ORIGINAL ARTICLE

Finite element analysis of miniscrew implants

Introduction: The miniscrew has been developed and effectively used as orthodontic anchorage, but current
studies of its usage are insufficient to provide information about the underlying mechanical mechanisms. The
aim of this study was to investigate the roles of bone quality, loading conditions, screw effects, and implanted
depth on the biomechanics of an orthodontic miniscrew system by using finite element analysis. Methods: A
3-dimensional model with a bone block integrated with a miniscrew was constructed to simulate various
cortex thicknesses, cancellous bone densities, force magnitudes and directions, screw diameters and
lengths, and implanted depths of miniscrews. Results: Both stress and displacement increased with decreasing
cortex thickness, whereas cancellous bone density played a minor role in the mechanical response. These 2
indexes were linearly proportional to the force magnitude and produced the highest values when the force
was perpendicular to the long axis of the miniscrew. A wider screw provided superior mechanical advantages.
The exposed length of the miniscrew was the real factor affecting mechanical performance. Conclusions: The
screw diameter was the dominant factor for minscrew mechanical responses. Both bone stress and screw dis-
placement decreased with increasing screw diameter and cortex thickness, and decreasing exposed length of
the screw, force magnitude, and oblique loading direction. (Am J Orthod Dentofacial Orthop 2012;141:468-76)

A
nchorage control plays a crucial role in ortho- and lower costs.6-8 However, some clinical studies have
dontic treatment. It can maximize desired tooth reported a relatively high failure rate in miniscrews
movement and minimize undesired side ef- used for orthodontic anchorage. Factors identified as
fects.1 To obtain stronger anchorage, the orthodontic causing failure include inflammation, infection,
miniscrew was developed and has been used effectively nonkeratinized implant sites, and small miniscrews.9-14
as orthodontic anchorage for various types of tooth Because of the nature of the orthodontic miniscrew,
movement.2-5 Compared with conventional dental load transfer, and small size, biomechanical factors have
implants used for orthodontic anchorage, the been investigated in many studies. Previous studies have
orthodontic miniscrew, as a temporary mini-implant, of- evaluated the stability of miniscrew anchorage systems
fers many advantages, such as easier surgical procedure, with mechanical experiments, histomorphometric stud-
less trauma during insertion and removal, minimal ana- ies, and finite element simulations of the roles of screw
tomic limitations, immediate loading after implantation, geometry, bone quality, implantation conditions, and
loading effects. Many suggestions were provided to in-
a
Postgraduate student, Institute of Oral Medicine, College of Medicine, National crease the stability, such as using conical-shaped
Cheng Kung University, Tainan, Taiwan, ROC. screws,15 including abutment,16 preventing cervical
threading,17 using screws with a wide diameter,15 apply-
b
Professor, Institute of Biomedical Engineering, National Cheng Kung University,
Tainan, Taiwan, ROC.
c
Associate professor, Department of Stomatology, National Cheng Kung Univer- ing screws with a length of 9 mm,18 achieving bicortical
sity Hospital, College of Medicine and Institute of Oral Medicine, College of Med- or partial osseointegration,19 implanting in cortical bone
icine. more than 1-mm thick, 20-22 mplanting in high-density
The authors report no commercial, proprietary, or financial interest in the prod-
ucts or companies described in this article. bone,23 exploiting drill-free miniscrews,24 insertion with
Supported by the National Science Council, Taiwan, ROC, under grants NSC 93- 60 to 70 of angulation,25 securing with 5 to 10 Ncm
2320-B-006-067 and NSC 94-2320-B-006-023. insertion torque,26 and tilting the load in a buccal direc-
Reprint requests to: Jia-Kuang Liu, Department of Stomatology, National Cheng
Kung University Hospital, 138 Sheng-Li Rd, Tainan 704, Taiwan, ROC; e-mail, tion.27 However, most of these suggestions were pro-
jkliu@mail.ncku.edu.tw. vided without the support of mechanical reasoning.
Submitted, January 2011; revised and accepted, November 2011. These outcomes could depend on the model or method
0889-5406/$36.00
Copyright Ó 2012 by the American Association of Orthodontists. and should be applied with caution. Without a thorough
doi:10.1016/j.ajodo.2011.11.012 understanding of the biomechanical rationale of the
468
Liu et al 469

