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Temporary anchorage devices (TADs) in orthodontics: review of the factors

that influences the clinical success rate of the mini-implants

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e70 M. Leo et al.

Review Clin Ter 2016; 167 (3):e70-77. doi: 10.7417/CT.2016.1936

Temporary anchorage devices (TADs) in orthodontics:

review of the factors that influence the clinical success
rate of the mini-implants
M. Leo1, L. Cerroni2, G. Pasquantonio3, S.G. Condò4, R. Condò2
1
PhD in Materials for Health, Environment and Energy, Department of Clinical Sciences and Translational Medicine, Tor Vergata
University of Rome; 2Researcher, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome; 3As-
sociate Professor, Department of Clinical Sciences and Traslational Medicine; 4Full Professor Department of Clinical Sciences and
Translational Medicine, School of Dentistry, Faculty of Medicine and Surgery, Tor Vergata University of Rome,Italy

Abstract Introduction

The mini-implant, temporary anchorage devices (TADS), are
now a common method of treatment in Orthodontics with versatility,
minimal invasiveness and the relationship between costs and benefits
that they offer even today. Skeletal anchorage has, to a large degree,
replaced conventional anchorage in situations where anchorage is
considered either critical, insufficient, or likely to result in undesirable
side effects such as vertical displacements generated by inter-maxillary
force systems.
Objective. The objective of this study is to carry out a review about
the factors that seem affect the success or failure rate of orthodontic
mini-implants. A computerized literature review was performed by
searching the MEDLINE database (Entrez PubMed, www.ncbi.nlm.
nih.gov), Google Scholar, Scopus, Cochrane Central Register of Con-
trolled Trials, Isi Web of Knowledge until March 2016 . The main
subject heading “orthodontics” was combined with these keywords
mini-implant, mini-screw, micro-implants, mini-implant success rate,
mini-implant failure rate, skeletal anchorage, temporary anchorage
device (TADS). In the selection process, abstracts were initially read
independently by two researchers to identify potentially eligible full
text papers which were then retrieved and assessed in order to decide
on the final inclusion.
Conclusions. The clinical success of orthodontic anchorage by
mini-implants depends on the stability of the miniscrews used for
fixation. For good stability, the application site must provide bone of
good quantity and quality. We can reasonably assume that the stability
of the anchorage of the mini-implants could be optimized by selecting
a position with particular characteristics of quality and quantity of bone,
in relation to cortical and total mandibular and jaw bone thickness.
These expected informations are important because they indicates
that the bone quality and quantity are significant when considering
an implant placement site, but also that there are other confounding
factors influencing the success rate. Clin Ter 2016; 167(3):e70-77. doi:
10.7417/CT.2016.1936
Key words: mini-implants success-rate, mini-implants failure-rate,
orthodontic, skeletal-anchorage,TADs
The use of the temporary anchorage devices (TADS) or
mini-implants as means of absolute anchorage in orthodon-
tics, is probably the most important revolution of the last
years, prompting research to design devices always most
versatile, effective and easy to use. Over the last years the
anchorage control with mini-implants has acquired more and
more importance in the clinical management of orthodon-
tic patients. Different systems of mini-implants have been
developed in order to obtain a skeletal anchorage and avoid
the use of the most common intra and extraoral orthodon-
tic appliances, usually unwelcome to the patients. Today
mini-implants are a safe, reliable and efficient method with
respect to other more invasive osseo-integrated systems for
skeletal anchorage. The development of mini-implants with
high resistance and with different shapes proves that research
on materials and the processes of miniaturization are well
directed and made great advances, enhancing implantology
in the orthodontic field.
Background
Mini-implant, temporary anchorage devices (TADS),
are now a common method of treatment in orthodontics
with versatility, minimal invasiveness and the relationship
between costs and benefits that they offer even today. The
simplification of procedures for insertion and the versatil-
ity of the mechanics have made the use of mini- implants a
routine in clinical practice and have eliminated the need for
complex laboratory procedures. When maximum anchorage
is necessary, the mini-implants appear to be a new alternative
in orthodontic treatment, since these devices are inserted in
the bone providing effective anchorage (skeletal anchor-
age). Skeletal anchorage has, to a large degree, replaced
conventional anchorage in situations where anchorage is
considered either critical, insufficient, or likely to result
in undesirable side effects such as vertical displacements

