ORIGINAL ARTICLE

Factors affecting the clinical success of screw

implants used as orthodontic anchorage
Hyo-Sang Park,a Seong-Hwa Jeong,b and Oh-Won Kwonc
Daegu, Republic of South Korea

Introduction: The purposes of this study were to examine the success rates and find factors affecting the
clinical success of screw implants used as orthodontic anchorage. Methods: Eighty-seven consecutive
patients (35 male, 52 female; mean age, 15.5 years) with a total of 227 screw implants of 4 types were
examined. Success rates during a 15-month period of force application were determined according to 18
clinical variables. Results: The overall success rate was 91.6%. The clinical variables of screw-implant
factors (type, diameter, and length), local host factors (occlusogingival positioning), and management factors
(angle of placement, onset and method of force application, ligature wire extension, exposure of screw head,
and oral hygiene) did not show any statistical differences in success rates. General host factors (age, sex) had
no statistical significance. Mobility, jaw (maxilla or mandible), and side of placement (right or left), and
inflammation showed significant differences in success rates. Mobility, the right side of the jaw, and the
mandible were the relative risk factors in the logistic regression analysis when excluding mobility,
inflammation around the screw implants was added to the risk factors. Conclusions: To minimize the failure
of screw implants, inflammation around the implant must be controlled, especially for screws placed in the
right side of the mandible. (Am J Orthod Dentofacial Orthop 2006;130:18-25)

A
nchorage control is an important factor in the The success of dental implants has been studied
success of orthodontic treatment. There have extensively. Miniscrew or microscrew implants, how-
been many attempts to devise suitable anchor- ever, used as orthodontic anchorage should be loaded
age methods, including intraoral and extraoral appli- early to reduce treatment time and should be removed
ances. All intraoral appliances, however, show some after treatment. In addition, microscrew implants are
loss of anchorage. Extraoral appliances do not provide normally placed below or above the roots or between
reliable anchorage without patient compliance. the roots of the teeth, or in the palatal or retromolar
When using skeletal anchorage such as osseous area, whereas dental implants are placed in the edentu-
dental implants, miniplates,1 miniscrews,2,3 or micro- lous ridges. Patients receiving dental implants are
screws,4-7 clinicians can expect reliable anchorage generally older than patients who have them for orth-
without patient compliance. Among these anchorage odontic purposes. Therefore, factors affecting the clin-
devices, microscrew implants have increasingly been ical success of dental implants might not be associated
used for orthodontic anchorage because of their abso- with miniscrew or microscrew implants for orthodontic
lute anchorage, easy placement and removal, and low anchorage. Miyawaki et al8 and Cheng et al9 studied the
cost. The small size of microscrew implants allows stability of screw implants for orthodontic purposes.
These studies mostly dealt with factors affecting the
them to be placed into bone between the teeth, thus
stability of miniscrews (over 1.5 mm in diameter) and
expanding their clinical applications.4-7 With more
miniplates. The use of microscrew implants has now been
patients treated with screw implants as anchorage, their
expanded, but there are still many unknown factors that
stability is gathering attention.
could affect the clinical success of miniscrew or micro-
screw (less than 1.2 mm in diameter) implants.
From the Department of Orthodontics, School of Dentistry, Kyungpook The purposes of this study were to find factors
National University, Daegu, Republic of Korea.
a
Assistant professor. related to the clinical success of miniscrew and micro-
b
Research assistant. screw implants and to examine the success rates of
c
Professor. various types of microscrew and miniscrew implants.
Reprint requests to: Dr Hyo-Sang Park, Department of Orthodontics, School of
Dentistry, Kyungpook National University, 101 Dongin-2-Ga, Daegu, Republic
of Korea, 700-422; e-mail, parkhs@knu.ac.kr.
MATERIAL AND METHODS
Submitted, July 2004; revised and accepted, November 2004. The sample consisted of 87 consecutive patients (35
0889-5406/$32.00
Copyright 2006 by the American Association of Orthodontists. male, 52 female; mean age, 15.5 years; SD, 8.3 years)
doi:10.1016/j.ajodo.2004.11.032 who received miniscrew or microscrew implants as
18
American Journal of Orthodontics and Dentofacial Orthopedics Park, Jeong, and Kwon 19
Volume 130, Number 1

