ORIGINAL ARTICLE

Finite element analysis of a newly

designed miniplate for orthodontic
anchorage in the maxillary anterior
region
Alexandre Mae ^da Neves,a Monikelly do Carmo Chagas do Nascimento,b Maurıcio de Almeida Cardoso,c
Fernanda Meloti,c Ertty Silva,d and Tien-Li Ane
Campinas, S~ao Paulo, and Brasılia, Distrito Federal, Brazil

Introduction: Multiple force vector applications may be indicated when an arch segment or en masse intrusion
is needed. This finite element method study aimed to evaluate the total deform the stress yielded in the bone and
the miniplate when forces with different directions and magnitudes were applied. Methods: First, the prototyped
skull model was fabricated on the basis of computed tomography (CT) scans. On this model, the miniplate was
fixed, and orthodontic appliances were attached. Then, a 3-dimensional finite element model was constructed by
reproducing the characteristics of the physical model. Seven situations were investigated, which diverged in the
point of force application, the direction and the number of force vectors, and the force magnitudes. Results:
When the force was applied at 1 point, similar behavior could be observed concerning the deformation and
the stress in the miniplate, the maxilla, and the screw holes. Most deformation and stress appeared in the trans-
mucosal arm below the step bend and at the force application point. The angled vectors ( 45 and 30 ) pre-
sented smaller values concerning the vertical vectors. Similar or better performances could be observed
when the forces were simultaneously applied at the 2 points. Conclusions: The newly designed miniplate
showed similar or improved performances when multiple vectors were applied at the 2 points simultaneously
compared with the force applied at 1 point. This newly designed miniplate may present improved performance
in a clinical situation when multiple forces are demanded. (Am J Orthod Dentofacial Orthop 2022;-:---)

M
axillary orthopedic correction with en masse
dental control has been accepted for decades,
although maxillary splint has been indicated
only for patients during the growth period.1 Presently,
orthosurgical procedures are the gold standard in
managing vertical dentoskeletal problems, for the man-
agement with conventional anchorage devices is limited
a
Master Degree Program Student, Dental School of S~ao Leopoldo Mandic, Cam-
pinas, S~ao Paulo, Brazil.
b
Division of Oral Radiology, Dental School of S~ao Leopoldo Mandic, Campinas,
S~ao Paulo, Brazil.
c
Master Degree Program Professor, Dental School of S~ao Leopoldo Mandic, Cam-
pinas, S~ao Paulo, Brazil.
d
Private Practice, Brasılia, Distrito Federal, Brazil.
e
Department of Dentistry, Health Science School, University of Brasılia, Brasılia,
Distrito Federal, Brazil.
All authors have completed and submitted the ICMJE Form for Disclosure of Po-
tential Conflicts of Interest, and none were reported.
Address correspondence to: Alexandre Ma^eda Neves, R Coronel Jo~ao Vaz, 03 –
Centro, 75.780-000, Ipameri, Goias, Brazil; e-mail, maeddalf@gmail.com.
Submitted, December 2020; revised and accepted, June 2021.
0889-5406/$36.00
Ó 2022 by the American Association of Orthodontists. All rights reserved.
https://doi.org/10.1016/j.ajodo.2021.06.021
in providing clinically significant outcomes. Skeletal
anchorage devices have been advocated and provided
promising results by intruding molars in treating ante-
rior open bite when posterior excess is more evident.2
However, there are patients in which the vertical excess
involves all the maxillary arch in which only posterior
intrusion is insufficient; rather, en masse intrusion is
required. Scarce evidence can be found in the literature
when en masse intrusion of the maxillary dental arch
in an adult is concerned. Clinically, this rationale can
be applied by attaching forces to 4 miniplates located
at the canines and molars region when many intruding
force vectors with orthopedic magnitude are exerted
on the orthodontic wire. A recent study has shown
that the teeth submitted to en masse intrusion in pa-
tients out of the growth period presented clinically ne-
glectable root resorption.3
Concerning the anchorage devices, after the first
report of bone plates for orthodontic anchorage in
1985,4 several designs of miniplates have been presented
for orthodontic purposes since 1999.5,6 The designs may