orthodontic miniscrew, no reliable guidelines can be that were normal and 1/2, 1/4, and 1/8 of Young’s mod-
provided for its clinical usage. The aim of this study ulus (1.3 GPa, and 650, 325, and 162.5 Mpa) of normal
was therefore to investigate the roles of bone quality, cancellous bone were studied. To determine the loading
loading conditions, screw size, and implanted depth on effect, 3 force magnitudes (2, 4, and 6 N) and force di-
orthodontic miniscrews by using finite element analysis. rections (60 , 90 and 120 ) to mimic various clinical
The hypothesis was that, with the full field of mechanical conditions were investigated. Force direction was de-
responses and the precise control of parameters in finite fined as the angle between the loading direction and
element analysis, it is possible to determine the underly- the long axis of the miniscrew, and a force direction of
ing biomechanical mechanism of miniscrews and thus 90 was the force perpendicular to the long axis of the
provide reliable usage guidelines. miniscrew (Fig 2).
To determine the screw size effect, 3 screw (outer) di-
MATERIAL AND METHODS ameters (1.2, 1.5, and 2.0 mm) and 5 screw lengths (7-15
A 3-dimensional bone block model integrated with mm at 2-mm intervals) were investigated. The screw
a miniscrew was constructed with a computer-aided de- length was measured including the screw head, which
sign program (SolidWorks; Dassault Syst
emes Solid- had a 2-mm height for all screw models. To provide in-
Works, Concord, Mass) to simulate a miniscrew formation on how deep a screw should be implanted,
implanted in bone as an orthodontic anchorage unit. various screw depths (screw length in the bone block)
The bone block, consisting of cortical and cancellous were modeled. For each screw length, the implanted
bones, was simplified to dimensions of 20 mm in length depth started at 2 mm and increased in 2-mm incre-
and width, and 15 mm in height for evaluation. The ments until the exposed screw length (screw segment
miniscrew geometry was based on the MONDEAL system above the bone block) was 3 mm (including the screw
(MONDEAL Medical Systems, Muhlheim, Germany): ie, head). For instance, the model with a 13-mm screw
the screw thread profile was an isosceles triangle 0.4 length would be implanted in the bone block at 2, 4,
mm in height and 0.16 mm along the base (Fig 1, A). 6, 8, and 10 mm.
The thread pitch was 1.0 mm. These thread dimensions
were fixed in all screw designs in this study. The model
RESULTS
was meshed automatically with 10-node tetrahedral
solid elements (Fig 1, B). The interface between the cor- Figure 3 shows the peak von Mises stress on the mini-
tex and the cancellous bone was assumed to be fully screw and the surrounding bone under 2 N, 90 force.
bonded; ie, the elements were continuous, sharing the Both compressive and tensile stresses were identified
same nodes along the interface. A node-to-node contact on 2 sides of the miniscrew, and the peak von Mises stress
condition was given on the interface between the mini- on the miniscrew was concentrated near the entrance
screw and the bone block to imitate a stage without os- point to the cortical bone, which represented a pivot
seointergration. point of the bending (Fig 3, A). For cortical bone, the
All materials in the model were homogeneous, isotro- peak stress was located on the compression side of the
pic, and linearly elastic. The miniscrew was assumed to be entrance point because of the contact between the mini-
pure titanium with a Young’s modulus of 110 GPa and screw and the cortex (Fig 3, B). The peak stress on cancel-
a Poisson’s ratio of 0.35.28 For healthy bone quality, lous bone was concentrated, again, at the entrance point
the Young’s moduli of the cortical and cancellous bones of the miniscrew, but this time on the screw’s tensile side,
were 14 GPa28 and 1.3 GPa,18 respectively, and the Pois- because of the seesaw effect (Fig 3, C).
son’s ratios were 0.3 for both. The static load along the x- In general, the stress induced on cancellous bone is
axis was applied to the head of the miniscrew and much lower than that on the cortex. In addition, the
perpendicular to its long axis to simulate the orthodontic most commonly identified structure failure in miniscrew
force. For the nodes located on the 5 exterior surfaces of anchorage systems is screw loosening. Therefore, only
the bone block, all but the superior surface where the cortex stress was examined in this study. The maximum
miniscrew entered was constrained in all degrees of free- displacement was always located at the top of the mini-
dom to simulate the boundary condition (Fig 1, B). The screw head in all models and also evaluated for stability
nodal solution of the von Mises stress in the bone and justification. For comparison among various factors in
the displacement of the miniscrew were calculated for the following analyses, a bone model with a cortex thick-
each model with the finite element analysis program. ness of 2 mm and a normal cancellous bone density im-
To justify the effect of bone quality on stress gener- planted with a miniscrew 2 mm in diameter and 13 mm
ation, 4 cortex thicknesses—0.5, 1.2, 2.0, and 3.0 mm— in length embedded at a depth of 8 mm under 2 N, 90
and 4 types of cancellous bone density with values loading was defined as the base model. The result from