Correspondence: Dr.ssa M. Leo, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Via Montpellier,1,
00133 Rome, Italy. Tel. +39 3935661370. E-mail: m.leo@email.it, m.leo@med.uniroma2.it

Copyright © Società Editrice Universo (SEU)

ISSN 1972-6007
Temporary Anchorage Devices (TADs) in Orthodontics: review e71

generated by inter-maxillary force systems (1). In general

then, it can be stated that skeletal anchorage is indicated
where the forces acting on the reactive units are undesirable
and cannot be neutralized by occlusal forces. Factors such
as inadequate patient compliance may contribute to loss of
anchorage, which can be defined as unwanted movement of
the anchor teeth and usually occurs when the posterior teeth
move forward relative to the anterior teeth. Anchorage can be
classified as: Type A or absolute anchorage, i.e. no movement
of the anchor teeth occurs; Type B anchorage, i.e. movement
of the anterior and posterior units toward each other; Type
C or total loss of anchorage, i.e. the anchor teeth are free to
move, usually anteriorly (2). While many so called “com-
pliance free” anchorage systems have been introduced for
orthodontic treatment, none of these have proven to deliver
the absolute anchorage generated by skeletal anchorage sys-
tems. Finally, skeletal anchorage has widened the spectrum
of orthodontics allowing the orthodontist to perform treat-
ments that could not, or, only with great difficulty, otherwise
be done with conventional mechanics.

Materials and Methods

Objective

The aims of this article were to review and critically

analyze the available literature about mini-implants (TADS)
*General selection criteria
and to discuss, based on scientific evidence, factors that **Specific selection criteria
might influence the success or failure rate of orthodontic
mini-implants. Fig.1 QUOROM flow diagram

Study selection

In the initial phase of the review, a computerized literature

review was performed by searching the MEDLINE database
(Entrez PubMed, www.ncbi.nlm.nih.gov), Google Scholar,
Scopus, Cochrane Central Register of Controlled Trials, Isi
Web of Knowlwdge until March 2016 . The main subject
heading “orthodontics” was combined with these keywords
mini-implant, mini-screw, micro-implants, mini-implant
success rate, mini-implant failure rate, skeletal anchorage,
temporary anchorage device (TADS). Additionally, after the
electronic literature search, a hand search of key orthodontic
journals was undertaken to identify recent unindexed articles.
Two categories of selection criteria were estabilished (3).
General selection criteria were applied to find studies on mini-
implants and specific selection criteria to improve the quality
of the articles. Exclusion criteria included articles on standard
dental implants, onplants, palatal implants, miniplates used as
orthodontic anchorage, miniscrews or microscrews for dental
surgery, and implant materials research; animal studies; in-
vitro studies; case reports and case series; technique presenta-
tions of mini-implant and microimplant; review articles and
letters; articles that did not follow the objective of this review;
and articles in a language other than Italian and English. Spe-
cific selection criteria for studies on mini-implants included
only studies that defined success or failure; only studies that
defined the duration of the application of force. Patients of
both sexes without age restriction and with a need of absolute
anchorage for orthodontic purposes were included.
Methods of the review
In the selection process, abstracts were initially read
independently by two researchers to identify potentially
eligible full text papers which were then retrieved and as-
sessed in order to decide on the final inclusion. Ambiguous
articles were also read to avoid inappropriate exclusion.
Differences were resolved by rereading and discussion
until consensus was reached. Articles were examined and
excluded if: 1) studies were not pertaining to orthodontic
mini-implants anchorage, success or failure rate; 2) the full
text was not available.
Were evaluated scientific articles and reviews on experi-
mental work carried out in vivo . This decision was taken in
line with the objectives of this research, aimed to the study
and understanding of the factors that seem affect the success
rate of the orthodontic mini-implants in clinical therapies.
A decision to perform a meta-analysis was made if there
were sufficient similarities between studies in the type of
participants, interventions and outcomes. The significant
heterogeneity within and between studies did not allow for
pooling of data and carrying out a meta-analysis.
The selection procedure is explained in QUOROM flow
diagram (Fig.1). A total of 3890 abstract were found by the
search methods. Only 95 abstracts met the inclusion criteria
or were retrieved because the abstract did not provide enough
e72 M. Leo et al.

