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Nienkemper M, Ludwig B. Risk of root damage after using lateral cephalogram and intraoral scan for guided insertion of palatal miniscrews. Head Face Med 2022; 18:30. [PMID: 36057719 PMCID: PMC9440511 DOI: 10.1186/s13005-022-00335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Guided insertion of palatal miniscrews using a lateral cephalogram instead of cone beam computed tomography (CBCT) significantly reduces the radiation level for the patient. Till now no data are available on the risk of hitting the incisors in this regard, which is one of the worst clinical complications when inserting a paramedian miniscrew. Hence, this study aims to investigate the distance between the mini-implant and the roots of the central and lateral incisors. Methods Lateral cephalogram, an intraoral scan, and CBCT of 20 patients were superimposed. After a miniscrew (1.7 × 8 mm) placement based on intraoral scan and lateral cephalogram, the CBCT was used as control for the distance between the miniscrews and the roots of the incisors. Results The mean value of the shortest distance between the miniscrew and roots of the incisors in the lateral cephalogram was 4.74 ± 1.67 mm. The distance between both miniscrews and the central incisors measured in the CBCT was 5.03 ± 2.22 mm and 5.26 ± 2.21 mm and between the two miniscrews and the lateral incisors was 4.93 ± 1.91 mm and 5.21 ± 2.64 mm. No significant differences between the distances in the CBCT and the lateral cephalogram could be observed. In one case, the CBCT control revealed the penetration of two palatally displaced canines after insertion based on intraoral scan and lateral cephalogram. Conclusions The use of an intraoral scan and a lateral cephalogram for guided paramedian insertion of palatal miniscrews can prevent incisor root damage. This may reduce the radiation since no CBCT seems necessary. The current investigation focuses on the anterior paramedian area of the palate. Outside that region and in complex cases with displaced teeth in the palatal area, a CBCT might be indicated.
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Becker K, Rauch N, Brunello G, Azimi S, Beller M, Hüfner M, Nienkemper M, Schwarz-Herzke B, Drescher D. Bone remodelling patterns around orthodontic mini-implants migrating in bone: an experimental study in rat vertebrae. Eur J Orthod 2021; 43:708-717. [PMID: 34476491 PMCID: PMC8643410 DOI: 10.1093/ejo/cjab065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Orthodontic implant migration has been clinically observed in presence of continuous loading forces. Recent studies indicate that osteocytes play a crucial role in this phenomenon. Objectives Aim of this study was to investigate local osteocytic gene expression, protein expression, and bone micro-structure in peri-implant regions of pressure and tension. Material and methods The present work reports a complementary analysis to a previous micro-computed tomography study. Two customized mini-implants were placed in one caudal rat vertebra and connected by a nickel–titanium contraction spring generating different forces (i.e. 0, 0.5, 1.0, and 1.5 N). Either at 2 or 8 weeks, the vertebrae were harvested and utilized for 1. osteocytic gene expression using laser capture micro-dissection on frozen sections coupled with qPCR, 2. haematoxylin–eosin staining for qualitative and quantitative analyses, 3. immunofluorescence staining and analysis, and 4. bone-to-implant contact on undecalcified samples. Results At the two time points for all the performed analyses no significant differences were observed with respect to the applied force magnitudes and cell harvesting localization. However, descriptive histological analysis revealed remarkable bone remodelling at 2 weeks of loading. At 8 weeks the implants were osseointegrated and, especially in 1.0 and 1.5 N groups, newly formed bone presented a characteristic load bearing architecture with trabecula oriented in the direction of the loading. Conclusions The present study confirmed that stress-induced bone remodelling is the biological mechanism of orthodontic implant migration. Bone apposition was found at ‘tension’ and ‘pressure’ sites thus limiting implant migration over time.
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Affiliation(s)
- Kathrin Becker
- Department of Orthodontics, University Clinic of Düsseldorf, Germany
| | - Nicole Rauch
- Department of Oral Surgery, University Clinic of Düsseldorf, Germany
| | - Giulia Brunello
- Department of Oral Surgery, University Clinic of Düsseldorf, Germany.,Department of Neurosciences, University of Padua, Italy
| | - Sarah Azimi
- Department of Orthodontics, University Clinic of Düsseldorf, Germany
| | - Mathias Beller
- Institute for Mathematical Modeling of Biological Systems, University of Düsseldorf, Germany.,Systems Biology of Lipid Metabolism, University of Düsseldorf, Germany
| | - Mira Hüfner
- Department of Orthodontics, University Clinic of Düsseldorf, Germany
| | - Manuel Nienkemper
- Department of Orthodontics, University Clinic of Düsseldorf, Germany.,Private Practice, Dusseldorf, Germany
| | | | - Dieter Drescher
- Department of Orthodontics, University Clinic of Düsseldorf, Germany
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Khalaph S, Schwarz F, Rauch N, Mihatovic I, Nienkemper M, Hüfner M, Drescher D, Becker K. How do mini implants move in the bone? A microcomputed tomographic analysis in the rat tail. Clin Oral Implants Res 2020. [DOI: 10.1111/clr.58_13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Nicole Rauch
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | - Mira Hüfner
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Parvini P, Schwarz F, Hüfner MK, Rauch N, Nienkemper M, Becker K. Microstructural volumetric analysis of vertical alveolar ridge augmentation using autogenous tooth roots. Clin Implant Dent Relat Res 2020; 22:647-653. [PMID: 32876385 DOI: 10.1111/cid.12947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND To volumetrically assess the bone microstructure following vertical alveolar ridge augmentation using differently conditioned autogenous tooth roots (TR) and second-stage implant placement. MATERIALS AND METHODS The upper premolars were bilaterally extracted in n = 4 beagle dogs and randomly assigned to either autoclavation (TR-A) or no additional treatment (TR-C). Subsequently, TR were used as block grafts for vertical alveolar ridge augmentation in both lower quadrants. At 12 weeks, titanium implants were inserted and left to heal 3 weeks. Microcomputed tomography was used to quantify bone volume per tissue volume (BV/TV), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp) at vestibular (v) and oral (o) aspects along the implant and in the augmented upper half of the implant, respectively. RESULTS Median BV/TV [TR-C: 51.33% (v) and 70.42% (o) vs TR-A: 44.05% (v) and 64.46% (o)], Tb.th [TR-C: 0.22 mm (v) and 0.27 mm (o) vs TR-A: 0.23 mm (v) and 0.29 mm (o)] and Tb.Sp [TR-C: 0.26 mm (v) and 0.13 mm (o) vs TR-A: 0.29 μm (v) and 0.15 mm (o)] values were comparable in both groups. CONCLUSION Both TR-C and TR-A grafts were associated with a comparable bone microstructure within the grafted area.
