വിക്കിപീഡിയ

ഉപയോക്താവ്:Challiyan/orthodontic

< ഉപയോക്താവ്:Challiyan



Mini Implants are small customised screw (1.5 – 2 mm wide) made of Titanium or stainless steel alloys. which acts as temporary Anchorage Device. Mini-implants are frequently placed between the roots of teeth, roof of the mouth and zygomatic bone. They are then connected to a fixed brace to help move the teeth. [1] Good anchorage is fundamental and critical to Orthodontics treatments. Conventional means of supporting anchorage have been using either tooth borne anchorage or extra oral anchorage. Orthodontists add more number of tooth or take support from the soft tissues or use extra oral forces like headgear. [2] One of the greatest limitations in modern orthodontic treatment is Tooth borne anchorage. This is mainly due to the tooth movement in response to orthodontic tooth movement. [3] Although some conventional or compliance free anchorage systems have been developed such as differential moment concept, none of the methods has yet been able to provide absolute anchorage. [4] It is only possible with skeletal anchorage systems such as TADs or ankylosed teeth. [5][6]

Orthodontic mini-implants (OMIs) represent a new form of anchorage provision and appear to provide a variety of benefits for both anchorage-demanding and complex orthodontic cases. [7]

Most current miniscrews are titanium or titanium alloy and are manufactured with a smooth machined surface that is not designed to osseointegrate. by definition TADs are temporary devices and often removed after the orthodontic movements are achieved but some devices are not removed but put to seep, covered by soft tissues and may be used for prosthetic purposes. At present, the most common TADs include mini screws. micro screws, miniature implants (mini-implants). palatal implants or onplants. modified bone plates and retromolar implants, as well as functionally loaded osseointegrated prosthetic implants . In addition, a TAD may be a temporary prosthetic component that is removed after treatment. [8]

History

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All type of tooth movement, generates an equal and opposite reactive force, as first described by Newton's third law of motion. Anchorage (reinforcement) are the clinical approaches to reduce the negative effects of this reactive force, which manifests clinically as anchorage loss. Mesial movement of the first molar teeth is a classic example of anchorage loss. Unfortunately, all types of conventional intra-oral anchorage reinforcement are associated with some degree of anchorage loss. Throughout the twentieth century headgear was regarded as the 'gold standard' for anchorage reinforcement, as an anchorage not dependent on the dentition. Headgear, however, patient compliance often limits the results.[9]another draw back is that only maxillary teeth can be controlled effectively using the headgear.[10]

The concept of skeletal anchorage is not new. Basal bone anchorage was suggested more than 60 years ago as an alternative to increasing the number of teeth to achieve conventional anchorage. [11] 1945, research into the concept of using a pin or screw attachment to the ramus was initiated not only for moving teeth, but also for "exerting a pull on the mandible." Gainsforth et al placed vitallium screws on mandible of dogs for orthodontic movements with limited success. [12] These screws came loose after 16 to 31 days. [13] Bone screws were used extensively Even before.[14] For example, orthopedists have used stainless steel bone screws for leg lengthening since before 1905.[15] Linkow who was a pioneer in blade implant prostheses reported the use of the same in orthodontic tooth movements in 1969. [16]

The very first orthodontic literature describing the use of maxillofacial bone screws for orthodontic anchorage appeared in 1983. [17] In 1990 Roberts et al published a study using endosseous implants utilized as anchorage to protract molars and close an atrophic extraction site. [18] In the ensuing years, little was published on the subject until a paper by Kanomi in 1997 describing the intrusion of mandibular anterior and buccal teeth using mini-screw implants that are used for fixing bone plates. [19] More than 5000 publications have been made every since and majority of them are clinical cases. [20]

Screw head and bracket designs have changed dramatically during the past several decades, when Brainerd Swain designed the edgewise twin bracket that remains in use today, he used the head of a wood screw; by 1986, 90% of the orthodontists in the United States were using the pre-adjusted system with twin brackets favored for all teeth. [21]

The FDA finally cleared the use of titanium screws for anchorage, and, by 2005, 10 to 15 miniscrew systems were available on the United States market.

