ODW 268 No.

of Pages 10

orthodontic waves xxx (2017) xxx xxx

Available online at www.sciencedirect.com

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journal homepage: www.elsevier.com/locate/odw

Review

Orthodontic skeletal anchorage: Up-to-date review

H.M. Kyung, N.T.K. Ly, M. Hong *

Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea

article info abstract

Article history: Purpose: This review investigated the recent trend regarding skeletal anchorage in major six
Received 14 June 2017 journals of orthodontics since 2010.
Accepted 28 June 2017 Materials and methods: The MEDLINE were searched for finding related articles published in
Available online xxx American journals of orthodontics and Dentofacial orthopedics (AJO-DO), The Angle
Orthodontists (AO), Korean Journal of orthodontics (KJO), European Journal of orthodontics
(EJO), Australian Orthodontic Journal (AOJ) and Journal of clinical orthodontics (JCO)
Keywords:
regarding orthodontics skeletal anchorage. Keywords used for searching are microimplants,
Microimplant
mini-implant, miniscrews, miniplate, temporary anchorage devices, and skeletal ancho-
Mini-implant
rages orthodontics. Based on the information from the titles and abstracts from 2010 to 2016,
Miniscrew
relevant articles on orthodontic skeletal anchorage were selected and analyzed.
Miniplate
Results: Overall, 8.7% articles of major orthodontic journals were regarding orthodontic
Skeletal anchorage
skeletal anchorage during the time period, called as skeletal anchorage articles (SAA). The
87.8% of SAA used miniscrew implants including microimplants, mini-implants and
miniscrews as research materials. The rest 12.2% was about others such as miniplates and
new type expanders. AJO-DO published the highest percentage of SAA (33.4%). Percentage of
original researches among SAA varies according to Journal: 100% of EJO, 87.8% of AO, 72.1% of
KJO, 63.5% of AJO-DO and 33.3% of AOJ. The rest of SAA are mainly case reports. Clinical
studies among original researches have ranged from 46% to 85% depending on journals The
overall success rate of skeletal anchorage was ranged from 79% to 98.2%.
Conclusions: Steady stream of publication with skeletal anchorage comes 610% in the major
orthodontic journals.
2017 Elsevier Ltd and The Japanese Orthodontic Society. All rights reserved.

Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... .... .... .... .... ... .... .... .... .... . 00
2. Materials and method . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... .... .... .... .... ... .... .... .... .... . 00
3. Major findings . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... .... .... .... .... ... .... .... .... .... . 00
3.1. Publication volume . . . . . . . . . . . . . . .... .... .... .... .... ... .... .... .... .... .... ... .... .... .... .... . 00
3.2. Success rate and stability of OSA . . .... .... .... .... .... ... .... .... .... .... .... ... .... .... .... .... . 00
4. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... .... .... .... .... ... .... .... .... .... . 00

* Corresponding author at: Department of Orthodontics, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-
gu, Daegu 41940, Republic of Korea.
E-mail address: mhhong1208@knu.ac.kr (M. Hong).
http://dx.doi.org/10.1016/j.odw.2017.06.002
1344-0241/ 2017 Elsevier Ltd and The Japanese Orthodontic Society. All rights reserved.

Please cite this article in press as: H.M. Kyung, et al., Orthodontic skeletal anchorage: Up-to-date review, Orthod Waves (2017), http://
dx.doi.org/10.1016/j.odw.2017.06.002
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2 orthodontic waves xxx (2017) xxx xxx

Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

1. Introduction

Various skeletal anchorage systems were developed for

orthodontic treatment in early days of skeletal anchorage
systems since the first vitalium screw [15]. Thereafter, a series
of articles have summarized a great progress in the orthodon-
tic skeletal anchorage and tried to answer the clinical
questions for the valuable tools.
There are six major academic journals leading orthodontics
into the cutting-edge of new technology and approaches:
American journals of orthodontics and Dentofacial orthope-
dics (AJO DO), The Angle Orthodontists (AO), Korean Journal of Fig. 2 Distribution of skeletal anchorage articles according to
orthodontics (KJO), European Journal of orthodontics (EJO), main topic materials. MIs: microimplants, mini-implants
Australian Orthodontic Journal (AOJ) and Journal of clinical and miniscrews; others: miniplates, borne-borne expander,
orthodontics (JCO). They are the main sources for clinicians to and combinational used of functional appliances.
share new ideas regarding skeletal anchorages, clinical
applications, and biological and clinical assessments and also
to pursue further progresses in orthodontics. Therefore, it is
very meaningful to overview comprehensively their publica-
tion trend regarding orthodontic skeletal anchorage (OSA). risks and complications of orthodontic miniscrews were
Early review articles suggested clinical indications, advan- thoroughly reviewed during insertion, under orthodontic
tages and drawbacks, risk factors for failure such as oral loading, and during removal [9]. With prudence, Reynders
hygiene and also presented placement methods of miniscrew et al. systematically analyzed MIs success rate, which was
implants (MIs) including microimplants, mini-implants and greater than 80% [10]. Finally, Crismani et al. asserted that
miniscrews [6,7]. Regarding MIs length, 8-mm microimplants screws less than 8mm in length and 1.2mm in diameter should
were recommended due to higher success rate [8]. Further, be avoided [11]. Through meta-analysis, the mean difference
based on the fear for this strange new approach, the potential of anchorage loss between the MIs and conventional

Fig. 1 The percentage of recent articles regarding orthodontic skeletal anchorage in 6 major journals; AJO-DO: American
journals of orthodontics and Dentofacial orthopedics; AO: The Angle Orthodontists; EJO: European Journal of orthodontics; KJO:
Korean Journal of orthodontics; JCO: Journal of clinical orthodontics; and AOJ: Australian Orthodontic Journal.

Please cite this article in press as: H.M. Kyung, et al., Orthodontic skeletal anchorage: Up-to-date review, Orthod Waves (2017), http://
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orthodontic waves xxx (2017) xxx xxx 3

Fig. 3 Distribution of research types per each journal. AJO-DO: American journals of orthodontics and Dentofacial orthopedics;
AO: The Angle Orthodontists; EJO: European Journal of orthodontics; KJO: Korean Journal of orthodontics; JCO: Journal of clinical
orthodontics; and AOJ: Australian Orthodontic Journal; other research types: clinicians corner, techno bytes and brief report.

anchorage was calculated as 2.4mm [12]. Li et al. believed
that skeletal anchorage are better alternative to headgear due
to less anchorage loss and more anterior teeth retraction [13].
Alves et al. reviewed root repair by MIs contact, informing the
quality of root repair to depend on the amount of damage
caused by MIs [14]. Marquezan et al. investigated the positive
association between MIs primary stability and cortical
thickness of receptor sites [15].
However, to the best of our knowledge, there are few studies
about analyzing the volume of publication and summarizing
research results regarding skeletal anchorage from 2010 to
2016 in leading journals of orthodontics. Therefore, the
purpose of this review was to investigate the recent trend
regarding orthodontic skeletal anchorage from major six
journals of orthodontics since 2010.
2. Materials and method
MEDLINE database was searched thoroughly to find articles
relevant to orthodontics skeletal anchorage in AJO-DO, The
AO, KJO, EJO, AOJ and JCO. Keywords for computerized

Fig. 4 Yearly distribution of research methods among original research articles; FEA (finite element analysis): a computerized
method for predicting how a product reacts to real world forces; in vitro: the research doing in artificial bone or bone segment; in
vivo: the research doing in the animal; clinical study: the research based on the data collected from patients such as clinical
retrospective studies, clinical prospective studies, and randomized control trials.

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Table 1 Orthodontic skeletal anchorage: success rates.