Table 1. Description of the outcomes of studies on mini-implants.

Number of Success rate Design of

Authors Year Artt Variables associated
miniimplants % study

1.Baek SH et al. 2008 109 10 months 0,752 type, shape and diameter P

2.Chaddad K. et al 2008 17 5 months 0,824 surface characteristic P

3.Chen CH et al. 2006 59 6 months 0,847 length of miniscrew R

younger patients TADs placed on the

4.Chen YJ et al. 2007 359 ND ND R
mandibular arch

Inflammation of soft tissue surrounding

5.Chen YJ et al. 2008 492 ND ND R
a TAD and early loading

6.Cheng SJ et al. 2004 140 ND 0,89 insertion technique P

clinical learning curve associated
7.Garfinkle JS et al. 2008 82 ND 0,7073 P
surgery

8.Gupta N et al. 2012 40 6 months 0,775 self-tapping and drill free screw R

9.Park et al. 2006 227 15 months 0,916

10.Jeong JW et al. 2015 331 16 weeks Different % Loading time R

11. Antoszewska J. deep bites, placement in the attached

et al 2009 350 19,2 months 0,9343 gingiva of the maxilla, and en-masse R
distalization of teeth.

0,64
12.Justens E et al 2008 50 2 months patient’s compliance R

13.Lee MY et al. 2016 127 ND 0,85 Bone density R

14. Lee SJ. Et al. 2010 260 ND 0,84 Age SA

15.Manni A. et al 2010 300 3 years 0,81 diameter miniscrew and loading R

Flap surgery ,the diameter of a screw

of 1.0 mm or less, inflammation of the
16.Miyawaki .S et al 2003 134 12 months 0,761 R
peri-implant tissue, and a high mandibu-
lar plane angle (ie, thin cortical bone)

sex, age, soft-tissue management,

placement position, sagittal skeletal
17.Moon CH et al 2010 778 ND 0,79 R
classification, arch-length discrepancy,
and side

The placement and removal torques

18.Motoyoshi M et al 2010 134 ND ND of mini-implants were evaluated as an R
index of implant stability

cortical bone thickness,placement tor-

19.Motoyoshi M et al 2007 87 ND 0,874 P
que, location, and patient gender

20.Nienkemper M et al 20 6 weeks ND length of miniscrew CCT

21.Sarul M et al. 2015 54 ND 0,74 length of miniscrew P

22.Tseng YC et al 2006 45 16 months 0,911 length of miniscrew R

23.Türköz C et al 2011 43 1 month 0,777 drill-free and drilling methods P

carachteristic of patient such as age ,

24.Uribe F et al 2015 55 13.67 ± 6.79 0,882 R
gender, oral hygiene

25.Wiechmann D et al 2007 133 ND 0,868 insertion site P

Cohort
26.Wu TY et al . 2009 414 more 2 months 0,899 diameter, hygiene
study
0,98 if length
27.Yi Lin S et al 2015 285 12 months of miniscrew s length of miniscrew R
is 10-12mm
28.Ziebura T et al 2012 66 ND ND insertion site and type of mechanics R

