Original Article

Stability comparison between commercially available mini-implants and a

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novel design: Part 1
Christine Honga; Haofu Leeb; Richard Webstera; Jinny Kwaka; Benjamin M. Wuc; Won Moonb

ABSTRACT
Objective: To compare mechanical stability among five mini-implant designs—a newly invented
design and four commercially available designs that vary by shape and threading; to calculate
external surface area of each design using high-resolution micro-computed tomography; and to
evaluate the relationship between surface area and stability results.
Materials and Methods: The four commercially available mini-implants—single-threaded and
cylindrical (SC), single-threaded and tapered (ST), double-threaded and cylindrical (DC), double-
threaded and tapered (DT)—and a new implant that is designed to engage mostly in cortical bone
with shorter and wider dimensions (N1) were inserted in simulated bone with cortical and trabecular
bone layers. The mechanical study consisted of torque measurements and lateral displacement
tests. External surface area was computed using a 25-mm micro-CT.
Results: Maximum insertion torque, maximum removal torque, and force levels for displacements
were the highest in N1, followed by DT, ST, DC, and SC (a 5 .05). The surface area was largest in
DT, followed by N1, ST, DC, and SC. Surface area engaged in cortical bone, however, was the
greatest in N1. The surface area of mini-implants had positive correlation with stability.
Conclusion: Among commercial designs, both added tapering and double threading improved
stability. N1 was the most stable design within this research design. The new design has the
potential to be clinically superior; it has enhanced stability and there is diminished risk of
endangering nearby anatomic structures during placement and orthodontic treatment, but the
design requires refinements to reduce insertion torque to avoid clinical difficulty and patient
discomfort. (Angle Orthod. 2011;81:692–699.)
KEY WORDS: TADs, Mini-implants; Stability; Surface area; Cortical bone; Micro-CT

INTRODUCTION tic treatment.1 Despite the tremendous success of

Over the past decade, orthodontic mini-implants
have been proven to be useful in establishing absolute
anchorage and introducing compliance-free, more
efficient, and more precise biomechanics to orthodon-
a
Resident, Section of Orthodontics, UCLA School of Den-
tistry, Los Angeles, Calif.
b
Assistant Professor, Section of Orthodontics, UCLA School
of Dentistry, Los Angeles, Calif.
c
Associate Professor and Department Chair, UCLA Depart-
ment of Bioengineering and California NanoSystem Institute,
UCLA School of Engineering, Los Angeles, Calif.
Corresponding author: Dr Won Moon, Section of Orthodon-
tics, UCLA School of Dentistry, 10833 Le Conte Ave, CHS 20-
140, Los Angeles, CA 90095
(e-mail: wmoon@dentistry.ucla.edu).
Accepted: November 2010. Submitted: September 2010.
Published Online: February 9, 2011
G 2011 by The EH Angle Education and Research Foundation,
Inc.
mini-implants in facilitating treatment outcomes, how-
ever, the stability of mini-implants remains an impor-
tant issue that needs to be resolved because failure
rates are widely variable and could be as high as
25%.2,3 As the potential uses of mini-implants have
broadened, recent studies have focused on examining
factors contributing to failure and evaluating stability.4,5
The stability of mini-implants is generally defined with
two main components.6 Primary stability is established
from the mechanical retention between the mini-
implant surface and bone.7 It is dependent on the
thickness and integrity of the cortical bone, the mini-
implant design, and loading protocol.7,8 Secondary
stability is achieved through continuous bone remodeling
around the mini-implant, leading to osseointegration.9,10
To achieve optimal stability, previous studies have
examined various mini-implant parameters, such as
loading protocol, surface treatment, shape, diameter,
length, tapering, and thread count.7,9,11–13 Researchers