An active group of Korean clinicians developed the Abso-Anchor Screw (Dentos Inc., Taegu, Korea). They have published extensively, presented lectures and given many courses on this subject. [22] [23] [24]Concurrently, Melsen and co-workers in Denmark, developed the Aarhus Mini-Implant (Medicon eG, Tuttlingen, Germany. ScanOrto A/S, Charlottenlund, Denmark) and provided scientific evidence for the possibility of immediate loading of mini-screw implants.[25] The Spider Screw (Health Development Company Via dell’Industria 11, 36030 Sarcedo,VI Italy) is similar in design to the Aarhus Screw and was developed in Italy by Maino and co-workers.[26] Recent articles by Cope[27] and Herman[28] have documented the American influence, initiated the term Temporary Anchorage Device (TAD) and described the IMTEC Mini Ortho Implants (IMTEC Corp, Ardmore, OK, USA).

Advantages of Mini implants

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Skeletal anchorage would offer capabilities heretofore unavailable. They expand the range of biomechanical possibilities with screws, pins or some readily removable implants anchored to the jaws, so that forces might be applied to produce tooth movement in any direction without detrimental reciprocal forces on the anchor teeth. Orthodontic forces might be applied directly to the jaws through skeletal anchorage [29]. It is now possible to control anchorage, and hence tooth movements, in three dimensions. Therefore, OMI usage should be considered in each of the three planes of space. [30][31] [32]

  • antero-posterior
  • transverse
  • vertical.

Direct anchorage is typically achieved from a mini-implant inserted in a buccal site, through attached mucosa, and between the first molar and second premolar roots. Traction is applied from the head of the OMI either directly to a tooth (bracket) or via a powerarm (an elongated hook attached to either the archwire or a tooth) [33]

Antero-posterior mini-implant anchorage also facilitates molar distalisation, without the risk of anchorage loss. Premolar and incisor tooth advancement occurs with all forms of 'non-compliance' distaliser designs unless they are bone-anchored. [34]

Similarly, mid-palatal anchorage may be used for molar protraction, where the posterior teeth need to be moved mesially to close spaces due to hypodontia or premature tooth losses. [35]

Finally, skeletal anchorage promises to cause a paradigm shift in the management of patients with vertical growth discrepancies particularly anterior open bite (AOB). [36]

Material used

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Although it ranks ninth among the earth's most abundant elements, titanium was not discovered until 1791 and was not mass produced until 1948, when the technology to separate it from compounded materials was developed. Titanium has many valuable properties: it is three times stronger than stainless steel; exhibits little response to electricity, heat, or magnetic force; is highly biocompatible; and is inert. Type V titanium has the smallest amount of alloy (6% aluminium and 4% vanadium) of all titanium grades and hence the highest tensile strength, making it the material of choice for bone screws. [37]

More fibroblastic activity with less inflammatory cells reactions is observed in patients with titanium implants than in patients with stainless steel implants. Less metal impregnation in the soft tissue covering the titanium was found than in the tissue covering the stainless steel implants. Oxides grow when implant is contact with bodily fluids on both stainless steel and titanium devices. Osteo integration is better with titanium. Surfaces of stainless steel implants are much smoother, where average roughness ra = 6.5 nm has been measured, while on coated titanium average roughness ra was 68.6 nm, since titanium surfaces are coated with hard coatings. Young’s modulus of titanium is equal to bone. Increased young’s modulus– undue stress on bone – implant failure

Types of implants

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There are three types of dental implant: (a)The subperiosteal implant is placed under the periosteum and rests on the bone surface with�out penetrating it; (b)the endosteal implant is partially submerged and anchored within the bone; and c) the transosseous implant penetrates the bone completely.

Type of Mini Implants.

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3 Types of mini implants are Bone screws(6-15 mm long, 3-5 mm in diameter), Mini implants(6 mm long, 1.2 mm in diameter, Micro implants (1.2–1.8mm in diameter) Bone screws are seldom used in Orthodontics as they are closed implants and are used in bone lengthening or fractures.

Bone screws

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Bone screws are generally used for closed implants, so they require a less prominent head shape. Therefore, a female-type means of engaging a screw�driver is preferable, and the recessed hex has proved to be the most useful for bone screws. [38]

Mini Implants

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Ryuzo Kanomi introduced the Mini�implant in 1997. The mini implant is only 1.2mm in diameter and 6mm long making it much more useful in orthodontic applications. Mini implants are small enough to be used between the roots, placed in palate for molar distalization, molar intrusion and other tooth movements. Better oral hygiene. Can be easily removed after treatment.

