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MINI-IMPLANT SUPPLEMENT
Journal of Orthodontics, Vol. 41, 2014, S62–S74
Temporary replacement of missing maxillary
lateral incisors with orthodontic miniscrew
implants in growing patients: rationale, clinical
technique, and long-term results
Jason B. Cope1,2,3 and David McFadden4,5,6
1
American Board of Orthodontics; 2Department of Graduate Orthodontics, St Louis University, St. Louis, MO, USA; 3Private Practice of
Orthodontics, Dallas, TX, USA; 4American Board of Prosthodontics; 5American Board of Oral Implantology; 6Private Practice of Prosthodontics,
Dallas, TX, USA
The missing maxillary lateral incisor in adolescent patients presents an orthodontic challenge. Historically, there
have been three treatment options to address this clinical problem: (1) canine substitution, (2) tooth autotransplantation, and (3) dental restoration. Unfortunately, these methods are not without limitation. A novel
treatment concept, originating in 2003 and utilizing orthodontic miniscrew implants, is presented along with the
rationale, clinical technique and 8 years of follow-up.
Key words: Temporary anchorage device, miniscrew, miniscrew implant, lateral incisor, restoration
Received 14 May 2014; accepted 8 June 2014
Introduction
The missing maxillary lateral incisor in adolescent patients,
whether due to developmental absence or traumatic injury
is a challenge, which the orthodontic profession has
struggled to adequately treat since is inception as the first
dental specialty. To date, several treatment options have
been used for the replacement of absent maxillary lateral
incisors (Czochrowska et al., 2000; Zachrisson et al.,
2004; Kinzer and Kokich, 2005a; Kinzer and Kokich,
2005b; Kokich and Kinzer, 2005; Priest, 2006; Kavadia
et al., 2011; Kokich et al., 2011; Zachrisson et al., 2011;
Janakievski, 2012; Liu and Ramp, 2013; Norris and
Caesar, 2013). Unfortunately, none ideally addresses the
situation and this article will briefly review those options as
well as document a relatively new method of treatment first
conceived in 2003 and now with long-term follow-up from
2–8 years.
Until recently, there have been three treatment options
to address a missing maxillary lateral incisor in adolescents: (1) canine substitution, (2) tooth auto-transplantation, and (3) dental restoration. Unfortunately, all of the
above treatment options have limitations. The removable
options are not tolerated well in adolescents, who are
typically self-conscious about removing their ‘fake tooth’
and displaying their large edentulous space while eating in
Address for correspondence: Jason B. Cope, DDS, PhD, 7015
Snider Plaza, Suite 200, Dallas, TX 75205, USA.
Email: [email protected]
# 2014 British Orthodontic Society
front of their friends. They also risk losing or breaking the
removable appliance. The fixed options all require enamel
reduction of often perfectly healthy teeth. Moreover, they
do not guarantee ideal alveolar and gingival contours, or
aesthetics.
The common limitation to all of the above; however, is
the fact that none of them prevent alveolar bone resorption
and soft tissue shrinkage over time in the missing tooth
location. In fact, all of them promote alveolar bone loss
due to a lack of alveolar loading (Packota et al., 1988;
Bodic et al., 2005). This bone resorption eventually
compromises aesthetics at the pontic site and also makes
future restoration with dental implants more difficult.
Frequently, these patients require bone and soft tissue
grafts if the decision is later made to place a dental implant
and restoration, particularly if the patient is young at the
onset of orthodontic treatment.