Legenda: ND not-described; ARTT anchorage for required treatment time; Design of study: P, prospective. R, retrospective
Temporary Anchorage Devices (TADs) in Orthodontics: review e73

information to justify exclusion. 49 articles were excluded mini-implants provide high stability when inserted in the
according to the general selection criteria, and the specific midpalatal region (18).
selection criteria eliminated another 18 articles, leaving 28
studies. The description of the 28 selected studies is given Patient-related failure: the anatomical site should be
in Table 1. chosen so that the risk of root contact is minimized and the
clinician should avoid inserting screws in areas where nerves
or vessels are located, e.g. the posterior lateral part of the
palate. Prior to considering the use of skeletal anchorage,
Results
it is important to assess its possibilities carefully.
Mini-screws, although generally well accepted, require
The outcomes, defining success and failure rate of mini-
that the unique biological environment of the individual
implants are presented in Table 1. The factors that seem to
patient has to be thoroughly evaluated and understood. The
play an important role in the success use of mini-implants
bone turn-over of the patient may be influenced by factors
are: the quality of the devices, the protocol of insertion, the
that will interfere with the normal tissue reaction surroun-
anatomical features of the insertion site (bone quality, cha-
ding the screw. Relatively more failure in patients below 15
racteristics of the soft tissues), implant placement technique,
years of age is stated by Lee SJ et al. (19). This seems to
length of miniscrew, type, shape and diameter of the mini-
be because of the poor bone quality and quantity and high
implant, clinical management and home hygiene, maxillary
bone turnover rates in growing patients. Among the patient-
or mandibular location, cortical bone thickness, insertion
related failures, general and local turnover seem to have the
torque, location, and patient gender, sex, age, soft-tissue
greatest impact and the influence of a healthy environment
management, , sagittal skeletal classification (4,5,6), arch-
around the screw is repeatedly emphasized. An elevated
length discrepancy, and side (7) . Therefore clinical variables
bone turnover may lead to a loosening of a screw. This may
possibly influencing the success rates of mini-implants
be caused by a tooth approaching a screw or root resorption
will be categorized in relation to mini-implant type, to the
of a deciduous tooth. Moreover, high bone turnover is seen
patients, and to the clinician who insert the mini-implant,
in patients with endocrinological alterations such as hyper-
since there is a learning curve associated with the successful
thyroidism. Patients undergoing systemic pharmacological
mini-implant placement (22).
treatment reducing the bone turn-over and thereby also the
Mini-implant related failure: several studies in relation
bone adaptation occurring in relation to the screw (e.g.bis
to mini-implants have been conducted and concluded that
phosphonates,immunosoppressors, etc.) are at high risk; in
the type of mini-implant contributes moderately to failure
such cases, the use of TADs is not recommended. A thorough
(8, 9). The quality of the device is of certain importance. It
exam and medical history is required to rule out any contra-
is usually of the Titanium alloys generally contain elements
indications to treatment. If no contraindications are found,
such as aluminum, vanadium, iron and manganese. The use
the patient must be informed about the advantages, oral
of these additional element indispensable is to improve the
hygiene requirements, and the possible risk-factors before
characteristics of resistance to bending and to prevent the
the start of treatment. The importance of proper oral hygiene
fracture risk (10).
and plaque control was noted by Wu TY (20), who pointed
Some studies have focused on the fracture of the screw
out that brushing habits may lead to a greater risk of losing a
and have unanimously agreed on the fact that very thin screw
mini-implant on one side than on the other. Excellent patient
may have the advantage of requiring less space but also the
compliance, particularly avoidance of inflammation around
pronounced disadvantage of a high fracture risk (11). Mi-
the implant, is an important consideration for successful use
yawaki (12) demonstrated a failure of 100% due to fracture
of TADs (21).
during insertion / removal operations using diameters of 1
mm. It is therefore important to use devices with diameters
Clinician related failure: the failures were mostly seen