Angle Orthodontist, Vol 81, No 4, 2011 692 DOI: 10.2319/092410-556.1

STABILITY COMPARISON OF A NEW DESIGN
Table 1. Chemical Composition and Mechanical Properties of Micro-implantsa
Chemical Composition (%)
Alloy Nitrogen Carbon Hydrogen Iron
ASTM F138 0.05 0.08 0.01 0.25
a
TS indicates tensile strength; YM, Young’s modulus; YS, yield strength.
concluded that stability can be enhanced by maximizing
the interlocking surface area (SA) between the bone and
implant, which can be achieved by increasing diameter,
adding threading, and tapering mini-implants.4,11,13 How-
ever, these design modifications may cause patient
discomfort and bony microfractures during place-
ment.4,14 In recent years, mini-implants with various
thread designs have been developed with the goal of
improving stability, but few studies have tested the
stability of these mini-implants with a new thread design.
Among many known methods for assessing implant
stability,8,15 insertion torque is often measured in
determining initial stability.8,14 Removal torque should
be comparatively high to prevent unscrewing and is
considered to be a better measurement of stability.7 In
addition to torque testing, the lateral displacement test
to measure the force required for displacement of 0.01,
0.02, and 0.03 mm was performed.
The potential bone–implant contact area is important
for mechanical interlocking in establishing primary
stability and osseointegration in secondary stability.4,16
Although information on SA would have been valuable,
this parameter is very difficult to calculate using
mathematical methods alone because of the complex-
ity of mini-implant design features such as threading
and taper. In this study, we used micro-computed
tomography (m-CT) to precisely compute the mini-
implant surface area engaged in cortical and trabec-
ular bone layers for each design.16 The use of m-CT
has been proven to be an accurate and reproducible
method of quantifying microstructures in the field of
biomedical and material research.17
The aim of this study was to compare the stability
among five mini-implant designs using torque and
lateral displacement tests. As root proximity5 and root
contact are major factors in mini-implant failure,18,19 a
new design (N1) was invented. The N1 design is short
to engage mostly in cortical bone but wide to optimize
stability. Its exterior is single threaded and cylindrical
and its interior has a hollow center to facilitate insertion.
MATERIALS AND METHODS
According to the shape and thread design, Ti-6Al-4V
alloy mini-implants (Biomaterials Korea, Seoul, Korea)
(Table 1) were divided into five groups: single-thread-
ed and cylindrical (SC), single-threaded and tapered
(ST), double-threaded and cylindrical (DC), double-
693
Mechanical Properties
Oxygen Aluminum Vanadium Titanium TS (MPa) YM (GPa) YS (MPa)
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0.13 5.5–6.5 3.5–4.5 Balance 860–896 110 795–827
threaded and tapered (DT), and the single-threaded
and cylindrical new design with shorter and wider
dimensions (N1) (Figure 1).
For each test, 20 mini-implants of each design were
inserted by one technician into biosynthetic bone (170
3 120 3 40 mm [length 3 width 3 height] Sawbones,
Vashon, Wash). The bone block was composed of two
layers: 2-mm-thick20 30 pounds per cubic foot (PCF)
cortical bone simulation11 and 10 pcf trabecular bone
(Table 2). A 1-mm-thick plastic sheet was used to
simulate soft-tissue thickness. All mini-implants were
inserted perpendicular to the bone surface until their
necks contacted the soft-tissue simulation.
Torque Test
As in the study by Kim and colleagues,11 each design
of mini-implants (n 5 20) was inserted and removed
using a surgical engine and contra-angle handpiece
(ElcomedSA200C, W&H, Bürmoos, Austria). The unit
was calibrated each time and rotational speed was set
for 30 rpm.11 Maximum insertion torque (MIT) and
maximum removal torque (MRT) were measured.
Lateral Displacement Test
After a new set of 100 mini-implants was properly
inserted using a manual driver, mechanical testing was
performed using the compression mode of Instron
5560 (Instron Corp, Norwood, Mass) (Figure 2). With
1 kN load cell, applied force value and lateral
displacement data were computed with BluehillH2
Version 2.2, integrated software (Instron Corp, Nor-
wood, Mass). The biosynthetic bone with mini-implants
inserted was secured with the vice and positioned to
allow the indenter to deliver a force perpendicular to
the neck of the mini-implants in a downward direction.
The software was programmed to record the perpen-
dicular force as implants were displaced at 0.01 mm,
0.02 mm, and 0.03 mm, respectively, by the indenter
from their original position. After a row of mini-implants
was tested, it was removed to allow the machine to
access the next row.
Surface Area Measurement
Mini-implants were scanned using a high-resolution
m-CT (Skyscan1172F, Virginia Beach, Va) at an image
resolution of 25 mm, using 90 kV and 110 mA with an
Angle Orthodontist, Vol 81, No 4, 2011
694 HONG, LEE, WEBSTER, KWAK, WU, MOON

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Figure 1. Characteristics of five mini-implant designs. Ta indicates tapered; H, hollow; TD, thread design.