One treatment option that has not been mentioned to
this point is the placement and restoration of a dental
implant. This is because osseointegrated dental implants
are not appropriate in growing adolescents. Dental
implants, unlike natural teeth, do not continue to erupt,
as the adjacent dentition erupts into the inter-maxillary
growth space (Cronin and Oesterle, 1998; Percinoto
et al., 2001). An arbitrary minimum age of 15 in females
DOI 10.1179/1465313314Y.0000000112
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Figure 1 Pre-treatment photos: (a) right buccal; (b) anterior; (c) left buccal; (d) maxillary occlusal; (e) lateral overjet; (f)
mandibular occlusal (Reprinted with permission from Cope JB: Clinical Case Report 10005. www.CopestheticCE.com)
Figure 2 Pre-treatment panoramic radiograph (Reprinted
with permission from Cope JB: Clinical Case Report
10005. www.CopestheticCE.com)
and 18 in males has been suggested for placement of
osseointegrated implants (Cronin et al., 1994). Some
authors recommend an even later implant placement age
(Spear et al., 1997). The aforementioned guidelines;
however, do not account for individual variations in
growth patterns (Behrents, 1985a,b; Fishman, 1987;
Silveira et al., 1992). Dental implants placed in patients,
regardless of their chronological age, but with any facial
growth remaining, run the risk of the implants becoming
Figure 3 Post-treatment photos: (a) right buccal; (b) anterior; (c) left buccal; (d) maxillary occlusal; (e) lateral overjet; (f)
mandibular occlusal (Reprinted with permission from Cope JB: Clinical Case Report 10005. www.CopestheticCE.com)
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Figure 4 Intraoperative MSI placement photos: (a) mucoperiosteal flap and initial pilot hole placement; (b)
periapical radiograph of pilot drill angulation; (c) MSI at final placement depth; (d) MSI provisional coping in
place; (e) provisional coping after reshaping; (f) polycarbonate crown form selection; (g) pickup of reshaped
provisional coping inside of crown form; (h) provisional crown cemented in place and soft tissues sutured
(Reprinted with permission from Cope JB: Clinical Case Report 10005. www.CopestheticCE.com)
submerged relative to the adjacent erupting permanent
teeth (Spear et al., 1997; Thilander et al., 2001).
Although dental implants designed to osseointegrate
have been shown to be detrimental in growing adolescents, what about orthodontic miniscrew implants that
rely on bone-implant contact, but are designed to be
placed and removed at a later date without osseointegration? This paper will explain the rationale behind that
novel concept first performed on a case that began
treatment in 2003, and now with 99 months of follow-up.
Her sister’s case, with 27 months of follow-up, is also
presented.
Rationale
The detrimental effects of placing dental implants in
growing adolescents have been covered in detail elsewhere (Spear et al., 1997; Thilander et al., 2001). Briefly,
the valid concerns are that the dental implants will
osseointegrate, and lead to the following problems:
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Figure 5 Comparison photos from before and after restorative procedure: (a) post-orthodontic occlusal; (b) postorthodontic facial; (c) post-restorative occlusal; (d) post-restorative facial (Reprinted with permission from Cope JB:
Clinical Case Report 10005. www.CopestheticCE.com)
infraocclusion due to eruption of adjacent teeth, marginal
bone loss around adjacent teeth, buccal bone loss around
the implant, and possible vertical angular defect between
the implant and adjacent teeth (Thilander et al., 2001).
However, in non-growing patients, dental implants have
benefits. For example, they have been shown to stimulate
bone remodelling at a rate significantly higher that of
normal bone remodelling, and this is not a short-term
phenomenon; it is apparently increased for the life of the
implant (Huja, 2007).
Figure 6 Post-treatment panoramic radiograph (Reprinted
with permission from Cope JB: Clinical Case Report 10005.
www.CopestheticCE.com)
If there are bone stimulating benefits of dental implants,
but these are potentially detrimental for growing adolescents, the obvious question becomes ‘Is it possible to
harness the benefits of dental implants while at the same
time minimizing or eliminating the problems experienced
when placing them in growing children?’ It is this question
that the primary author began to contemplate in 2003
when considering the post-treatment options of a patient
with a congenitally missing lateral incisor. Concurrently,
temporary anchorage devices (TADs) were becoming a
popular topic in the pursuit of absolute orthodontic
anchorage. As a point of clarification, the term temporary
anchorage device broadly refers to a group of devices
temporarily fixed to bone for the purpose of enhancing
orthodontic anchorage and which are removed after use
(Cope and Owens, 2007). Included in this group are
miniscrew implants (MSIs), miniplate implants, palatal
implants, and others (Cope and Owens, 2007). For the
purpose of this article, the specific TAD of interest is the
MSI, so this term is used here to prevent confusion with
the other types of TADs.
Considering that MSIs used for orthodontic anchorage are generally 1.5 to 2.0 mm diameter and designed
to prevent osseointegration, and that dental implants
placed in the maxillary lateral incisor position are on
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Figure 7 99-month retention photos: (a) right buccal; (b) anterior; (c) left buccal; (d) maxillary occlusal; (e) lateral overjet; (f)
mandibular occlusal (Reprinted with permission from Cope JB: Clinical Case Report 10005. www.CopestheticCE.com)
average 3.5 mm in diameter and designed to encourage
osseointegration, might there be a possible application
of MSIs as a temporary dental implant during the
adolescent years, and then replaced by a ‘permanent’
dental implant after the cessation of growth? The
literature was searched in 2003, but there was no report
that anyone had utilised this apparently novel concept.
