaring of anterior teeth.
The archwire was kept flat without any compensating
curves and was extended distally beyond the canine
brackets on both sides. The ends of the wire were bent
cervically. 0.016” × 0.022” Stainless Steel archwire
section was used for the posterior segment [Figure 1].
The distal end of this wire was tightly cinched back,
and the mesial end was engaged passively (hooked) on
the distal end of the bent anterior archwire to minimize
flaring of anteriors.
Implant placement procedure
Self‑drilling titanium mini‑implants, PC head type,
7  mm  (AbsoAnchor microimplants; PH  1312‑07, Dentos
India Pvt., Ltd.) were used. After allowing 2–4 min for
the topical anesthetic to act, the predetermined location of
mini‑implant placement was marked with crystal violet
stain using a dental probe. In Group I, the mini‑implants
were placed into the alveolar bone between the roots of
maxillary central incisors at the mucogingival junction. In
Group II, they were placed into the alveolar bone between
the roots of maxillary lateral incisors and canines at the
mucogingival junction. The site of insertion was restricted to
the attached gingival region to prevent soft‑tissue coverage
over the mini‑implant. The mini‑implants were placed at an
angulation of about 30°–40° to the outer labial cortical bone.
Strict sterilization protocol was adhered to for each implant
placement procedure. Intraoral periapical radiographs were
taken before and after the mini‑implant placement procedure
to confirm the position of mini‑implants.
Force application ‑ A very light force of 15–20 g per tooth
is recommended for intrusion of anterior teeth.[16] It has
been documented that heavy force will not increase the
amount of intrusion, but it will lead to root resorption.[17]
Hence, in this study, a light force of 60 g was applied
using an elastomeric chain. Force of 60 g was applied
in the single mini‑implant group [Figure 2] and 30 g
per side in the two mini‑implants group [Figure 3] with
elastomeric chain.
A lateral cephalometric radiograph was obtained from
each patient before intrusion (T0) and after intrusion (T1).
Treatment time was limited to 4 months so as to compare
the intrusion rates and the treatment efficiencies of the 2
intrusion systems.
Following parameters were measured on the
cephalogram:
The centroid point was used for linear measurements. It
was considered as a point lying 13 mm from the incisal
edge measured along the long axis of the tooth as given
by Kinzel et al., 2002.[18]
 Tilekar, et al.: Maxillary anterior intrusion with mini-implants
Figure 1: Anterior segmental archwire 0.017” × 0.025” from maxillary
right canine to left canine; posterior stabilizing archwire 0.016” × 0.022”
SS (right side)
Figure 3: Mini‑implants placed bilaterally between maxillary lateral
incisors and canines with application of force
Linear measurements for evaluating maxillary
incisor intrusion [Figure 4]
i. CR‑SN – The length of the perpendicular drawn from
the centroid point of maxillary incisor to sella‑nasion
plane (in millimeters) at T0 and T1
ii. CR‑PP – The length of the perpendicular drawn from
the centroid point (a point 13 mm above the incisal
edge of the maxillary incisor) of the maxillary incisor
to the palatal plane (in millimeters) at T0 and T1
iii. M1‑PP – The length of the perpendicular drawn from
the mesiobuccal cusp of maxillary first molar to
palatal plane (in millimeters) at T0 and T1.
Linear measurements for evaluating overbite  Formula used:
[Figure 4]
iv. Overbite – A line was drawn perpendicular to
Frankfurt Horizontal plane passing through
subnasale. The distance between the perpendiculars
drawn to this line through incisal edges of
maxillary and mandibular incisors determines the
overbite (in millimeters).
Journal of Indian Orthodontic Society  ¦  Volume 52  ¦  Issue 1  ¦  January-March 2018
Figure 2: Midline mini‑implant placed between maxillary central incisors
with application of force
Figure 4: Cephalometric tracing showing various linear measurements
Angular measurements for evaluating change in
maxillary incisor inclination [Figure 5]
v. U1‑SN – The angular relation between the long axis
of the maxillary central incisor and the sella‑nasion
plane (in degrees) at T0 and T1
vi. U1‑PP – The angular relation between the long axis
of maxillary central incisor and the palatal plane
(in degrees) at T0 and T1.