Table I. Success rate, number of patients and implants,

and sizes of implants
Type of miniscrew or microscrew implant

A B C D

Success rate (%) 84.2 93.6 89.1 80.0

Patients (n) 10 67 16 4
Screw implants (n) 19 157 46 5
Success (n) 16 147 41 4
Size of screws (mm)
Diameter 1.2 1.2 1.2 2.0
Length (n) 5 (19) 10 (10) 10 (7) 15 (2)
8 (77) 8 (4) 14 (1)
6 (70) 7 (2) 12 (1)
Fig 1. Four types of screw implants used in study. 6 (15) 10 (1)
4 (18)

P .154, Fisher exact test.

orthodontic anchorage. The patients were informed of
the advantages and disadvantages of this procedure.
After collecting informed consent from the patients, the Clinical variables
implants were placed. To prevent examiner bias, 18 clinical variables
Four types of screw implants (total, 227) were used were investigated by the same doctor (H-S.P.). The
in this study: 19 type A microscrews (Stryker Leibinger variables were divided into 3 categories: screw implant
Inc, Kalamazoo, Mich) (diameter, 1.2 mm; length, 5 factors, host factors, and management factors. Screw
mm); 157 type B microscrews (Osteomed, Addison, implant factors included type, length, and diameter of
Tex) (diameter, 1.2 mm; length, 6, 8, or 10 mm); 46 the screw implants. Host factors were related to age and
type C microscrews (Absoanchor, Dentos, Daegu, Ko- sex. Local host factors at recipient sites included jaw in
rea) (diameter, 1.2 mm; length, 4, 6, 7, 8, or 10 mm), which the screws were placed, side of screw placement
and 5 type D miniscrews (KLS-Martin, Jacksonville, (right or left), sites of placement, and occlusogingival
Fla) (diameter, 2 mm; length, 10, 12, 14, or 15 mm) positioning of the screw implants. Procedure manage-
(Fig 1, Table I). The type C microscrew implants were ment factors referred to angle of placement, method of
developed for orthodontic purposes, with special fea- force application, onset of force application, duration of
tures for attaching elastic materials. loading to screw implants, use of ligature extension,
The surgical procedure included local anesthesia, a and exposure of the screw head. Environmental man-
small vertical stab incision (3-4 mm), reflection of agement factors were oral hygiene and inflammation
flaps, a pit made with a round bur, a hole made with a around the screw implants. Mobility was checked
pilot drill, and placement of the screw implants with a during use.
screwdriver. Surgical placement of the various screws According to occlusogingival positioning of the
followed the same procedure according to previous screws, the sample was divided into 4 groups: lower
reports.5-7 The screws were placed and checked by 1 oral mucosa (screws in the lower oral mucosa and deep
doctor (H-S.P.). The screw implants were placed at 30 in the vestibule), upper attached gingiva (placed in the
to 40 angles to the long axes of the teeth in the upper attached gingival zone), upper oral mucosa-low
maxillary arch and at 10 to 20 angles in the mandib- (placed in the upper oral mucosa up to 3 mm from
ular posterior area. The screw implants in the retromo- the mucogingival line), and upper oral mucosa-high
lar area and the distobuccal bone to the mandibular (placed high in the upper vestibule) (Fig 2). The lower
second molars were placed at 90 to the bone surface. oral mucosa and the upper oral mucosa-high groups had
The reason for placing the screw implants at those freely moving soft tissues at the site of placement, and
angulations was to reduce root contact by the screw the upper oral mucosa-low group had partly moving
implants without reducing the length of the screw. A soft tissues around the screw implants. The upper
long screw might have increased stability, and an attached gingiva group had firmly attached gingivae
angled screw provides more bone contact than a screw around the screw implants; this group included screw
placed perpendicular to the bone. Just after placement, implants in the palatal alveolar area.
the initial stability of the screw implant was checked; To assess the effect of site of placement on success,
there was no sign of mobility. because bone density and cortical bone thickness vary,
20 Park, Jeong, and Kwon American Journal of Orthodontics and Dentofacial Orthopedics
July 2006

