Background/aimRetraction of the upper incisors/canines requires maximum anchorage. The aim of the present study was to analyze the efficacy of mini implants in comparison to conventional devices in patients with need for en masse retraction of the front teeth in the upper jaw.Material and methodsAn electronic search of PubMed, Web of Science, and EMBASE and hand searching were performed. Relevant articles were assessed, and data were extracted for statistical analysis. A random effects model, weighted mean differences (WMD), and 95% confidence intervals (CI) were computed for horizontal and vertical anchorage loss at the first molars in the analyzed patient treatments.ResultsA total of seven RCTs employing direct anchorage through implants in the alveolar ridge were finally considered for qualitative and quantitative analysis, and further five publications were considered for the qualitative analysis only (three studies: indirect anchorage through implant in the mid-palate, two studies: direct/indirect anchorage in the alveolar ridge). In the control groups, anchorage was achieved through transpalatal arches, headgear, Nance buttons, intrusion arches, and differential moments.WMD [95% CI, p] in anchorage loss between test and control groups amounted to − 2.79 mm [− 3.56 to − 2.03 mm, p < 0.001] in the horizontal and − 1.76 mm [− 2.56 to − 0.97, p < 0.001] favoring skeletal anchorage over control measures. The qualitative analysis revealed that minor anchorage loss can be associated with indirect anchorage, whereas anchorage gain was commonly associated with direct anchorage. Implant failures were comparable for both anchorage modalities (direct 9.9%, indirect 8.6%).ConclusionWithin its limitations, the meta-analysis revealed that maximum anchorage en masse retraction can be achieved by orthodontic mini implants and direct anchorage; however, the ideal implant location (palate versus alveolar ridge) and the beneficial effect of direct over indirect anchorage needs to be further evaluated.Electronic supplementary materialThe online version of this article (10.1186/s40729-018-0144-4) contains supplementary material, which is available to authorized users.
Insertion guides are becoming popular for orthodontic mini-implant positioning. The aim of this study was to evaluate and compare the accuracy of two different mini-implant insertion guides, with or without pre-drilling, in a human cadaveric model. Maxillary casts of six fresh frozen specimens were digitized to create insertion guides. Sixty mini-implants were randomly inserted with full-arch or skeletonized guides, either with or without predrilling. Pre- and post-treatment CBCTs were superimposed using rigid registration. Transformation matrices of the planned and real positions were obtained, and distances at the mini-implant neck and apex, as well as the angular deviation, were calculated. The Kruskal–Wallis test was performed, followed by a post hoc test when indicated. Out of 60 inserted mini-implants, 46 could be evaluated. Of these, 10 initially assigned to no pre-drilling required this procedure due to very high bone density. Therefore, 32 implants were inserted with pre-drilling (n = 15 full-arch; n = 17 skeletonized) and 14 without (n = 7 full-arch; n = 7 skeletonized). The lowest mean deviation at the neck was 1.22 ± 0.6 mm, registered in the full-arch/pre-drilling group. The skeletonized/no pre-drilling group presented the lowest mean values at the apex, i.e., 1.72 ± 1.22 mm, as well as the lowest mean angular deviation, i.e., 8.23 ± 4.24°. Significant differences among groups were observed only at the neck, with higher mean deviation in the skeletonized/pre-drilling group than in the full-arch/pre-drilling one (p = 0.014). In conclusion, within the limitations of the study, rather high deviations between planned and real mini-implant positions were found. Further studies are needed on how to improve the accuracy within in vivo settings.
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