The mean rate of intrusion of incisor was calculated
comparing pre‑ and post‑intrusion from perpendicular
distance between centroid point to PP plane in mm
over 4 months and from perpendicular distance between
centroid point to SN plane in mm over 4 months.
Mean amount of rate of intrusion 
CR − PP / SN ( T0 − T1 )
=  mm/month
4
Statistical analysis
The statistical analysis was performed using Statistical
Package for the Social Sciences (SPSS, version 16.0,
37
 Tilekar, et al.: Maxillary anterior intrusion with mini-implants

Table 1: Mean values, standard deviations, and P values of linear measurements at T0 and T1 in Group I and Group II
Group I (mean±SD) P Group II (mean±SD) P
Preintrusion (T0) Postintrusion after Difference Preintrusion (T0) Postintrusion after Difference
4 months (T1) 4 months (T1)
CR‑SN (mm) 69.71±4.69 68.04±4.68 1.67±0.96 0.001*** 72.00±4.02 69.63±4.57 2.38±1.19 0.001***
CR‑PP (mm) 17.96±2.43 16.21±2.53 1.75±1.39 0.001*** 20.46±3.19 18.46±3.45 2.00±0.83 0.001***
MM‑PP (mm) 21.79±1.69 21.79±1.50 0.00±1.13 0.999 24.17±2.86 24.17±2.68 0.00±0.94 0.999
Overbite 4.67±1.48 2.63±1.40 2.04±1.37 0.001*** 4.08±1.06 2.17±0.75 1.92±1.24 0.001***
reduction (mm)
***Highly significant. SD: Standard deviation

Table 2: The comparison of linear cephalometric

measurements at T0 and T1 between group I and II
Parameters Mean±SD P
Group I (n=12) Group II (n=12)
CR‑SN (mm)
T0 69.71±4.69 72.00±4.02 0.213
T1 68.04±4.68 69.63±4.57 0.411
T0‑T1 1.67±0.96 2.38±1.19 0.123
CR‑PP (mm)
T0 17.96±2.43 20.46±3.19 0.042*
T1 16.21±2.53 18.46±3.45 0.082
T0‑T1 1.75±1.39 2.00±0.83 0.598
M1‑PP (mm)
T0 21.79±1.69 24.17±2.86 0.022*
T1 21.79±1.50 24.17±2.68 0.014*
Figure 5: Cephalometric tracing showing various angular measurements T0‑T1 00.00±1.13 0.00±0.94 0.999
Overbite reduction (mm)
Inc., Chicago, USA) for Microsoft Windows. All the T0 4.67±1.48 4.08±1.06 0.280
hypotheses were formulated using two‑tailed alternatives T1 2.63±1.40 2.17±0.75 0.328
against each null hypothesis (hypothesis of no difference). T0‑T1 2.04±1.37 1.92±1.24 0.817
The statistical significance of intergroup difference of *Significant, SD: Standard deviation
mean of continuous variables is tested using independent
sample t‑test. The intragroup differences were tested statistically significant difference in linear measurements
using paired t‑test in each study group. The underlying between the two groups [Table 4].
normality assumption was tested before subjecting the The mean rate of intrusion per month measured with
variables to t‑test. respect to CR‑SN (P = 0.123) and CR‑PP (P = 0.598)
did not differ significantly between two study
Results
groups [Table 5].
Table 1 shows mean values, standard deviations, and
P values of linear measurements at T0 and T1 in Group I Discussion
and Group  II. The incisors were intruded significantly
Deep bite is a common malocclusion seen in the
in both groups (P < 0.001) as depicted by reduction in
measurements CR‑SN and CR‑PP. Molar extrusion in orthodontic practice. It is a clinical manifestation of an
both groups was not statistically significant  (P > 0.05). underlying skeletal or dental discrepancy.[19] It can occur
There was statistically significant reduction in overbite due to various reasons such as converging jaw bases
in both the groups. There is no statistically significant and infraeruption of molars leading to skeletal deep bite
difference in linear measurements between the two or extrusion of upper or/and lower anteriors leading to
groups [Table 2]. pseudo deep bite.
