Korean J Orthod.  2015 May;45(3):146-150. 10.4041/kjod.2015.45.3.146.

Scar formation and revision after the removal of orthodontic miniscrews

• Choi YJ
• Lee DW
• Kim KH
• Chung CJ

• KMID: 1974806
• DOI: http://doi.org/10.4041/kjod.2015.45.3.146

Abstract

Many clinicians expect complete healing after the removal of temporary anchorage devices, but clinical examination may reveal scar-like tissue. This report presents the typical features of scarring detected after the removal of miniscrews, and the clinical outcome of scar revision along with its pathologic features.

Keyword

Scar; Miniscrew; Wound healing; Soft tissue; Scarring

MeSH Terms

Cicatrix*
Wound Healing

Figure

• 

  Figure 1 Typical soft tissue scars after miniscrew removal. The scar tissue was localized to the removal sites and exhibited a protuberant appearance with clear margins and whitish coloration (arrows). A and D, Female in 20s, distal to upper canine. Immediately after (A) and 34 months after miniscrew removal (D). B and E, Female in 20s, upper molar region. Immediately after (B) and 18 months after miniscrew removal (E). C and F, Male in 20s, palatal slope. Immediately after (C) and 10 months after (F) the removal of the miniscrew. The arrows indicate the site of miniscrew removal.

• 

  Figure 2 Serial intra-oral photographs and histological evaluation of the scar tissue. A, Initial presentation; B, during orthodontic treatment; C, after miniscrew removal; D, 36 months after miniscrew removal; E and F, before scar revision (right and left, respectively); G and H, 3 months after scar revision (right and left, respectively). Hematoxylin-Eosin staining of the excised scar tissue; I, adjacent normal gingiva; J, scar tissue showing hyperkeratosis and dense extracellular fibers in the dermis. The arrows indicate the site of miniscrew removal.

Reference

1. Lee KJ, Joo E, Kim KD, Lee JS, Park YC, Yu HS. Computed tomographic analysis of tooth-bearing alveolar bone for orthodontic miniscrew placement. Am J Orthod Dentofacial Orthop. 2009; 135:486–494.

2. Sawada K, Nakahara K, Matsunaga S, Abe S, Ide Y. Evaluation of cortical bone thickness and root proximity at maxillary interradicular sites for mini-implant placement. Clin Oral Implants Res. 2013; 24:Suppl A100. 1–7.

3. Schätzle M, Männchen R, Zwahlen M, Lang NP. Survival and failure rates of orthodontic temporary anchorage devices: a systematic review. Clin Oral Implants Res. 2009; 20:1351–1359.

4. Choi JH, Yu HS, Lee KJ, Park YC. Three-dimensional evaluation of maxillary anterior alveolar bone for optimal placement of miniscrew implants. Korean J Orthod. 2014; 44:54–61.

5. Larjava H, Wiebe C, Gallant-Behm C, Hart DA, Heino J, Häkkinen L. Exploring scarless healing of oral soft tissues. J Can Dent Assoc. 2011; 77:b18.

6. Mak K, Manji A, Gallant-Behm C, Wiebe C, Hart DA, Larjava H, et al. Scarless healing of oral mucosa is characterized by faster resolution of inflammation and control of myofibroblast action compared to skin wounds in the red Duroc pig model. J Dermatol Sci. 2009; 56:168–180.

7. Jung SA, Choi YJ, Lee DW, Kim KH, Chung CJ. Cross-sectional evaluation of the prevalence and factors associated with soft tissue scarring after the removal of miniscrews. Angle Orthod. 2014; [Epub ahead of print].

8. Lim JK. Gummy smile correction using mini implant. Korean J Clin Orthod. 2010; 9:14–31.

9. Zhu Z, Ding J, Shankowsky HA, Tredget EE. The molecular mechanism of hypertrophic scar. J Cell Commun Signal. 2013; 7:239–252.

10. Bond JS, Duncan JA, Sattar A, Boanas A, Mason T, O'Kane S, et al. Maturation of the human scar: an observational study. Plast Reconstr Surg. 2008; 121:1650–1658.

11. Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair and regeneration. Nature. 2008; 453:314–321.

12. Pietrokovski J, Massler M. Ridge remodeling after tooth extraction in rats. J Dent Res. 1967; 46:222–231.

13. Mahdavian Delavary B, van der Veer WM, Ferreira JA, Niessen FB. Formation of hypertrophic scars: evolution and susceptibility. J Plast Surg Hand Surg. 2012; 46:95–101.

14. Wolfram D, Tzankov A, Pülzl P, Piza-Katzer H. Hypertrophic scars and keloids--a review of their pathophysiology, risk factors, and therapeutic management. Dermatol Surg. 2009; 35:171–181.

15. Kim JH, Sung JY, Kim YH, Lee YS, Chang HS, Park CS, et al. Risk factors for hypertrophic surgical scar development after thyroidectomy. Wound Repair Regen. 2012; 20:304–310.

16. Chen SSH, Chang HH, Chen YH, Wang YP, Chen YJ, Chen YJ, et al. Tissue reaction surrounding miniscrews for orthodontic anchorage: an animal experiment. J Dent Sci. 2012; 7:57–64.

17. Olsson M, Lindhe J. Periodontal characteristics in individuals with varying form of the upper central incisors. J Clin Periodontol. 1991; 18:78–82.