Fig 2. Occlusogingival position of micro-implant: A, upper oral mucosa-high; B, upper oral

mucosa-low; C, upper attached gingiva; D, lower oral mucosa.

placement sites were examined and divided into 5 implants. If oral hygiene deteriorated, the patient was
groups: (1) retromolar area, distobuccal to the lower reinstructed to improve hygiene.
second molar (LR and LD7), (2) buccal alveolar bone Mobility was checked with cotton tweezers at 5 to
between the lower first and second molars (L67), (3) 8 months after placement. There were 3 groups: yes
upper and lower anterior area (A), (4) buccal alveolar (mobile), no (not mobile), and unknown (impossible to
bone between the upper second premolar and the first check because of overlying soft tissue). If there was any
molar, and between the upper first and second molars discernible mobility, the screw implant was counted in
(U56 and U67), and (5) upper palatal alveolar bone mobile group.
between the first and second molars (UP) (Fig 3). Screw implants that were maintained in the bone to
Three angulations were used: 10 to 203, 30 to 40, the end of treatment or to intentional removal regard-
and 90. There were 4 methods of force application, less of mobility were considered successful. If the
with less than 200 g of force applied by (1) power screw implants loosened during treatment, they were
chain, (2) Super thread (Rocky Mountain Orthodontics, considered to have failed.
Denver, Colo), (3) nickel-titanium coil spring, and
(4) ligature tie-back. The sample was divided into 2
groups according to the ligature wire extension: yes or Statistics
no. To attach the elastic materials, the ligature exten- The overall success rate and the success rates for
sion was connected to the neck of the screw implants the type of screw implant and other clinical variables
when the screw head was expected to be covered by were calculated.
soft tissue. The exposure of the screws was either open To compare the differences of the levels of success
or closed. If the head of screw was exposed in the according to age, onset of force, duration of force
mouth, the patients were included in the open group. application, and length of the screw implants, the
Otherwise, they were included in the closed group. Student t test was used. To compare the differences in
To check the effect of oral hygiene on success, the the success rate according to the classification of each
amount of food debris and plaque accumulation on the clinical variable, the chi-square or Fisher exact test was
tooth surfaces were assessed; the sample was divided performed with a statistical analysis program (version
into 3 groups: good, fair, or poor. Inflammation around 1.0, SPSS, Chicago, Ill). Logistic regression analysis
the screw implant was checked in the following cate- was performed to estimate the influence of each factor
gories: yes or no. Redness or swelling around the neck on failure. The odds ratio of each factor for failure of
of the screws was a sign of inflammation. Each patient the screw implants was calculated. The odds ratio
was instructed to use a tooth brush to clean the teeth represents the proportionate risk for failure of screw
and a compressed water spray to clean the screw implants.
American Journal of Orthodontics and Dentofacial Orthopedics Park, Jeong, and Kwon 21
Volume 130, Number 1

Fig 3. Sites of placement: A, retromolar area distobuccal to mandibular second molar; B, buccal
alveolar bone between mandibular first and second molars, and buccal alveolar bone between
maxillary second premolar and first molar, and between maxillary first and second molars;
C, maxillary and mandibular anterior area; D, maxillary palatal alveolar bone between first and
second molars.