Table 3 shows mean values, standard deviations, and According to El‑Dawlatly et al., 2012,[19] the overeruption
P  values of angular measurements at T0 and T1 in of the maxillary incisors was the second highest
Group I and Group II. The incisors were proclined contributing dental component to deep bite malocclusion.
significantly in both groups  (P < 0.001) as depicted by The display of the maxillary incisors at rest and on smile
increase in measurements U1‑SN and U1‑PP. There is no influences the treatment decision favoring intrusion

38 Journal of Indian Orthodontic Society  ¦  Volume 52  ¦  Issue 1  ¦  January-March 2018

 Tilekar, et al.: Maxillary anterior intrusion with mini-implants

Table 3: Mean values, standard deviations, and P values of angular measurements at T0 and T1 in Group I and
Group II
Group I (mean±SD) P Group II (mean±SD) P
Preintrusion (T0) Postintrusion after Difference Preintrusion (T0) Postintrusion after Difference
4 months (T1) 4 months (T1)
U1‑SN (mm) 108.42±4.83 115.25±5.49 −6.83±3.42 0.001*** 108.75±5.49 112.83±6.63 −4.08±5.02 0.040*
CR‑PP (mm) 66.50±4.68 59.75±5.36 6.75±2.96 0.001*** 65.75±4.63 62.92±5.52 2.83±5.94 0.126
*Significant, ***Highly significant. SD: Standard deviation

Table 4: The comparison of cephalometric angular placing the screws distal to the maxillary lateral incisors,
measurements at T0 and T1 between Group I and II the intrusive force could be applied close to the center
Parameters Mean±SD P of resistance of the 4 incisors, and there would be no
Group I (n=12) Group II (n=12) or minimal flaring. Proclination of incisors was seen
U1‑SN (°) in previous studies of maxillary incisors intrusion
T0 108.42±4.83 108.75±5.49 0.876 (most of the case reports) using single mini‑implant.[23,24]
T1 115.25±5.49 112.83±6.63 0.342 However, these studies cannot be used for comparing the
T0‑T1 −6.83±3.41 −4.08±5.02 0.186 two positions of mini‑implants due to varying parameters
U1‑PP (°)
in the studies such as duration and forces.
T0 66.50±4.68 65.75±4.63 0.697
T1 59.75±5.36 62.92±5.52 0.168 Thus, this study was done to compare the effects
T0‑T1 6.75±2.96 2.83±5.94 0.053 of varying positions of mini‑implants on intrusion
SD: Standard deviation of maxillary incisors keeping all other parameters
(duration, force, and mechanics used) same.
0.017 × 0.025” was used for consolidation in the anterior
Table 5: The intergroup comparison of rate of intrusion
segment during incisor intrusion so that the centers of
per month
Rate of intrusion Mean±SD P
resistance of the incisors move closer to each other.[16]
per month Group I (n=12) Group II (n=12) This could eliminate the undesirable side effects such
CR‑SN (mm) 0.417±0.240 0.594±0.297 0.123 as protrusion during incisor intrusion. In the posterior
CR‑PP (mm) 0.438±0.347 0.500±0.206 0.598 segment, 0.016  ×  0.022” stainless steel archwire was
SD: Standard deviation used as a stabilizing archwire. The posterior wire was
hooked onto the anterior archwire and cinched back to
of the maxillary anterior teeth. Conversely, normal or prevent the flaring of incisors.
decreased incisor display favors extrusion of posterior A very light force of 15–20 g per tooth is recommended
teeth or intrusion of mandibular anterior teeth. In case for intrusion.[16] Hence, in this study, a light force of 60 g
of a flat smile arc, intrusion of the maxillary incisors is was applied using an elastomeric chain to intrude the
contraindicated.[19] maxillary anteriors.