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Affiliation(s)
- Puria Parvini
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany
| | - Mira Kristin Hüfner
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Nicole Rauch
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Manuel Nienkemper
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Kathrin Becker
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany.,Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Nienkemper M, Willmann JH, Drescher D. Long-term stability behavior of paramedian palatal mini-implants: A repeated cross-sectional study. Am J Orthod Dentofacial Orthop 2020; 157:165-171. [PMID: 32005467 DOI: 10.1016/j.ajodo.2019.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/01/2019] [Accepted: 01/01/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The initial stability of orthodontic mini-implants is well investigated over a period of 6 weeks. There is no clinical data available dealing with the long-term stability. The aim of this study was the assessment of long-term stability of paramedian palatal mini-implants in humans. METHODS Stability of 20 implants was measured after removal of the orthodontic appliance (sliding mechanics for sagittal molar movement 200 cN each side) before explantation (T4) using resonance frequency analysis (RFA). Data were compared with a matched group of 21 mini-implants assessing the stability immediately after insertion, and after 2, 4, and 6 weeks (T0-T3). The mini-implants used in this study were machined self-drilling titanium implants (2.0 × 9.0 mm). Gingival thickness at the insertion site was 1-2 mm. RESULTS The implant stability quotient (ISQ) values before removal of the implant at T4 were 25.2 ± 2.9 after 1.7 ± 0.2 years and did not show a statistically significant change over time compared with the initial healing group (T0-T3). CONCLUSIONS Comparing the stability of mini-implants just after completion of the healing period and at the end of their respective usage period revealed no significant difference. An increase of secondary stability could not be detected. The level of stability seemed to be appropriate for orthodontic anchorage.
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Affiliation(s)
- Manuel Nienkemper
- Private practice, Düsseldorf, Germany; Department of Orthodontics, Heinrich Heine University, Düsseldorf, Germany
| | - Jan H Willmann
- Department of Orthodontics, Heinrich Heine University, Düsseldorf, Germany.
| | - Dieter Drescher
- Department of Orthodontics, Heinrich Heine University, Düsseldorf, Germany
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Nienkemper M, Willmann JH, Becker K, Drescher D. RFA measurements of survival midpalatal orthodontic mini-implants in comparison to initial healing period. Prog Orthod 2020; 21:5. [PMID: 32064547 PMCID: PMC7024683 DOI: 10.1186/s40510-020-0305-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background In dental implantology, the development of stability over time is a well-investigated topic. In case of orthodontic mini-implants, quantitative data for long-term stability is not available yet. This study aims to clinically investigate the long-term stability of mini-implants inserted in the midsagittal suture of the anterior palate. Moreover, the influence of the length of implants was elucidated. The stability of 2 × 9 and 2 × 11 mm mini-implants after orthodontic treatment (9 mm, 2.84 years ± 1.25 years; 11 mm, 3.17 years ± 0.96 years) was assessed by resonance frequency analysis (RFA). The obtained long-term pieces of data were compared with each other (9 mm vs 11 mm), as well as with the data from the matched early stability groups, to assess the initial and early secondary stability after the insertion from previous clinical trials. Results For both lengths, the long-term stability (2 × 9 mm, 25.12 ± 7.11, n = 21; 2 × 11 mm, 24.39 ± 5.82, n = 18) was significantly lower than primary stability (2 × 9 mm, 36.14 ± 6.08, n = 19; 2 × 11 mm, 33.35 ± 3.53, n = 20). The differences within the groups disappeared over the initial healing period: after 4 weeks for the 2 × 9 mm implants and after 2 weeks for the 2 × 11 mm implants. Also, the 2 × 9 mm and 2 × 11 mm implants showed comparable long-term stability values. Conclusion The stability of midpalatal mini-implants does not change in the long term after the initial healing period. Moreover, 2 × 9 mm mini-implants seem to be appropriate for orthodontic anchorage, as the stability of 2 × 11 mm implants is not higher. Therefore, owing to lower invasiveness, 2 × 9 mm implants should be preferred.
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Affiliation(s)
- Manuel Nienkemper
- Department of Orthodontics, Heinrich-Heine-University of Düsseldorf, Moorenstr.5, Building 18.21, 40225, Düsseldorf, Germany.,Private Practice, Düsseldorf, Germany
| | - Jan H Willmann
- Department of Orthodontics, Heinrich-Heine-University of Düsseldorf, Moorenstr.5, Building 18.21, 40225, Düsseldorf, Germany.
| | - Kathrin Becker
- Department of Orthodontics, Heinrich-Heine-University of Düsseldorf, Moorenstr.5, Building 18.21, 40225, Düsseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, Heinrich-Heine-University of Düsseldorf, Moorenstr.5, Building 18.21, 40225, Düsseldorf, Germany
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Willmann JH, Nienkemper M, Tarraf NE, Wilmes B, Drescher D. Early Class III treatment with Hybrid-Hyrax - Facemask in comparison to Hybrid-Hyrax-Mentoplate - skeletal and dental outcomes. Prog Orthod 2018; 19:42. [PMID: 30345472 PMCID: PMC6196146 DOI: 10.1186/s40510-018-0239-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Protraction of maxilla is usually the preferred and more commonly used treatment approach for skeletal Class III with a retrognathic maxilla. The aim of this study was the comparison of the skeletal and dental effects of two skeletally borne appliances for maxillary protraction: a) Hybrid-Hyrax in combination with facemask (FM), b) Hybrid-Hyrax in combination with Mentoplate (ME). METHODS Thirty four Patients (17 facemask, 17 Mentoplate) were investigated by means of pre- and posttreatment cephalograms. The two groups matched with regard to treatment time, age gender and type of dentoskeletal deformity before treatment. RESULTS Both groups showed a significant forward movement of A-point (FM GROUP: SNA + 2.23° ± 1.30°- p 0.000*; ME: 2.23° ± 1.43°- p 0.000*). B-Point showed a larger sagittal change in the FM Group (SNB 1.51° ± 1.1°- p 0.000*) compared to the ME group (SNB: - 0.30° ± 0.9°- p 0.070). The FM group showed a significant increase of the ML-NL + 1.86° ± 1.65° (p 0.000*) and NSL-ML + 1.17° ± 1.48 (p 0.006*). Upper Incisor inclination did not change significantly during treatment in both groups as well as the distance of the first upper Molar in relation to A-point. CONCLUSION Both treatments achieve comparable rates of maxillary protraction, without dentoalveolar side effects. Skeletal anchorage with symphysial plates in the mandible provides greater vertical control and might be the treatment of choice in high angle patients.
