Histomorphological and torque removal comparison of 6 mm orthodontic miniscrews with and without surface treatment in New Zealand rabbits

Effect of surface treatment on the mechanical stability of orthodontic miniscrews

OBJECTIVES

To provide collective quantitative evidence about the effect of surface treatments on the mechanical stability of orthodontic miniscrews (MSs).

MATERIALS AND METHODS

The study was registered in PROSPERO (No. CRD42020209652). The research question was defined according to the PICO (population, intervention, control, and outcomes) format. Various research databases were searched for animal and human studies on effects of surface treatment on the mechanical stability of MSs. Both prospective and retrospective in vivo clinical studies published in English were included. The risk of bias was assessed using SYRCLE's risk of bias tool for animal studies. The meta-analysis was conducted using RevMan 5.4.

RESULTS

A total of 109 articles were identified; 14 were included in the systematic review, and seven studies with sandblasting, acid etching (SLA) methods of surface treatment were included for meta-analysis. The number of study participants ranged from 6 to 24 (total n = 185), with a mean of 13.2. A total of 949 MSs were used with a mean of 67.8. The overall success rate for surface-treated MSs ranged from 47.9% to 100%. Forest plot of removal torque values showed significantly higher values for SLA surface-treated MSs compared with controls with a standard mean difference of 2.61 (95% confidence interval = 1.49-3.72, I2 = 85%). Forest plot of insertion torque showed a standard mean difference of -6.19 (95% confidence interval = -13.63-1.25, I2 = 98%, P = .10).

CONCLUSIONS

Surface treatment of MSs improved primary and secondary stability with good osseointegration at the bone-implant surface. However, significant heterogeneity across the studies included in the meta-analysis made it difficult to draw conclusions.

Degradation and Biocompatibility of AZ31 Magnesium Alloy Implants In Vitro and In Vivo: A Micro-Computed Tomography Study in Rats

In current orthodontic practice, miniscrew implants (MSIs) for anchorage and bone fixation plates (BFPs) for surgical orthodontic treatment are commonly used. MSIs and BFPs that are made of bioabsorbable material would avoid the need for removal surgery. We investigated the mechanical, degradation and osseointegration properties and the bone-implant interface strength of the AZ31 bioabsorbable magnesium alloy to assess its suitability for MSIs and BFPs. The mechanical properties of a Ti alloy (TiA), AZ31 Mg alloy (MgA), pure Mg and poly-L-lactic acid (PLA) were investigated using a nanoindentation test. Also, pH changes in the solution and degradation rates were determined using immersion tests. Three-dimensional, high-resolution, micro-computed tomography (CT) of implants in the rat femur was performed. Biomechanical push-out testing was conducted to calculate the maximum shear strength of the bone-implant interface. Scanning electron microscopy (SEM), histological analysis and an evaluation of systemic inflammation were performed. MgA has mechanical properties similar to those of bone, and is suitable for implants. The degradation rate of MgA was significantly lower than that of Mg. MgA achieved a significantly higher bone-implant bond strength than TiA. Micro-CT revealed no significant differences in bone density or bone-implant contact between TiA and MgA. In conclusion, the AZ31 Mg alloy is suitable for both MSIs and BFPs.

Evaluation of osseous integration of titanium orthopedic screws with novel SLA treatment in porcine model

The success of many endosseous implants in orthopaedic and dental applications depends on the surface characteristics, as they affect osseous integration. Previous investigations indicated that a novel large-grit sand-blasted and acid-etched (SLA) titanium (denoted as SLAffinity-Ti) implant had better bone integration than that of a comparably shaped implant with a plasma-sprayed titanium surface. The purpose of the present investigation was to create a SLAffinity surface on pedicle screws and trauma screws and to compare it with the surfaces of a sand-blasted-only implant and commercial implants in terms of bone integration. The cortical bone and spine of twelve minipigs were implanted with 3 and 4 implants, respectively, and the bone integration was evaluated using micro-computed tomography (micro-CT), mechanical tests (pull-out strength and stripping torque), and histological analysis (toluidine blue and hematoxylin and eosin staining) one and three months after implantation. The micro-CT images showed that the gap between the bone and implant was consistently higher in the sand-blasted-only and commercial groups compared to that in the SLAffinity group 1 and 3 months after implantation. Moreover, the bone volume of implant inserted into bone and the percentage of implant inside bone tissue were greater in the SLAffinity screws 1 and 3 months after implantation, as compared to the sand-blasted and commercial screws. In the mechanical tests, the removal torque and pull-out strength (p < 0.05) were higher in the SLAffinity group at 1 and 3 months. The histological results were consistent with mechanical testing, showing that the SLAffinity group had the most mineralized matrix, the most bone formation around the screws, and the most bone cells in bone tissue. These findings indicate that a SLAffinity surface can effectively enhance the holding strength and integration of pedicle screws and cortical screws, promoting early healing and improving outcomes, compared to sand-blasted-only and commercial implants.