Clinical case 1
The patient presented at 9 years 8 months of age with the
diagnosis of skeletal class II, class II right and class I left
buccal relationships, congenitally missing maxillary right
lateral incisor, peg maxillary left lateral incisor, and
buccally impacted maxillary left canine. All deciduous
second molars were present clinically and the permanent
second molars had not yet erupted (Figures 1 and 2). The
treatment plan was to initiate an early phase of treatment
in the maxillary arch due to the location of the maxillary
left canine over the adjacent lateral incisor root and the
anticipated duration of time to bring the impacted canine
into the arch. The canine would be uncovered and slowly
moved postero-inferiorly into its normal position in the
arch. The lower arch would be bonded later to minimize
the duration of full appliances. Cervical-pull headgear
with the possible addition of right side Class II elastics
would be worn nightly for approximately six months
to correct the right Class II dental relationship. Upon
completion of treatment, all appliances would be removed.
An MSI would be placed in the missing maxillary right
lateral incisor position and restored with a provisional
polycarbonate crown. The maxillary left peg lateral
incisor would be restored at the same time. The MSI
would remain in place until the cessation of growth,
followed by replacement of the MSI with a permanent
dental implant.
Treatment proceeded as prescribed. The canine was
uncovered and brought into position. An ideal occlusion
was established followed by orthodontic appliance
removal. Diagnostic records were acquired at 12 years 6
months of age (Figure 3). The patient proceeded to the
prosthodontist for placement of the MSI and restoration.
The procedure was as follows (Figure 4):
1.
2.
Under local anaesthesia a mid-crestal incision was
made in the edentulous site with sulcular incisions
at the proximal teeth.
A full thickness soft tissue flap was elevated to
expose the underlying ridge crest to enable:
a. Direct visualization of the bony crest, as preferred in cases where bone volume and thickness
is poor,
b. Cement removal prior to soft tissue re-approximation and closure.
3.
4.
Minor alveoplasty, or bony recontouring, of the
edentulous ridge was completed to simulate natural
tooth bony architecture.
A 2.2 mm diameter MSI (IMTEC Sendax MDI
MAX, 3M Unitek, St. Paul, MN, USA, www.
3MUnitek.com) was placed in the centre of the site,
equidistance from the adjacent roots.
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Comparison photos from porcelain crown cementation at 12 months in retention to 99 months in retention:
(a) 12 months retention facial; (b) 12 months retention anterior; (c) 99 months retention facial; (d) 99 months retention
anterior (Reprinted with permission from Cope JB: Clinical Case Report 10005. www.CopestheticCE.com)
Figure 8
a. Use of a surgical guide was preferable, but
difficult due to the 1.0 mm single-drill protocol.
b. Visualization and palpation of the adjacent root
eminences was performed to assist with initial
1.0 mm diameter drill placement and angulation
(Figure 4a).
c. Intraoperative periapical radiographs were taken
– a shallow 3.0 mm penetration depth using the
1.0 mm diameter drill as a radiographic guide pin
(Figure 4b). The shallower drill depths allowed
easier angular corrections, when necessary.
d. The MSI was placed to the final depth (Figure 4c).
Buccolingual implant trajectory was of minimal
concern since the abutment head was only
4.0 mm tall. The implant was facially inclined
due to typical bony anatomy.
5.
6.
7.
8.
The provisional coping was placed on the implant
(Figure 4d). The coping was reshaped extraorally
to fit within the confines of the provisional crown
(Figure 4e).
An appropriate sized polycarbonate crown was
selected and modified in length and width
(Figure 4f).
Intraorally, the polycarbonate crown was used
to pick up the provisional coping using crown
and bridge resin (Figure 4g). Only minimal
acrylic resin was used for initial coping pick
up.
In the laboratory, additional acrylic was added to
thicken the gingival margins. The crown was then
placed on a lab analogue to adjust and create the
ideal emergence profile.
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Figure 9 Periapical radiographs: (a) day of MSI placement; (b) 99 months of retention. Note that superimposition
of the periapical radiographs indicates approximately 1.0 mm of bone grown coronally down the distal MSI
threads (Reprinted with permission from Cope JB: Clinical Case Report 10005. www.CopestheticCE.com)
9.
10.
11.
12.
13.
The provisional crown was placed intraorally and
adjusted. It fitted snugly with interproximal contacts
and was free of functional occlusal and excursive
contacts. Most adjustments were performed extraorally, when possible, to reduce contamination of the
surgical site with acrylic shavings.