aluminum-copper filter. Three-dimensional (3D) data
sets were reconstructed from two-dimensional (2D)
images, corrected of ring artifacts and beam hardening
and fine-tuned for alignment. The orientations of the
data sets were standardized three-dimensionally. As
shown in Figure 3a, the implants were viewed in 3D m-
CT image-viewing software to locate the base of tissue
collar (TC), soft tissue, cortical bone (CB), and
trabecular bone (TB) sections (the area from CB to
the tip). External surface was divided according to the
thickness of soft-tissue template and cortical bone
used in the mechanical study. The optimal threshold of
65 was determined for 2D binarized and 3D images to
depict the true morphology.21 The cylindrical volume of
interests was drawn to enclose CB and CB + TB areas.
To calculate the surface area of the CB region, the 3D
SA parameter, bone surface (BS), was measured and
subtracted by the 2D SA parameter, bone area (B.Ar),
of the top and bottom cross-sections that do not
contribute to SA engaged in the bone. Similarly, the SA
of CB + TB was calculated as B.Ar of the top cross-
section of the CB + TB subtracted from BS.21 Finally,
3D images were rendered for visualization (Figure 3b).
Statistical Method
Mean MIT, MRT, and force levels for each lateral
displacement distance were compared across designs
using one-way analysis of variance. Statistical signif-
icance was defined as P , .05 using the Fisher least
significant difference criterion. Means and standard
deviations were reported. Scatter plots were examined
to assess the relationships between SA and torque
values and between SA and force levels for each
displacement. Correlation coefficients (r) were ob-
tained using Pearson’s correlation.

Table 2. Properties of Biosynthetic Material Simulating Cortical and Trabecular Bonea

Density Compressive Tensile Shear Cell Size
Material pcf g/c3 S (mPa) M (MPa) S (mPa) M (mPa) S (mPa) M (mPa) (mm)
SRPF 30 0.48 18 445 12 592 7.6 87 -
CRPF 10 0.16 2.3 23 - - - - 0.5–2.0
a
SRPF indicates solid rigid polyurethane foam; CRPF, cellular rigid polyurethane foam; S, strength; M, modulus; pcf, pounds per cubic foot.

Angle Orthodontist, Vol 81, No 4, 2011

STABILITY COMPARISON OF A NEW DESIGN
Figure 2. Instron 5564 Universal Testing Apparatus for lateral
displacement test.
RESULTS
Torque Test
Both mean MIT and MRT were highest in N1,
followed by DT, ST, DC, and SC (Table 3, Figure 4).
The MRT was lower than the MIT in all groups. The
means of MIT in all groups were statistically different at
P , .05, and the means of MRT in all groups were
significantly different except between SC and DC and
between ST and DC (Table 4). DT showed higher MIT
and MRT than DC or ST. Adding tapering or double
threading separately increased MIT and MRT.
Lateral Displacement Test
As in the torque tests, the mean force required for
displacement of all three distances was greatest in N1,
followed by DT, ST, DC, and SC (Figure 5a, Table 5).
Figure 3. (a) Different sections of surface-area measurements. (b) m-CT scanned three-dimensional images of five designs.
695
The means in all groups were significantly different
(P , .05), except for SC and DC at the 0.01-mm
displacement (Table 6). Besides registering the high-
est MIT and MRT, N1 also required the greatest force
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for all displacement distances. Adding tapering and
double threading increased the force required as in the
torque tests. Figure 5b shows that the initial displace-
ment of 0.01 mm from the original position required the
highest force compared to the additional force required
for subsequent 0.01-mm displacements.
Surface Area Calculation
Figure 6a represents the differential SA embedded
in cortical bone and trabecular bone layers for each
design. N1 had the greatest SA in cortical bone. The
total external SA was largest in DT, followed by N1,
ST, DC, and SC. Figure 6b also shows that as the SA
increases, mean MIT and MRT also increase with a
positive correlation in a linear relationship except for
N1. There is a stronger positive correlation (r . .9) with
torque among the four commercial designs than
among all designs including N1 (r . .75). Figure 6c
shows that as external SA increases, average force
required for displacement increases in a linear
relationship. There is a strong positive correlation
(r . .95) between SA and force. N1 had less total SA
than DT, but it required greater MIT, MRT, and force.
DISCUSSION
The order of stability was established as N1 followed
by DT, ST, DC, and SC. Possible explanations for this
order may stem from differences in diameter, tapering,
and threading. Because of its large diameter (4.1 mm),
N1 required considerably high torque and force for
lateral displacement consistent with previous studies.22
In addition, both tests proved that tapered mini-
implants were more stable than cylindrical ones with
either single thread or double thread.7,11 Because
tapered mini-implants are wider in the neck, tighter
engagement and greater contact with cortical bone is
Angle Orthodontist, Vol 81, No 4, 2011
696 HONG, LEE, WEBSTER, KWAK, WU, MOON