equal to or greater than 1.3 mm that can withstand higher
with screws placed earlier in the study, thus it can been sta-
torsional loads and bending, and will provide greater safety
ted that there is a learning curve in successful mini-implant
in the insertion removal maneuvers. Considering the clini-
insertion and with experience the failure rate decreases (22).
cally controllable parameters, 1.3 mm diameter miniscrews
The self-drilling method, a new technique, was analyzed in
inserted in attached gingiva and immediately loaded had the
two studies (23-24). The placement procedure is simplified,
most favourable prognosis (8).
without pilot drilling and incision. Even though success
Melsen and Dalstra explained the relationship between
rates were similar, it was believed that failure rates might
the internal stress and diameter. They demonstrated that the
be further reduced with increasing clinical experience and
benefit of screws thinner than 1.3mm was minimal compared
perfecting of the placement technique.
to the increased fracture risk (16).
Therefore mini-implant loss might be associated with
According to the available data, the impact of the or-
the implant placement technique (25-27).
thodontic mini-screw implants’ length on their stability
It is worth highlighting that: In some cases, the site of
was tested in vivo in only a few multivariate analyses. A
professional choice is not the most appropriate for mini-
statistically significant relationship was not shown (12,17).
implant placement. Alveolar bone of questionable quality
In turn, Chen et al. (13-14) conducted a thorough analysis
and reduced space between roots should be avoided; mini-
of various articles, studying the factors responsible for the
implant length is determined by the buccolingual thickness
success rate of TADS. The authors concluded that the mi-
of the alveolar bone. Large diameters weaken the alveolar
nimum length of the TADS should be at least 6 mm. Long
bone. On the other hand, bicortical mini-implant anchorage
e74
increases stability (28); clinical examination, assessment of
root contour and CT scans decrease the risk of flaws. Precise
lancing procedures and pressure firm enough to perforate
the alveolar bone provide ease for mini-implant threading;
a mini-implant should be placed with the thread inside the
alveolar bone, the transmucosal profile covered by gingival
tissue and the head supported by the gingiva; mini-implant
placement should be performed after careful planning and
by means of a judicious technique (29).
The failures related to the clinician (30) lacing the mini-
implant include one or more of the following:
Selection of the insertion site: the insertion of mini-
implants in the mandible and upper jaw for orthodontic
purposes requires a careful analysis of the receiving site:
this must have a suitable bone thickness proportional to the
screw length, and be at least 2.5 mm wide to avoid damages
to dental roots or other adjacent structures (31-33).
In order to obtain anatomical data useful for the placement
of mini-implants, studies were conducted with computer-
ized tomography (34-35). To choose the maximal miniscrew
length, it is necessary to analyse the bone thickness (36-37).
The optimal information can be obtained from Cone Beam
Computed tomography (CBCT) slices though the region of
interest in superior and lower arch. Lekholm and Zarb (38)
explain the classification system of bone as follows, based
on its radiographic appearance and the resistance at drilling,
bone quality has been classified in four categories:
Type 1 bone in which almost the entire bone is composed
of homogenous compact bone;
Type 2 bone in which a thick layer of compact bone
surrounds a core of dense trabecular bone;
Type 3 bone in which a thin layer of cortical bone sur-
rounds a core of dense trabecular bone;
Type 4 bone characterized as a thin layer of cortical
bone surrounding a core of low density trabecular bone of
poor strength.
These differences in bone quality can be associated
with different areas of anatomy in the upper and lower
jaw. Mandibles generally are more densely corticated than
maxillas and both jaws tend to decrease in their cortical
thickness and increase in their trabecular porosity as they
move posteriorly.
The cortical thickness should guarantee the primary
stability. The failure related to poor cortical thickness or
bone quality will take place immediately after insertion.
Studies (19, 37) suggest that the thickness of the cortical
bone increases, while proceeding in a mesio-distal direction,
in the posterior teeth area. The buccal area of the posterior
mandibular teeth shows increased thicknesses in comparison