1
2 Neves et al
Fig 1. Lateral view of en masse intrusion mechanics with
the elastics anchored on a conventional miniplate. One
the miniplate multiple forces were loaded by ligating elas-
tics from the miniplate to orthodontic archwire. The vector
directions are customized according to the need of each
patient.
differ with the head,7-14 the transmucosal arm,3,7,10-14
and the subperiosteal plate which may diverge
concerning the number of holes for the fixation
screws,7-15 and to the shape.7,8,12-14,16,17
Different miniplate designs may influence the bone
stress under force loading, which may influence the sta-
bility and failure of the miniplate. Finite element method
(FEM) data have evidenced higher peak values of von
Mises stress of cortical bone for I-shaped plates than
for L and T-shaped.16 Similar findings have shown that
the I-shaped plate presented the highest peak stress for
cortical bone, followed by L, Y, and T-shaped mini-
plates.17 However, a clinical investigation has not
observed significant mobility and failure rate differences
between L and T-shaped miniplates.16-18
En masse intrusion is one of the steps required during
vertical dentoskeletal problems management. According
to this rationale, several force vectors anchored in the
miniplates are applied simultaneously; each force can
range from 200 to 400 g of force (Fig 1). This approach
can manage some vertical problems indicated in ortho-
surgical procedures without surgery (Fig 2). Ancorfix
CPMH miniplates were specifically developed for ortho-
dontic anchorage with multiple points of force applica-
tion to facilitate en masse intrusion. The new miniplate
was designed with a T-shaped subperiosteal plate with 3
screw holes and an ovoid transmucosal arm that
bifurcates into 2 arms angled at 45 between each
arm. Besides, there is a wire-lock hole in the bifurcation
region. The present FEM study aims to evaluate the total
deformation of the Ancorfix CPMH miniplate, and the
- 2022  Vol -  Issue - American Journal of Orthodontics and Dentofacial Orthopedics
stress yielded in the bone and the miniplate when forces
with different directions and intensities are applied.
MATERIAL AND METHODS
A physical skull prototype model was fabricated on
the basis of the computed tomography (CT) scans with
an extended field of view (23 3 17 cm). Sequential CT
images were taken at 0.3-mm voxel of the skull of a
27.5-years old female who presented $1 mm of cortical
bone at the region lateral to the right pyriform aperture.
On the physical skull model, the Ancorfix CPMH mini-
plates were fixed by an experienced professional. A
step bend was made in the transmucosal arm; the
bend aims to simulate the clinical situation and provide
a plateau to facilitate the cleaning at the emergence pro-
file area of the transmucosal arm.8 Furthermore, Ricketts
standard prescription appliance, with slot 0.018 3
0.028-in (Forestadent, Pforzheim, Germany) and 0.016
3 0.016-in Blue Elgiloy archwire (Rocky Mountain Or-
thodontics, Denver, Colo) were attached in the physical
skull model to simulate the orthodontic forces (Fig 3).
For FEM model creation, the skull was reconstructed
from the CT images using the Mimics (version
23.0.2.530; Materialise, Leuven, Belgium) 3-Matic
(version 15.0.0.3227; Materialise) software. The Mimics
software was initially used to generate the 3-
dimensional mask with digital imaging and communica-
tions in medicine files and for bone segmentation. Then,
the mask was converted, exported as stereolithography
file format, and imported into 3-Matic software.
Before importing these models into Ansys Startup
Program, Structural and Fluids bundle (Ansys, Canons-
burg, Pa), a new import to Mimics software was neces-
sary to map the bone densities of the model based on
the shades of gray, which includes Poisson’s ratios,
and Young’s modulus. Finally, a heterogeneous (aniso-
tropic) model was obtained (Fig 4, Table I). A pyramidal,
3-dimensional, and isoparametric element with 4 nodes
(tetrahedral) was used to generate the finite element
mesh.
For miniplates, first, a scanned stereolithography file
was obtained, then imported into 3-Matic software. The
anchorage plates and screws were modeled using the
design tool, then inserted into the FEM of the maxilla.
Eventually, maxilla and the miniplate models were im-
ported into Ansys, Inc. The same procedure was per-
formed to design the screws. The miniplate and screws
were considered homogeneous, isotropic, and linearly
elastic material and the manufacturer provided Poisson’s
ratio, Young’s modulus, and yield strength, as shown in
Table II. The amounts of nodes and tetrahedron
Neves et al 3

Fig 2. An example patient treated by en masse intrusion mechanics: A, The initial photograph pictured
the chief complaint presented by the patient, the gummy smile; B, Before the miniplates removal, the
final photograph showed the treatment outcome; a balanced smile showing a harmonious gingival
display was achieved without orthosurgical procedure.