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470 Liu et al

Fig 1. A, The dimensions of the base miniscrew model; B, the whole structure is meshed, loaded, and
constrained.

the base model was set as 1, and the resulting data were
expressed as ratios of values to the base model in the fol-
lowing figures.
The peak von Mises stress on the cortex increased as
the cortex thickness decreased from 3.0 to 0.5 mm under
the same loading conditions. However, these stress in-
creases were mild, less than 10%, except when the cortex
thickness was reduced from 1.2 to 0.5 mm, which in-
duced a significant stress increase of 20% to 25% for dif-
ferent densities of cancellous bone. On the other hand,
the density of the cancellous bone had a minor effect
on the cortex bone stress, no matter how thick the cortex
was. Coupling these 2 bone factors, cortex thickness and
cancellous bone density, comparisons of the peak von
Mises stress on the cortex are summarized in Figure 4,
A. In the base model, when the Young’s modulus of can-
cellous bone was reduced to one eighth of normal, the
peak von Mises stress on the cortex increased by only
3%. However, if the cortex thickness and Young’s mod- Fig 2. Various force directions applied to the head of the
ulus of cancellous bone were reduced simultaneously to miniscrew.
0.5 mm and one eighth of normal, respectively, the peak
von Mises stress increased by 34%. cancellous bone density are summarized in Figure 4, B.
The maximum displacement, occurring at the mini- In the base model, when the Young’s modulus of cancel-
screw head as stated above, was always located at the lous bone decreased to one eighth of normal, the max-
top of the miniscrew head in all models under all loading imum displacement of the miniscrews increased by
conditions. The tendencies of maximum displacement of only 4%. However, if the cortex thickness and the
the miniscrews related to cortex thickness and cancel- Young’s modulus of cancellous bone were reduced
lous bone density were similar to the results of the simultaneously to 0.5 mm and one eighth of normal,
peak von Mises stresses on the cortex. The displacement respectively, the maximum displacement of the mini-
results of the coupling effects of cortex thickness and screw increased by 27%.

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Liu et al 471

Fig 3. The stress contour plots of the sectioned base model (only the portion near the miniscrew, the
high-stress region, is shown): A, the von Mises stress distribution on the miniscrew (the displacement is
enlarged 150 times); B, the von Mises stress distribution on cortical bone (the miniscrew has been re-
moved from the structure); C, the von Mises stress distribution on cancellous bone (miniscrew and cor-
tex have been removed) (left side, compressive side; right side, tensile side).