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Affiliation(s)
- Jan H Willmann
- Department of Orthodontics, Heinrich-Heine-University, Kasernenstr. 1, 40213, Düsseldorf, Germany
| | - Manuel Nienkemper
- Department of Orthodontics, Heinrich-Heine-University, Kasernenstr. 1, 40213, Düsseldorf, Germany. .,Private Practice, Düsseldorf, Germany.
| | | | - Benedict Wilmes
- Department of Orthodontics, Heinrich-Heine-University, Kasernenstr. 1, 40213, Düsseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, Heinrich-Heine-University, Kasernenstr. 1, 40213, Düsseldorf, Germany
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Wilmes B, Ludwig B, Vasudavan S, Nienkemper M, Drescher D. The T-Zone: Median vs. Paramedian Insertion of Palatal Mini-Implants. J Clin Orthod 2016; 50:543-551. [PMID: 27809213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany; Department of Orthodontics, University of Alabama at Birmingham School of Dentistry; Benefit System.
| | - Bjorn Ludwig
- Journal of Clinical Orthodontics; Department of Orthodontics, University of Homburg, Saar, Germany; Private Practice of Orthodontics in Traben-Trarbach, Germany
| | - Sivabalan Vasudavan
- Department of Dentistry, Boston Children's Hospital; Department of Developmental Biology, Harvard School of Dental Medicine, Boston
| | - Manuel Nienkemper
- Department of Orthodontics, University of Dusseldorf; Private Practice of Orthodontics in Dusseldorf
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Nienkemper M, Ludwig B, Kanavakis G, Pauls A, Wilmes B, Drescher D. Uprighting Mesially Impacted Lower Third Molars with Skeletal Anchorage. J Clin Orthod 2016; 50:420-426. [PMID: 27575886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Manuel Nienkemper
- Department of Orthodontics, University of Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany; Private Practice of Orthodontics in Dusseldorf.
| | - Bjorn Ludwig
- Journal of Clinical Orthodontics; Department of Orthodontics, University of Homburg, Saar, Germany; Private Practice of Orthodontics in Traben-Trarbach, Germany
| | - Georgios Kanavakis
- Department of Orthodontics, Tufts University School of Dental Medicine, Boston
| | | | - Benedict Wilmes
- Department of Orthodontics, University of Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, University of Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany
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Nienkemper M, Santel N, Hönscheid R, Drescher D. Orthodontic mini-implant stability at different insertion depths : Sensitivity of three stability measurement methods. J Orofac Orthop 2016; 77:296-303. [PMID: 27272055 DOI: 10.1007/s00056-016-0036-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/30/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this work was to evaluate the influence of insertion depth on the stability of orthodontic mini-implants. Sensitivity of three different methods to measure implant stability based on differences in insertion depth were determined. METHODS A total of 82 mini-implants (2 × 9 mm) were inserted into pelvic bone of Swabian Hall pigs. Each implant was inserted stepwise to depths of 4, 5, 6, 7, and 8 mm. At each of these depths, three different methods were used to measure implant stability, including maximum insertion torque (MIT), resonance frequency analysis (RFA), and Periotest(®). Differences between the recorded values were statistically analyzed and the methods tested for correlations. RESULTS Almost linear changes from each insertion depth were measured with the values of RFA [implant stability quotient (ISQ) values range from 1-100], which increased from 6.95 ± 2.85 ISQ at 4 mm to 34.63 ± 5.51 ISQ at 8 mm, and with those of Periotest(®) [periotest values (PTV) range from -8 to 50], which decreased from 13.24 ± 4.03 PTV to -2.89 ± 1.87 PTV. Both methods were found to record highly significant (p < 0.0001) changes for each additional millimeter of insertion depth. The MIT increased significantly (p < 0.0001) from 153.67 ± 69.32 Nmm to 261 ± 103.73 Nmm between 4 and 5 mm of insertion depth but no further significant changes were observed as the implants were driven deeper. The RFA and Periotest(®) values were highly correlated (r = -0.907). CONCLUSIONS Mini-implant stability varies significantly with insertion depth. The RFA and the Periotest(®) yielded a linear relationship between stability and insertion depth. MIT does not appear to be an adequate method to determine implant stability based on insertion depth.
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Affiliation(s)
- Manuel Nienkemper
- Department of Orthodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Natascha Santel
- Department of Orthodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Ralf Hönscheid
- Department of Orthodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Katyal V, Wilmes B, Nienkemper M, Darendeliler MA, Sampson W, Drescher D. The efficacy of Hybrid Hyrax-Mentoplate combination in early Class III treatment: a novel approach and pilot study. Aust Orthod J 2016; 32:88-96. [PMID: 27468596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The aim of the present study was to assess the skeletal, dental and soft tissue effects of a specific treatment protocol in consecutively treated patients who presented with a Class III malocclusion. Treatment involved the use of a Hybrid Hyrax (HH) in the maxilla, a Mentoplate in the mandible and the application of continuous intra-oral Class III elastics. METHOD The treated group was comprised of seven males and seven females (mean pretreatment age 10.4 ± 1.7 yr, range 7.8-12.9 yr). Treatment changes were analysed on lateral cephalograms taken 6-12 months prior to commencing treatment (T1) and at the finish of the orthopaedic phase (T2). Where a normality assumption was met, a parametric paired-sample t-test was used to assess the change differences at T1 and T2. For non-normal data, a non-parametric Wilcoxon sign rank test for related samples was used to assess T1 and T2 differences. The level of statistical significance was set at p < 0.05 (2-tailed). RESULTS The average sagittal changes showed an improved SNA angle of 2.1 ± 2° (p = 0.002), an ANB angle of 1.9 ± 1.8° (p = 0.002), a Wits improvement of 3.4 ± 2.7 mm (p < 0.001) and an overjet reduction of 2.0 ± 2.2 mm (p = 0.005). There were no statistically significant correlations found between the age at T1, age at treatment start and age at T2 and the changes identified in the cephalometric variables (T2-T1). CONCLUSION The HH-Mentoplate Class III treatment protocol induced a mean Wits improvement of 3.4 mm in the maxillary and mandibular sagittal base relationship at the functional occlusal level. This was primarily achieved by sagittal maxillary skeletal protraction with negligible effects on the mandible, facial vertical dimension and the incisor angulations. A controlled clinical study with larger sample sizes and longer follow-up times is needed.