Final crown modifications were made followed by
laboratory polishing.
The crown was cemented with temporary cement.
The lateral walls of the abutment head were parallel
to the body of the MSI, and so provided improved
resistance and retention form. In addition, the
abutment head had a circumferential undercut, and
so provided improved retention form. Therefore,
very little cement was necessary. Contrary to popular
belief, definitive cementation is not necessary.
Cement was cleaned while the flap was open. The
surgical site was irrigated with sterile saline.
The soft tissues were closed with resorbable sutures
(Figure 4h). Although not necessary in this case,
some tissue sculpting can be performed if a large
band of keratinized tissue exists.
14. The patient was instructed to brush, floss and eat
normally, but refrain from eating anything hard in
the area of the MSI crown.
Upon completion of the procedure, a maxillary retainer
was fabricated, and post-operative photographs (Figure 5)
and radiographs taken (Figure 6). The plan at that point
was to continue to observe the patient every six months
during her school years to insure that infra-occlusion
did not develop. After approximately nine months, the
provisional crowns began to discolour. Since the MSI was
anticipated to be in place for approximately 6–8 years, a
‘temporary’ porcelain crown was placed until the final
implant and restorations were placed. The porcelain crown
was cemented at 12 months of retention.
As the clinical photographs (Figures 7 and 8) and
periapical radiographs (Figure 9) demonstrate, no infraocclusion has developed after eight years, nor has any
bone defects been created around the MSI or adjacent
teeth. Although the original plan was to remove and
replace the MSI with a ‘permanent’ dental implant, it is
hard to justify the additional procedure considering the
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Intraoperative MSI placement photos: (a) mucoperiosteal flap; (b) minor alveolar crest recontouring for
emergence profile; (c) initial pilot hole placement; (d) initial MSI placement; (e) final MSI placement; (f) impression
coping in place; (g) MSI O-Ball Immediate Temporization Cap in place; (h) MSI O-Ball Immediate Temporization Cap
from occlusal (Reprinted with permission from Cope JB: Clinical Case Report 14001. In Press, www.CopestheticCE.com)
Figure 10
lack of problems while the ‘temporary’ MSI and restoration have been in place.
Clinical case 2
This patient, the younger sister of Case 1, presented at
11 years 6 months of age with a skeletal class III
relationship, dental class I with a class III tendency,
congenitally missing maxillary right lateral incisor, peg
maxillary left lateral incisor, and retroclined lower
anterior teeth. Nine deciduous teeth were present. A
lingual arch was placed to maintain the mandibular
second deciduous molar spaces until active treatment
commenced 14 months later when all of the permanent
teeth were present.
The treatment plan was to accept the class III skeletal
relationship and to achieve a class I dental relationship
by retracting the mandibular premolars into the
deciduous molar spaces followed by retraction of the
mandibular anterior teeth. Class III elastics would be
worn 22 hours per day as needed once full-sized
archwires were placed. Upon completion of treatment
an MSI would be placed in the missing maxillary right
lateral incisor position and restored with a provisional
polycarbonate crown. The maxillary left peg lateral
would be restored at the same time. The MSI would
remain in place until the cessation of growth and then
replaced by a permanent dental implant, if necessary.
Orthodontic treatment proceeded as prescribed for
15.5 months, then the patient was referred to the
prosthodontist for placement of the MSI and restoration. The same MSI procedure was followed as in Case 1
(Figures 10 and 11). Based on the sibling’s previous
experience with the polycarbonate crown, a ‘temporary’
porcelain crown was planned in this case until the final
implant and restoration stage. The porcelain crown was
cemented after bleaching at 6 months of retention.
As the clinical photographs (Figure 12) and periapical
radiographs (Figure 13) demonstrate, no infraocclusion has
developed after 27 months. Interestingly, superimposition
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Figure 11 Comparison photographs from before and after restorative procedure: (a) post-orthodontic occlusal; (b)
post-orthodontic facial; (c) post-restorative occlusal; (d) post-restorative facial (Reprinted with permission from
Cope JB: Clinical Case Report 14001. In Press, www.CopestheticCE.com)
of periapical radiographs taken the day of MSI placement and 27 months later demonstrate that approximately 1.2 mm of bone growth occurred coronally along
the threads of the MSI.
Discussion
The results of these two cases indicate that the placement
of MSIs with provisional restorations may be a viable
treatment option in certain growing individuals. Three
other adolescents have been treated in a similar manner
by the author. None of these five patients have shown any
type of deleterious effect, such as infraocclusion or bony
defects, as would be expected for osseointegrating dental
implants in growing individuals after 2 to 8 years of
follow-up. However, it is accepted that properly conducted cohort studies are required to fully validate this
approach.