Increasing the force magnitude resulted in a higher The miniscrew size and implanted depth effects on
peak von Mises stress on the cortex, and the peak stress the maximum von Mises stress of the cortex were also
was linearly proportional to the force magnitude. A force examined. The maximum von Mises stress on the cortex
direction of 90 showed a higher peak von Mises stress increased significantly as the diameter of the miniscrew
than force directions of 60 and 120 , and the peak decreased. For example, as the miniscrew diameter de-
von Mises stress values for 60 and 120 were almost creased from 2.0 to 1.2 mm, the maximum von Mises
the same. If the peak von Mises stress value from the stress increased more than 30 times. With the same mini-
base model was set as 1, those from force directions of screw, the maximum von Mises stress on the cortex de-
60 and 120 decreased by 13% and 15%, respectively. creased as the implanted depth increased. But as the
Figure 5, A, summarizes the effects of force factors on implant length increased, under the same implanted
the peak von Mises stress on the cortex. depth, the maximum von Mises stress on the cortex in-
The results of the force effects related to the maximum creased. Close examination of the results showed that
displacement of the miniscrews were also similar to the re- the exposed screw length (screw length above the cortex
sults from the peak von Mises stress on the cortex. Increas- or total screw length minus the implanted depth) was the
ing the force magnitude resulted in greater displacement dominant factor. For the same screw diameter, the von
of the miniscrew, and the maximum displacement of the Mises stress was almost the same when the exposed
miniscrews was also linearly proportional to the force screw length was the same, no matter how long the
magnitude. A force direction of 90 showed the highest screw was and how deep the screw was implanted. To
maximum displacement in the miniscrews, whereas the give an overview of the results of miniscrew effects,
values from 60 and 120 were almost same. If the max- the maximum von Mises stress values on the cortex
imum displacement from the base model was set as 1, were plotted against the miniscrew diameter, length,
those from force directions of 60 and 120 decreased and exposed length, as shown in Figure 6. The trend
by 14% and 12%, respectively. Figure 5, B, shows the of the maximum displacement of the miniscrew related
force effects on maximum miniscrew displacement. to the miniscrew effects was similar to that of the

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472 Liu et al

Fig 4. Bone effects with: A, the peak von Mises stress on the cortex; and B, the maximum displace-
ment of the miniscrews.

maximum von Mises stress in bone related to the mini- measureable mechanical index, imprecise parameter
screw effects. control, and the large variations among samples. On
the other hand, finite element analysis provides a more
DISCUSSION manageable and flexible approach for the evaluation of
dental biomechanics than the experimental approach.29
Finite element models Based on their numeric origin, the investigated parame-
Because of its mechanical nature, it is important to ters can be controlled more precisely, and many mechan-
understand the mechanical rationale of miniscrew usage. ical indexes can be examined at any location on the
But it would be difficult to determine the underlying bio- model to reflect the rationale of a mechanical response.
mechanical mechanisms for miniscrew applications However, the reliability of finite element analysis de-
through an experimental approach because of the limited pends on the mesh model. In this study, the mesh models

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Liu et al 473

Fig 5. Force effects with: A, the peak von Mises stress on the cortex; and B, the maximum displace-
ment of the miniscrews.

contained roughly 80,000 to 110,000 nodes and 55,000 miniscrew was implanted in the bone block in a perfect
to 80,000 elements, depending on the model conditions. condition, perpendicular to the bone surface. Finally,
The convergent criteria were set with a change in the the interface between the bone and the miniscrew was
global strain energy of less than 2%, and the element pure frictionless contact. However, these simplifications
strain energy error was less than 5%. should affect the quantitative values of the simulations,
This study had some limitations in the simulation. not the underlying mechanical mechanism.
First, the geometry of the bone block was simplified to
a rectangular block, and the material properties were as- Bone effects related to stress
sumed to be homogeneous. No soft tissue was simulated, Previous finite element analysis studies found that
although its impact would have been minor. Second, the cortex thickness determines the overall load transfer

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474 Liu et al

Fig 6. Miniscrew effects (diameter, length, and exposed length) with the maximum von Mises stress on
the cortex.