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Katyal V, Wilmes B, Nienkemper M, Darendeliler MA, Sampson W, Drescher D. The efficacy of Hybrid Hyrax-Mentoplate combination in early Class III treatment: a novel approach and pilot study. Australasian Orthodontic Journal 2016. [DOI: 10.21307/aoj-2020-117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Introduction
The aim of the present study was to assess the skeletal, dental and soft tissue effects of a specific treatment protocol in consecutively treated patients who presented with a Class III malocclusion. Treatment involved the use of a Hybrid Hyrax (HH) in the maxilla, a Mentoplate in the mandible and the application of continuous intra-oral Class III elastics.
Method
The treated group was comprised of seven males and seven females (mean pretreatment age 10.4 ± 1.7 yr, range 7.8 – 12.9 yr). Treatment changes were analysed on lateral cephalograms taken 6–12 months prior to commencing treatment (T1) and at the finish of the orthopaedic phase (T2). Where a normality assumption was met, a parametric paired-sample t-test was used to assess the change differences at T1 and T2. For non-normal data, a non-parametric Wilcoxon sign rank test for related samples was used to assess T1 and T2 differences. The level of statistical significance was set at p < 0.05 (2-tailed).
Results
The average sagittal changes showed an improved SNA angle of 2.1 ± 2° (p = 0.002), an ANB angle of 1.9 ± 1.8° (p = 0.002), a Wits improvement of 3.4 ± 2.7 mm (p < 0.001) and an overjet reduction of 2.0 ± 2.2 mm (p = 0.005). There were no statistically significant correlations found between the age at T1, age at treatment start and age at T2 and the changes identified in the cephalometric variables (T2-T1).
Conclusion
The HH-Mentoplate Class III treatment protocol induced a mean Wits improvement of 3.4 mm in the maxillary and mandibular sagittal base relationship at the functional occlusal level. This was primarily achieved by sagittal maxillary skeletal protraction with negligible effects on the mandible, facial vertical dimension and the incisor angulations. A controlled clinical study with larger sample sizes and longer follow-up times is needed.
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Affiliation(s)
- Vandana Katyal
- * Department of Orthodontics , The University of Düsseldorf , Düsseldorf , Germany
| | - Benedict Wilmes
- * Department of Orthodontics , The University of Düsseldorf , Düsseldorf , Germany
| | - Manuel Nienkemper
- * Department of Orthodontics , The University of Düsseldorf , Düsseldorf , Germany
| | - M. Ali Darendeliler
- † Department of Orthodontics , The University of Sydney , Sydney , Australia
| | - Wayne Sampson
- + Discipline of Orthodontics , The University of Adelaide , Adelaide , Australia
| | - Dieter Drescher
- * Department of Orthodontics , The University of Düsseldorf , Düsseldorf , Germany
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Nienkemper M, Wilmes B, Franchi L, Drescher D. Effectiveness of maxillary protraction using a hybrid hyrax-facemask combination: a controlled clinical study. Angle Orthod 2015; 85:764-70. [PMID: 25393800 PMCID: PMC8610391 DOI: 10.2319/071614-497.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/01/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the treatment effects of a hybrid hyrax-facemask (FM) combination in growing Class III patients. MATERIAL AND METHODS A sample of 16 prepubertal patients (mean age, 9.5 ± 1.6 years) was investigated by means of pre- and posttreatment cephalograms. The treatment comprised rapid palatal expansion with a hybrid hyrax, a bone- and toothborne device. Simultaneously, maxillary protraction using an FM was performed. Mean treatment duration was 5.8 ± 1.6 months. The treatment group was compared with a matched control group of 16 untreated Class III subjects. Statistical comparisons were performed with the Mann-Whitney U-test. RESULTS Significant improvement in skeletal sagittal values could be observed in the treatment group over controls: SNA: 2.4°, SNB: -1.7°, Co-Gn: -2.3 mm, Wits appraisal: 4.5 mm. Regarding vertical changes, maintenance of vertical growth was obtained as shown by a small nonsignificant increase of FMA and a small significant decrease of the Co-Go-Me angle. CONCLUSIONS The hybrid hyrax-FM combination was found to be effective for orthopedic treatment in growing Class III patients in the short term. Favorable skeletal changes were observed both in the maxilla and in the mandible. No dentoalveolar compensations were found.
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Affiliation(s)
- Manuel Nienkemper
- Instructor, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Benedict Wilmes
- Associate Professor, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lorenzo Franchi
- Associate Professor, Department of Orthodontics, University of Firenze, Florence, Italy
| | - Dieter Drescher
- Professor and Department Chair, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
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Wilmes B, Ludwig B, Katyal V, Nienkemper M, Rein A, Drescher D. The Hybrid Hyrax Distalizer, a new all-in-one appliance for rapid palatal expansion, early class III treatment and upper molar distalization. J Orthod 2015; 41 Suppl 1:S47-53. [PMID: 25138366 DOI: 10.1179/1465313314y.0000000107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Growing class III patients with maxillary deficiency may be treated with a maxillary protraction facemask. Because the force generated by this appliance is applied to the teeth, the inevitable mesial migration of the dentition can result in anterior crowding, incisor proclination and a possible need for subsequent extraction therapy. The Hybrid Hyrax appliance, anchored on mini-implants in the anterior palate, can be used to overcome these side-effects during the facemask therapy. In some class III cases, there is also a need for subsequent distalization after the orthopaedic treatment. In this paper, clinical application of the Hybrid Hyrax Distalizer is described, facilitating both orthopaedic advancement of the maxilla and simultaneous orthodontic distalization of the maxillary molars.
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Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany
| | - Björn Ludwig
- Private Office Am Bahnhof 54, Traben-Trarbach, Germany
| | - Vandana Katyal
- Australian Society of Orthodontist Foundation For Research and Education, Sydney, Australia
| | - Manuel Nienkemper
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany
| | - Anna Rein
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany
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15
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Hourfar J, Kanavakis G, Bister D, Schätzle M, Awad L, Nienkemper M, Goldbecher C, Ludwig B. Three dimensional anatomical exploration of the anterior hard palate at the level of the third ruga for the placement of mini-implants--a cone-beam CT study. Eur J Orthod 2015; 37:589-95. [PMID: 25564503 DOI: 10.1093/ejo/cju093] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM The aim of this retrospective investigation was to measure vertical bone thickness on the hard palate, determine areas with adequate bone for the insertion of orthodontic mini-implants (MIs), and provide clinical guidelines for identification of those areas. MATERIALS AND METHODS Pre-treatment records of 1007 patients were reviewed by a single examiner. A total of 125 records fulfilled the inclusion criteria and were further investigated. Bone measurements were performed on cone-beam computed tomography scans, at a 90° angle to the bone surface, on 28 predetermined and standardized points on the hard palate. Bone thickness at various areas was associated to clinically identifiable areas on the hard palate by means of pre-treatment plaster models. RESULTS Bone thickness ranged between 1.51 and 13.86 mm (total thickness) and 0.33 and 1.65 mm (cortical bone thickness), respectively. Bone thickness was highest in the anterior palate and decreased significantly towards more posterior areas. Plaster model analysis revealed that bone thickness was highest at the level of the third palatal ruga. CONCLUSIONS The areas on the anterior palate with adequate bone thickness for successful insertion of orthodontic MI correspond to the region of the third palatal ruga. These results provide stable and clinically identifiable landmarks for the insertion of palatal MIs.