Year Type MI- Pt MI-cha Success factors Success
# rates
Lee et al. [16] CS 260 141 1.8;8.5mm, C-implant, Btw Mx #5&#6 Survival characteristics and risk factors of MI 91.5%
Moon et al. [17] CS 778 306 1.6;8, Dual Top, Mx and Mn posterior Clinical variables and skeletal variables 79%
Buccal
Kim et al. [18] CS, 50 25 1.8;8.5 C-implant, Btw Mx #5&#6, Root proximity 96%
Lee et al. [19] CS 72 36 1.8;7- 2.5; 7 Orlus, Posterior areaAnteroposterior and vertical displacement patterns of 94.4%
Mx teeth
Manni et al. CS 300 132 1.5;9&11mm;1.3;11 mm; Micerium, Loading time and location of the MI related to gingiva 81%
[20] Avegno and root
Al Maaitah CS 44 22 1.3;8 Dentos, Btw Mx #5&#6 Interproximal alveolar bone density, adjacent gingival 88.63%
et al. [21] tissue
Ge et al. [22] CS 40 20 2;14 mm, Shengang, ZhangHua Zygo- Facemask in association with MI in growing Class III 87.5%
matic buttress patients
Kim et al. [23] CS 429 286 1.6; 6 mm&8mm, Dual Top, Jeil, Mx Manual vs. motor-driven MI insertion methods ac- Mx 84.6%,
and Mn cording to age, gender, MI length, and insertion sites. Mn 69.2%
6 mm 69.1%,
8 mm 90.4%
Samrit et al. CS 38 10 Btw #5&#6 Bone density in buccal inter-radicular bone Mx 100%,
[24] Mn 77.8%
Karagkiolidou CS 204 196 1.6;8, Orthoeasy, Forestadent, Palate 97.8%
et al. [25]
Suzuki et al. CS 186 105 1.3;5,6,7mm, Dentos, Btw Mx #5&#6 MI optimal length, insertion torque Mx:93.4%,
[26] Mn: 70.4%
Shinohara CS 147 50 1.6;8 mm Biodent, Tokyo, Btw Mx Root proximity and variability of the placement 94.6%,
et al. [27] #5&#6, inclination
Jung et al. [28] CS 228 130 1.3;8 mm Dentos, Mx buccal alveolar Placement angles 87.7%.
bone
Lee et al. [29] CS 341 217 1.5;4&6 mm C-tube, Jin Biomed, The clinical survival and complication rates 96%
Symphysis
Lee et al. [30] CS 23 51 1.8;6 mm, 2;6mm, Induce MSII, Dual Modified trans-palatal arch supported by 2 mid- 93.4%
Top, palatal MI
Son et al. [31] CS 140 70 1.6;8, Biodent, Japan, Btw Mx #5&#6 self-tapping vs. self-drilling placement 96%
ar et al. [32] CS 51 Osteomed, Addison; Tex, Trimed, The skeletal, dentoalveolar, and soft-tissue effects 95%
Lateral nasal wall, Symphyseal region
Yoo et al. [33] CS T 132 1.5;7 mm Biomaterials Korea T vs. C MI T: 82.9%, C:
105 Mx buccal & Mn alveolar 80.3%
C
122
Zger et al. CS 145 143 Orthosystem, Straumann AG, Basel, success rate of paramedian palatal Orthosystem 98.2%
[34]
Chang et al. CS 1680 840 2;12 mm Newtons A, Miniscrews placed in movable mucosa (MM) or 93%
[35] Hsinchu City, Mandibular #6&#7 attached gingiva (AG).
Saaed et al. CS 24 2,8mm, Dual Top, Jeil Skeletal effects using modified palatal anchorage 97.2%
[36] plate

MI-#: the number MIs using in the study; Pt: the number of patients were treated with skeletal anchorage; MI-cha: MI characteristics (MI
diameter, length, brand); Mx: maxilla; Mn: mandible, btw: between; CS: clinical study; T: tapered; C: cylindrical; Mo: motor; Ma: manual; Ov:
overall.

literature searching included miniscrews; microimplants;
miniplate; TADs; and skeletal anchorages. Articles meeting
the inclusion criteria were selected based on information from
the titles and abstracts; articles on standard dental implants;
systematic review; review article and letters; and articles with
no abstract was excluded.
Collected articles were classified into subgroups according
to research types including original researches, case report,
and others. The original researches were again sub-grouped by
research methods into finite element analysis (FEA), clinical
study (CS), in vitro/ex vivo study and randomized clinical trials
(RCT). Simple descriptive statistics such as total numbers,
average, and percentage were used for statistical analysis.
3. Major findings
3.1. Publication volume
From 2010 to 2016, the 377 skeletal anchorage articles (SAA)
were published out of total 4317 in six major orthodontic
journals; average 8.7% of total articles were dealing with

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Table 2 MI stability: AJO-DO.