Table 3. Maximum Insertion Torque (MIT) and Maximum Removal Table 4. Cross Comparisons of Torque (MIT and MRT)
Torque (MRT) of Each Designa Measurements Among Five Different Designs Tested by Fisher’s
Least Significant Difference for Each Pair of Designsa
MIT (Ncm) MRT (Ncm)
Design 1 Design 2 MIT MRT
Design Mean SD Mean SD

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SC ST *** *
SC 4.17 0.70 2.70 0.52
DC * NS
ST 7.39 0.98 4.24 0.80
DT *** ***
DC 5.39 0.56 3.57 0.50
N1 *** ***
DT 9.45 1.00 5.60 0.96
ST DC * NS
N1 15.58 3.92 8.83 4.02
DT *** *
a
MIT: F ratio 111.2 Ncm (P , .0001), MRT: F ratio 31.5 Ncm (P , N1 *** ***
.0001); SC indicates single-threaded and cylindrical; ST, single- DC DT *** *
threaded and tapered; DC, double-threaded and cylindrical; DT, N1 *** ***
double-threaded and tapered; N1, single-threaded and cylindrical DT N1 *** ***
new design with shorter and wider dimensions. a
MIT indicates maximum insertion torque; MRT, maximum
removal torque; ST, single-threaded and tapered; DC, double-
established, lending increased stability. Similarly, threaded and cylindrical; DT, double-threaded and tapered; N1,
double threading increases contact area with cortical single-threaded and cylindrical new design with shorter and wider
bone. dimensions; * P , .05; *** P , .001; NS, not significant.
In this study, SA values were successfully computed
using m-CT scans despite the complexity of the design contributor to mini-implant stability than in trabecular
of implants studied. The positive proportional relation- bone.12 Because we used commercially available
ship and the correlation between external SA and designs, the length of cylindrical designs (5.5 mm)
stability values (MIT, MRT, force for displacement) was shorter than that of tapered designs (6.1 mm).
reaffirmed the importance of the contact area between
implant and bone for initial mechanical interlocking.4 At
the same time, increased implant–bone contact area
allows for greater osseointegration, thereby enhancing
secondary stability as well.16 Direct bone–implant
contact is reported to be 10% to 58%.23 With growing
versatility in clinical uses of mini-implants, they are
remaining inserted for longer periods, including the
retention phase, making osseointegration an increas-
ingly important factor in mini-implant stability.24
Interestingly, N1 required significantly higher force
for all displacement distances than DT, although N1
had a smaller surface area than DT. Similarly, N1
generated greater MIT and MRT than DT. This trend
shows that surface area in cortical bone is a stronger

Figure 4. Means of maximum insertion and removal torque for Figure 5. (a) Lateral displacement test summary. (b) Force required
all groups. for subsequent 0.01-mm displacement.

Angle Orthodontist, Vol 81, No 4, 2011

STABILITY COMPARISON OF A NEW DESIGN 697

Table 5. Force Levels (Mean Grams 6 SD) at 0.01, 0.02, and

0.03 mm Lateral Displacement of Each Designa
0.01 mm 0.02 mm 0.03 mm
Design Mean SD Mean SD Mean SD

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SC 214.73 19.61 374.12 24.56 527.08 37.00
ST 282.20 26.03 493.03 26.39 672.72 27.35
DC 227.96 30.67 397.98 32.10 552.13 33.24
DT 300.64 28.18 532.20 29.54 739.09 30.61
N1 320.29 36.94 568.93 39.70 801.01 41.39
a
0.01 mm: F ratio 50.6 g (P , .0001); 0.02 mm: F ratio 149.2 g
(P , .0001); 0.03 mm: F ratio 236.7 g (P , .0001); ST, single-
threaded and tapered; DC, double-threaded and cylindrical; DT,
double-threaded and tapered; N1, single-threaded and cylindrical
new design with shorter and wider dimensions.