There are different methods for intruding anterior Many previous studies have used either the incisor
teeth using mini‑implants. Intrusion of anterior teeth crown tip or the apex for the evaluation of the amount
using mini‑implants placed either between the two of intrusion on cephalogram. However, labial tipping
central incisors[4‑8] or between the lateral incisors and of incisors gives the clinical impression of deep bite
canines[3,6,7,9‑15] have been attempted previously. It has correction because it influences the vertical incisal edge
been a topic of debate whether a single mini‑implant is position. Therefore, these are not good reference points
sufficient or two mini‑implants are necessary for intrusion since they are dependent on inclination changes.[25]
of maxillary anteriors. It is believed that to minimize Therefore, the centroid point which lies at the center of
the flaring of incisors during intrusion the forces should resistance of the tooth, serves as an accurate landmark and
be applied through the center of resistance of the four
was selected for the measurement of incisor intrusion. In
incisors. Previous attempts to determine the center of
the present study, the centroid was considered as a point
resistance of incisors with different methods such as the
lying 13 mm from the incisal edge measured along the
laser reflection technique, holographic interferometry,[20]
long axis of the tooth as given by Kinzel et al., 2002.[18]
photoelastic stress analysis the finite element method,[21]
and in vivo studies[22] were done. All showed that the For cephalometric measurements, both SN and PP plane
center of resistance of the 4 incisors lie 8–10 mm were used in our study for comparison with other studies as
apically and 5–7 mm distal to the lateral incisors. By some of the studies have used SN plane while some have

Journal of Indian Orthodontic Society  ¦  Volume 52  ¦  Issue 1  ¦  January-March 2018 39

 Tilekar, et al.: Maxillary anterior intrusion with mini-implants
used PP plane. The level of SN plane is assumed to remain
static as it is formed by two fixed anatomic landmarks,
and hence can be taken as a more reliable plane compared
to palatal plane. Table 1 showed that the mean amount
of intrusion obtained for Group I and II with respect to
CR‑SN was 1.67 mm (±0.96) and 2.38 mm (±1.19),
respectively, which was highly significant  (P = 0.001).
Table 2 showed that the mean amount of incisor intrusion
between the two study groups was not statistically
significant for CR‑SN plane with P = 0.123. This change
implied that the incisors have intruded with respect to the
SN plane and more in Group II than Group I although
the difference in values between the two groups was not
statistically significant  (P = 0.123). The amounts of true
incisor intrusion attained in this study was less than the
values obtained by Senışık and Türkkahraman, 2012[3]
using two mini‑implants placed between maxillary lateral
incisors and canines. The reason for more intrusion
obtained in their study may be due to increased duration of
maxillary incisor intrusion. They obtained incisor intrusion
of 2.47 mm in 7 months, whereas the present study period
was only 4 months.
In Group I of single mini‑implant, Table 1 showed
that the mean amount of intrusion for Group I and II
obtained with respect to CR‑PP was 1.75 mm (±1.39)
and 2.00 mm (±0.83), respectively, which was highly
significant  (P = 0.001). Table 2 showed that the mean
amount of incisor intrusion between the two study groups
was not statistically significant for CR‑PP plane with
P  = 0.598. Thus, when measured in respect to palatal
plane, intrusion was greater in Group II than in Group I
although it was not statistically significant. Figure 6
graphically represents the intergroup comparison of
cephalometric linear parameters. In a study by Polat‑Özsoy
et  al., 2011,[10] incisor intrusion with two mini‑implants
in the anterior region was less (1.75 ± 0.4 mm in
6.61  ±  2.95  months; force‑80  g) compared to the present
study which was statistically significant and measured in
Figure 6: The intergroup comparison of linear cephalometric parameters
40 Journal of Indian Orthodontic Society  ¦  Volume 52  ¦  Issue 1  ¦  January-March 2018
a similar manner as this study. Despite intrusion period
and intrusion force being less in the present study, more
intrusion was seen as compared to their study probably
because of the optimum force used in the present study.