Microimplants

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Micromplant: Conventional endosseous implants have been used to provide anchorage control in orthodontic treatment procedures. 1.2-1.8mm in diameter. The titanium micro implant has been designed specifically for orthodontic use. These micro implants are smaller in diameter of 1.2mm–1.8mm allows its insertion into many areas of the maxilla and mandible previous unavoidable (e.g.) Between the roots of adjacent teeth. It is inexpensive, loaded immediately and provides anchorage throughout treatment

Screw Designs

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Screw

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A screw is a simple machine that converts rotational motion into translational motion while providing a me�chanical advantage. [39] Generally, a screw has three basic components: a core, a helix (called the thread), and a head . [40] Each component plays an important role in the function of the screw.

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This part f the mini implant is exposed to the oral environment for placement of the archwire or elastics

Isthmus

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This is the connection between the head and the platform of the mini implant. It helps in the attachment of the orthodontic accessories like elastics, coil springs to the implant head

Plat form

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It is of three different heights such as 1 mm, 2 mm, 3 mm for accomadating different soft tissue thicknesses

Body

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The body of the implant screw is parellel, It is either of self drilling or self tapping type.

Core

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The core, which forms the support of the screw, is attached to the head and is wrapped in the helical thread. [41] The cross-sectional area of the core (called the root area of the screw) determines the torsional strength of the screw. The greater the core diameter, the lower the incidence of screw failure arising from fracture during insertion of the screw. The shank is the part of the screw that extends from the head to the beginning of the threads. The spacing between adjacent threads is called the pitch. The lead of a screw refers to the distance that the screw will advance with each turn.

Classification

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Based on Implant morphology,

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1) Implant disc - Onplants

2) Screw Designs - Mini Implants, Micro Implants, Arhus Implant, Spider Screw, Omas System, Leone Mini Implant

3) Plate design - SASl Graz Implant supported systems, Zygoma support systems.

Screws are classified as pretapped screws, self-tapping screws, or self-drilling screws, according to the method of insertion [42] The insertion method is also related to the physical properties of materials. Pretapped screws are used in harder, less compressible materials, such as in metal or in cortical bone.[43]

Based on Origin

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Osseointegrated implants and non-osseointegrated implants.

Osseointegrated implants

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These are developed from prosthetic dental implants and is characterized by intraosseous part which is surface treated for osseointegration. This category includes palatal and retromolar implants and also Onplants [44] [45]These are placed after pre drilling procedure and followed by a healing period after which the loading is accomplished. A special type of these impants are Onplants developed by Block an Hoffman. [46]

1) Palatal Implants

2) Retromolar Implants

3) Orthodontic Implants

4) Onplants

Non-osseointegrated implants

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This category of implants originates from surgical screws and is characterized by a polished intraosseous part and a screw head. It is loaded immediately of after insertion. [47] [48]Two main groups are 1) mini plates with various transmucosal extenstion [49] and 2) singles screws or mini implants. [50]

1) Mini plates ( one point contact)

2) Mini Screws ( One point contact)

3) Arhus implant ( 3 dimensional control)

Onplants

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Onplants is considered less invasive because it is not placed into bone but rather between the periosteum of the palate and the bone using a tunneling procedure. It consists of a titanium hydroxyapatite coated disk with a threaded hole that is placed toward the mucosa.

Pretapped screws

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Because the screw threads cannot readily compress these firm materials, pretapped screws require the use of a tap to precut the thread. Pretapped screws are not suitable for thin bone, such as the maxilla [51]

Self tapping screws

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Self-tapping screws are used in softer, less compressible materials and form threads by compressing and cutting the surrounding materials. They have a fluted leading edge and require only a predrilling procedure, meaning that the tapping procedure is omitted.

Self drilling scres

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Self-drilling screws, also referred to as drill-free screws, have a corkscrew-like tip; therefore, neither predrilling nor tapping procedures are needed. [52][53]

Indications

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1) Patients with insufficient teeth to provide conventional anchorage .

2) Patients in whom forces to the reactive units would cause adverse movements

3) Patients with Skeletal defects as an alternative to the Orthognathic surgery

4) Patients with need for asymmetric movements in all planes of space.

5) Patients in which tooth movement is needed for providing bone support for dental implants.