The potential benefits of temporary MSI lateral incisor
replacement include: prevention of bone resorption, stimulation of bone remodelling, prevention of adjacent
tooth migration vertically and/or horizontally, prevention
of root migration into the edentulous area, minimization
or elimination of bony and/or soft tissue grafts, less
demanding orthodontic retention, little risk of orthodontic
MSI osseointegration, and the dark collar seen through
the gingiva around dental implants should not occur
because the smaller diameter MSI is placed more lingually
towards the centre of the alveolar crest.
Initially, the desired clinical technique was a modification
of the Cope Placement ProtocolTM (Cope and Herman,
2007), i.e. a minimally invasive technique using topical
anaesthetic, no incision/flap, and no pilot hole followed by
placement of an untreated, self-drilling machine polished
1.8 mm Unitek TADTM. However, the prosthodontist,
who routinely places dental implants surgically, saw little
need for a minimally invasive protocol. In particular, his
rationale for elevating a mucoperiosteal flap was for better
surgical visualization of the knife-edged alveolar ridge.
Likewise, a minimal 1.0 mm diameter by 3.0 mm deep
pilot hole prevented the miniscrew from ‘slipping’ to the
buccal or lingual upon placement, and also allowed intraoperative radiographs for proper angulation. Considering
placement in a growing individual, the only unacceptable
deviation of the proposed protocol was the placement of a
‘treated’ miniscrew, i.e. the miniscrew was surface treated
like a traditional dental implant (sandblasted and acid
etched [SLA treatment] to roughen the surface and
encourage osseointegration). This type of implant was
placed in Case 1 due to a lack of communication, but has
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Figure 12 Comparison photos from porcelain crown cementation at 6 months in retention to 27 months in retention:
(a) 6 months retention facial; (b) 6 months retention anterior; (c) 27 months retention facial; (d) 27 months retention
anterior (Reprinted with permission from Cope JB: Clinical Case Report 14001. In Press, www.CopestheticCE.com)
since been replaced with a standard machine polished MSI
in subsequent cases. The rationale for using a machine
polished, rather than an SLA treated, MSI is that the latter
would have a significantly greater risk of osseointegrating,
and hence submerging during continued adolescent facial
growth.
Holmes (2013) reported that ‘Some authors have
suggested use of miniscrews with a temporary restoration;
there is a theoretic concern (emphasis added) that the
screw could impair vertical development of the alveolus
and result in a vertical defect, which will require further
site development. Here he refers to an article by Kokich
and Swift (2011) which stated ‘I would not recommend
placing a miniscrew in an adolescent orthodontic patient
who will eventually receive an implant restoration to
replace a missing maxillary lateral incisor. Two primary
reasons supported this perspective: (1) If a miniscrew
perforates the periosteum, as the teeth erupt, the implant
is left behind and vertical angular defects are created in the
implant site. (2) Miniscrews lack versatility for restorative
purposes and most do not have the ability to receive
standard abutments. Further, miniscrew diameters average 1.5 mm, which compromise the emergence profile,
and therefore, the esthetic appearance of the crown.
Unfortunately, no reference was given to support Dr
Kokich’s points. To date, no animal or clinical research
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Figure 13 Periapical radiographs: (a) day of MSI placement; (b) 27 months of retention. Note that superimposition
of the periapical radiographs indicates approximately 1.2 mm of bone grown coronally down the MSI threads
(Reprinted with permission from Cope JB: Clinical Case Report 14001. In Press, www.CopestheticCE.com)
has been published documenting that a small diameter
miniscrew implant causes vertical angular defects when
placed in a growing individual. Although, this does not
mean that an MSI cannot cause a vertical defect, no
evidence currently exists. Moreover, at the time of
publication of Dr Kokich’s article, there were, in fact, at
least two, commercially available MSI systems that had
the necessary versatility to allow for prosthetic restoration
without a compromised emergence profile (Cope and
Herman, 2007; Jeong et al., 2011).
