Assessment of Interradicular Spaces for Miniscrew Implant Placement: A Systematic Literature Review
The use of miniscrew implants as an orthodontic anchorage device has become an accepted method for providing absolute anchorage. The purpose of this systematic review was to summarize the safe zones in the interradicular spaces and the recommended diameters and lengths of miniscrew implants for use in interradicular spaces. The PubMed electronic database was searched for original articles to the end of December 2009. The selection criteria were human anatomical studies, written in English, about the safe zones in the interradicular spaces for miniscrew implant placement. The final selection was completed after the author read the complete articles. Most of these studies measured the availability of interradicular space in patients without malocclusion, i.e. no severe crowding, no spacing, no missing teeth except the third molars, and no periodontal disease, by using CT images. In these studies, types of occlusion or dento-skeletal patterns of the samples were not specified. In the maxilla and mandible, all interradicular sites had adequate space for miniscrew implant placement; however, the areas with adequate interradicular space at each site presented at different distances from either the cemento-enamel junction or the alveolar crest. In the maxilla, the safest site was between the second premolar and the first molar. In the mandible, the safest sites were between the first and second molars or between the first and second premolars. The recommended miniscrew diameters ranged from 1.2 to 1.5 mm with the lengths ranging from 4.0 to 10.0 mm. Based on these results, an empirical clinical guideline can be provided. However, various malocclusions and dento-skeletal patterns, and individual variations must be considered.
1. Prabhu J, Cousley RR. Current products and practice: bone anchorage devices in orthodontics. J Orthod 2006;33:288-307.
2. Tseng YC, Hsieh CH, Chen CH, Shen YS, Huang IY, Chen CM. The application of miniimplants for orthodontic anchorage. Int J Oral Maxillofac Surg 2006; 35: 704-707.
3. McGuire MK, Scheyer ET, Gallerano RL. Temporary anchorage devices for tooth movement: a review and case reports. J Periodontol 2006; 77: 1613-1624.
4. Papadopoulos MA, Tarawneh F. The use of miniscrew implants for temporary skeletal anchorage in orthodontics: a comprehensive review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103: e6-15.
5. Motoyoshi M, Matsuoka M, Shimizu N. Application of orthodontic mini-implants in adolescents. Int J Oral Maxillofac Surg 2007; 36: 695-699.
6. Bae SM, Park HS, Kyung HM, Kwon OW, Sung JH. Clinical application of microimplant anchorage. J Clin Orthod 2002; 36: 298-302.
7. Cope JB. Temporary anchorage devices in orthodontics: a paradigm shift. Semin Orthod 2005; 11: 3-9.
8. Kyung HM, Park HS, Bae SM, Sung JH, Kim IB. Development of orthodontic microimplants for intraoral anchorage. J Clin Orthod 2003; 37: 321-328; quiz 314.
9. Schnelle MA, Beck FM, Jaynes RM, Huja SS. A radiographic evaluation of the availability of bone for placement of miniscrews. Angle Orthod 2004; 74: 832-837.
10. Asscherickx K, Vannet BV, Wehrbein H, Sabzevar MM. Root repair after injury from mini-screw. Clin Oral Implants Res 2005; 16: 575-578.
11. Carano A, Velo S, Incorvati C, Poggio P. Clinical applications of the Mini-ScrewAnchorage-System (M.A.S.) in the maxillary alveolar bone. Prog Orthod 2004; 5: 212-235.
12. Costa A, Raffainl M, Melsen B. Miniscrews as orthodontic anchorage: a preliminary report. Int J Adult Orthodon Orthognath Surg 1998; 13: 201-209.
13. Torut S, Aranyawongsakorn S, Suzuki EY, Suzuki B. Trends in miniscrew implant design and use for orthodontic anchorage: a systematic literature review. J Dent Assoc Thai 2008; 7: 34-44.
14. Aranyawongsakorn S, Torut S, Suzuki B, Suzuki EY. Insertion angulation protocol for miniscrew implant placement in the dentoalveolar area. J Dent Assoc Thai 2007; 57: 285-297.
15. Kuroda S, Yamada K, Deguchi T, Hashimoto T, Kyung HM, Takano-Yamamoto T. Root proximity is a major factor for screw failure in orthodontic anchorage. Am J Orthod Dentofacial Orthop 2007; 131: S68-73.
16. Kravitz ND, Kusnoto B. Risks and complications of orthodontic miniscrews. Am J Orthod Dentofacial Orthop 2007; 131: S43- 51.
17. Brisceno CE, Rossouw PE, Carrillo R, Spears R, Buschang PH. Healing of the roots and surrounding structures after intentional damage with miniscrew implants. Am J Orthod Dentofacial Orthop 2009; 135: 292- 301.
18. Poggio PM, Incorvati C, Velo S, Carano A. “Safe zones”: a guide for miniscrew positioning in the maxillary and mandibular arch. Angle Orthod 2006; 76: 191-197.
19. Deguchi T, Nasu M, Murakami K, Yabuuchi T, Kamioka H, Takano-Yamamoto T. Quantitative evaluation of cortical bone thickness with computed tomographic scanning for orthodontic implants. Am J Orthod Dentofacial Orthop 2006; 129: 721 e727-712.
20. Kim HJ, Yun HS, Park HD, Kim DH, Park YC. Soft-tissue and cortical-bone thickness at orthodontic implant sites. Am J Orthod Dentofacial Orthop 2006; 130: 177-182.
21. Hu SK, Kang KM, Kim WT, Kim HK, Kim JH. Relationships between dental roots and surrounding tissues for orthodontic miniscrew installation. Angle Orthod 2009; 79: 37-45.
22. Ishii T, Nojima K, Nishii Y, Takaki T, Yamaguchi H. Evaluation of the implantation position of mini-screws for orthodontic treatment in the maxillary molar area by a micro CT. Bull Tokyo Dent Coll 2004;45:165- 172.
23. Lee KJ, Joo E, Kim KD, Lee JS, Park YC, Yu HS. Computed tomographic analysis of toothbearing alveolar bone for orthodontic miniscrew placement. Am J Orthod Dentofacial Orthop 2009; 135: 486-494.
24. Lim WH, Lee SK, Wikesjo UM, Chun YS. A descriptive tissue evaluation at maxillary interradicular sites: Implications for orthodontic mini-implant placement. Clin Anat 2007.
25. Hernandez LC, Montoto G, Puente Rodriguez M, Galban L, Martinez V. ‘Bone map’ for a safe placement of miniscrews generated by computed tomography. Clin Oral Implants Res 2008; 19: 576-581.
26. Ishikawa H, Nakamura S, Iwasaki H, Kitazawa S, Tsukada H, Sato Y. Dentoalveolar compensation related to variations in sagittal jaw relationships. Angle Orthod 1999; 69: 534-538.
27. Ishikawa H, Nakamura S, Iwasaki H, Kitazawa S, Tsukada H, Chu S. Dentoalveolar compensation in negative overjet cases. Angle Orthod 2000; 70: 145-148.
28. Bibby RE. Incisor relationships in different skeletofacial patterns. Angle Orthod 1980; 50: 41-44.
29. Solow B. The dento-alveolar compensatory mechanism. Br J Orthod 1980; 7: 145-161.
30. Masumoto T, Hayashi I, Kawamura A, Tanaka K, Kasai K. Relationships among facial type, buccolingual molar inclination, and cortical bone thickness of the mandible. Eur J Orthod 2001; 23: 15-23.