Year Type MI- MI-cha Stability factors Evaluation Results Stability
# method
Motoyoshi CS 134 1.6;8 mm Placement and removal tor- Peak torque No correlation btw placement & removal LS
et al. [37] que, age, sex, cortical bone values torque Placement torque related age, cortical
thickness bone thickness
Pickard et al. In- 1.8;6 mm MI orientation effect on the Failure in 90 MI: highest tensile force; MI angled in the PS
[38] vitro resistance to failure tensile & same direction as the line of force; highest
shear tests shear force
Gracco et al. In- 35 2;12 mm Variations in thread shape POT Buttress reverse thread: greatest pull out PS
[39] vitro strength
Chang et al. FEA Thread depth, degree of taper, FEA 2 mm diameter, 9,82 mm length with a pitch PS
[40] taper length, pullout 0.75 mm with greater thread depth, smaller
strength, stiffness, screw taper degrees, and shorter taper length: higher
displacement maximum stresses
Migliorati In- 4 kinds Bone characteristics, MI de- Cortical Dependence btw pitch and MIT PS
et al. [41] vitro signs, POT, MIT thickness POT correlated to MIT, cortical thickness, bone
Bone density density
ehreli et al. In- 72 1.4;7 mm Self-drilling vs. self-tapping Insertion 2 MIs: no differences PS
[42] vitro torque Self-drilling implants: higher bone implant
Periotest contact
Son et al. [43] CS 140 1.6;8 mm Self-drilling vs. self-tapping Success rate, Both techniques: high stability in the Mx bone PS
Torque, Self-drilling with root contact: greater mobility
Periotest,
Root contact,
Mobility
Cunha et al. In- 1.6;8 mm Mechanical interlocking btw Insertion No significant difference btw 2 groups PS
[44] vitro MI and B torque, POT
2 types self-drilling MI
Araghbidika- In- 64 1.6;6 mm 4 insertion angles POT 90 insertion angle; highest PS PS
shani et al. vitro Shear test 9045 : increased shear strength
[45] 30 : reduced PS

MI-#: the number MIs using in the study; MI-cha: MI characteristics (MI diameter, length, brand); Mx: maxilla; Mn: mandible, btw: between; CS:
clinical study; PS: primary stability; MS: mechanical stability; LS: long-term stability; MIT: maximum insertion torque, POT: pull out test.

microimplants, miniscrews, miniplate, TADs, and skeletal
anchorages. In 2010, the only 5.9% was counted as SAA;
however, the percentage of SAA was doubled up to 9.7% until
2012. The SAA percentage has been maintained above 10.0%
both 2015 and 2016, following little depression during 2013
2014 (Fig. 1). Overall, 87.8% of SAA used MIs such as micro-
implants, miniscrews, and miniplate as research materials,
while only 12.2% was on other types of skeletal anchorage such
as mini-plates and borne-borne expanders (Fig. 2). During the
time period, AJO-DO published 33.4% of SAA (126 out of 377),
followed by JCO (20.6%,), AO (19.6%), EJO (13.3%), KJO (11.4%)
and AOJ (1.6%).
SAA was sub-grouped by research types; original research
group of SAA was 60.5% with 31.8% case report and 7.7% other
research types such as clinicians corner and brief reports
(Fig. 3). Composition of research types was various per each
journal; 100% of EJO, 87.8% of AO, 72.1% of KJO, 63.5% of AJO- DO
and 33.3% of AOJ included original researches. JCO presented
mainly case reports and other research types, as monthly peer-
reviewed journal covering the practical aspects of orthodon-
tics and practice management.
The original research articles were re-subgrouped into
finite element analysis (FEA), in-vitro, in vivo and clinical
study. FEA is a computerized method for predicting how a
product reacts to real world forces. In-vitro is the research
doing in artificial bone or bone segment. In-vivo is the research
doing in the animal. Clinical study is the research based on the
data collected from patients such as clinical retrospective
studies, clinical prospective studies, and randomized control
trials. Clinical study showed the highest percentage every
year, ranged from 46.0% to 85.0% among original research
articles and since 2013 (Fig. 4).
3.2. Success rate and stability of OSA
26.8% of total original research articles from 2010 to 2016 were
interested in variables that affect success rate and stability of
OSA. 21 articles have explicitly presented their clinical success
rate of OSA, which were summarized in Table 1 [1636]. The
overall success rate of OSA was ranged from 79% to 98.2% for
5332 MIs among 2987 patients (Table 1).
Either clinical success or failure criteria of OSA is depending
on individual research methods, however, the main core for
the clinical decision on success/failure is based on OSA
stability. 40 articles were dealing with stability factors and
presented various evaluation methods such as maximum
insertion torque (MIT), pull out test (POT), periotest, shear test,
resonance frequency analysis (RFA), FEA, bone-to-implant