RESULTS icance. There was no significant correlation in success

The overall success rate was 91.6% for all screw rate according to the method of force application or
implants (208 of 227 screws) with a mean period of placement angle. For environmental management fac-
force application of 15 months. When the screw im- tors, screw implants with inflammation showed signif-
plants failed, new ones were placed into a neighboring icantly less success.
area. Eleven of 19 screws that failed were replaced and Some screw implants showed fracturing during
were successful to the end of treatment. placement and removal. A total of 8 screws were
The success rates for the types of screw implants were broken, 3 during placement and 5 during removal.
84.2 % for type A, 93.6% for type B, 89.1% for type C, Seven of the 8 fractured screws were type B, and the
and 80% for type D. There were no significant differences other was a type D miniscrew.
in the success rates between the types of screw implants Screw implants with mobility and unknown sam-
(P .154), although the success rates for types B and C ples showed significantly less success than those with-
were higher than for types A and D (Table I). There out mobility.
were no statistically significant differences in the suc- The odds ratios (relative risk) for screw implant
cess rates between diameter and length of the screws. failure with mobility and unknown were 0.041 and
For host factors, there were no significant differ- 0.167, respectively. The odds ratios of failure in the
ences according to age and sex (Tables II and III). For right side and in the mandible were 0.187 and 0.203,
the local host factor, the screw implants placed in the respectively (Table IV). Excluding the mobility vari-
maxilla showed a significantly higher success rate than ables in the logistic regression model, the odds ratios
those placed in the mandible (Table III). The left side were 0.168 for screws on the right side, 0.187 for
had significantly higher success than the right side. screws in the mandible, and 0.208 for implants with
For procedure management factors, the screw heads inflammation around them (Table V).
covered by overlying soft tissue showed higher success
than the exposed screw heads in the oral mucosa, DISCUSSION
although it was not statistically significant. The screw Screw implants can fail for various reasons, as was
implants in the UP showed higher success than those in found with dental implants.10 The causes of dental
other locations, although there was no statistical signif- implant failure include host factors (osteoporosis and
22 Park, Jeong, and Kwon American Journal of Orthodontics and Dentofacial Orthopedics
July 2006

Table II. Means and standard deviations of clinical Table III.

Success rate and number of screw implants
variables in success and failure groups according to clinical variables
Success Failure Success Success/total Significance
(n 208) (n 19) rate screw (chi-square or
Significance Clinical variable (%) implants (n) Fisher exact)
Clinical variable Mean SD Mean SD (Student t test)
Diameter of screw .357
Length of screw 1.2 mm 91.9 204/222
(mm) 7.06 1.74 6.58 2.09 .257 2.0 mm 80 4/5
