Contributions of Alveolar Bone Density and Habitual Chewing Side to the Unilateral Failure of Orthodontic Mini-Screws: A Cross-Sectional Study

This study aimed to analyze the relationship between bone density, habitual chewing side (HCS), and mini-screw stability to investigate the intra-individual factors contributing to mini-screw failure. This retrospective study included 86 sides in 43 adults, who underwent bilateral maxillary mini-screw placement with subsequent unilateral failure of the mini-screw. Pre-treatment cone-beam computed tomography was used to measure the buccal cortical bone thickness and bone density on the failed and successful sides. Pre-treatment mandibular kinesiographic records were used to determine the HCS. Paired t-tests, one-proportion z-tests, and multivariable multilevel Poisson regression were used to examine the statistical significance. The buccal cortical bone thicknesses were 0.93 ± 0.27 mm (unsuccessful side) and 1.01 ± 0.27 mm (successful side), with no significant difference. The bone density on the unsuccessful side (1059.64 ± 202.64 mg/cm3) was significantly lower than the success side (1317.89 ± 332.23 mg/cm3). Regarding HCS, 27.9% of failures occurred on the preferred side, and 62.8% occurred on the non-preferred side. After adjusting for all factors, the non-preferred side showed a 2.22 times higher prevalence ratio for mini-screw failure than the preferred side. HCS is significantly related to mini-screw stability, while the cortical bone thickness, bone density, and site of mini-screw implantation were not correlated