from miniscrew to bone, and the density of cancellous cortical bone (\0.5 mm) with low-density trabecular
bone plays only a minor role in resisting this force.20,27 bone. For medium- and high-density trabecular bone,
The results from our study were similar to previous this danger is not present, since bone strains always oc-
findings. There were 2 reasons for this. First, cortical cur within mild overload or adapted windows.20 In this
bone with a higher Young’s modulus resists more study, when the cortex thickness was 0.5 mm, the peak
deformation and sustains higher loads than does stress increased with both low-density (162.5 Mpa)
cancellous bone. Second, the bending mode, as and high-density (1.3 GPa) Young’s modulus cancellous
identified in the miniscrew stress, has more effect at the bone. Therefore, cortex thickness was a determining fac-
base support region, as justified by the concentrated tor of bone quality for miniscrew stability.
high base stress in the entrance region of the cortex in Thicker cortical bone increases the primary stability
Figure 3, B, than the rest of the embedded region, but might decrease the secondary stability because of
a straighter and less bent region. This could also explain excessive bone compression if the site is not adequately
the cortex thickness effect. When the cortex was thicker prepared.30 Primary stability means the initial stability
than 1.2 mm, the high base stress was distributed, and immediately after insertion of an implant, and secondary
the stress demonstrated only a mild change as the cortex stability indicates gains after osseointegration.31 Pri-
thickness changed. But as the cortex thickness was re- mary stability is important during the healing and re-
duced to 0.5 mm, it was not enough to spread the base modeling period, especially when the implant is
stress from bending, and therefore the peak stress in- immediately loaded. Secondary stability is responsible
creased more significantly. Although models with cortex for implant success after the healing period and during
thicknesses between 1.2 and 0.5 mm were not evaluated most of the loading period. For increased stability of
in this study, other studies have suggested that a cortical the miniscrew, no predrilling is required for 0.5 to 1.5-
bone thickness of 1 mm improves the success rate of mm cortical bone, perforation of cortical bone with
miniscrews; this is reasonable, based on the thickness a 1-mm round bur is used for 1.5 to 2.5-mm cortical
effects in this study.20-22 bone, and 4-mm long predrilling is recommended for
When considering the effect of bone quality on stress corticol bone more than 2.5 mm thick.30,31 In this
distribution, bone strains could reach values associated study, primary stability between the miniscrew and the
with the pathologic overload window only for thin bone block was simulated. If secondary stability was

