Page 17 - MDJ 2022 Jan-Jun, Volume 45 Number 1

Orthodontic Mini Implant: Malaysian perspective

Table 3: Three commonly used MI in Malaysia.
Orlus AbsoAnchor Dual-Top
Manufacturer Ortholution, South Korea Dentos, South Korea Jeil, South Korea
Cost/each (RM) 130 125 155
Thread design Self-drilling, conical Self-drilling, cylindrical and conical Self-drilling and self-tapping,
cylindrical
Screw head 1. Button 1. Small head 1. Hexagonal
design 2. No head 2. Button
3. Long head 3. 0.22 inch cross slot
4. Circle head
5. Fixation head
6. Bracket head
7. Hook head
8. Double head
9. Golf head
10. Joint head
Connecting Hole (eyelet) and button 1. Ball head 1. Ball head
elements 2. Single slot 2. Hole
3. Hole 3. Single slot
4. Cross slot
2 types of designs. 10 variations in designs 12 variations in designs
Length (mm) 5.0–7.0 with 1 cylindrical neck. 5.0–12.0 5.0–12.0
5.0–6.0 with 2.0–4.0 cylindrical neck.
Diameter (mm) 1. Mini: 1.4 (centre), 1.6 (cervical). 1.2–2.0 (for each diameter) and 2.7 1.3–2.0 (for each diameter)
2. Regular: 1.6 (centre), 1.9 (cervical).
3. Wide: 1.8 (centre), 2.2 (cervical).

less retention we will get. However, the MI thread indication, the en-masse retraction of the anterior segment
diameter and thread length were found not to be associated where MIs are placed at the most common site between the
6
with MI failure rates. All the three MI systems are self- buccal aspects of the second premolar and first molar
drilling and cylindrical except for ORLUS® which comes (Table 1). 33–35 Two randomised controlled trials mentioned
in a conical shape (Table 3). the use of MIs for canine retraction. 25,36 Some studies
reported MIs being used as anchorage reinforcement at the
THE CLINICAL APPLICATIONS outset of the treatment to replace the use of TPA or TPA
Nance because it is proven to be more effective in
Clinical application of MIs cover a large prevention of mesialization of molars. 2,14
spectrum in orthodontics. The use of MIs as anchorage is
classified into direct or indirect anchorage followed by the FINAL CONSIDERATION
desired biomechanics. It facilitates teeth movements in all
three dimensions. Correction of transverse discrepancy is Selection of MIs should be tailored to various
made possible with miniscrew-assisted rapid palatal factors such as cost-effectiveness, geometry, and the
expander (MARPE) with minimal side effects such as intended mechanics. There is no “cookbook” for the best
minimal root resorption and more parallel suture opening or the most stable MI, because stability and success is
27
in comparison to the traditional rapid palatal expander. multifactorial. We should also not be deluded assuming
By inserting the MIs into the palate and expanding the that MIs can solve every skeletal camouflage in
midpalatal suture using the midline expander without orthodontics, it is very much dependent on the magnitude
attachment to teeth results in a more predictable skeletal of the skeletal discrepancies. It’s best if we are equipped
expansion. Apart from aiming for Andrew’s six keys of with sufficient knowledge to improve the delivery of a
occlusion, our ultimate goal is to create a beautiful smile; predictable and improved orthodontic treatment outcome.
a gummy smile, on the other hand, is perceived to be Technology will come and go, but this assimilation of MIs
unattractive and challenging to orthodontists. The use of in orthodontics is likely to stay for a while. It is our
MIs is able to mimic the outcome of Le Fort 1 in the responsibility as clinicians to learn and adapt to the new
correction of the gummy smile. 28,29 Correction of vertical technology with an open mind and use it to the best interest
problems such as open bite using MIs, avoiding of our patients.
osteotomies that comes with the cost and trauma of
30
orthognathic surgeries, is proven to be relatively stable REFERENCES
too. Nonetheless, there are limitations in terms of
31
rotation that can only be produced through surgery. In 1. Alharbi F, Almuzian M, Bearn D. Anchorage
typical mechanics to upright the impacted teeth using effectiveness of orthodontic miniscrews compared to
headgear and transpalatal arches: a systematic review
loops or springs, extrusion is commonly caused, but with and meta-analysis. Acta Odontol Scand.
32
MIs such issues are avoided. In Malaysia, the majority of 2019;77(2):88-98.
papers being published used MIs based on classic doi:10.1080/00016357.2018.1508742

16