Thus, we can conclude that lesser forces are more
beneficial for intrusion of maxillary incisors. The results
of the present study can be appropriately compared to the
study by Aras and Tuncer, 2016,[15] in which they used two
mini‑implants in the anterior region for maxillary anterior
intrusion and obtained 1.5 mm of intrusion over 4 months.
Force level was 80 g. The intrusion obtained was less in
their study compared to the present study despite the study
period being same and force levels being more. This could
probably because of lesser force used for intrusion in the
present study. The present study findings were similar to
study by Polat‑Ozsoy et  al., 2009,[9] where using a force
of 80 g and two mini‑implants in the anterior region, the
amount of maxillary incisor intrusion was 1.92 ± 1.19 mm
over 4.55 ± 2.64 months. In a study by El Namrawy
et  al., 2015,[12] more amount of intrusion (2.9 ± 2 mm)
was obtained as compared to the present study over a
study period of 6 months and with force levels of 100 g.
The possible reason for this could be extended study
period and the combination of intrusion force along with
class I force leading to direction of force vector more
through center of resistance of maxillary incisors. Similar
mechanism was used in the present study where sectional
archwires were used instead of elastomeric chains in
posterior segment which were cinched back tightly.
However, rate of intrusion of their study was similar to the
present study. Raj et al., 2015[13] also achieved 4.4 mm of
maxillary incisor intrusion in 5 months which was more
as compared to the present study. Their force levels were
70 g. This could be because of extended study period and
force levels used. The single mini‑implant results could
not be compared with any other studies because none of
those studies have measured intrusion from centroid point.
Chandrasekharan and Balaji, 2010[4] achieved 7 mm of
intrusion in 4 months when measured from incisal edge
to palatal plane. However, as mentioned earlier the true
amount of intrusion obtained is masked if measured from
incisal edge as labial tipping of incisors gives the clinical
impression of deep bite correction much more than
what is actually achieved. They did observe proclination
of incisors; however, the amount of proclination was
not specified. Hence, their results cannot be compared
with the present study. Similarly, Ohnishi et  al., 2005[23]
also achieved 2.5 mm of intrusion in 15 months when
measured from incisal edge of maxillary incisor while Kim
et al., 2006[24] achieved 4 mm of intrusion over 7 months.
However, both of these studies were case reports.
In the present study, posterior segments were stabilized
with 0.016  ×  0.022” stainless steel wire which was
 Tilekar, et al.: Maxillary anterior intrusion with mini-implants
hooked onto the anterior arch wire and cinched back
at its distal end to reduce flaring of anteriors and at
the same time allow vertical movement of the anterior
segment. The results from the present study showed
that both intrusion systems led to intrusion as well as
mild protrusion of the maxillary incisors as the force
application in both groups was labial to center of
resistance of the maxillary incisors. Table 3 showed that
the mean amount of proclination of incisors obtained
in Group I and II with respect to U1‑SN plane was
6.83° (±1.39) and 4.08° (±5.02) which was highly
significant  (P = 0.001). Table 4 showed that the mean
amount of proclination of incisors between the two study
groups for U1‑SN plane was not statistically significant
with P = 0.186. Thus, when measured in respect to
SN plane, the proclination of incisors was greater in
Group II than in Group I although it was not statistically
significant. Figure 7 graphically represents the intergroup
comparison of cephalometric angular parameters.
Table 3 showed that the mean amount of proclination
of incisors obtained in Group I with respect
to U1‑PP plane was 6.75° (±2.96) which was
highly significant  (P = 0.001). In Group II of two
mini‑implants, Table 3 showed that the mean amount of
proclination of incisors obtained with respect to U1‑PP
plane was 2.83° (±5.94) which was not statistically
significant  (P = 0.126). This could be because the force
application in 2 mini‑implants group was closer to the
center of resistance of the four maxillary incisors. Table 4
showed that the mean amount of proclination of incisors
between the two study groups was not statistically
significant for U1‑PP plane with P = 0.053. Thus, when
measured in respect to PP plane, the proclination of
incisors was greater in Group II than in Group I although
it was not statistically significant.