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Affiliation(s)
- Jan Hourfar
- *Private Practice, Reinheim, Germany, **Department of Orthodontics, University of Heidelberg, Germany
| | - Georgios Kanavakis
- ***Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Dirk Bister
- ****Department of Orthodontics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marc Schätzle
- *****Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, Zurich, Switzerland
| | - Layla Awad
- ******Department of Orthodontics, University of Homburg/Saar, Saarland, Germany
| | - Manuel Nienkemper
- *******Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Björn Ludwig
- ******Department of Orthodontics, University of Homburg/Saar, Saarland, Germany, *********Private Practice, Traben-Trarbach, Germany
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Lübberink G, Nienkemper M, Wilmes B, Ludwig B, Drescher D. Nonsurgical treatment of a mature adult Class III patient. J Clin Orthod 2014; 48:697-702. [PMID: 25707949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Gudrun Lübberink
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany.
| | - Manuel Nienkemper
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany
| | - Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany
| | - Björn Ludwig
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, University of Homburg, Saar, Germany
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17
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Wilmes B, Nienkemper M, Renger S, Drescher D. Mini-implant-supported temporary pontics. J Clin Orthod 2014; 48:422-429. [PMID: 25127382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; Department of Orthodontics, University of Alabama at Birmingham School of Dentistry, USA.
| | - Manuel Nienkemper
- Department of Orthodontics, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | | | - Dieter Drescher
- Department of Orthodontics, University of Düusseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
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Nienkemper M, Wilmes B, Pauls A, Yamaguchi S, Ludwig B, Drescher D. Treatment efficiency of mini-implant-borne distalization depending on age and second-molar eruption. J Orofac Orthop 2014; 75:118-32. [PMID: 24577015 DOI: 10.1007/s00056-013-0199-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 07/26/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficiency of molar distalization depending on age and second-molar eruption using the Beneslider. MATERIALS AND METHODS Treatment of 51 patients (mean age 17.8 ± 9.6 years) was investigated retrospectively by means of pre- and posttreatment cephalograms. Patients were divided into three groups: 14 children with unerupted upper second molars (group 1), 23 adolescents with second molar in place (group 2), and 14 adults (group 3). The distalization forces applied were 2.4 N in group 1 and 5.0 N in groups 2 and 3. Treatment changes were evaluated and examined statistically for significant differences. RESULTS In all patients a Class I molar relationship was achieved. All mini-implants remained stable during treatment. Mean distalization distance as measured by the displacement of the center of resistance was 3.6 ± 1.9 mm (range 1.2-8.5 mm depending on treatment needs). Since no significant tipping was detected, the type of movement can be described as bodily movement. Mean overall distalization speed was 0.6 ± 0.4 mm per month. There were no statistical differences between the groups. CONCLUSION We found the Beneslider to be an effective appliance that enables bodily distalization in adequate treatment time. The higher resistance due to erupted second molars can be compensated by the use of higher forces without significantly reducing distalization speed.
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Affiliation(s)
- M Nienkemper
- Department of Orthodontics, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany,
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19
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Nienkemper M, Wilmes B, Pauls A, Drescher D. Mini-implant stability at the initial healing period: a clinical pilot study. Angle Orthod 2014; 84:127-33. [PMID: 23883287 PMCID: PMC8683051 DOI: 10.2319/040813-271.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 06/01/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the changes of mini-implant stability over the initial healing period in humans. MATERIAL AND METHODS A sample of 19 consecutively treated patients (mean age 15.5 ± 7.3 years) was examined. In each patient, a mini-implant of a size of 2 × 9 mm was inserted into the anterior palate. Implant stability was assessed using resonance frequency analysis (RFA) immediately after insertion (T0), 2 weeks later (T1), 4 weeks later (T2), and 6 weeks later (T3). Insertion depth (ID) and the maximum insertion torque (IT) were measured. Data were tested for correlations between RFA, ID, and IT. All RFA values were tested for statistically significant differences between the different times. RESULTS The mean ID was 7.5 ± 0.6 mm, and the mean IT was 16.8 ± 0.6 Ncm. A correlation was found between RFA and ID (r = .726, P < .0001), whereas no correlations between RFA and IT or between IT and ID were observed. From T0 to T1, the stability (36.1 ± 6.1 implant stability quotient [ISQ]) decreased nonsignificantly by 4.9 ± 6.1 ISQ values (P > .05). Between T1 and T2, the stability decreased highly significantly (P < .001) by 7.9 ± 5.9 ISQ values. From T2 on, RFA remained nearly unchanged (-1.7 ± 3.5 ISQ; P > .05). CONCLUSIONS Mini-implant stability is subject to changes during the healing process. During weeks 3 and 4, a significant decrease of the stability was observed. After 4 weeks, the stability did not change significantly.
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Affiliation(s)
- Manuel Nienkemper
- Instructor, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Benedict Wilmes
- Associate Professor, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Alexander Pauls
- Postgraduate Student, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Dieter Drescher
- Professor and Department Chair, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
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Nienkemper M, Pauls A, Ludwig B, Drescher D. Stability of paramedian inserted palatal mini-implants at the initial healing period: a controlled clinical study. Clin Oral Implants Res 2013; 26:870-875. [DOI: 10.1111/clr.12321] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Manuel Nienkemper
- Department of Orthodontics; Heinrich-Heine-University; Düsseldorf Germany
| | | | | | - Dieter Drescher
- Department of Orthodontics; Heinrich-Heine-University; Düsseldorf Germany
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Wilmes B, Nienkemper M, Mazaud-Schmelter M, Renger S, Drescher D. [Combined use of Beneslider and lingual braces, mechanical aspects and procedures]. Orthod Fr 2013; 84:347-59. [PMID: 24280550 DOI: 10.1051/orthodfr/2013065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/27/2013] [Indexed: 11/14/2022]
Abstract
Over the last years, a tendency to prefer purely intra-oral appliances with minimal need for patient cooperation is noticed if upper molars should be distalized. Unfortunately, most of the conventional devices for non-compliance upper molar distalization produce unwanted side effects such as anchorage loss. To minimize or eliminate anchorage loss, mini-screws attracted a great attention in recent years because of minimal surgical invasiveness and low cost. Using the anterior palate as an insertion site, the failure rate is extremely low, there is no risk of root damage and the appliances are out of the path of tooth movement. Based on comprehensive clinical documentation, the rational and practical applications of the Beneslider in combination with lingual braces are presented. By this procedure, extractions in the upper arch and reactive forces in the lower arch resulting in a protrusion of the incisors can be avoided with an invisible treatment appliance.