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Liu et al 475

simulated, the interface between the miniscrew and the values of the structure among all investigated factors in
bone block was assumed to be fully bonded. The this study. Increasing the miniscrew diameter was the
situation would be complicated, so we did not most effective way to reduce the peak stress.
simulate secondary stability in this study. Some studies evaluated the miniscrew-length effect
and had inconsistent or inconclusive results.18,27 The
Force effects related to stress reason was that the screw length itself was not the
The simulated outcomes, stress and displacement, dominant factor under the bending mode. The exposed
were almost linearly proportional to the force magnitude length, the level arm of the bending moment, was the
in our study, even though a nonlinear contact interface real factor influencing stress and displacement.
was present in the model. These results were reasonable Therefore, both screw length and implanted depth of
and predictable, because the material properties in all the miniscrew should be considered. A longer
components were assumed to be linearly elastic, and miniscrew might not be able to provide extra stability if
the contact interface provided insignificant nonlinear it cannot be implanted deeply enough to reduce the
effects because of the small force applied. Nevertheless, lever arm. However, in this study, the minimum
the 6-N model had 3 times the stress in bone compared implanted depth was 3 mm, which was 1 mm over the
with the 2-N model, so a higher initial load should be cortex. Further reducing the implanted depth might
avoided. This possibly agrees with other studies that provide insufficient support to resist bending.
found no detectable mobility or loosening of miniscrews
when applying a light to moderate initial force.18,32,33 CONCLUSIONS
The peak von Mises stress on the cortex of the
Three conclusions can be derived from this study: (1)
miniscrews had the greatest values with a force direction
the quality of cancellous bone is not cruical for mini-
of 90 in this study. This force direction was a pure
screw stability as long as a minimum cortex thickness,
bending load, whereas the force directions of 60 and
1.2 mm in this study, can be achieved; (2) to reduce
120 were bending plus axial loading. A bending load
the biomechanical risk in miniscrew applications, the im-
induced much higher stress than an axial load. There-
plant site and the orientation of the miniscrew should be
fore, bone stress was mainly affected by the bending
arranged to minimize the bend effect, reducing the force
component of force, a force component perpendicular
component perpendicular to the screw axis; and (3)
to the screw axis. This supports the results derived
a wider miniscrew is helpful, but a long screw could be
from S€ utpideler et al,34 who conducted finite element
harmful if it causes a long exposed length.
analysis to evaluate the effects of the applied force angle
on supporting bone. They concluded that, once the force
deviated from vertical, it induced a horizontal compo- REFERENCES
nent that increased the stress on bone, and further in-
1. Proffit WR. Mechanical principles in orthodontic force control. In:
creasing the deviation angle significantly increased the Proffit WR, Fields HW, editors. Contemporary orthodontics. 4th ed.
stress. Barbier et al35 emphasized the importance of pre- St Louis: Mosby; 2007. p. 359-94.
venting or minimizing horizontal force on implants in 2. Kanomi R. Mini-implant for orthodontic anchorage. J Clin Orthod
their finite element analysis. Another finite element 1997;31:763-7.
3. Costa A, Raffainl M, Melsen B. Miniscrews as orthodontic anchor-
analysis study also stated that, with a load tilted in a buc-
age: a preliminary report. Int J Adult Orthod Orthognath Surg
cal direction of 45 to a mimiscrew, the stresses were re- 1998;13:201-9.
duced by 35%.27 This could also be extrapolated for the 4. Giancotti A, Arcuri C, Barlattani A. Treatment of ectopic mandib-
miniscrew system in our study. If we tilted the horizontal ular second molar with titanium miniscrews. Am J Orthod Dento-
load direction by 30 , it could reduce stress by 15%. facial Orthop 2004;126:113-7.
5. Park HS, Kwon OW, Sung JH. Micro-implant anchorage for forced
eruption of impacted canines. J Clin Orthod 2004;36:297-302.
Screw effects related to stress 6. Deguchi T, Takano-Yamamoto T, Kanomi R, Hartsfield JK Jr,
Roberts WE, Garetto LP. The use of small titanium screws for or-
Previous studies found that wider miniscrews had thodontic anchorage. J Dent Res 2003;82:377-81.
better stability, but observations of miniscrew length 7. Park HS, Kwon TG. Sliding mechanics with microscrew implant an-
were inconsistent.15,27 This could again be easily chorage. Angle Orthod 2004;74:703-10.
explained by the bending mode of the loaded miniscrew. 8. Cope JB. Temporary anchorage devices in orthodontics: a para-
Under bending, based on the second moment of inertia digm shift. Semin Orthod 2005;11:3-9.
9. Miyawaki S, Koyama I, Inoue M, Mishima K, Sugahara T,
of a cylinder, the peak stress is inversely proportional to Takano-Yamamoto T. Factors associated with the stability of tita-
the third power of the diameter. Therefore, the miniscrew nium screws placed in the posterior region for orthodontic anchor-
diameter was the dominant factor in governing the stress age. Am J Orthod Dentofacial Orthop 2003;124:373-8.

American Journal of Orthodontics and Dentofacial Orthopedics April 2012  Vol 141  Issue 4
476 Liu et al