Different directions and magnitudes of forces were

Fig 3. A set of miniplates with the step bend and the fixed
appliance attached to the prototyped skull model.
applied at a single point and at both points to determine
the loading effect. In the miniplate, the distal application
point was named A, whereas the mesial point was named
B. Concerning the force directions, a convention of signs
was made. The vertical direction is considered 0 , the
force that was directed distally presented negative angu-
lation, whereas the force that was directed mesially pre-
sented positive angulation. In this context 45 , 0 , and
30 directions were simulated (Fig 6).
The mechanical tests were performed in 7 different
situations: (1) single 0 force applied at point A; (2) sin-
gle 45 force applied the point A; (3) single 0 force
applied at point B; 4) single 30 force applied at point
B; (5) two, 0 and 30 , forces applied at the point B;
(6) two single 0 forces applied at points A and B, simul-
taneously; and (7) single 0 force applied at point A and
two, 0 and 30 forces applied at point B, simulta-
neously. Single force magnitudes of 300 and 350 g of
force were tested. In situations 5-7, 300 and 350 g of
force were tested 2-3 times each.

elements for maxilla, miniplates, and screws are pre-
sented in Table III. In addition, the contact between
the miniplate and screws and between the miniplate
and the bone was set to touch, and the contact between
the screw and the bone was set to Bonded (Fig 5).
RESULTS
In all situations, when a single force was applied at
point A or point B, the miniplates showed a minimum
of total deformation; the greatest deformation was evi-
denced at the hook, and total deformation appeared

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4 Neves et al

Fig 4. Illustration of the obtained anisotropic model of the maxilla in different color values.

Table I. Bone density, Young’s modulus, and Pois- Table II. Miniplates and screw properties
son’s coeficient values of the maxilla
Poisson’s Young’s modulus Yield strength
Color Bone density Young’s modulus Poisson’s ratios Element ratio (Mpa) (Mpa)
50 10.3 0.3 Miniplate 0.3 102.000 315
Screw 0.3 96.000 930
256.42 278.0 0.3

666.81 1898.0 0.3 Table III. The amounts of nodes and tetrahedron ele-
ments for maxilla, miniplates, and screws
1077.2 4977.1 0.3
Element Tetraedric elements Knots
1487.59 9522.5 0.3 Maxilla 1.794.055 316.248
Miniplate 432.566 78.357
1897.98 15539.1 0.3 Screw 125.526 32.030

2308.37 23030.5 0.3

The greatest von Mises stress was concentrated in the
2718.75 31999.5 0.3
transmucosal arm, at the step bend (Fig 8), except for
the 45 vector (Fig 9). The variation of von Mises stress
3129.14 42448.7 0.3
showed similar patterns to the deformation. For situations
3539.53 54380.2 0.3
1-4, under the same vector, the von Mises stress increased
linearly by about 16.6% with each increase of 50 g in force
3949.92 67795.6 0.3
magnitude. In situation 5, the von Mises stress increased
linearly by 7.9% with 50 g of force (Table IV).
In the maxilla, von Mises stress changes were also
found in the area underlying the transmucosal arm at
the level of step bend (Fig 10). At points A and B, the
below the step bend (Fig 7). At points A and B, the small- lowest von Mises stress was found, respectively, in sit-
est deformation was observed, respectively, in situations uation 2 (2.93 MPa) (Fig 11) and situation 4 (8.60
2 (0.299 mm) and 4 (0.401 mm) with 300 g of force, MPa) with 300 g of force, whereas the highest von
whereas the largest deformation was observed in situa- Mises stress was found, respectively, in situation 1
tions 1 (0.560 mm) and 5 (0.852 mm) with 350 g of (18.71 MPa) and 5 (22.15 MPa) with 350 g of force.
force. For situations 1-4, under the same vector, the to- For situations 1-4, under the same vector, the von
tal deformation increased linearly by about 16.6% with Mises stress increased linearly by about 16.6% with
each increase of 50 g in force magnitude. In situation each increase of 50 g in magnitude. In situation 5,
5, the total deformation increased linearly by 8.1% the von Mises stress increased linearly by 9.6% with
with 50 g of force (Table IV). 50 g of force (Table IV).