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Affiliation(s)
- Benedict Wilmes
- Poliklinik für Kieferorthopädie, Universitätsklinikum Düsseldorf, Moorenstr. 5, Geb. 18.21, D-40225 Düsseldorf, Allemagne
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22
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Wilmes B, Nanda R, Nienkemper M, Ludwig B, Drescher D. Correction of upper-arch asymmetries using the Mesial-Distalslider. J Clin Orthod 2013; 47:648-655. [PMID: 24378543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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23
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Pauls A, Nienkemper M, Panayotidis A, Wilmes B, Drescher D. Effects of wear time recording on the patient's compliance. Angle Orthod 2013; 83:1002-1008. [PMID: 23611166 PMCID: PMC8722835 DOI: 10.2319/010913-25.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 03/01/2013] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To assess the effect of wear-time recording on subjective and objective wear time. MATERIALS AND METHODS This study retrospectively examined a group of 18 patients and a control group of 14 patients at four appointments over 168 days. The patients were treated with removable appliances with embedded TheraMon-microsensors to be worn for 15 hours per day. The study group was not told about the microsensor until the first appointment after fitting of the appliance. At each appointment patients were asked about their subjective wear time and afterward were told about the objective wear time. The existence of the microsensor was revealed to the control group when the appliance was fitted. Objective wear time was also announced at every appointment. RESULTS Mean wear times did not significantly differ between groups at any appointment or regarding overall wear time. Highly significant differences between subjective and objective wear time were found when patients did not know that their wear time had been monitored. CONCLUSION Mean wear times assessed in this study concur with data of previous studies. Patients tend to overestimate their wear times but become more realistic once they know wear time is being monitored. Objective measurement of wear time allows a more realistic view of compliance by patient and orthodontist. Knowing that wear time is recorded does not necessarily increase the amount of time removable appliances are worn by the patient.
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Affiliation(s)
- Alexander Pauls
- Researcher, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Manuel Nienkemper
- Instructor, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Agamemnon Panayotidis
- Researcher, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Benedict Wilmes
- Associate Professor, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Dieter Drescher
- Professor and Department Chair, Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany
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Nienkemper M, Wilmes B, Pauls A, Drescher D. Impact of mini-implant length on stability at the initial healing period: a controlled clinical study. Head Face Med 2013; 9:30. [PMID: 24382059 PMCID: PMC4029568 DOI: 10.1186/1746-160x-9-30] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/09/2013] [Indexed: 11/16/2022] Open
Abstract
Introduction Aim of the study was to assess the impact of the length of mini-implants inserted in the midpalatal region on the stability at the initial healing period. Methods A sample of 20 consecutively treated patients (15.6 ± 7.2 years) was examined. A long mini-implant with a length of 11 mm and a diameter of 2 mm was inserted into the anterior palate of each patient. Resonance frequency analysis (RFA) was performed after insertion (T0), two weeks (T1), four weeks (T2), and six weeks (T3). Insertion depth (ID) and the maximum insertion torque (IT) were measured. RFA, ID and IT data were tested for correlations. RFA values were tested for statistical differences between the different times. Data was compared to a matched control group of patients who received short mini-implants with a length of 9 mm and a diameter of 2 mm. Results Mean ID was 9.5 ± 0.6 mm and mean IT was 17.9 ± 3.8 Ncm. A correlation was found between RFA and ID (r = 0.59, P < .01). From T0 to T1 the stability (33.4 ± 3.5 ISQ) decreased highly significantly by 5.3 ± 3.5 ISQ values (P < .001) and significantly from T1 and T2 (P < .05) by 3.5 ± 3.7 ISQ values. From T2 on RFA nearly remained unchanged (−1.7 ± 3.9 ISQ; P > .05). At T1 stability was significantly lower than the control group. From T2 on there were no significant differences between the groups. Conclusions Long mini-implants provide high stability when inserted in the midpalatal region. After initial decrease RFA values remained stable from four weeks on and did not differ from the control group. Trial registration ID: 2013081293 (Clinical study register, University of Düsseldorf, Germany).
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Nienkemper M, Pauls A, Ludwig B, Wilmes B, Drescher D. Preprosthetic molar uprighting using skeletal anchorage. J Clin Orthod 2013; 47:433-437. [PMID: 23928819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Nienkemper M, Wilmes B, Pauls A, Drescher D. Maxillary protraction using a hybrid hyrax-facemask combination. Prog Orthod 2013; 14:5. [PMID: 24325812 PMCID: PMC3847851 DOI: 10.1186/2196-1042-14-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 11/14/2022] Open
Abstract
Background The aim of this in study was the evaluation of treatment outcomes after using a hybrid hyrax-facemask combination in growing class III patients. Methods Treatment of 16 children (mean age 9.5 ± 1.3 years) was investigated clinically and by means of pre- and post-treatment cephalograms. Changes in sagittal and vertical, and dental and skeletal values were evaluated and tested for statistically significant differences. Results All mini-implants remained stable during treatment. Mean treatment duration was 5.8 ± 1.7 months. There was a significant improvement in skeletal sagittal values: SNA, +2.0°; SNB, -1.2°; ANB, +3.2°; WITS appraisal, +4.1 mm and overjet, +2.7 mm. No significant changes were found concerning vertical skeletal relationships and upper incisor inclination. In relation to A point, the upper first molars moved mesially about 0.4 mm (P = 0.134). Conclusions The hybrid hyrax-facemask combination seems to be effective for orthopaedic treatment in growing class III patients. Unwanted maxillary dental movements can be avoided due to stable skeletal anchorage.
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Affiliation(s)
- Manuel Nienkemper
- University of Düsseldorf, Department of orthodontics, Moorenstr, 5, 40225 Düsseldorf, Germany.
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27
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Pauls A, Nienkemper M, Drescher D. Accuracy of torque-limiting devices for mini-implant removal: an in vitro study. J Orofac Orthop 2013; 74:205-16. [DOI: 10.1007/s00056-013-0141-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 11/02/2012] [Indexed: 11/29/2022]
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Wilmes B, Nienkemper M, Ludwig B, Nanda R, Drescher D. Upper-molar intrusion using anterior palatal anchorage and the Mousetrap appliance. J Clin Orthod 2013; 47:314-328. [PMID: 23863498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany.