to the correspondent maxillary area; whereas the situation
is opposite on the palatal side. The site with greater bone
thickness in the jaw is the buccal inter-radicular area between
the first and second molar and in the maxillary bone it is
between the canine and the lateral incisor. In the maxil-
lary bone other suitable areas are the interradicular spaces
between the first molar and the second premolar both in the
buccal and in the palatal side. Although there is enough bone
thickness also in the inter-radicular areas between first and
second maxillary molars, according to Carano et al. (39),
these sites should not be considered ideal, because it is quite
difficult for the clinician to reach them both for the correct
M. Leo et al.
preparation of the site and for the insertion of the screw.
According to Holm et al. (40) long miniscrews should not
be inserted in the median sagittal plane, because less bone
thickness is available in this region. It is recommended that
placement of orthodontic miniscrews should be made in
different region according to patient’s age. The thickness
of the soft tissue will also influence the failure rate, since a
gingival thickness of more than 3 mm will move the point
of force application too far from the center of resistance of
the mini-implant, thus generating a large moment that will
adversely affect the stability of mini-implant.
Insertion technique : ������������������������������������
to achieve the best primary stabili-
ty, an insertion angle ranging from 60 degrees to 70 degrees
is advisable. If the available space between two adjacent
roots is small, a more oblique direction of insertion seems
to be favorable to minimize the risk of root contact (41).
Maintaining a steady hand is important, as wiggling
will lead to micro-fractures of the cortical bone. The pres-
sure should be applied by the palm of the hand, turning
the screw driver by the fingers, and without moving the
wrist. It is important not to overturn the screw driver once
the collar has reached the periosteum, since ischemia and
micro-damages may occur, thus increasing the risk of los-
ing primary stability. It is therefore important to choose a
mini-implant with larger collar than the thread, in order to
have a positive stop during the insertion. A change in direc-
tion while inserting has also been described as leading to
fractures; it is therefore important to choose a screwdriver
that provide a stable grip. Another consideration regarding
the insertion is the inclination of the screw: the higher the
insertion site, the higher the horizontal inclination of the
axis (perpendicular to the bone surface) (26).
Loading: recent studies have shown that increasing the
torque will,in the long run, decrease the primary stability(33,
34). When evaluating the influence of loading, not only the
magnitude of the force should be considered, but first and
foremost, the type of loading. There is general agreement
that applying a moment to the mini-implant will lead to
loosening due to the shearing forces applied on the bone
surface. The resistance to the pull out test is influenced by
the design of the threaded shaft and an asymmetrical cut is
advantageous. Mini-implant stability is typically acquired
12 to 16 weeks after insertion, and immediate loading can
cause failure of the mini-implant. Failure after loading was
observed during the first 12 weeks (34).
Discussion
Skeletal anchorage was introduced as a solution to treat
adult patients with reduced dentition, where conventional
anchorage was not possible. Even in cases with lack of
compliance skeletal������������������������������������
anchorage
�����������������������������������
was preferred over remov-
able appliances or elastics. At last, it will be described that
simply the presence of the skeletal anchorage can lead to
improved quality of bone as well consequently an improved
prognosis for a later dental implant insertion. Anchorage
control is a key factor for successful treatment in orthodon-
tics. Skeletal anchorage can be very helpful especially in
critical anchorage situations. TADS are used for this purpose.
Mini-implants have become increasingly widespread in the
Temporary Anchorage Devices (TADs) in Orthodontics: review
recent past because of their low invasiveness during insertion
and removal, their versatility and low costs (31). However,
relatively high failure rates ranging from 10% up to 30%
remain the major problem using this type of temporary
anchorage devices (32).
A systematic review with a strict protocol and a thorough
search strategy was performed to analyze the effectiveness
of mini-implants as orthodontic anchorage, and understand-