Age (y) 19.7 7.31 17.59 6.66 .227 Sex .21
Onset of force Male 88.76 79/89
(wk) 3.93 2.84 4.16 3.53 .741 Female 93.48 129/138
Duration of force Jaw of placement .01
(mo) 15.08 6.16 3.40 4.08 .00 Maxilla 96.0 119/124
Mandible 86.4 89/103
Side of placement .03
uncontrolled diabetes, smoking, and parafunctional Right 86.3 101/117
Left 97.3 107/110
habits), surgical factors of improper surgical technique,
Site of placement .059
and management factors. Among these factors, smok- LR and LD7 81.8 27/33
ing and other host factors were not evaluated in this L67 90.5 57/63
study because the sample comprised children and A 81.8 9/11
young adults. The effects of these factors on failure of U56 and U67 95.4 103/108
UP 100 12/12
screw implants, however, should be elucidated in a
Occlusogingival position .45
future study. Lower oral mucosa 88.4 76/86
Surgical factors include improper surgical tech- Upper attached
niques such as lack of initial stability, overheating gingiva 91.2 31/34
during placement, and the fitness of the pilot hole to the Upper oral
mucosa-low 91.5 65/71
diameter of the screw implant. In this study, because all
Upper oral
screw implants were placed by same doctor with the mucosa-high 100 23/23
same procedure, the effect of the surgical factors on the Angle of placement .95
clinical success of the screw implants was not evalu- 10-20 91.0 61/67
ated. However, by following this surgical procedure, 30-40 95.2 100/105
90 85.2 46/54
clinicians might have acceptable success in practice.
Method of force
Management factors include poor home care, in- application .26
flammation or infection, oral hygiene, and excessive Power chain 83.3 5/6
load. An earlier study found that 6 of 12 failed screw Super thread 88.8 95/107
implants failed within 2 months after placement.11 The Nickel-titanium coil
spring 94.6 106/112
reasons for failure might be errors during the surgical
Ligature tie-back 100 2/2
procedure. The remaining 6 screw implants failed Ligature extension .77
between 2 and 10 months, and the cause might be Yes 93.8 45/48
management error. This might indicate that surgical No 91.1 163/179
and management procedures are both important for Exposure of screw head .06
Closed 94.6 123/130
screw implant success.
Open 87.6 85/97
Because this study is a new field, we know little Oral hygiene .40
about factors that affect the rates of success of screw Good 100 18/18
implants. Therefore, in this study, we wanted to include Fair 91.2 125/137
as many factors as possible. Screw implant factors, host Poor 90.3 65/72
Inflammation .05
factors including local host factors at recipient sites,
Yes 84.4 65/77
and procedure and environmental management factors No 95.3 143/150
were evaluated. Among them, significant differences Mobility .00
were found in local host and management factors. Yes 75.6 34/45
The factors associated with the failure of screw No 98.6 137/139
Unknown 86.0 37/43
implants were mobility, side, and jaw of placement.
Screw implants on the right side of the jaw had a higher Statistics: Chi-square or Fisher exact test.
failure rate, and the mandible had a higher failure rate
American Journal of Orthodontics and Dentofacial Orthopedics Park, Jeong, and Kwon 23
Volume 130, Number 1