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Table 3 MI stability: AO.

Year Type MI- MI-cha Stability factors Evaluation Results Stability
# methods
Hong et al. In-vitro 100 5 designs Single-threaded: T vs. C Torque measurement N1: highest in MIT, maximum re- PS
[46] Double-threaded: T vs. C Lateral displacement moval torque, and force levels for
Shorter & wider dimen- test displacements
sion(N1)
Hong et al. In-vitro 6 1.5,6 mm Newly revised orthodontic Buccal bone thickness, N2: enhanced stability and high MS
[47] MI (N2) Mechanical stability mechanical efficiency
Tortamano CS his- 136 1.6;8 mm Periodontopathogens: P. Polymerase chain The presence of three periodonto-
et al. [48] tology intermedia, A. actinomy- reaction pathogens around MIs: not associ-
cetemcomitans, and P. ated with mobility
gingivalis
Jang et al. FEA 3 spike Biomechanical effects of FEA models More homogeneous distribution of PS
[49] lengths washer designed MI bone stress and less displacement of
MIs
Heo et al. [50] In-vitro 30 7 mm MIs: T vs. C Total insertion energy Angled-predrilling insertion of MIs PS
Angled-predrilling depth (TIE), MIT, inclination into thick cortical bone: T MIs_ better
of the time-torque choice due to higher MIT and similar
graph (INC) TIE values
Lee et al. [51] FEA Placement angle POT Placement perpendicular to cortical PS
Direction of orthopedic FEA models bone
force Less than 60 :reduction in stability
Nienkemper In-vitro 110 Resonance frequency RFA Feasible method PS
et al. [52] analysis (RFA) for mea- Periotest
suring MI stability
Nienkemper CS 19 2;9 mm Change of MI stability over During week 3 and 4: decreased LS
et al. [53] initial healing period stability
After 4 weeks: steady stability
Marquezan In-vitro 52 1.4;6 mm Trabecular properties Insertion torque, MI Cancellous bone: important role in PS
et al. [54] mobility, POT PS
Sarul et al. CS 6 mm vs. MI length Long term success rate 8 mm MI: more stable than 6 mm MI LS
[55] 8 mm

MI-#: the number MIs using in the study; MI-cha: MI characteristics (MI diameter, length, brand); Mx: maxilla; Mn: mandible, btw: between; CS:
clinical study; PS: primary stability; MS: mechanical stability; LS: long-term stability; MIT: maximum insertion torque, POT: pull out test; T:
tapered; C: cylindrical.

