Korean J Orthod.  2021 May;51(3):199-216. 10.4041/kjod.2021.51.3.199.

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

• Giudice AL
• Rustico L
• Longo M
• Oteri G
• Papadopoulos MA
• Nucera R

• KMID: 2515823
• DOI: http://doi.org/10.4041/kjod.2021.51.3.199

Abstract

Objective
The aim of this systematic review was to evaluate the complications and side effects associated with the clinical use of orthodontic miniscrews by systematically reviewing the best available evidence.
Methods
A survey of articles published up to March 2020 investigating the complications associated with miniscrew insertion, in both the maxilla and mandible, was performed using 7 electronic databases. Clinical studies, case reports, and case series reporting complications associated with the use of orthodontic miniscrew implants were included. Two authors independently performed study selection, data extraction, and risk-of-bias assessment.
Results
The database survey yielded 24 articles. The risk-of-bias assessment revealed low methodological quality for the included studies. The most frequent adverse event reported was root injury with an associated periradicular lesion, vitality loss, pink discoloration of the tooth, and transitory loss of pulp sensitivity. Chronic inflammation of the soft tissue surrounding the miniscrew with mucosal overgrowth was also reported. The other adverse events reported were lesion of the buccal mucosa at the insertion site, soft-tissue necrosis, and perforation of the floor of the nasal cavity and maxillary sinus. Adverse events were also reported after miniscrew removal and included secondary bleeding, miniscrew fracture, scars, and exostosis.
Conclusions
These findings highlight the need for clinicians to preliminarily assess generic and specific insertion site complications and side effects.

Keyword

Orthodontic mini-implant; Evidence-based orthodontics; Anchorage; Microimplant

Figure

• 

  Figure 1 Flow chart showing the selection of studies performed according to the PRISMA guidelines.

• 

  Figure 2 Pie chart showing the proportion of the selected study designs.

Reference

1. Proffit WR, Fields HW, Larson BE, Sarver DM. 2019. Contemporary orthodontics. Elsevier;Philadelphia:

2. Antoszewska-Smith J, Sarul M, Łyczek J, Konopka T, Kawala B. 2017; Effectiveness of orthodontic miniscrew implants in anchorage reinforcement during en-masse retraction: a systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 151:440–55. DOI: 10.1016/j.ajodo.2016.08.029. PMID: 28257728.

3. Papadopoulos MA, Tarawneh F. 2007; The use of miniscrew implants for temporary skeletal anchorage in orthodontics: a comprehensive review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 103:e6–15. DOI: 10.1016/j.tripleo.2006.11.022. PMID: 17317235.

4. Jones JP, Elnagar MH, Perez DE. 2020; Temporary skeletal anchorage techniques. Oral Maxillofac Surg Clin North Am. 32:27–37. DOI: 10.1016/j.coms.2019.08.003. PMID: 31685345.

5. Papadopoulos MA, Papageorgiou SN, Zogakis IP. 2011; Clinical effectiveness of orthodontic miniscrew implants: a meta-analysis. J Dent Res. 90:969–76. DOI: 10.1177/0022034511409236. PMID: 21593250.

6. Lin L, Ahn HW, Kim SJ, Moon SC, Kim SH, Nelson G. 2015; Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence. Angle Orthod. 85:253–62. DOI: 10.2319/030514-156.1. PMID: 25490552.

7. Papageorgiou SN, Zogakis IP, Papadopoulos MA. 2012; Failure rates and associated risk factors of orthodontic miniscrew implants: a meta-analysis. Am J Orthod Dentofacial Orthop. 142:577–95.e7. DOI: 10.1016/j.ajodo.2012.05.016. PMID: 23116500.

8. Higgins JPT, Green S. 2011. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration;London:

9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. 2009; The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 62:e1–34. DOI: 10.1016/j.jclinepi.2009.06.006. PMID: 19631507.

10. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. 2013. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. University of Ottawa;Ottawa:

11. Alharbi F, Almuzian M, Bearn D. 2018; Miniscrews failure rate in orthodontics: systematic review and meta-analysis. Eur J Orthod. 40:519–30. DOI: 10.1093/ejo/cjx093. PMID: 29315365.

12. Reynders R, Ronchi L, Bipat S. 2009; Mini-implants in orthodontics: a systematic review of the literature. Am J Orthod Dentofacial Orthop. 135:564.e1–19. discussion 564–5. DOI: 10.1016/j.ajodo.2008.09.026. PMID: 19409331.