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Neves et al
Fig 5. FEM generated from the prototyped model.
Fig 6. Schematic illustration of force vectors applied at
point A ( 45 and 0 ) and at point B (0 and 30 ).
When a single force was applied at point A, stress
variation was found simultaneously at the bone sur-
rounding screws number 2 and 3 (Fig 11). When a single
force was applied at point B, stress variation was found
at the bone surrounding screws number 1 and 2, or only
American Journal of Orthodontics and Dentofacial Orthopedics
5
screw number 2 (Figure 12). For situations 1-4, under
the same vector, the von Mises stress increased linearly
by about 16.8% with each increase of 50 g in magnitude.
In situation 5, the von Mises stress increased linearly by
9.6% with 50 g of force (Table V).
When vectors of forces were combined, total deforma-
tion was evidenced at point A in situation 6, and total
deformation was evidenced at point B in situation 7
below the step bend (Fig 13). The smallest deformation
was found in situation 6 with 300 g in each force
(0.313 mm), whereas the largest total deformation was
found in situation 7 (0.6714 mm) with 350 g of force
each. The increase was 16.6% and 23.5%, respectively,
for situations 6 and 7, when each was increased by 50 g
of force (Table IV).
Concerning von Mises stress, the stress peak was
found at the step bend, in the bifurcation of the arms
in situation 6, and at the step bend and the mesial arm
in situation 7. The lowest von Mises stress was found
in situation 6 with 300 g of force (46.27 MPa), whereas
the highest stress was found in situation 7 with 350 g of
force (72.35 MPa). The increase was 16.6% and 8.1%,
respectively, for situations 6 and 7, when each was
increased by 50 g of force (Table IV).
In the maxilla, von Mises stress changes were also
found in the area underlying the transmucosal arm. In
situation 6, less pronounced stress was found
compared with situation 7 (Fig 14). The lowest stress
peak was found in situation 6 (14.29 MPa) with 300 g
of force, whereas the highest stress was found in sit-
uation 7 (23.22 MPa) with 350 g of force. The in-
crease was 16.6% and 8.6%, respectively, for
situations 6 and 7 when 50 g was increased in each
force (Table IV).
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6 Neves et al

Fig 7. Total deformation shown in the situation in which 0 and 300 g of force were applied at point A.

Table IV. Total deformation, von Mises stress of the miniplate, and von Mises stress of Maxilla values under different
force vectors, magnitudes, and point of application combinations
Total deformation Von Mises stress miniplate Von Mises stress maxilla

Force magnitude and vectors 300 g 350 g 300 g 350 g 300 g 350 g
0 at point A 0.480 0.560 40.62 47.39 16.04 18.71
45 at point A 0.299 0.348 25.95 30.23 2.93 3.41
0 at point B 0.426 0.497 54.47 63.55 8.60 10.04
30 at point B 0.401 0.468 49.72 57.96 11.81 13.77
0 1 30 at point B 0.788 0.852 99.02 106.83 20.20 22.15
0 1 0 at points A and B 0.313 0.365 46.27 53.98 14.29 16.67
0 1 0 1 30 at points A and B 0.545 0.671 66.92 72.35 21.38 23.22