contact (BIC), and scanning electron microscopy (SEM);
stability was conceptually divided into primary stability (PS),
late stability (LS) and mechanical stability (MS) (Tables 25).
Various factors are known to affect the OSA stability and
can be grouped into patient factors, MIs design factors such as
diameter, length, surface treatment and thread shape, inser-
tion method factors including self-drilling, self-tapping,
various placement angle and insertion depth, loading factors
from different loading protocols and the amount and direction
of orthodontic force, biological factors of anatomic locations,
root proximity bone characteristics, and bone quality. There-
fore, we reviewed comprehensively and summarized the
useful content of the meaningful researches and presented in
the form of several tables as follows (Tables 25) [3776].
Patient factors for influencing the success rates or stability
were paid attention to; adolescent younger than 20 years was
analyzed as a high-risk group of skeletal anchorage success
rate through survival analysis [16]; The subjects with average
upper gonial angle had almost a 2-times higher success rate
compared with low upper gonial angle subjects [17].
Different designs were compared; Tapered type MIs had
82.9% and cylindrical type MIs showed 80.3% success rate [33];
In general, there was agreement that longer MI may provide
better stability than shorter one; 8-mm MI had higher success
rate than that of 6-mm MI (90.4% vs. 69.1%); 8mm is the
minimum optical length to guarantee higher success rate
[23,55]. 1.3mm wide miniscrew inserted in the attached
gingiva, with immediate loading showed an optimum success
rate [61].
Implantation methods were investigated; success rate of
motor-driven method was 84.6% while that of manual-driven
method was 69.2% [23]. The actual impact of different insertion
angles on miniscrew stability remains controversial. Some
suggested that MIs with perpendicular insertion angle may
have better stability while others reported MIs with 45 oblique
angle was a better choice [38,45,51,68].
The relationship between loading and stability has been
studied; some preferred immediate loading, but clinical
assessment and performance is important; a significant
stability loss was observed in the first week after implantation
for both immediate loading and late loading [20,57,60,70].
Biological factors such as anatomic location matters;
success rate in mandibular arch was lower than that of
maxillary arch (Maxilla 100.0% vs. Mandible 77.8%; Maxilla

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Table 4 MI stability: EJO.

Year Type MI-# MI-cha Stability factors Evaluation Results Stability
methods
Cho et al. [56] In- 36 1.45;7mm Direction and magni- Bone-to-implant Counterclockwise rotational moments: PS & LS
vivo tude of the rotation volume potential risk factor impairing MI stability
moment to loaded MIs
Chatzigianni In- 90 2 lengths Effect of MI length and MI deflection Implant length and diameter: influencing PS
et al. [57] vitro 2 diameters diameter parameters on implant stability only when
a high force level is applied
Lim et al. [58] CS 407 Gender, age, jaw, site, Miniscrew Initial stability depends on insertion site PS
tissue type, length and loosening and clinician experience
diameter (MI)
Uysal et al. In- 60 1.4;8 mm Effect of LED photo-bi- Resonance fre- Favorable effect on healing and attach- PS
[59] vivo omodulation therapy quency analysis ment of titanium orthodontic MIs
Trkz et al. CS 112 1.4;7 mm Drill free vs. drilling Success rates Drill- free method MI: highest success rate PS
[60] methods, for Smaller drill diameters: stability of MI in
distalization short-term
Manni et al. CS 300 1.5;9 mm Loading time and loca- Success rates 1.3 mm diameter MI inserted in attached LS
[61] 1.5;11mm tion for type V titanium gingiva and immediately loaded had the
1.3;11mm MI over 3 years most favorable prognosis
Uemura et al. In- 1.4;4 mm The ratio of pilot hole Bone- to- im- Pilot hole diameter should be between LS
[62] vivo and implant diameter plant contact, 69 and 77% of the diameter of the mini-
Periotest implant
Migliorati In- 1.8;10mm Thread shape factor Scanning elec- MIT and maximum load values of pull-out PS
et al. [63] vitro 1.6;10mm (TSF) tron microscopy test: correlation to depth of the thread of
1.7;10mm (SEM) MIT, POT the screw and TSF
Miura et al. In- 14 1.4;4 mm Low-intensity pulsed Mobility test, LIPUS: increase the boneminiscrew con- PS
[64] vivo ultrasound (LIPUS) Field emission tact and reduce the mobility of MI in
SEM growing subjects
Holberg et al. FEA 1.6;5, 7, Local bone stress in FEA model Lower effective stress values in bi-cortical PS
[65] 10mm mono vs. bi-cortically anchorage
anchored MIs Highest stress values in mono-cortical
anchorage
Yoo et al. [66] CS T:105 1.5;7 mm T MI vs. cylindrical MI Insertion torque T MI: higher initial stability PS
C:122 Removal torque Success rate and removal torque btw T and
Periotest values C: similar
Migliorati In-vi- 12 Different shaped MI MIT, POT, bone Bone characteristics: major role in MI PS
et al. [67] tro brands characteristics primary stability
CBCT
Perillo et al. FEA 1.6,8 mm Placement angle FEA model Insertion of MIs at 90 : better anchorage PS
[68] direction of force than 30, 60,120 and 150 at either direction
of force
Cha et al. [69] In- Dual- Design of MIs Strain Self-drilling dual-thread MIs: better initial PS
vitro thread MIs Insertion torque mechanical stability
Migliorati CS 81 1.8;8,10 mm Immediate loading MIs MIT Both groups: significant stability loss in the PS
et al. [70] vs. unloading MIs first week
Unloaded MI: higher torque loss than
immediate loading MI