13. Agrawal N, Kallury A, Agrawal K, Nair PP. 2013; Alveolar bone exostoses subsequent to orthodontic implant placement. BMJ Case Rep. 2013:bcr2012007951. DOI: 10.1136/bcr-2012-007951. PMID: 23355580. PMCID: PMC3604206.

14. Al-Kharsa SS, Masoud AI. 2017; A proposed method for covering a mini-screw head while maintaining space for ligation. Int J Orthod Milwaukee. 28:65–6. PMID: 29990405.

15. Choi YJ, Lee DW, Kim KH, Chung CJ. 2015; Scar formation and revision after the removal of orthodontic miniscrews. Korean J Orthod. 45:146–50. DOI: 10.4041/kjod.2015.45.3.146. PMID: 26023543. PMCID: PMC4446376.

16. Er K, Bayram M, Taşdemir T. 2011; Root canal treatment of a periradicular lesion caused by unintentional root damage after orthodontic miniscrew placement: a case report. Int Endod J. 44:1170–5. DOI: 10.1111/j.1365-2591.2011.01933.x. PMID: 21851367.

17. Ghislanzoni LH, Berardinelli F, Ludwig B, Lucchese A. 2016; Considerations involved in placing miniscrews near the nasopalatine bundle. J Clin Orthod. 50:321–8. PMID: 27323275.

18. Hwang YC, Hwang HS. 2011; Surgical repair of root perforation caused by an orthodontic miniscrew implant. Am J Orthod Dentofacial Orthop. 139:407–11. DOI: 10.1016/j.ajodo.2008.11.032. PMID: 21392697.

19. Lee JY, Kim PS, Choi C, Kim KB. 2016; Root repair and regeneration after miniscrew root damage. J World Fed Orthod. 5:70–8. DOI: 10.1016/j.ejwf.2016.02.005.

20. Marquezan M, de Freitas AO, Nojima LI. 2012; Miniscrew covering: an alternative to prevent traumatic lesions. Am J Orthod Dentofacial Orthop. 141:242–4. DOI: 10.1016/j.ajodo.2010.05.027. PMID: 22284292.

21. McCabe P, Kavanagh C. 2012; Root perforation associated with the use of a miniscrew implant used for orthodontic anchorage: a case report. Int Endod J. 45:678–88. DOI: 10.1111/j.1365-2591.2012.02022.x. PMID: 22309739.

22. Qin YJ, Zhang GD, Zhang Y, Ping YF, Zhao CY. 2016; Natural reversal of tooth discoloration and pulpal response to testing following removal of a miniscrew implant for orthodontic anchorage: a case report. Int Endod J. 49:402–9. DOI: 10.1111/iej.12459. PMID: 25877019.

23. Lim G, Kim KD, Park W, Jung BY, Pang NS. 2013; Endodontic and surgical treatment of root damage caused by orthodontic miniscrew placement. J Endod. 39:1073–7. DOI: 10.1016/j.joen.2013.04.037. PMID: 23880281.

24. Chen CM, Chang CS, Tseng YC, Hsu KR, Lee KT, Lee HE. 2011; The perception of pain following interdental microimplant treatment for skeletal anchorage: a retrospective study. Odontology. 99:88–91. DOI: 10.1007/s10266-010-0152-1. PMID: 21271332.

25. Fäh R, Schätzle M. 2014; Complications and adverse patient reactions associated with the surgical insertion and removal of palatal implants: a retrospective study. Clin Oral Implants Res. 25:653–8. DOI: 10.1111/clr.12152. PMID: 23551587.

26. Gurdan Z, Szalma J. 2018; Evaluation of the success and complication rates of self-drilling orthodontic mini-implants. Niger J Clin Pract. 21:546–52. DOI: 10.4103/njcp.njcp_105_17. PMID: 29735852.

27. Hourfar J, Bister D, Lisson JA, Ludwig B. 2017; Incidence of pulp sensibility loss of anterior teeth after paramedian insertion of orthodontic mini-implants in the anterior maxilla. Head Face Med. 13:1. DOI: 10.1186/s13005-016-0134-9. PMID: 28061791. PMCID: PMC5217250.

28. Jia X, Chen X, Huang X. 2018; Influence of orthodontic mini-implant penetration of the maxillary sinus in the infrazygomatic crest region. Am J Orthod Dentofacial Orthop. 153:656–61. DOI: 10.1016/j.ajodo.2017.08.021. PMID: 29706213.