What appears to be overlooked by those opposed to the
temporary use of MSIs for the replacement of maxillary
lateral incisors is that while both a small diameter MSI
and a larger diameter dental implant are technically both
dental implants, their characteristics are distinctly different, especially the total surface area and surface roughness. For example, comparing a 10 mm long61.8 mm
diameter Unitek TADTM and a 10 mm long63.5 mm
diameter dental implant (Figure 14), the surface area of
the dental implant is 142.5% greater than the TAD. This
does not even consider the surface roughness of the MSI
and dental implant. Except for the Korean C-implant
(Jeong et al., 2011) all other commercially available MSIs
are machine polished or smooth. Dental implants, on
the other hand, are surface roughened to substantially
increase surface area and osseointegration by several
hundred percent (Thomas et al., 1987; Buser et al., 1991).
This is a key concept to understand. Several definitions
of osseointegration have been put forward, which is
beyond the scope of this article. At a basic level, osseointegration is related to the amount or percentage of bone in
contact with the implant (Huja, 2007). It logically follows
that the greater amount of surface area, the greater the
chance of osseointegration. In light of several scientific
studies that report a lack of MSI osseointegration
(Deguchi et al., 2003; Huja et al., 2006; Roberts and
Roberts, 2007), the primary author’s 15-year TAD clinical
experience without a single MSI osseointegrating, and the
significantly greater surface area of a dental implant
compared to an MSI, it is highly unlikely that a smoothsurfaced, machine-polished MSI will osseointegrate.
Considering the possible negative sequellae in advance,
what could go wrong, and if so, what measures would be
necessary to adequately treat the situation?
1. The MSI could osseointegrate and submerge relative
to the adjacent teeth – even if an MSI does
submerge, it should not do so to a significant extent
in any six month observation period and so could be
addressed by two means: backing the MSI out and
re-restoring the clinical crown or by simply additive
restoration of the clinical crown. Another option for
a submerged MSI would be to trephine and remove
it altogether. At a diameter of 1.8 mm, the trephined
hole would be a maximum of 2.2 mm, which is still
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treatment to either parallel roots or make adequate space
for an ideal restoration. All of those implants were placed
in the maxillary lateral incisor or lower incisor positions with no failures to date. Other authors have also
demonstrated that mini-dental implants are capable of
sustaining long-term function when placed under ideal
conditions for both adults (Mazor et al., 2004; Dilek et al.,
2007; Flanagan, 2008; Flanagan and Mascolo, 2011;
Gleiznys et al., 2012; Shatkin and Petrotto, 2012; Sohrabi
et al., 2012; Bidra et al., 2013) and children (Graham,
2007; Jeong et al., 2011; Kalia, 2014; Wilmes, 2014).
Comparison of surface areas of dental implant
and miniscrew implant (Reprinted with permission from
Cope JB: Clinical Case Report 14001. www.CopestheticCE.
com)
Figure 14
smaller than the pilot hole of a 3.5 mm diameter
dental implant.
2. The crown could fracture or come loose: refabrication and/or recementation of the clinical crown.
3. The MSI could fracture in a traumatic event:
removal and/or replacement of the fractured MSI.
A more likely event, assuming ideal initial placement, is
that the resulting MSI hole upon removal years later will
be smaller than the pilot hole for the definitive dental
implant, and so additional bone removal will be required
prior to final dental implant placement.
A final concern that some clinicians have expressed is
that a 2.0 mm implant is not sufficient to withstand the
functional forces of occlusion. In the past seven years, the
second author has placed approximately 15 mini-dental
implants in adults unwilling to undergo orthodontic
Conclusions
The absence of anterior teeth in the growing individual has
historically presented a difficult clinical treatment challenge.
The use of a miniscrew implant as a temporary treatment
option holds considerable promise. The benefits of using a
miniscrew implant and a crown as an interim restoration are
significant. For the patient, the obvious psychosocial benefit
is not having to wear a retainer 24 h a day only to remove it
immediately prior to eating; the crestal and buccolingual
alveolar bone and soft tissue volume is preserved during and
through the completion of facial growth. All other
treatment options doom the alveolar bone to disuse
atrophy, necessitating future bone and soft tissue grafting
in the event a definitive implant and restoration is desired
(Spear et al., 1997). Therefore, the possibility of a miniscrew
implant and a cemented crown become an attractive
alternative for the growing patient. Since the initial concept
in 2003, several authors have implemented similar techniques (Ciarlantini 2012; Giannetti 2010; Graham, 2007;
Jeong et al., 2011; Kalia, 2014; Wilmes, 2014). Ciarlantini
2012, Giannetti 2010. Although to date no long-term
randomized clinical trial has been published, no deleterious
effects have been reported elsewhere.
Disclaimer statements
Contributors No statement made.
Funding None.
Conflicts of interest The primary author has a financial
interest in the Unitek TAD system.
Ethics approval None.
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