Orthopedic Correction of Growing Hyperdivergent, Retrognathic Patients With Miniscrew Implants

Traditional orthodontic treatments do not adequately address the skeletal problems of retrognathic, hyperdivergent, Class II adolescents; the few approaches that do require long-term patient compliance. This paper introduces a novel approach using miniscrew implants (MSIa) and growth to treat retrognathic hyperdivergent adolescents. Nine consecutive patients were evaluated at the start of treatment (13.2 ±1.1 years of age) and again at the end of the orthopedic phase (after 1.9 ±0.3 years). Each patient had two MSIs placed in either side of the palate. Coil springs (150 g) extended from the MSIs to a RPE, which served as a rigid segment for intruding the maxillary premolar and molars. Two additional MSIs were placed between the first mandibular molars and second premolars; coil spring (150 g) extended from the MSIs to hold or intrude the mandibular molars. Prior to treatment, the patients exhibited substantial and significant mandibular retrusion (Z-score=−1.0), facial convexity (Z-score=0.7), and hyperdivergence (Z-score=1.6). Treatment produced consistent and substantial orthopedic effects. The chin was advanced an average of 2.4 mm, the SNB angle increased by 2.1°, the mandibular plane angle decreased 3.9°, and facial convexity decreased by approximately 3.2°. Questionnaires showed that this treatment approach was not painful or uncomfortable; the majority of the patients indicated that they were very likely to recommend the treatment to others. Treatment was accomplished by titrating the amount of orthodontic intrusion performed based on the individuals’ growth potential

Role of anatomical sites and correlated risk factors on the survival of orthodontic miniscrew implants:a systematic review and meta-analysis

Abstract Objectives The aim of this review was to systematically evaluate the failure rates of miniscrews related to their specific insertion site and explore the insertion site dependent risk factors contributing to their failure. Search methods An electronic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Knowledge, Scopus, MEDLINE and PubMed up to October 2017. A comprehensive manual search was also performed. Eligibility criteria Randomised clinical trials and prospective non-randomised studies, reporting a minimum of 20 inserted miniscrews in a specific insertion site and reporting the miniscrews’ failure rate in that insertion site, were included. Data collection and analysis Study selection, data extraction and quality assessment were performed independently by two reviewers. Studies were sub-grouped according to the insertion site, and the failure rates for every individual insertion site were analysed using a random-effects model with corresponding 95% confidence interval. Sensitivity analyses were performed in order to test the robustness of the reported results. Results Overall, 61 studies were included in the quantitative synthesis. Palatal sites had failure rates of 1.3% (95% CI 0.3–6), 4.8% (95% CI 1.6–13.4) and 5.5% (95% CI 2.8–10.7) for the midpalatal, paramedian and parapalatal insertion sites, respectively. The failure rates for the maxillary buccal sites were 9.2% (95% CI 7.4–11.4), 9.7% (95% CI 5.1–17.6) and 16.4% (95% CI 4.9–42.5) for the interradicular miniscrews inserted between maxillary first molars and second premolars and between maxillary canines and lateral incisors, and those inserted in the zygomatic buttress respectively. The failure rates for the mandibular buccal insertion sites were 13.5% (95% CI 7.3–23.6) and 9.9% (95% CI 4.9–19.1) for the interradicular miniscrews inserted between mandibular first molars and second premolars and between mandibular canines and first premolars, respectively. The risk of failure increased when the miniscrews contacted the roots, with a risk ratio of 8.7 (95% CI 5.1–14.7). Conclusions Orthodontic miniscrew implants provide acceptable success rates that vary among the explored insertion sites. Very low to low quality of evidence suggests that miniscrews inserted in midpalatal locations have a failure rate of 1.3% and those inserted in the zygomatic buttress have a failure rate of 16.4%. Moderate quality of evidence indicates that root contact significantly contributes to the failure of interradicular miniscrews placed between the first molars and second premolars. Results should be interpreted with caution due to methodological drawbacks in some of the included studies

Three-dimensional mapping of cortical bone thickness in subjects with different vertical facial dimensions

Abstract Background The purpose of this study was to determine differences in cortical bone thickness among subjects with different vertical facial dimensions using cone beam computed tomography (CBCT). Methods From 114 pre-treatment CBCT scans, 48 scans were selected to be included in the study. CBCT-synthesized lateral cephalograms were used to categorize subjects into three groups based on their vertical skeletal pattern. Cortical bone thickness (CBT) at two vertical levels (4 and 7 mm) from the alveolar crest were measured in the entire tooth-bearing region in the maxilla and mandible. Results Significant group differences were detected with high-angle subjects having significantly narrower inter-radicular CBT at some sites as compared to average- and low-angle subjects. Conclusions Inter-radicular cortical bone is thinner in high-angle than in average- or low-angle subjects in few selected sites at the vertical height in which mini-implants are commonly inserted for orthodontic anchorage

Childhood and adolescent changes of skeletal relationship (vol 68, pg 199, 1998)

UNESP, Dept Orthodont, Araraquara, BrazilUNESP, Dept Orthodont, Araraquara, Brazi

Mandibular skeletal growth and modelling between 10 and 15 years of age

This study pertains to a random sample of untreated French-Canadian adolescents (79 females and 107 males) evaluated at 10 and again at 15 years of age. Superimpositions on natural reference structures were performed to describe condylar growth and modelling of 11 mandibular landmarks. Superimpositions on natural cranial/cranial base reference structures were performed to describe mandibular displacement and true rotation.The results showed significant superior and posterior growth/modelling of the condyle and ramus. Males underwent significantly (P < 0.01) greater condylar growth and ramus modelling than females. With the exception of point B, which showed significant superior drift, modelling changes for the corpus landmarks were small and variable. The mandible rotated forward 2-3.3 degrees and was displaced 9.6-12.7 mm inferiorly and 1.9-2.7 mm anteriorly. Individual differences in ramus growth and modelling, both amount and direction, can be explained by mandibular rotation and displacements. Multivariate assessments revealed that superior condylar growth and ramus modelling were most closely associated with forward rotation and inferior mandibular displacement. Posterior growth and modelling were most closely correlated with anterior mandibular displacement and forward rotation. Modelling of the lower anterior border was independent of rotation and displacement

Maxillary and mandibular width changes studied using metallic implants.

The purpose of this implant study was to evaluate the transverse stability of the basal maxillary and mandibular structures. The sample included 25 subjects between 12 and 18 years of age who were followed for approximately 2.6 years. Metallic implants were placed bilaterally into the maxillary and mandibular corpora before treatment. Once implant stability had been confirmed, treatment (4 first premolar extractions followed by fixed appliance therapy) was initiated. Changes in the transverse maxillary and mandibular implants were evaluated cephalometrically and two groups (GROW+ and GROW++; selection based on growth changes in facial height and mandibular length) were compared. The GROW++ group showed significant width increases of the posterior maxillary implants (P <.001) and the mandibular implants (P =.009); there was no significant change for the anterior maxillary implants. The GROW+ group showed no significant width changes between the maxillary and mandibular implants. We conclude that (1) there are significant width increases during late adolescence of the basal mandibular and maxillary skeletal structures and (2) the width changes are related with growth potential