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29
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Affiliation(s)
- B. Wilmes
- Poliklinik für Kieferorthopädie, Universität Düsseldorf
| | - M. Nienkemper
- Poliklinik für Kieferorthopädie, Universität Düsseldorf
| | - D. Drescher
- Poliklinik für Kieferorthopädie, Universität Düsseldorf
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30
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Reichert C, Kutschera E, Nienkemper M, Scharf S, Mengel M, Fimmers R, Fuhrmann C, Plötz C, Gölz L, Drescher D, Braumann B, Jäger A. Influence of time after extraction on the development of gingival invagination: study protocol for a multicenter pilot randomized controlled clinical trial. Trials 2013; 14:108. [PMID: 23782625 PMCID: PMC3748838 DOI: 10.1186/1745-6215-14-108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/10/2013] [Indexed: 11/13/2022] Open
Abstract
Background Gingival invaginations are a common side effect of orthodontic therapy involving tooth extraction and subsequent space closure. Consequences of gingival invaginations are a jeopardized stability of the space closure and hampered oral hygiene. In a retrospective study, the factor time until initiation of orthodontic space closure after tooth extraction has been identified as a potential risk factor for the development of gingival invaginations. The aim of this pilot study is to proof this hypothesis and to enable a caseload calculation for further clinical trials. The referring question is: is it possible to reduce the number of developing gingival invaginations by initiation of orthodontic space closure after tooth extraction at an early point of time? Design The intended pilot study is designed as a multicenter randomized controlled clinical trial, comparing the impact of two different time intervals from tooth extraction to initiation of orthodontic space closure on the development of gingival invaginations. Forty participants, men and women in the age range of 11 to 30 years with orthodontically related indication for tooth extraction in the lower jaw, will be randomized 1:1 in one of two treatment groups. In group A the orthodontic tooth movement into the extraction area will be initiated in a time interval 2 to 4 weeks after tooth extraction. In group B the tooth movement will be initiated in a time interval >12 weeks after extraction. A possible effect of these treatment modalities on the development of gingival invaginations will be documented at the moment of space closure or 10 months +/- 14 days after initiation of space closure respectively, by clinical documentation of the primary (reduced number of gingival invagination) and the secondary endpoint (reduction of the severity of gingival invaginations). Trial registration Universal Trial Number U1111-1132-6655; German Clinical Trials Register DRKS00004248
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Affiliation(s)
- Christoph Reichert
- Department of Orthodontics, University Hospital Bonn, Welschnonnenstraße 17, 53111 Bonn, Germany.
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31
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Pauls A, Nienkemper M, Drescher D. Accuracy of torque-limiting devices used for mini-implant placement--an in vitro study. J Orofac Orthop 2013; 74:124-36. [PMID: 23467731 DOI: 10.1007/s00056-012-0127-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 07/10/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Mini-implants are used when enhanced orthodontic anchorage is needed. Documented risks include damage inflicted to tooth structures and implant loosening, but also fracture. An important factor in minimizing adverse side effects is to control the insertion torque. The goal of the present study was to investigate the accuracy of various torque-limiting devices available for this purpose. MATERIALS AND METHODS Eight torque-limiting devices were analyzed, including a group of manually-operated drivers (n=3), a group of battery-operated drivers (n=4), and a surgical unit (n=1). The accuracy of these devices was tested over the entire range of applicable torque levels, using an experimental design simulating the insertion of mini-implants. RESULTS No significant differences were noted between the group of manually-operated and the group of battery-operated devices within the clinically relevant range of 10-25 Ncm. Comparing the individual devices revealed several significant differences. Some devices yielded both effective torque levels very close to the set levels and small standard deviations. CONCLUSION Mini-implants can be put in place in a controlled fashion regardless of whether the torque-limiting device used for this purpose is a manual- or battery-operated driver or a surgical unit. However, we observed that the accuracy of torque limitation differed greatly between individual devices across these groups. Our results can therefore help clinicians select an appropriate insertion device for mini-implants.
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Affiliation(s)
- Alexander Pauls
- Policlinic of Orthodontics, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Wilmes B, Nienkemper M, Nanda R, Lübberink G, Drescher D. Palatally anchored maxillary molar mesialization using the mesialslider. J Clin Orthod 2013; 47:172-179. [PMID: 23660790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany.
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Nienkemper M, Pauls A, Ludwig B, Wilmes B, Drescher D. Multifunctional use of palatal mini-implants. J Clin Orthod 2012; 46:679-704. [PMID: 23395870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Manuel Nienkemper
- Department of Orthodontics, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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Nienkemper M, Wilmes B, Pauls A, Drescher D. Multipurpose use of orthodontic mini-implants to achieve different treatment goals. J Orofac Orthop 2012; 73:467-76. [PMID: 23104396 DOI: 10.1007/s00056-012-0107-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 06/18/2012] [Indexed: 11/25/2022]
Affiliation(s)
- M Nienkemper
- Policlinic of Orthodontics, University Hospital Düsseldorf, Germany.
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Nienkemper M, Wilmes B, Renger S, Mazaud-Schmelter M, Drescher D. [Improvement of mini-implant stability in orthodontics]. Orthod Fr 2012; 83:201-7. [PMID: 22944013 DOI: 10.1051/orthodfr/2012021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 03/22/2012] [Indexed: 11/14/2022]
Abstract
Orthodontists are continuing to increase the use of mini-implants as a source of skeletal anchorage. However, the relatively high 16.4% rate of their failures remains a problem. An analysis of articles in the literature on the loss of mini-implants shows that larger size anchorage screws and plates inserted in the anterior and median regions of the hard palate are highly stable and, accordingly, contribute to a high rate of optimum orthodontic outcomes. It is the reliability of the mini-implant/skeletal structure couple that is the principal factor in this success. With mini-implants whose heads possess internal threads, orthodontists can attach different types of stable, screwed-in abutments. And with long plates with specifically designed perforations splinting two mini-implants together, orthodontists can further increase the stability of this artificial anchorage. By employing a system with pre-fabricated components orthodontists can quickly create skeletal anchorage adaptable to the mechanics of different techniques.