Concerning the bone surrounding the screws, stress
variation was observed for all the screws (nos. 1, 2,
and 3). The stress was more pronounced at the bone sur-
rounding screw 2 for situations 6 and 7 (Fig 15). The
lowest stress was found in situation 6 (5.10 MPa) with
300 g of force, whereas the highest stress was found in
situation 7 (8.29 MPa) with 350 g of force. The increase
was 16.6% and 8.6%, respectively, for situations 6 and 7,
when each was increased by 50 g of force (Table V).
DISCUSSION
This study used CT scans of a patient with cortical
bone .1 mm to simulate the clinical condition.16,17,19
Some studies have considered the bone to be isotropic
(homogeneous).16,17,20,21 Nevertheless, the bone is not
isotropic; thus, an anisotropic (heterogeneous) structure
was created in this study, as performed by Cattaneo
et al.22 that modeled with different bone density, Pois-
son’s coefficients, and Young’s modulus. Furthermore,
the fabrication of a prototyped skull model in which the
miniplate was fitted and the step bend was made in the re-
gion of emergence profile of the transmucosal arm,8 and
the attachment of the orthodontic appliance to generate
real clinical situations of orthodontic mechanics, accu-
rately reproduced the actual clinical situation.
The contacts between bone and screw set in this
study were of the bond type, adopted by several
authors,15,16,21,23 although touch contact has been
considered.17
Implant, mini-implant or miniscrews, onplant, and
miniplates have been advocated as anchorage devices
to improve orthodontic biomechanics. Although
miniscrews are very popular, they present limitations
when multiple forces and intense magnitudes of forces
are loaded; besides, the range of tooth movement and
bone changes are very restricted, for miniscrews are in-
serted at the interdental level. As for miniplates, real
absolute anchorage can be provided, for they are fixed
in areas out of alveolar bone and sustained by thick
cortical bone and dense trabeculae. Through proper

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Neves et al 7

Fig 8. In the buccal and lateral aspect, Von Mises stress is shown in the situation in which 0 and 300 g
of force were applied at point A.

Fig 9. Von Mises stress shown in the situation in which 45 and 350 g of force were applied at point A.

fixation and thick bone structure, deflection and defor-
mation of the osteocyte network are minimum; then, an
absolute anchorage condition is achieved.24 Compared
with miniscrews, the installation of miniplates can be
considered less conservative; however, if an orthosurgi-
cal procedure can be substituted by the en masse
intrusion rationale, the use of miniplates can be reason-
ably justified.
For en masse intrusion biomechanics, multiple loading
forces with orthopedic force magnitudes are required; all
the force vectors were selected according to the clinical
need, according to the intrusion biomechanics in the

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8 Neves et al

Fig 10. Von Mises stress on maxilla underlying the transmucosal arm in situations in which different
vectors with 300 g of force were applied at point A.

Fig 11. Von Mises stress at the bone surrounding the screws \300 g of force loading at point A.

Fig 12. Von Mises stress at the bone surrounding the screws \300 g of force loading at point B.