Table IV.Odds ratios for failure of 227 screw implants lateral forces. Therefore, minimal mobility can be
including mobility allowed in orthodontic screw implants. A study
showing the reintegration of titanium implants after
Log odds
Odds P mechanical loosening14 and the speculation of the
Clinical variable Estimate SE ratio value 95% CI possible success of implants with rotational mobility
Mobility of screws
without bacterial infection after delayed loading15
(mobile) 3.203 0.830 0.041 .000 0.008-0.207 might support this. The nature of screw-implant
Mobility of screws removal after treatment can expand the boundaries of
(unknown) 1.792 0.873 0.167 .040 0.030-0.922 success to screw implants showing minimally dis-
Side of placement
cernible mobility.
(right) 1.678 0.681 0.187 .014 0.049-0.709
Jaw of placement The left side had higher success than the right. This
(mandible) 1.596 0.681 0.203 .019 0.053-0.769 might be explained by better hygiene on the left side of
the dental arch by right-handed patients, who are most
of the population.16 Better hygiene could reduce in-
Table V. Odds ratios for failure of 227 screw implants flammation around the screw implants.
excluding mobility The mandible was expected to have a higher suc-
Log odds
cess rate because it has a thicker and more dense
Odds P cortical bone than the maxilla.17,18 The results, how-
Clinical variable Estimate SE ratio value 95% CI ever, were the opposite of our expectations. The as-
Side of placement sumed reasons might be overheating of the bone during
(right) 1.783 0.666 0.168 .007 0.046-0.619 drilling and irritation during chewing. Because the
Jaw of placement mandible has denser bone, there is a greater chance of
(mandible) 1.675 0.581 0.187 .004 0.060-0.584 generating heat greater than 47C, which is the critical
Inflammation 1.572 0.540 0.208 .004 0.072-0.598
temperature that can cause bone damage.19,20 In addi-
tion, screw implants placed in the posterior part of the
mandible can easily be irritated by food during chew-
than the maxilla. Excluding mobility, inflammation ing. These factors might negatively affect the clinical
around the screw implants was added as a relative risk success of screw implants. The reduced success of the
factor. screw implants in the LR and LD7 group might support
In dental implants, mobility due to lack of osseointe- this assumption. The mandibular posterior area was
gration is a sign of failure.10 For screw implants used as also considered a risk site in a study by Cheng et al.9 To
orthodontic anchorage, however, mobility might not reduce heat generation, copious irrigation with saline
represent failure. We checked the mobility of the screw solution was recommended.21 Excessive pressure of the
implants 5 to 8 months after placement, during loading. drill on the bone surface increased heat. Worn drills
Even though minimal mobility was a risk factor of also produced more heat.21
failure, 34 of 45 minimally mobile screw implants As discussed in many previous studies of dental
were successful. By using comparatively low force implants, peri-implantitis is an important factor in
(less than 200 g), the screw implants that showed dental-implant failure.22 Our results are similar to
minimal mobility could be set as anchorage. If heavy previous studies. Inflammation can damage the bone
force is applied to screw implants, their mobility might surrounding the neck of screw implants. With progres-
be increased, and they can fail by not becoming suffi- sive damage of the cortical bone, screw implants can
ciently osseointegrated to the bone. In the animal studies be endangered.22,23 To ensure success, it is important to
of Ohmae et al12 and Deguchi et al,13 stable screw prevent inflammation around the screw implants. In this
implants showed osseointegration from 25% to 40%. study, oral hygiene did not affect success, but local
Deguchi et al13 postulated that less osseointegration inflammation around the screw implants did. Local
does not necessarily indicate a negative finding. When inflammation can be exaggerated not only by oral
an excessive load is applied, partly osseointegrated hygiene but also by weak nonkeratinized soft tissue
screw implants can become severely mobile and even- around the neck of the screw implant. A recent study
tually fail. Screw implants, however, can be maintained showed that nonkeratinized mucosa was a risk factor
with minimal mobility when applied force is light. for miniscrews.9 The highest success rate (100%) of
Dental implants are usually loaded in all directions in screw implants placed in the maxillary palatal area
addition to vertical occlusal forces, but orthodontic where there is thick keratinized mucosa might support
screw implants are usually loaded with unidirectional this. In addition, the screw implants in closed group, in
24 Park, Jeong, and Kwon American Journal of Orthodontics and Dentofacial Orthopedics
July 2006