MI-#: the number MIs using in the study; MI-cha: MI characteristics (MI diameter, length, brand); Mx: maxillary; Mn: mandible, btw: between; CS:
clinical study; PS: primary stability; MS: mechanical stability; LS: long-term stability; MIT: maximum insertion torque, POT: pull out test; T:
tapered; C: cylindrical.

93.4% vs. Mandible 70.4%) [24,26]; MIs in palatal area have high
success rate above 95% [25,30]. Bone properties such as cortical
bone thickness and mineral bone density, trabecular number
were investigated [54,67].
This review, on account of space consideration, could not
cover the rest of research topics such as challenging clinical
modalities/protocols.
4. Conclusions
Steady stream of publication with skeletal anchorage comes 6
10% in the major orthodontic journals. Overall success rate of
OSA was above 80%; however, unceasing many-sided efforts
for improving OSA stability have been presented in SAA.

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Table 5 MI stability: KJO.

Year Study Mi_# MI-cha Stability factors Evaluation Result Stability
design methods
Cho et al. In- 16 C-implant Different pilot-drilling Maximum torque The effect of the manual pilot-drilling MS
[71] vitro methods value, total energy method on energy usage: similar to
that of motor-driven pilot-drilling
method
Baek et al. FEA 1.2;6.5mm Mandibular deformation FEA The maximum peri-orthodontic mini- LS
[72] under clenching implant compressive strain needed
additional orthodontic traction force
to the MI for stability
Karmarker In-vivo 36 machined Surface anodization PIT and PRT Anodization of orthodontic MIs may PS
et al. [73] vs. anod- enhance their early-phase retention
ized MIs capability
Lee et al. FEA CT 2.2;7.0mm The effect of bite force on Five Finite element Placement of MIs between the 2nd PS
[74] MI by placement site, in- models premolar and 1 st molar at 45 to the
sertion angle and loading cortical bone reduces the effect of bite
direction force on MIs.
Cho et al. In-vivo 32 16 ion-im- Biologic stability of plasma Insertion torque, Plasma ion-implanted miniscrews: LS
[75] planted ion-implanted miniscrews mobility, bone im- similar biologic characteristics to SLA
and16 SLA plant contact, bone miniscrews
MI volume ratio
Katic et al. In- 100 ten types of Geometrical design char- Maximum inser- The MIT values can be controlled by PS
[76] vitro cylindrical acteristics of MI tion torque choosing an implant diameter and
self-drilling lead angle of the thread
MI

MI-#: the number MIs using in the study; MI-cha: MI characteristics (MI diameter, length, brand); Mx: maxilla; Mn: mandible, btw: between; PS:
primary stability; MS: mechanical stability; LS: long-term stability; PIT: peak insertion torque; PRT: peak removal torque.

[10] Reynders R, Ronchi L, Bipat S. Mini-implants in orthodontics: a

Conflict of interest
We declare that there is no conflict of interest in this paper.
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