Force Delivery

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Mini screws are used to generate a constant single force with mild to moderate magnitude regardless of the patients compliance. The force delivered by the mini screws are characterized as follows

Single Linear force system

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A single mini screw and the elastic components (elastic chain or Niti coil springs) engaged to the screw head generate a linear force whose line of action is same as the elastic component. Torsional force is not recommended to be used on a single implant as it may threaten the stability. Line of action can be modified using attachments or hooks. [54]

Moderate magnitude of force

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A single mini screw is expected to withstand approximately 200 to 300 grams of force, which appears to be sufficient to move segments of teeth or a single tooth. Multiple mini screws may be required to provide anchorage to heavier forces for the movement of larger segment such as the posterior segment or the whole arch. [55]

Intrusive Component of force

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Conventional orthodontic mechanics tend to extrude the teeth by jiggling motion. Because the mini screws are usually placed apical to the archwire the forces from a mini screw normally always have an intrusive component.


Implant placement

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Safe zones

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In the maxilla, the greatest amount of mesiodistal bone is on the palatal side between the second premolar and the first molar. The least amount of bone was in the tuberosity. The greatest thickness of bone in the buccopalatal dimension was between the first and second molars, whereas the least was found in the tuberosity. In the mandible, the greatest amount of mesiodistal dimension was between first and second premolar. The least amount of bone was between the first premolar and the canine. In the buccolingual dimension, the greatest thickness was between first and second molars. The least amount of bone was between first premolar and the canine.

The insertion of screws in the maxillary molar region above 8–11 mm from the bone crest has to be avoided with any type of screw because of the presence of the sinus. Another area that is generally not suitable for screw implantation is the tuberosity, where the amount of bone is very limited by the presence of wisdom teeth. If the screw is inserted perpendicular to the dental axis, it might reach the narrowest inter radicular space earlier than when inserted at an oblique angle. It should be embedded for no more than 6–8 mm of bone depth, ie, the 50% of the buccolingual average measure between first and second molars. A minis crew insertion at 30–40 to the dental axis allows the insertion of a longer screw in the available bone depth. Because of the reduced tip diameter, a conic screw insertion has a lower risk of damaging roots.

Screw Selection

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The 1.5mm- diameter bone screw is intended for tooth bearing areas, particularly the interseptal bone between teeth. The extra thickness provides better mechanical retention with its deeper thread pitches. This screw should be placed in the interseptal bone. The 2.0mm and 2.7mm diameter screws are designed for use in non- tooth bearing areas such as the zygomatic buttress, the midsagittal region of the hard palate and mandibular buccal shelf region. These screws can bear forces as high as 500-600gms. The 14mm and 17mm screw lengths are primarily designed for insertion in the zygomatic buttress. The 7mm, 10mm, and 12mm lengths can be selected based on the bone height at the implant site

General rules of placement

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According to the length of microimplant

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The recommended sizes are more than 6mm in maxilla, and 5mm in mandible. The cortical surfaces of the maxilla are thinner and less compact than those of the mandible and accordingly will require longer micro implants. A general rule of thumb should be, to use the longest possible microimplant, without affecting the health of adjacent tissues

According to the diameter of microimplant:

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Microimplants are available in 1.2 to 1.8 mm diameter (no.12- 18 series). No. 12 series (1.2mm diameter) and no. 13 series (1.3mm in diameter) can all withstand up to 450g of orthodontic force when patient has good quality of cortical bone. In the mandible, the buccal surfaces and retromolar areas offer adequate thickness and high quality cortex for the acceptance of microimplants. Usually, those of 4–5mm in length with 1.2 – 1.3mm in diameter provide adequate retention

Site for microimplant placement

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In the Maxilla:

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The micro implant can be used in both the maxilla and the mandible. Several areas of the maxilla can be used for insertion. One location is the inferior surface of the anterior nasal spine, where the micro implant can be used for proclination of the incisors. The location can also be that of the implant and the onplant in the midpalatal suture, taking advan tage of the density and height of the cresta nasalis, where the bone structure is dense enough for retention of the implant. The anteroposterior position can vary slightly according to the individual anatomy. The orientation may likewise vary from almost vertical to an oblique anterior direction. It is, however, important to avoid the incisal canal, and when situated anteriorly, the miniscrew should be inserted a slight distance from the midline or more posteriorly. In this position the micro implant may render direct anchorage for retraction and intrusion of flared and overerupted incisors. Anchorage in this location has also been used for symmetric mesial movement of lateral teeth when the anterior teeth could serve as anchorage. Indirectly this location can also be used for consolidating miniscrcw anchorage with the teeth that are serving as anchorage but delivering too little resistance.Another location isin the Infrazygomatic crest. Level and direction may vary depending on the individual anatomy. From this position the zygoma wire and the implant can deliver anchorage for retraction and intrusion of anterior teeth.