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Affiliation(s)
- Manuel Nienkemper
- Poliklinik für Kieferorthopädie, Universitätsklinikum Düsseldorf, Moorenstr. 5, Geb. 18.21, D-40225 Düsseldorf, Allemagne
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Nienkemper M, Wilmes B, Panayotidis A, Pauls A, Golubovic V, Schwarz F, Drescher D. Measurement of mini-implant stability using resonance frequency analysis. Angle Orthod 2012; 83:230-8. [PMID: 22931201 DOI: 10.2319/043012-354.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate whether resonance frequency analysis (RFA) is suitable to measure orthodontic mini-implant stability. Implant size significantly affects the level of resonance frequency. Regarding the operating mode of RFA, it has to be proven whether the resonance frequency of mini-implants in bone fits the range of frequency emitted by the Osstell ISQ device. MATERIAL AND METHODS For this purpose the SmartPegs in the Osstell ISQ device were modified to fit with the inner screw thread of orthodontic mini-implants, and 110 mini-implants were inserted into porcine pelvic bone. RFA was performed parallel and perpendicular to the run of superficial bone fibers. A suitability test, Periotest, was also performed in the same directions. Compacta thickness was measured using cone-beam computed tomography. Correlation tests and linear regression analysis were carried out between the three methods. RESULTS The RFA showed a mean Implant Stability Quotient value of 36.36 ± 2.67, and the Periotest mean value was -2.10 ± 1.17. The differences between the two directions of measurement were statistically significant (P > .001) for RFA and the Periotest. There was a high correlation between RFA and the Periotest (r = -0.90) and between RFA and compacta thickness (r = 0.71). The comparison between the Periotest and compacta thickness showed a correlation coefficient of r = -0.64. CONCLUSION The present results suggest that RFA is feasible as a measurement method for orthodontic mini-implant stability. As a consequence, it could be used for clinical evaluation of current stability and allow stability-related loading of mini-implants to reduce the failure rate.
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Affiliation(s)
- Manuel Nienkemper
- Department of Orthodontics, Heinrich-Heine-University, Düsseldorf, Germany.
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Wilmes B, Nienkemper M, Ludwig B, Kau CH, Pauls A, Drescher D. Esthetic Class II treatment with the Beneslider and aligners. J Clin Orthod 2012; 46:390-437. [PMID: 23059461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Benedict Wilmes
- University of Düsseldorf, Department of Orthodontics, Düsseldorf, Germany.
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Nienkemper M, Wilmes B, Lübberink G, Ludwig B, Drescher D. Extrusion of impacted teeth using mini-implant mechanics. J Clin Orthod 2012; 46:150-183. [PMID: 22784980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Manuel Nienkemper
- Department of Orthodontics, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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Wilmes B, Nienkemper M, Ludwig B, Kau CH, Drescher D. Early Class III treatment with a hybrid hyrax-mentoplate combination. J Clin Orthod 2011; 45:15-39. [PMID: 21874777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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Wilmes B, Nienkemper M, Drescher D. Application and effectiveness of a mini-implant- and tooth-borne rapid palatal expansion device: the hybrid hyrax. World J Orthod 2010; 11:323-330. [PMID: 21490997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Rapid palatal expansion (RPE) is used for treatment of skeletal crossbites. It may be combined with a face mask if the maxilla is to be protracted. Conventional tooth-borne appliances rely on an almost complete dentition to transmit the relatively high forces to the bony structures of the maxilla and midface. In most situations, tooth-borne appliances produce adverse effects such as buccal tipping of the lateral teeth, imposing the risk of recessions and vestibular bone fenestrations. To overcome these drawbacks, an RPE appliance was developed that utilizes mini-implants anteriorly in the palate for skeletal anchorage. Because this device is also attached to the first molars, it can be denominated as a bone- and tooth-borne appliance (hybrid hyrax). The objective of this clinical pilot study was to investigate its dental and skeletal effects. METHODS RPE was performed in 13 patients (seven females, six males; mean age 11.2 years). In 10 patients with a skeletal Class III occlusion, a face mask was used simultaneously for maxillary protraction. Three-dimensional scans of the individual study models were digitally superimposed for the assessment of the dental effects. Skeletal effects were evaluated by lateral cephalograms taken before and after RPE and protraction. RESULTS The time needed to achieve the intended expansion ranged from 4 to 14 days (mean 8.7 ± 3.6 days). The mean expansion in the first premolar/first primary molar region was 6.3 ± 2.9 mm and 5.0 ± 1.5 mm in the first molar region. The Wits appraisal changed from -5.2 ± 1.3 mm to -2.5 ± 1.5 mm (mean improvement 2.7 ± 1.3 mm). The right first molar migrated 0.4 ± 0.6 mm mesially and the left one 0.3 ± 0.2 mm. CONCLUSIONS The hybrid hyrax is effective for RPE and can be employed especially in patients with reduced anterior dental anchorage. Since most teeth are not in the appliance, regular orthodontic treatment can start early. The combination of the hybrid hyrax with a face mask for maxillary protraction appears to be effective in minimizing mesial migration of the dentition.
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Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany.
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Wilmes B, Drescher D, Nienkemper M. A miniplate system for improved stability of skeletal anchorage. J Clin Orthod 2009; 43:494-501. [PMID: 19904040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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Büchter A, Kleinheinz J, Wiesmann HP, Kersken J, Nienkemper M, Weyhrother HV, Joos U, Meyer U. Biological and biomechanical evaluation of bone remodelling and implant stability after using an osteotome technique. Clin Oral Implants Res 2004; 16:1-8. [PMID: 15642025 DOI: 10.1111/j.1600-0501.2004.01081.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The influence of the osteotome technique on the osseointegration and biomechanical behaviour of cylinder implants (SLA, ITI was compared with conventional preparation of the implant site in an animal model. A total of 56 implants were placed in the cranial and caudal tibia condyle of six Gottinger minipigs. The implant site was prepared either by the conventional technique with drills (control group A) or by the osteotome technique (experimental group B). Resonance frequency measurements (RFMs) were made on each implant at the time of fixture placement and at the time of scarification. Half of the minipigs were sacrificed 7 days and 28 days after implant placement and the implants were removed with the surrounding bone. Bone tissue responses were evaluated by histological analysis and removal torque testing. For histological evaluation 30-50 microm-thick ground sections were examined. Biomechanical testing revealed a significantly higher stability of implants in the control group (A) than in the experimental group (B) (P = 0.004) at day 7. After 28 days implant stability in the control group remained significant higher (47%) than those of group B (P > 0.001). RFM demonstrated no significant difference between both groups and during the experimental course. Histological analysis demonstrated fractured trabeculae in peri-implant bone in the experimental group at day 7, while they were not posed at day 28. We conclude that the decreased implant stability by using the osteotome technique is based on microfractures in peri-implant bone.
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Affiliation(s)
- André Büchter
- Department of Cranio-Maxillofacial Surgery, University of Münster, Waldeyerstrasse 30, D-48129 Münster, Germany.
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