Palatal plane could be altered during treatment. It can
be tipped up due to intrusion and proclination. Hence,
SN plane is a more stable and reliable plane to be used.
It has been claimed in previous studies by Polat‑Ozsoy
et  al., 2009[9] (1.81° ± 3°), El Namrawy et  al., 2015[12]
(2.3° ± 5.7°), and Raj et  al., 2015[13] (1°) that there is
more amount of intrusion using two mini‑implants
placed distal to maxillary lateral incisors and minimal
amount of incisor proclination which was not statistically
significant. All of these studies have measured change
in incisor inclination with respect to palatal plane. The
results obtained in the present study were similar to
study by Polat‑Özsoy et  al., 2011[10] (3.85° ± 2.4°), but
their duration of study period was more (6 months). Mild
amount of incisor flaring was seen in the present study
despite the fact that posterior wire was cinched back
tightly to prevent flaring of anteriors. Only in one study
Journal of Indian Orthodontic Society  ¦  Volume 52  ¦  Issue 1  ¦  January-March 2018
by Senışık and Türkkahraman, 2012[3] obtained similar
amount of intrusion (2 mm) as in the present study but
more amount of proclination 8.10° ± 5.7° (U1‑PP) using
two mini‑implants distal to maxillary lateral incisors.
This could be because of the force decay of elastomeric
chain they had used to prevent flaring of anteriors. Hence,
comparing both the studies, it can be concluded that the
system used in the present study is more efficient because
there was no force decay. However, with the similar
mechanics system as Senisika et  al. used in a study by
Virang et  al., 2013,[11] the amount of maxillary incisor
proclination obtained was minimal (U1‑SN = 0.7° ± 4°).
Although the mean proclination obtained was less, the
standard deviation for proclination in this study is too
high which can explain the varying results.
In a study by Deguchi et  al.,[26] they used two
mini‑implants for maxillary incisor intrusion, but they
were placed between the central incisors and lateral
incisors bilaterally. The amount of proclination achieved
by them was 6.2° ± 8.9° (U1‑SN). Thus, the proclination
seen was more as compared to the proclination in
the present study. Hence, it can be concluded that the
position of mini‑implants for intrusion of upper incisors
between lateral incisors and canines directs force vector
more toward the center of resistance of the 4 incisors
than the mini‑implants placed mesial to lateral incisors.
However, the proclination of incisors obtained
with conventional mechanics, such as utility
arch[10] (U1‑PP = 13.55° ± 2.4°), Burstone’s
intrusion arch[13] (U1‑PP = 10.90°), and J‑HG
(Deguchi et  al., 2008[26]; 8.5° ± 9.8) is higher compared
to the mini‑implant system used in the present study.
Thus, we can conclude that mini‑implants serve as a
better anchorage for incisor intrusion than conventional
mechanics.
Intrusion of incisors with anchorage in the posterior
region as in conventional mechanics [16,27‑29] can cause
the molars to angulate distally and extrude. Both
these effects can cause the mandibular plane to rotate
downward and backward. In the present study, stabilizing
archwire was used in posterior segment to prevent flaring
and not as an anchorage unit. Molar extrusion was thus
checked in both the groups to evaluate whether this
system caused any effects on the posterior segment.
However, the mean extrusion (0.0 ± 1.13 mm – Group I;
0.0 ± 0.94 mm – Group II) of molars seen in both the
groups was not significant. Thus, the mini‑implants
served as a source of absolute anchorage preventing any
effects on the posterior teeth.