In Mandible:

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Three different locations are suggested for use in the mandible. Roberts et al routinely placed micro implant in the retromolar position and established a satisfactory anchorage for mesial movement of molars, thereby avoiding retraction of the anterior tecth in thc casc of spacc closure following extraction of first molar. Roberts et al also used this position to neutralize the eruptive force generated in uprighting mesially tipped molars [56] . A second location is within edentulous areas of the alveolar proeess. The purpose here would be to move single teeth without interfering with the remaining dentition. The micro implant can be inserted laterally in the molar and premolar region and can act as anchorage for vertical and/or transverse movement of lateral teeth, molars, and premolars. In the anterior region of the mandible the screws can be inserted into the symphysis to be used as anchorage for intrusion and protraction mandibular incisors. A miniscrew in this location can be useful as indirect anchorage by consolidating with a dental anchorage, as indicated by Kanomi [57]

Implant placement and Complications

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Implant insertion

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Choice of insertion site and the screw type depends on the indication, with reference to radiographs and clinical findings such as interradicular space, postion of the foramens, dimensions of the maxillary sinus, soft tissue situation.

only light anesthesia is required so that contact with the roots can be identified and avoided.

before the surgery patient rinses the mouth with 0.1 % chlorhexidine digulconate solution.

After infilterative local anesthesia with epinephrine free anesthetic, a pilot hole is drilled directly through the mucosa using a low speed water cooled pilot drill in mandible. Pilot holes are avoided in maxilla as the holes can impain the primary stability of the screws. Screws are inserted slowly with the manual screwdriver or with the help of a contra angle low speed handpiece . A steady hand is required to avoid wobbling of the srews.

Loading

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After the insertion immediate loading can be achieved. Either by directly applying the force or by attaching the screw head to a tooth or a group of tooth, thereby providing an anchorage.

Implant removal

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Implants are gently removed using the same screw driver. Anesthesia is not generally required.

Complications

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Intra Operative

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1) Trauma of vessels ( palatine artery)

2) Trauma of nerves ( IAN, Menta)

3) Sinus exposure

4) Root contact

5) Fracture of the screw

Post Operative

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1) Periimplant inflammation

2) Mucosal irritations

3) mobility

4) Other Failures

Failure of Mini implants

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Failure of the mini-implant can be divided into early (short-term) and later (long-term) failure; these categories can be further subdivided into hard tissue-implant inter�face failure, soft tissue-implant interface failure, implant failure from fracture, and psychological failure

Hard Tissue implant interface failure

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Failure at the hard tissue-implant interface results in loosen�ing of the implant. According to studies of the success rate of orthodontic mini-implants, most failures result from the loosening of the implant shortly after implanta�tion. [58]

Early failure

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Early failure at the hard tissue-implant interface is re�lated to primary stability which is obtained from me�chanical support from the surrounding bone tissue. [59] In other words, primary stability is related to the thickness of the cortical bone at the implantation site, the amount of damage caused by surgical trauma, and the closeness of the contact between the bone and the implant.

Later failure

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Later failure at the hard tissue-implant interface is related to the type of interface formed through the heal�ing process following implantation.[60] Long-term failure is also associated with the type of stress loaded on the implant. Formation of fibrous tissue at the bone-implant interface is regarded as the most important risk factor in the loosening of screws. [61] Primary stability, which is the mechanical stability present immediately following implantation, has significant effects on both short-term and long-term stability.[62] [63]

Soft Tissue implant interface failure

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Plaque accumulation around the implant or persistent mechanical irritation can cause soft tissue interface prob�lems, such as acute or chronic inflammation or infection. Epithelial hyperplasia or epithelial covering may also occur. In severe cases, infection can progress to abscesses. The potential for this kind of problem to develop is signifi�cantly increased when the implant is placed on movable tissue. [64]

Implant failure from fracture

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Implant fracture may occur during surgical placement or removal [65] [66] [67] but will not occur during orthodontic force application.

Drugs that affect the stability of Mini Implants

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Cox inhibitors

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Cyclooxyhenase ( COX) is the rate-limiting anzyme responsible for the conversion of arachidonic acid into prostaglandins. There are two isoforms of the enzyme COX-1 which is constantly expressed and COX-2 which is inducible. In bone cells the increase in prostaglandin levels caused by various stimuli depends on the induction of COX-2. Inhibitors of COX-2 cause a delay in fracture healing. [68]Eg: NSAIDs.