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Neves et al
Table V. Von Mises stress values (Mpa) at the bone
around the screws
Force magnitude and vectors Screws 300 g 350 g
0 at point A 2, 3 5.72 6.68
45 at point A 2, 3 1.04 1.21
0 at point B 1, 2 3.82 4.46
30 at point B 2 5.24 6.12
0 1 30 at point B 2 6.73 7.38
0 1 0 at points A and B 1, 2, 3 5.10 5.95
0 1 0 1 30 at points A and B 1, 2, 3 7.63 8.29
region nearby the pyriform aperture. The simulated situa-
tions 1, 3, and 6 performed in this study are applied for
intrusion, whereas 4, 5, and 7 are applied when intrusion
with simultaneous anterior retraction is needed. Eventu-
ally, situation 2 is indicated in patients provided Class II or-
thopedic treatment anchored on the minisplates.25
Concerning force magnitudes, 200, 200-450,25 400, and
600 g of force17; 200 and 500 g of force23; 200 g of
force15,16,26; and 600 g of force21 have been investigated.
In this study, only 300 and 350 g of force were applied as a
single force or in association, for these magnitudes were
more realistic in the intrusion biomechanics in the anterior
region of the dental arch. Notably, these forces are loaded
by ligating elastics from the miniplates to the orthodontic
archwire; consequently, the sum of force magnitudes is
dissipated to all maxillary teeth instead of concentrating
on 1 single tooth.
The existence of deformation in the structures that
support orthodontic anchorage may be a factor that
contributes to anchorage loss.27 In this study, the total
deformation was the sum of the deformation values in
the x, y, and z-axis of the whole plate body. For both
the single force and combined force situations, the total
deformation was concentrated below the step bend, and
the greatest deformation was found at the point of the
force application. All deformation varied \1 mm. The
clinical effects of these magnitudes of deformation de-
mand more investigation. It was observed that when a
single force was applied, the total deformation increased
according to the increase of the force; similar behavior
was also found in other studies.17,23
Compared with the vertical vectors, smaller deforma-
tion was observed when the vectors of the forces fol-
lowed the long axes of the transmucosal arm after
bifurcation ( 45 and 30 ); this may be explained by
the smaller moment generated by these vectors. These
data support customized miniplate designs for the clin-
ical application of specific force vectors.
American Journal of Orthodontics and Dentofacial Orthopedics
9
The von Mises stress in the miniplate presented vari-
ation that followed the deformation trends, which
ranged below its yield stress (315 Mpa), suggesting the
existence of elastic deformation in the miniplate. The
highest von Mises stress was found in the step bend re-
gion, probably because of a segment of the transmu-
cosal arm perpendicular to the application points that
may generate a greater moment. None of this informa-
tion could be found in the literature, for the investiga-
tions have never made a step bend in the transmucosal
arm.
Surprisingly, because of the slight elastic deforma-
tion of the miniplate, it was observed that the trans-
mucosal arm tended to touch the maxilla, causing
stress points in that region. Although the stress values
were lower than the stress limit supported by the
bone (50 Mpa),26,28 a maneuver to uplift the trans-
mucosal arm maintaining a distance of 2 mm from
the bone is strongly suggested during the installation
of the miniplate to avoid damage to the anatomic
structures.
The stress generated at the bone surrounding the fix-
ation screws may cause bone resorption and may
compromise the stability of the miniplate.16,17,21 If the
subperiosteal plate does not rest passively on the bone
surface and the screws are not fixed properly, higher
stress may be generated on the bone. In this study,
this variable was disregarded, for the MEF model may
fit the plate passively to the bone. In contrast, stress
also may be generated by the applied forces. Images
data in this study confirm that the cortical bone
region was submitted to the highest stress reported in
the literature.15-17,21,26
The stress values at the bone surrounding the screws
observed in this study were similar to other studies,
although different force magnitudes were
applied.15-17,26 Similar stress behavior was observed
around the screws, as reported by other authors.15,18,21
According to the data, the central screw, screw 2, was
the most demanded, followed by the screw opposite to
the resultant vectors; these data were similar to previous
studies.16,17,21 The central screw is the most demanded
probably because it is the nearest support point to the
point of force application, which is more influenced by
the generated moment.
When both the application points were loaded
simultaneously, it was observed that the results of to-
tal deformation and von Mises stresses, in the maxilla
and around the screws, were similar or even lower
than the values when the force was applied at 1 point.
The possible explanation for this occurrence is that
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10 Neves et al

Fig 13. Total deformation shown in the situation in which two 0 with 300 g of force were applied at
points A and B.

this new miniplate design when multiple vectors of

force are demanded in the situation of en masse intru-
sion.

CONCLUSIONS
Based on the limitations of FEM models, it was
possible to conclude the following concerning the per-
formance of the newly designed miniplate.
1. Similar performance was found compared with the
existing designs of the miniplates, concerning total
deformation and von Mises stress generated in the
miniplate and the screw holes.
2. Stress may be found because of the contact between
the transmucosal arm and maxilla in some associa-
tions of force vectors.
3. Two points force application is more advantageous
than single-point force application; in clinical situ-
Fig 14. Von Mises stress on maxilla underlying the trans-
mucosal arm in the situation in which two 0 with 300 g of ations when multiple forces are demanded, this
force were applied at points A and B. newly designed miniplate may present improved
performance.

AUTHOR CREDIT STATEMENT

when 2 points are loaded simultaneously, the resul- Alexandre Ma^eda Neves contributed to conceptuali-
tant moment is decreased or annulled, as in situation zation, methodology, investigation, and original draft
6, simulated in this study (Fig 16). These data indicate preparation; Monikelly do Carmo Chagas do Nascimento

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Neves et al 11

Fig 15. Von Mises stress at the bone surrounding the screws\300 g of force loading at points A and B.

Fig 16. Comparison of 1-point and 2-point loading effects. Note that when 2 points were loaded simul-
taneously, the resultant moment is decreased.

contributed to manuscript review and editing, supervi- REFERENCES

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formal analysis; Fernanda Meloti contributed to re-
sources, data curation, and supervision; Ertty Silva
contributed to validation, resources, and investigation;
and Tien-Li An contributed to validation, manuscript re-
view and editing, and supervision.
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