Maxillary sinus perforation by orthodontic anchor screws

Abstract

To facilitate safe placement of orthodontic anchor screws (miniscrews), we investigated the frequency of maxillary sinus perforation after screw placement and the effect of sinus perforation on screw stability. Maxillary sinus perforations involving 82 miniscrews (diameter, 1.6 mm; length, 8 mm) were evaluated using cone-beam computed tomography. All miniscrews were placed in maxillary alveolar bone between the second premolar and first molar for anchorage for anterior retraction in patients undergoing first premolar extraction. The placement torque and screw mobility of each implant were determined using a torque tester and a Periotest device, and variability in these values in relation to sinus perforation was evaluated. Eight of the 82 miniscrews perforated the maxillary sinus. There was no case of sinusitis in patients with miniscrew perforation and no significant difference in screw mobility or placement torque between perforating and non-perforating miniscrews. The sinus floor was significantly thinner in perforated cases than in non-perforated cases. A sinus floor thickness of 6.0 mm or more is recommended in order to avoid miniscrew perforation of the maxillary sinus. (J Oral Sci 57, 95-100, 2015)

Complications reported with the use of orthodontic miniscrews: A systematic review

“…All studies reported side effects and complications associated with the use of orthodontic miniscrews. The studies, as summarized in Figure 2 , were identified as follows: 11 case reports, 13 - 23 8 retrospective longitudinal studies, 24 - 31 3 prospective controlled trials, 32 - 34 1 preliminary study, 35 and 1 case series. 36 All studies were conducted in a university setting and included both male and female participants.…”

“…The reported average age of the patients ranged from 11 to 52 years old. Self-drilling titanium orthodontic miniscrews were used in 7 different studies, 15 , 23 , 26 , 28 - 30 , 32 whereas non-self-drilling screws were used in 4 studies. 19 , 24 , 25 , 27 The other studies did not specify the type of miniscrew inserted.…”

“…All the miniscrews were surgically inserted according to the protocol suggested by the respective manufacturer. According to each orthodontic treatment plan, the miniscrews were positioned both in the maxilla and in the mandible, in the interradicular area, 13 , 15 , 18 , 19 , 21 - 24 , 32 , 33 , 36 palatal zone, 16 , 17 , 25 , 26 , 31 infrazygomatic crest, 28 , 36 ascending ramus, 26 or buccal shelf. 20 , 26 , 29 …”

Anatomical consideration for optimal position of orthodontic miniscrews in the maxilla: a CBCT appraisal

“…An important factor to consider when planning orthodontic miniscrew placement is safety by avoiding injury to adjacent anatomical structures such as roots, blood vessels, nerve fibers, nasal cavity and the maxillary sinus. [31][32][33][34][35][36] There are studies that have evaluated bone thickness, bone volume and height in the maxilla, but no consensus has been reached on the proximity of the maxillary sinus and nasal cavity to areas where miniscrews are frequently inserted. 12,13,21,22,[37][38][39][40] Furthermore, a large number of studies have been performed on either dry skulls or cadavers.…”

Ortodontik Tedavide İskeletsel Ankraj Amaçlı Olarak Kullanılan Mini Vidalar: Literatür Derlemesi

“…Motoyoshi ve ark. 'nın 37 yaptığı çalışma sonucunda, mini vida perforasyonu olan hastalarda sinüzite rastlanmamıştır, sinüste perforasyon olan ve perforasyon olmayan mini vidalar arasında vida hareketliliği veya yerleştirme torkunda önemli bir farklılık olmadığı belirtilmiştir. Mini vida perforasyonu olan olgularda sinus tabanının, perforasyon olmayan olgulara kıyasla anlamlı derecede ince olduğu belirtildi.…”