29. Jung SA, Choi YJ, Lee DW, Kim KH, Chung CJ. 2015; Cross-sectional evaluation of the prevalence and factors associated with soft tissue scarring after the removal of miniscrews. Angle Orthod. 85:420–6. DOI: 10.2319/101813-772.1. PMID: 25153264.

30. Takaki T, Tamura N, Yamamoto M, Takano N, Shibahara T, Yasumura T, et al. 2010; Clinical study of temporary anchorage devices for orthodontic treatment--stability of micro/mini-screws and mini-plates: experience with 455 cases. Bull Tokyo Dent Coll. 51:151–63. DOI: 10.2209/tdcpublication.51.151. PMID: 20877162.

31. Ziebura T, Flieger S, Wiechmann D. 2012; Mini-implants in the palatal slope--a retrospective analysis of implant survival and tissue reaction. Head Face Med. 8:32. DOI: 10.1186/1746-160X-8-32. PMID: 23157849. PMCID: PMC3546431.

32. Motoyoshi M, Sanuki-Suzuki R, Uchida Y, Saiki A, Shimizu N. 2015; Maxillary sinus perforation by orthodontic anchor screws. J Oral Sci. 57:95–100. DOI: 10.2334/josnusd.57.95. PMID: 26062857.

33. Shinohara A, Motoyoshi M, Uchida Y, Shimizu N. 2013; Root proximity and inclination of orthodontic mini-implants after placement: cone-beam computed tomography evaluation. Am J Orthod Dentofacial Orthop. 144:50–6. DOI: 10.1016/j.ajodo.2013.02.021. PMID: 23810045.

34. Fabbroni G, Aabed S, Mizen K, Starr DG. 2004; Transalveolar screws and the incidence of dental damage: a prospective study. Int J Oral Maxillofac Surg. 33:442–6. DOI: 10.1016/j.ijom.2003.10.014. PMID: 15183406.

35. Wang Z, Zhang D, Liu Y, Zhao Z. 2010; Buccal mucosal lesions caused by the interradicular miniscrew: a preliminary report. Int J Oral Maxillofac Implants. 25:1183–8. PMID: 21197496.

36. Gracco A, Tracey S, Baciliero U. 2010; Miniscrew insertion and the maxillary sinus: an endoscopic evaluation. J Clin Orthod. 44:439–43. PMID: 21038797.

37. Nucera R, Bellocchio AM, Oteri G, Farah AJ, Rosalia L, Giancarlo C, et al. 2019; Bone and cortical bone characteristics of mandibular retromolar trigone and anterior ramus region for miniscrew insertion in adults. Am J Orthod Dentofacial Orthop. 155:330–8. DOI: 10.1016/j.ajodo.2018.04.025. PMID: 30826035.

38. Nucera R, Lo Giudice A, Bellocchio AM, Spinuzza P, Caprioglio A, Perillo L, et al. 2017; Bone and cortical bone thickness of mandibular buccal shelf for mini-screw insertion in adults. Angle Orthod. 87:745–51. DOI: 10.2319/011117-34.1. PMID: 28598220.

39. Liou EJ, Pai BC, Lin JC. 2004; Do miniscrews remain stationary under orthodontic forces? Am J Orthod Dentofacial Orthop. 126:42–7. DOI: 10.1016/j.ajodo.2003.06.018. PMID: 15224057.

40. Kuroda S, Yamada K, Deguchi T, Hashimoto T, Kyung HM, Takano-Yamamoto T. 2007; Root proximity is a major factor for screw failure in orthodontic anchorage. Am J Orthod Dentofacial Orthop. 131(4 Suppl):S68–73. DOI: 10.1016/j.ajodo.2006.06.017. PMID: 17448389.

41. Tronstad L. 1988; Root resorption--etiology, terminology and clinical manifestations. Endod Dent Traumatol. 4:241–52. DOI: 10.1111/j.1600-9657.1988.tb00642.x. PMID: 3078294.

42. Renjen R, Maganzini AL, Rohrer MD, Prasad HS, Kraut RA. 2009; Root and pulp response after intentional injury from miniscrew placement. Am J Orthod Dentofacial Orthop. 136:708–14. DOI: 10.1016/j.ajodo.2007.12.031. PMID: 19892289.

43. Carano A, Velo S, Leone P, Siciliani G. 2005; Clinical applications of the Miniscrew Anchorage System. J Clin Orthod. 39:9–24. quiz 29–30. PMID: 29130922.

44. Suzuki EY, Buranastidporn B. 2005; An adjustable surgical guide for miniscrew placement. J Clin Orthod. 39:588–90. PMID: 16244426.