Numerous studies25–29 have established a consensus

that screw length is not associated with failure or
stability, and our study also highlighted the importance
of engagement in cortical bone. Thus, differences in
length can be deemed to have little impact in
comparisons of stability in this study.
The study by Kim and colleagues7 reported the
decrease in MIT for ‘‘dual-thread’’ implants compared
to single-threaded implants. This disparity in findings is
attributable to the essential difference in design
between Kim and colleague’s dual-thread and this
study’s double-thread. Dual-thread design has a
thread count that is doubled per unit length in the
neck region, possibly causing insertion rate to be
decreased by half. However, because double-thread
design has additional overlapping set of threads with
the same thread count per unit length as single
threading, insertion rate is not altered (Figure 7).
The lateral displacement test was first introduced in
this study and showed results consistent with the torque
tests. Unlike the study of Florvaag and colleagues,30
which investigated mini-implant deformation up to
3.5 mm using the pull-out strength test, which applies

Table 6. Cross Comparisons of Lateral Displacement Force Level

Among Five Different Designs Tested by Fisher’s Least Significant
Difference for Each Pair of Designsa
Design 1 Design 2 0.01 mm 0.02 mm 0.03 mm
SC ST *** *** ***
DC NS * *
DT *** *** ***
N1 *** *** *** Figure 6. (a) Surface area (SA) divided into cortical and trabecular
ST DC *** *** *** bone. (b) The relationship between SA and torque values. (c) The
DT * *** *** relationship between SA and force required for lateral displacement.
N1 *** *** ***
DC DT *** *** ***
N1 *** *** ***
vertical force, this study used a test with perpendicular
DT N1 * *** *** force, which is consistent with how orthodontic forces
a
are applied on mini-implants. Also, this study focused
ST indicates single-threaded and tapered; DC, double-threaded
and cylindrical; DT, double-threaded and tapered; N1, single- on initial loosening at microlevels of 0.01, 0.02, and
threaded and cylindrical new design with shorter and wider 0.03 mm, as initial mobility is the key determinant for
dimensions; * P , .05; *** P , .001; NS, not significant. success of mini-implants.31 After initial enlargement of

Angle Orthodontist, Vol 81, No 4, 2011

698
Figure 7. Thread-pattern comparison between dual-threaded and
double-threaded implants.
bony socket or possible microfractures created with
initial movement, mechanical retention between bone
and implant diminishes and less additional force was
needed to displace further distances (Figure 6).
Considering that orthodontists use light force of less
than 200 g for tooth movements, all designs used in
this study could withstand orthodontic force as the
force required for 0.01 mm displacement exceeded
200 g. The force needed to displace 0.02 mm and
0.03 mm for more stable designs (ST, DT, and N1)
approximated or exceeded the 500 g needed for
orthopedic movements. With the development of
designs that provide better stability, mini-implants
can aid orthopedic movements and minimize adverse
effects on anchor teeth. Thus, mini-implants with
headgear tubes or hooks for face masks can become
reality.
Overall, N1 is a very stable design, as proven by
both tests. The N1 design, engaged mostly in cortical
bone, has the potential to be clinically superior as it can
avoid root proximity in areas with adequate cortical
Angle Orthodontist, Vol 81, No 4, 2011
HONG, LEE, WEBSTER, KWAK, WU, MOON
bone thickness, which is a major factor in mini-implant
loosening and risk of root resorption and ankylo-
sis.18,19,27 Furthermore, in carefully selected cases, N1
can not only reduce the risk of damage to neurovas-
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cular bundle and sinuses but can also perform en
masse retraction more efficiently without the limitation
of inter radicular space. The MIT of N1 (15.6 Ncm),
however, exceeds recommended insertion torque
range of 5 to 10 Ncm,25 and N1 has a low torque ratio
of MRT to MIT because of this high MIT. Excessive
insertion torque can introduce clinical difficulty of
insertion and bone strain, which in turn can adversely
affect the stability of mini-implants.14,25 The N1 design
requires improvements to reduce MIT to facilitate
placement and to lower the risk of bone strain while
maintaining high MRT. In addition, clinical trials, in vivo
studies, and histologic analysis to evaluate bone
remodeling with N1 are required to further investigate
its use.
CONCLUSIONS
N Mini-implants with increased diameter, tapering, and
double threading can maximize interlocking SA
between bone and implant, thereby increasing
primary stability.
N As the implant surface area embedded in bone
increases, stability increases. The large SA of N1 in
cortical bone yielded the highest stability despite its
having a smaller total SA than DT, suggesting that SA
in the cortical bone plays a more vital role in
mechanical retention. Increasing cortical bone–implant
contact should be considered for future designs.
N The new design (N1) is promising as it showed
superior stability with less risk of endangering nearby
anatomic structures during placement and orthodon-
tic treatment. However, modifications of N1 to lower
insertion torque are indicated to avoid clinical
difficulty and patient discomfort.
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Angle Orthodontist, Vol 81, No 4, 2011