which the head of screw was covered by soft tissue, had seemed to be insufficient to evaluate the effect of each
greater success than the open group, although it was not factor with statistical significance.
statistically significant. The overlying soft tissue on the As mentioned earlier, the success rate for screw
head of screw implants might be a barrier against implants in previous studies varied between 83.9% and
inflammation. We instructed patients to clean the screw 93.3%.8,9,11 These rates might be explained by the
implants with compressed water spray. Once inflam- various types of screw implants, different surgical
mation arose, it tended to persist in nonkeratinized techniques, and varying management protocols. There-
mucosa areas. Francetti et al24 compared the effects of fore, a direct comparison of success rates might not be
chlorhexidine spray and mouthwash on controlling possible. An important aspect, however, is that by
plaque after implant surgery. They found that the removing every possible cause of failure that was
plaque index improved, but there was no difference discussed in each study, clinicians might be able to
between the 2 methods. Therefore, water spray on increase the chances of success.
screw implants might be an effective method to control In this study, the overall success rate of screw
inflammation. implants used as anchorage was 91.6% with a mean
There was no significant difference in the success time of 15 months of force application. Including the
rate with respect to the onset of force application. This replaced the screw implants, the success rate would be
might indicate that immediate loading of screw im- almost 96.5%. In a study by Miyawaki et al,8 all
plants is possible. An animal experiment proved that 1.0-mm diameter screws failed, but the 1.5-mm and
there was osseointegration after immediate loading of 2.3-mm diameter screws showed no significant differ-
the screw implants and suggested immediate loading to ence with success rates of 83.9% and 85%, respec-
reduce the treatment time.25 Recent reports also recom- tively. Our results, in conjunction with the study by
mended immediate loading of screw implants.6 There- Miyawaki et al,8 indicate that screws with diameters of
fore, screw implants can be loaded immediately after 1.2, 1.5, and 2.3 mm have acceptable levels of success.
placement without a discernible deterioration of stability. The 1.0-mm diameter screw, however, had too much
There was no significant difference in the failure failure clinically even though animal studies showed
rates between the 3 placement angles of the screw osseointegration.12,13 From a clinical point of view,
implants. The reason for placing the screw implants at smaller diameter screws are easier and less traumatic to
angles to the bone surface was to allow for use of long place and use. Screw implants with a diameter over 1.2
screw implants without damaging roots. The contact mm can be recommended as orthodontic anchor screw
surface of the screw implants to the cortical bone was implants.
increased by placing them at angles. A study to eluci- The mean period of force application to the minis-
date the effects of the screw angle on the stability of the crew or microscrew implants was 15 months, which is
mandibular sagittal split osseotomy showed no differ- sufficient to provide proper anchorage in most orth-
ence in resistance to segment movement between the odontic patients. The most critical time period demand-
60 and 90 angle groups.26 Therefore, clinicians can ing anchorage control for successful orthodontic treat-
place long screw implants with angulations to bone ment is for anterior tooth retraction in extraction
surface without decreasing stability, and the capability patients. This usually takes 10 to 12 months of micro-
of using long screws might influence success posi- screw implant anchorage sliding mechanics.6 In nonex-
tively. The length of dental implants was reported to traction treatment, the distal movement of the posterior
have a positive effect on stability.27 In our study, segment can be obtained within 10 months. This is
however, the length of the screw implants did not because the posterior segment can be distalized to-
significantly affect their clinical success. Also, their gether, and not 1 tooth at a time.7 Therefore, micro-
diameter did not affect success rates, in contrast to screw implants seem to cover the critical time period
another study.8 This was caused by a small sample requiring absolute anchorage.
using 2.0-mm diameter screws. Five screw implants were fractured during the
This study was performed to screen every possible removal procedure. If there is too much osseointegra-
factor that could affect the success of screw implants. tion, clinicians might have difficulty in removing the
The sample was collected consecutively in 1 clinic, so screws, or they can fracture. There has been no study of
the study design might not have been appropriate to how much osseointegration is needed for orthodontic
assess the effect of screw diameter, length, and type on screw implants when considering the need for both
success. The other problem in this study was a small stability and easy removal. This should be elucidated in
failure rate. This small number of failures (19 of 227) a well-designed experimental model.
American Journal of Orthodontics and Dentofacial Orthopedics Park, Jeong, and Kwon 25
Volume 130, Number 1