45. Poggio PM, Incorvati C, Velo S, Carano A. 2006; "Safe zones": a guide for miniscrew positioning in the maxillary and mandibular arch. Angle Orthod. 76:191–7.

46. Carano A, Velo S, Incorvati C, Poggio P. 2004; Clinical applications of the Mini-Screw-Anchorage-System (M.A.S.) in the maxillary alveolar bone. Prog Orthod. 5:212–35. PMID: 15546013.

47. Reicheneder C, Rottner K, Bokan I, Mai R, Lauer G, Richter G, et al. 2008; Mechanical loading of orthodontic miniscrews - significance and problems: an experimental study. Biomed Tech (Berl). 53:242–5. DOI: 10.1515/BMT.2008.038. PMID: 18840065.

48. Kyung HM, Park HS, Bae SM, Sung JH, Kim IB. 2003; Development of orthodontic micro-implants for intraoral anchorage. J Clin Orthod. 37:321–8. quiz 314PMID: 12866214.

49. Smith A, Hosein YK, Dunning CE, Tassi A. 2015; Fracture resistance of commonly used self-drilling orthodontic mini-implants. Angle Orthod. 85:26–32. DOI: 10.2319/112213-860.1. PMID: 24869900.

50. Chen Y, Kyung HM, Gao L, Yu WJ, Bae EJ, Kim SM. 2010; Mechanical properties of self-drilling orthodontic micro-implants with different diameters. Angle Orthod. 80:821–7. DOI: 10.2319/103009-607.1. PMID: 20578851.

51. Lim SA, Cha JY, Hwang CJ. 2008; Insertion torque of orthodontic miniscrews according to changes in shape, diameter and length. Angle Orthod. 78:234–40. DOI: 10.2319/121206-507.1. PMID: 18251617.

52. Wilmes B, Rademacher C, Olthoff G, Drescher D. 2006; Parameters affecting primary stability of orthodontic mini-implants. J Orofac Orthop. 67:162–74. DOI: 10.1007/s00056-006-0611-z. PMID: 16736117.

53. Ludwig B, Glasl B, Bowman SJ, Wilmes B, Kinzinger GS, Lisson JA. 2011; Anatomical guidelines for miniscrew insertion: palatal sites. J Clin Orthod. 45:433–41. quiz 467PMID: 22094724.

54. Winsauer H, Vlachojannis C, Bumann A, Vlachojannis J, Chrubasik S. 2014; Paramedian vertical palatal bone height for mini-implant insertion: a systematic review. Eur J Orthod. 36:541–9. DOI: 10.1093/ejo/cjs068. PMID: 23221896.

55. Lo Giudice A, Quinzi V, Ronsivalle V, Martina S, Bennici O, Isola G. 2020; Description of a digital work-flow for CBCT-guided construction of micro-implant supported maxillary skeletal expander. Materials (Basel). 13:1815. DOI: 10.3390/ma13081815. PMID: 32290597. PMCID: PMC7215674.

56. Yoon S, Lee DY, Jung SK. 2019; Influence of changing various parameters in miniscrew-assisted rapid palatal expansion: a three-dimensional finite element analysis. Korean J Orthod. 49:150–60. DOI: 10.4041/kjod.2019.49.3.150. PMID: 31149605. PMCID: PMC6533180.

57. Hourfar J, Ludwig B, Bister D, Braun A, Kanavakis G. 2015; The most distal palatal ruga for placement of orthodontic mini-implants. Eur J Orthod. 37:373–8. DOI: 10.1093/ejo/cju056. PMID: 25336563.

58. Liou EJ, Chen PH, Wang YC, Lin JC. 2007; A computed tomographic image study on the thickness of the infrazygomatic crest of the maxilla and its clinical implications for miniscrew insertion. Am J Orthod Dentofacial Orthop. 131:352–6. DOI: 10.1016/j.ajodo.2005.04.044. PMID: 17346590.

59. Baumgaertel S, Hans MG. 2009; Assessment of infrazygomatic bone depth for mini-screw insertion. Clin Oral Implants Res. 20:638–42. DOI: 10.1111/j.1600-0501.2008.01691.x. PMID: 19281501.

60. Kravitz ND, Kusnoto B. 2007; Risks and complications of orthodontic miniscrews. Am J Orthod Dentofacial Orthop. 131(4 Suppl):S43–51. DOI: 10.1016/j.ajodo.2006.04.027. PMID: 17448385.