10. Cheng SJ, Tseng IY, Lee JJ, Kok SH. A prospective study of the 23. Wang Z, Zhao Z, Xue J, Song J, Deng F, Yang P. Pullout strength of
risk factors associated with failure of mini-implants used for or- miniscrews placed in anterior mandibles of adult and adolescent
thodontic anchorage. Int J Oral Maxillofac Implants 2004;19: dogs: a microcomputed tomographic analysis. Am J Orthod Den-
100-6. tofacial Orthop 2010;137:100-7.
11. Papadopoulos MA, Tarawneh F. The use of miniscrew implants for 24. Kim JW, Ahn SJ, Chang YI. Histomorphometric and mechanical
temporary skeletal anchorage in orthodontics: a comprehensive analyses of the drill-free screw as orthodontic anchorage. Am J Or-
review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; thod Dentofacial Orthop 2005;128:190-4.
103:e6-15. 25. Wilmes B, Su YY, Drescher D. Insertion angle impact on primary
12. Justens E, De Bruyn H. Clinical outcome of mini-screws used as or- stability of orthodontic mini-implants. Angle Orthod 2008;78:
thodontic anchorage. Clin Implant Dent Relat Res 2008;10: 1065-70.
174-80. 26. Motoyoshi M, Hirabayashi M, Uemura M, Shimizu N. Recommen-
13. Chen YJ, Chang HH, Huang CY, Hung HC, Lai HH, Yao CC. A ret- ded placement torque when tightening an orthodontic mini-im-
rospective analysis of the failure rate of three different orthodontic plant. Clin Oral Implants Res 2006;17:109-14.
skeletal anchorage systems. Clin Oral Implants Res 2007;18: 27. Stahl E, Keilig L, Abdelgader I, Jager A, Bourauel C. Numerical
768-75. analyses of biomechanical behavior of various orthodontic anchor-
14. Crismani AG, Bertl MH, Celar  AG, Bantleon HP, Burstone CJ. age implants. J Orofac Orthop 2009;70:115-27.
Miniscrews in orthodontic treatment: review and analysis of pub- 28. Motoyoshi M, Ueno S, Okazaki K, Shimizu N. Bone stress for a min-
lished clinical trials. Am J Orthod Dentofacial Orthop 2010;137: i-implant close to the roots of adjacent teeth—3D finite element
108-13. analysis. Int J Oral Maxillofac Surg 2009;38:363-8.
15. Wilmes B, Ottenstreuer S, Su YY, Drescher D. Impact of implant de- 29. Chang CH, Fang CL, Hsu JT, Chen CP, Chuang SF. Cavity dimen-
sign on primary stability of orthodontic mini-implants. J Orofac sion effect on MOD dental restoration filled with resin composi-
Orthop 2008;69:42-50. te—a finite element interface stress evaluation. J Med Biol Eng
16. Motoyoshi M, Yano S, Tsuruoka T, Shimizu N. Biomechanical ef- 2004;24:195-200.
fect of abutment on stability of orthodontic mini-implant. A finite 30. Baumgaertel S. Predrilling of the implant site: is it necessary for or-
element analysis. Clin Oral Implants Res 2005;16:480-5. thodontic mini-implants? Am J Orthod Dentofacial Orthop 2010;
17. Motoyoshi M, Inaba M, Ono A, Ueno S, Shimizu N. Mechanical an- 137:825-9.
isotropy of orthodontic mini-implants. Int J Oral Maxillofac Surg 31. Wilmes B, Rademacher C, Olthoff G, Drescher D. Parameters affect-
2009;38:972-7. ing primary stability of orthodontic mini-implants. J Orofac Or-
18. Gracco A, Cirignaco A, Cozzani M, Boccaccio A, Pappalettere C, thop 2006;67:162-74.
Vitale G. Numerical/experimental analysis of the stress field around 32. B}uchter A, Wiechmann D, Koerdt S, Wiesmann HP, Piffko J,
miniscrews for orthodontic anchorage. Eur J Orthod 2009;31:12-20. Meyer U. Load-related implant reaction of mini-implants used
19. Lombardo L, Gracco A, Zampini F, Stefanoni F, Mollica F. Optimal for orthodontic anchorage. Clin Oral Implants Res 2005;16:
palatal configuration for miniscrew applications. Angle Orthod 473-9.
2010;80:145-52. 33. Wang YC, Liou EJW. Comparison of the loading behavior of
20. Melsen B, Verna C. Miniscrew implants: the Aarhus anchorage sys- self-drilling and predrilled miniscrews throughout orthodontic
tem. Semin Orthod 2005;11:24-31. loading. Am J Orthod Dentofacial Orthop 2008;133:38-43.
21. Motoyoshi M, Inaba M, Ono A, Ueno S, Shimizu N. The effect of cor- 34. S€utpideler M, Eckert SE, Zobi M, An KN. Finite element analysis of
tical bone thickness on the stability of orthodontic mini-implants and effect of prosthesis height, angle of force application, and implant
on the stress distribution in surrounding bone. Int J Oral Maxillofac offset on supporting bone. Int J Oral Maxillofac Implants 2004;19:
Surg 2009;38:13-8. 819-25.
22. Motoyoshi M, Yoshida T, Ono A, Ueno S, Shimizu N. Effect of cor- 35. Barbier L, Vander Sloten J, Krzesinski G, Schepers E, Vander
tical bone thickness and implant placement torque on stability of Perre G. Finite element analysis of non-axial versus axial loading
orthodontic mini-implants. Int J Oral Maxillofac Implants 2007; of oral implants in the mandible of the dog. J Oral Rehabil
22:779-84. 1998;25:847-58.

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