CONCLUSIONS as anchors for orthodontic intrusion in the beagle dog. Am J

Orthod Dentofacial Orthop 2001;119:489-97.
The overall success rate was 91.6%, with a mean 13. Deguchi T, Takano-Yamamoto T, Kanomi R, Hartsfield JK Jr,
period of force application of 15 months. Therefore, Roberts WE, Garetto LP. The use of small titanium screws for
screw implants can be used for orthodontic anchorage orthodontic anchorage. J Dent Res 2003;82:377-81.
predictably and consistently in routine orthodontic 14. Ivanoff CJ, Sennerby L, Lekholm U. Reintegration of mobilized
titanium implants. An experimental study in rabbit tibia. Int
practice. Mobility, the patients right side, mandibular J Oral Maxillofac Surg 1997;26:310-5.
implant sites, and inflammation were associated with 15. Esposito M, Hirsch J, Lekholm U, Thomsen P. Differential
screw implant failure in this study. To minimize failure, diagnosis and treatment strategies for biologic complications
clinicians should attempt to reduce inflammation around and failing oral implants: a review of the literature. Int J Oral
the screw implants, especially for screws placed on the Maxillofac Implants 1999;14:473-90.
16. Tezel A, Orbak R, Canakci V. The effect of right or left-
right side in the mandible. handedness on oral hygiene. Int J Neurosci 2001;109:1-9.
17. Champy M, Pape H, Gerlach KL, Lodde JP. Mandibular fracture.
REFERENCES In: Kruger E, Schilli W, editors. Oral and maxillofacial trauma-
1. Umemori M, Sugawara J, Mitani H, Nagasaka H, Kawamura H. tology. Vol. 2, Chicago: Quintessence; 1986. p. 19-43.
Skeletal anchorage system for open bite correction. Am J Orthod 18. Park HS. An anatomical study using CT images for the implan-
Dentofacial Orthop 1999;115:166-74. tation of micro-implants. Korean J Orthod 2002;32:435-41.
2. Creekmore TD, Eklund MK. The possibility of skeletal anchor- 19. Eriksson AR, Albrektsson T. Temperature threshold levels for
age. J Clin Orthod 1983;17:266-9. heat-induced bone tissue injury: a vital-microscopic study in the
3. Costa A, Raffaini M, Melsen B. Miniscrews as orthodontic rabbit. J Prosthet Dent 1983;50:101-7.
anchorage: a preliminary report. Int J Adult Orthod Orthognath 20. Tehemar SH. Factors affecting heat generation during implant
Surg 1998;13:201-9. site preparation: a review of biologic observations and future
4. Kanomi R. Mini-implant for orthodontic anchorage. J Clin considerations. Int J Oral Maxillofac Implants 1999;14:
Orthod 1997;31:763-7. 127-36.
5. Park HS. The skeletal cortical anchorage using titanium micro- 21. Matthews LS, Hirsch C. Temperatures measured in human
screw implants. Korean J Orthod 1999;29:699-706. cortical bone when drilling. J Bone Joint Surg Am 1972;54:
6. Park HS. The use of micro-implant as orthodontic anchorage. 297-308.
Seoul, Korea: Narae; 2001. 22. Zitzmann NU, Berglundh T, Ericsson I, Lindhe J. Spontaneous
7. Park HS, Kwon TG, Sung JH. Nonextraction treatment with progression of experimentally induced peri-implantitis. J Clin
microscrew implants. Angle Orthod 2004;74:539-49. Periodontol 2004;31:845-9.
8. Miyawaki S, Koyama I, Inoue M, Mishima K, Sugahara T, 23. Ericsson I, Berglundh T, Marinello C, Liljenberg B, Lindhe J.
Takano-Yamamoto T. Factors associated with the stability of Long-standing plaque and gingivitis at implants and teeth in the
titanium screws placed in the posterior region for orthodontic dog. Clin Oral Implants Res 1992;3:99-103.
anchorage. Am J Orthod Dentofacial Orthop 2003;124:373-8. 24. Francetti L, Del Fabbro M, Basso M, Testori T, Taschieri S, Weinstein
9. Cheng SJ, Tseng IY, Lee JJ, Kok SH. A prospective study of the R. Chlorhexidine spray versus mouthwash in the control of dental
risk factors associated with failure of mini-implants used for plaque after implant surgery. J Clin Periodontol 2004;31:857-62.
orthodontic anchorage. Int J Oral Maxillofac Implants 2004;19: 25. Melsen B, Costa A. Immediate loading of implants used for
100-6. orthodontic anchorage. Clin Orthod Res 2000;3:23-8.
10. Ashley ET, Covington LL, Bishop BG, Breault LG. Ailing and 26. Uckan S, Schwimmer A, Kummer F, Greenberg AM. Effect of
failing endosseous dental implants: a literature review. J Con- the angle of the screw on the stability of the mandibular sagittal
temp Dent Pract 2003;4:35-50. split ramus osteotomy: a study in sheep mandibles. Br J Oral
11. Park HS. Clinical study on success rate of microscrew implants Maxillofac Surg 2001;39:266-8.
for orthodontic anchorage. Korean J Orthod 2003;33:151-6. 27. Himmlova L, Dostalova T, Kacovsky A, Konvickova S. Influ-
12. Ohmae M, Saito S, Morohashi T, Seki K, Qu H, Kanomi R, et al. ence of implant length and diameter on stress distribution: a finite
A clinical and histological evaluation of titanium mini-implants element analysis. J Prosthet Dent 2004;19:20-5.