ing of the factors that seem affect the success rate of the
orthodontic mini-implants. To ensure that the most valid
and reliable results were obtained, the articles were selected
according to inclusion and exclusion criteria. Some well-
known articles might have been excluded. After reviewing
all published articles on mini-implants, only 28 satisfied
the inclusion criteria for mini-implants as orthodontic
anchorage.
TADS were one of the most discussed topics of the
last decade. It started in the 90th and experienced in the
last 15 years an extreme hype. Clinicians were enthusiastic
about the possibility to counteract Newton’s third law. Now,
more than 15 years later quite a lot of clinicians a frustrated
about high loss rates and non-working biomechanics (30).
Different studies have evaluated the clinical success of the
mini-implants. The majority of them addresses the external
structure of the mini-implants as well as its diameter and
length (12,17,20), the type and the mechanical resistance
(10,42) the bone density (43); other studies in literature
commonly discussed the surgical procedure, mini-implants
direction of placement, force applied to the mini-implants,
osseo-integration, site of insertion, loading, the characteristic
of the patients (4,7,8,12,13,14,15,18,19,20,22,23,24,25,26,
27,28,29,30,32,33,37), and the experience of the clinicians
(31).
Wilmes and Drescher (41) stated that primary stability
of mini-implants is dependent on the predrilling diameter,
insertion torque, and insertion depth. Tseng et al. (2006) (31)
reported that the length of the implant is related to the success
rate and stated that the depth of insertion is more important
than its location or length, the recommended depth being
at least 6 mm. Chen et al. (13) also found a significant dif-
ference in the length of mini-implants in relation to success
rates. Miyawaki et al. said that the stability of mini-implants
depends on mechanical (device design and dimensions) and
biological (bone quality, quantity, and time before loading)
factors. So,the clinical success of orthodontic anchorage
depends on the stability of the miniscrews used for fixation.
For good stability, the application site must provide bone of
good quantity and quality. We can reasonably assume that the
stability of anchorage mini-implants could be optimized by
selecting a position with particular characteristics of quality
and quantity of bone, in relation to cortical and total man-
dibular and jaw bone thickness. the bone quality and quan-
tity are significant when considering an implant placement
site, but also that there other confounding factors influencing
the success rate, such as the condition of the patient and his
compliance, and factors related to the clinician who insert
the mini-implant, since there is a learning curve associated
with successful mini-implant placement (22).
e75
Conclusions
Anchorage control is one of the key issues to be taken
into account when planning orthodontic treatment. Expec-
tations are not always met, despite the applied different
anchorage reinforcement protocols. Most of conventional
anchorage devices require either the patients’ compliance or
they load patients’ teeth, thus leading to their uncontrolled,
mostly undesired movement. Temporary anchorage devices
(TADS) have many advantages, such as low price, ease
of insertion and removal, and rare complications related
to their application, but most of all they ensure excellent
biomechanics of tooth movement and anchorage control,
even in uncooperative patients (42). The premature loss of a
mini-screw implant is considered a failure that prevents the
achievement of treatment goals. Thus, it is fully justified that
numerous studies focus on the analysis of factors influencing
TADS stability during orthodontic treatment. The analysis
of the reported results has revealed that those factors may
be the patient’s oral hygiene, coexisting diseases, smoking,
the condition of mucosal membranes, the surgical protocol
(including mini-screw implant location), the method of load-
ing (time, force, and its direction), and the type of TADS.
Unfortunately, it is quite likely that multifactorial analysis
of TADS stability may lead to bias; therefore, forming a
homogenous group of patients is mandatory for reliable
results and conclusions. Mini-implant failure can involve
factors related to the clinician, the patient, and the screw
itself. Large, multicenter studies are needed to shed addi-
tional light on the processes involved in skeletal anchorage
so that failure rates can be reduced even further.
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