Overbite was significantly reduced in both the treatment
groups in the present study. In Group I, the mean
41
 Tilekar, et al.: Maxillary anterior intrusion with mini-implants
Figure 7: The intergroup comparison of angular cephalometric parameters
overbite reduction was 2.04 ± 1.37 mm and in Group II
was 1.92 ± 1.24 mm. However, the difference in the
mean overbite reduction between the two groups was
not significant. In both the groups, overbite reduction
was obtained by both maxillary incisor intrusion and
protrusion. Similar reduction in overbite were obtained
in studies with two mini‑implants by Polat‑Ozsoy et  al.,
2009[9] (2.5 ± 1.73 mm) in 4.55 months, Polat‑Özsoy
et  al., 2011[10] (2.18 ± 0.6 mm) in 6.61 months, and
Senışık and Türkkahraman, 2012[3] (2.27 ± 0.59 mm)
in 4 months. Similar result was also obtained in single
mini‑implant study by Chandrasekharan and Balaji,
2010[4] in a period of 4 months.
The duration of intrusion varied in other studies. Hence,
the rate of intrusion per month was measured which
could then be compared with the other studies. The rate
of intrusion per month in Group I (0.417 mm/month)
was less compared to Group II (0.594 mm/month).
However, intergroup comparison of the rate of intrusion
showed that these results were not significant. Figure 8
graphically represents the intergroup comparison of the
rate of intrusion per month between the two groups.
Polat‑Özsoy et  al., 2011[10] (0.44 mm/month), Virang
et al., 2013[11] (0.43 mm/month), and El Namrawy et al.,
2015[12] (0.49 mm/month), found rate of intrusion using
two mini‑implants less as compared to the present study,
whereas Aras and Tuncer, 2016[15] found rate of intrusion
similar compared to the present study (0.62 mm/month).
In this study, similar treatment results were achieved
by both the single mini‑implant and two mini‑implant
intrusion systems. The differences in the treatment
results of the 2 maxillary intrusion systems were
not statistically significant. However, the differences
between the two groups could be clinically significant
as even a millimetric measurement matters clinically
in orthodontics. The proclination obtained in Group II
was nonsignificant while it was highly significant in
42 Journal of Indian Orthodontic Society  ¦  Volume 52  ¦  Issue 1  ¦  January-March 2018
Figure 8: The intergroup comparison of rate of intrusion per month
Group I. Furthermore, in the single mini‑implant cases,
labial frenum may interfere with the placement of
mini‑implants at exact location and at times gingival
overgrowth over the mini‑implants may be seen while
the placement of mini‑implants at exact location is
easier in two mini‑implant cases. Thus, it can be
concluded that two mini‑implants are better than single
mini‑implant clinically for incisor intrusion and causes
less proclination although no statistically significant
results were obtained. Furthermore, it can be concluded
that mini‑implants are better way of anchorage for
incisor intrusion as compared to conventional mechanics.
Further studies should confirm these important findings
and investigate the posttreatment stability of these
techniques.
The limitations of this study were as follows:
1. Intrusion should have been continued probably for a
longer time to get substantial results
2. The force values could also be varied to find out the
optimal force value necessary for maxillary incisor
intrusion.
Conclusion
The following conclusions were drawn:
1. Significant amount of true incisor intrusion was
seen with the single mini‑implant as well as double
mini‑implant group, though the difference between
the groups was not significant. The rate of intrusion
was also similar for both the groups
2. The incisors proclined significantly in the single
mini‑implant group, but the difference between the
two groups was not significant
3. The mean amount of molar extrusion obtained was
zero mm in both groups and was not significant.
Thus, mini‑implants act as absolute anchorage.
Overall, both the techniques gave acceptable treatment
effects but two mini‑implants can be preferred for
 Tilekar, et al.: Maxillary anterior intrusion with mini-implants
patients having thick labial frenum to avoid gingival
overgrowth over mini‑implants and/or in patients with
proclined incisors to minimize incisor flaring.
Acknowledgment
I would like to thank my PG guide and Professor Late
Dr. Ravindranath B. Sable for his constant support and
contribution in successful completion of my dissertation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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