Bisphosphonates

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Bisphosphonates are a class of drugs that inhibits the resorption of bone. [69] It is used in a variety of conditions that cause bone fragility, including osteoporosis, osteitis deformans, osteofgenesis imperfecta and in cancer and bone metastasis. Bisphonate related osteonecrosis have been reported in cancer patients taking nitrogenous bisphosphonates. [70]










References

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  1. ↑ https://www.bos.org.uk/BOS-Homepage/Orthodontics-for-Children-Teens/Treatment-brace-types/Orthodontic-mini-implants-TADs
  2. ↑ https://uomustansiriyah.edu.iq/media/lectures/3/3_2021_11_27!11_38_03_PM.pdf
  3. ↑ Melsen B, Verna C. Miniscrew implants: the Aarhus anchorage system. Semin Orthod 2005;11:24-31.
  4. ↑ Birte Melsen, Carlalberta Verna: Miniscrew implants: The Aarhus anchorage system' Seminars in Orthodontics Volume 11, Issue 1, March 2005, Pages 24-31
  5. ↑ Rozencweig G, Rozencweig S. Utilisation des implants et des dents ankylosées en orthodontie. Revue de la littérature [Use of implants and ankylosed teeth in orthodontics. Review of the literature]. J Parodontol. 1989 May;8(2):179-84. French. PMID: 2700761.
  6. ↑ Kofod T, Würtz V, Melsen B. Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop. 2005 Jan;127(1):72-80. doi: 10.1016/j.ajodo.2003.12.020. PMID: 15643418.
  7. ↑ https://www.nature.com/articles/sj.bdj.2015.53
  8. ↑ Nanda, Ravindra (2009). Temporary anchorage devices in orthodontics. Flavio Andres Uribe. St. Louis, Mo.: Mosby Elsevier. ISBN 978-0-323-04807-1. OCLC 244813787.
  9. ↑ Cureton S, Regennitter, F J, Yancey J . The role of the headgear calendar in headgear compliance. Am J Orthod Dentofac Orthop 1995; 104: 387–394.
  10. ↑ https://www.nature.com/articles/sj.bdj.2015.53
  11. ↑ Gainsforth, B. L and L. Bodine Higley. “A study of orthodontic anchorage possibilities in basal bone.” American Journal of Orthodontics and Oral Surgery 31 (1945): 406-417.
  12. ↑ Gainsforth BL, Higley LB. A study of orthodontic anchorage pos�sibilities in basal bone. Am J Orthod Oral Surg 1945;31:406-417.
  13. ↑ Gainsforth, B. L and L. Bodine Higley. “A study of orthodontic anchorage possibilities in basal bone.” American Journal of Orthodontics and Oral Surgery 31 (1945): 406-417.
  14. ↑ Seitz WH Jr, Froimson AI, Brooks DB, Postak P, Polando G, Greenwald AS. External fixator pin insertion techniques: biomechanical analysis and clinical relevance. J Hand Surg Am. 1991 May;16(3):560-3. doi: 10.1016/0363-5023(91)90033-8. PMID: 1861045.
  15. ↑ Codivilla A. On the means of lengthening in the lower limbs, the muscles and tissues which are shortened through deformity. Am J OrthopSurg 1905;2:353-369.
  16. ↑ Linkow LI. The endosseous blade implant and its use in orthodontics. Int J Orthod. 1969 Dec;7(4):149-54. PMID: 5264326.
  17. ↑ Creekmore T, Eklund M . The possibility of skeletal anchorage. J Clin Orthod 1983; 4: 266–269.
  18. ↑ Roberts WE, Marshall KJ, Mozsary PG. Rigid endosseous implant utilized as anchorage to protract molars and close an atrophic extraction site. Angle Orthod. 1990 Summer;60(2):135-52. doi: 10.1043/0003-3219(1990)060<0135:REIUAA>2.0.CO;2. PMID: 2344070.
  19. ↑ Kanomi R. Mini-implant for orthodontic anchorage. J Clin Orthod. 1997 Nov;31(11):763-7. PMID: 9511584.
  20. ↑ Cousley R R J . The orthodontic mini-implant clinical handbook. London: Wiley-Blackwell, 2013.
  21. ↑ Applications of orthodontic mini-implants; J. S. Lee, K. K. Kim, Y-C. Park & R. L. Vanarsdall; UK: Quintessence price £89.00; pp 286 ISBN 032304574X | ISBN: 0-323-04574-X
  22. ↑ Park HS. The skeletal cortical anchorage using titanium microscrew implants. Korean J Orthod 1999; 29: 699–706
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