Mini-Implants in the Anterior Palate: How to improve Stability in the Long-term
Björn Ludwig / Traben-Trarbach / Germany Benedict Wilmes / University of Düsseldorf / Germany Stability of Mini-implants
Phase
of low stability Stability
Primary Secondary stability stability
1 2 3 4 5 6 7 8 9 Weeks Stability of Mini-implants
How to measure primary stability:
- Insertion Torque (in vivo / in vitro)
- Resonance Frequency Analysis (RFA) (in vivo / in vitro)
- Periotest (in vivo / in vitro)
- Lateral loading / Pull Out Test (in vitro) Stability of Mini-implants Insertion site? No difference between median
ISQ and paramedian insertion
40 Resonance 35 median Frequency 30 Analysis 25 ns paramedian ** * 20 ns median * 15
10
5
0 paramedian 0 2 4 6 Weeks Nienkemper M, Pauls A, Wilmes B, Drescher D. Development of mini-implant stability over the initial healing period: A prospective clinical pilot study. Angle Orthod. 2013 Nienkemper M, Pauls A, Wilmes B, Drescher D. Effect of implant length on mini-implant stability during the initial healing period: A prospective clinical study, Head and Face Med 2013 Nienkemper M, Pauls A, Ludwig B, Drescher D. Stability of paramedian inserted palatal mini- implants at the initial healing period: a controlled clinical study. Clin Oral Implants Res. 2013 Stability of Mini-implants
Success rate in the anterior palate: 97.9%
Karagkiolidou A, Ludwig B, Pazera P, Gkantidis N, Pandis N, Katsaros C. Survival of palatal miniscrews used for orthodontic appliance anchorage: A retrospective cohort study. Am J Orthod Dentofacial Orthop. 2013
1. Low failure rate 2. No root damage 3. Tad´s not in the path Stability of Mini-implants Stability of Mini-implants
Optimal -Thick Bone site -Thin Mucosa
Restricted site
Ludwig B, Glasl T, Bowman J, Wilmes B, Kinzinger G, Lisson G. Anatomical Guidelines for Miniscrew Insertion: Palatal Sites. J Clin Orthod. 2011:45(8):433-441 Mini-Implants with Abutments
Mini-implant Abutments
Coupling with the appliance Mini-Implants with Abutments
Screwed Screwed Bonded Bonded
Spider Screw Benefit Orthoeasy Dual Top HDC PSM Forestadent Jeil Mini-Implants with Abutments
Benefit System Beneplate System
Wilmes B, Drescher, D. Wilmes B, Drescher, D. Nienkemper M. A mini-implant system with A miniplate system for improved interchangeable abutments. stability of skeletal anchorage. J Clin Orthod 2008; 42:574-580 J Clin Orthod 2009; 43:494-501 Mini-Implants with Abutments
Pre-drilling in adults
Handpiece
Insertion Orthodontist could insert Stability of Mini-implants Consider angle of insertion! Mechanics with palatal TAD´s
Molar distalization
Beneslider Pendulum B
Molar mesialization
T-Bow Mesialslider
RPE / Class III Molar Hybridhyrax anchorage
Molar Alignment of Intrusion retained teeth Beneslider
Beneplate
Benetube Wilmes B, Drescher, D. Nienkemper M. Beneplate - A miniplate system for improved stability of skeletal anchorage. J Clin Orthod 2009; 43:494-501 Wilmes B, Drescher D. Application and effectiveness of the Beneslider molar distalization device. World J Orthod. 11:331–34 Combination of distalization mechanics and…
… conventional braces
… lingual braces
… Aligners Beneslider Beneslider Beneslider Beneslider & Aligner
J Clin Orthod 2012:390-8 Beneslider & Aligner Beneslider & Aligner Beneslider & Aligner Beneslider & Aligner Beneslider & Aligner Beneslider & Aligner Beneslider & Aligner Beneslider & Aligner Beneslider & Aligner Beneslider, Efficiency?
Study: N=51
- Moderate implant tipping in 2 cases
- Distalization effect: 3.6 mm (+/- 1.9 mm)
- Distalization speed: 0.6 mm/month
Nienkemper M, Wilmes B, Yamaguchi S, Pauls A, Drescher D. Treatment efficiency of Mini-implant borne distalization depending on age and eruption of the second molars. J Orofac Orthop 2014 Pendulum B 0.8 mm TMA
Wilmes B. Clinical management of the Beneslider and the Pendulum B appliances for maxillary molar distalization. In: Moschos Papadopoulus: Skeletal anchorage in orthodontic treatment of Class II malocclusion: Contemporary applications of orthodontic implants, miniscrew implants and mini plates. Amsterdam. Mosby, Elsevier (in press) Pendulum B Upper molar mesialization
T-Bow Mesialslider
Indirect Direct Anchorage Anchorage Upper molar mesialization
If missing 3,4,5 or 6: no brackets needed Mesialslider T-Mesialslider Hybrid-Hyrax
Wilmes B, Fields of Application of Mini-Implants. In: Ludwig, Baumgaertel, Bowman: Mini-Implants in orthodontics. Innovative anchorage concepts. London, Berlin etc. Quintessence. 2008: 91- 122 Wilmes B, Nienkemper M, Drescher D. Application and effectiveness of a new mini- implant and tooth-borne rapid palatal expansion device. World J Orthod.2010 Hybrid-Hyrax
Force near the CR of the maxilla
Baumgaertel S, Ludwig B, Kinzinger G, Zorkun B, Glasl B, Wilmes B. Application of a new visco-elastic FEM-Model and analysis of miniscrew supported Hybrid-Hyrax treatment. Am J Orthod Dentofacial Orthop 2013 Hybrid-Hyrax
Goal 1: No load on the bicuspids/ deciduous molars No/less tipping of the teeth Wilmes B. Fields of Application of Mini-Implants. In: Ludwig B, Baumgaertel S, Bowman JS, editor. Mini-Implants in Orthodontics Innovative Anchorage Concepts. London: Quintessence Publishing Co Ltd;2008. p. 91-122 011351 term study.term long aprospective children: growingin malocclusions Class of III treatment the in facemask protraction DM, Sarver Williams MD, maxillary Ngan Maxillary Transfer Mesialmigration the of dentition P, Yiu to expansion Semin C, Hu C, A, the of Orthod advancement and bone Hagg the protraction Sadowsky 1997;3:265 U, WeiU, SH, force . PL, Bradley E. Combined rapid maxillary expansion and expansion maxillary rapid E. Combined PL, Bradley Eur - 274. Gunel J Orthod E. using Cephalometric 1998;20:237 a Goal 2: - of the teeth 254. and Facemask Avoid migration mesial advancement F Just occlusal skeletal
changes
following maxillary - Hybrid-Hyrax
Mini-Implants with abutments
Hyrax Expander Hybrid-Hyrax / Facemask Hybrid-Hyrax / Facemask
Nienkemper M, Wilmes B, Pauls A, Drescher D. Maxillary protraction using a hybrid hyrax - facemask combination. Prog Orthod 2013 Hybrid-Hyrax / Facemask Hybrid-Hyrax / Facemask + Alt-Ramec
Wilmes B, Ngan P, Liou E, Franchi L, Drescher B, Early Class III Facemask Treatment with the Hybrid Hyrax and Alt-RAMEC Protocol J Clin Orthod 2014 Hybrid-Hyrax / Facemask Alt-Ramec
WITS -8.2 mm WITS -1.1 mm Hybrid-Hyrax / Facemask Alt-Ramec
Clinical Studies needed…. Hybrid-Hyrax / Facemask
Hybridhyrax
Mentoplate
Wilmes B, Kau CH, Ludwig B, Drescher D. Early Class III Treatment with a Hybrid Hyrax-Mentoplate Combination, J Clin Orthod 2011 Hybridhyrax and Mentoplate Hybridhyrax and Mentoplate
Peter Ngan, Hong He, and Benedict Wilmes. Early Treatment of Class III Malocclusion. In: Peter Ngan, Class III Malocclusion: Craniofacial Biology and Treatment Strategies" Oak Park. Bentham eBooks (in press) Hybridhyrax and Mentoplate
Before 8 months After
WITS: -8.3 mm WITS: -2.8 mm Hybridhyrax and Mentoplate
17 years Overview early class III treatment
Conv.RPE + Hybrid Hyrax Hybrid Hyrax 4 Bollard Facemask + Facemask + Mentoplate Plates
2 mini-implants 4 miniplates Surgery? No 2 mini-implants 1 miniplate Skeletal Efficiency? Molar anchorage Molar anchorage Molar intrusion
J Clin Orthod 2013 Molar intrusion Forced eruption of retained teeth Forced eruption of impacted teeth Outlook: Multipurpose appliances…
Wilmes B, Ludwig, B, Katyal V, Nienkemper M, Rein A, Drescher D. The Hybrid Hyrax Distaliser, a new all-in-one appliance for rapid palatal expansion, early class III treatment and upper molar distalisation. J Orthod (in press) Conclusions: 1. Anterior palate is the best insertion site
Ludwig B, Glasl T, Bowman J, Wilmes B, Kinzinger G, Lisson G. Anatomical Guidelines for Miniscrew Insertion: Palatal Sites. J Clin Orthod. 2011:45(8):433-441 Conclusions: 2. Tad´s with abutments for the palate
Molar distalization
Beneslider Pendulum B
Molar mesialization
T-Bow Mesialslider
RPE / Class III Molar Hybridhyrax anchorage
Molar Alignment of Intrusion retained teeth Conclusions: 3. No difference between median and lateral Conclusions: 4. Just do it !
Insertion of mini-implants in the palate is very easy!!! Orthdontists can do it
Courage! Palatal Mini-implants
[email protected] www.uniklinik-duesseldorf.de/kieferorthopaedie
Thank you very much for your attention!