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13 views2 pages

JContempOrthod 1 1 67 68

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drzana78
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© © All Rights Reserved
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Technique Clinic 67

A simple mesh guide for accurate inter-radicular miniscrew


placement
Divyaroop Raia, Janardhanam Pb, Anuroop Raic, Dhruv Yadavd

iniscrews are being widely used for intrusion of inci-

M sors and posteriors, as well as antero-posterior dental


retraction and protraction. With the increase in the
the usage of Miniscrews in recent times, particularly in the
dentoalveolar areas, the accuracy in inter-radicular insertion of
miniscrews without harming the roots of the adjacent teeth have
been found challenging. Since the roots are in contiguity of the
buccal cortical plate and have space restraints between the roots
of two adjacent teeth, the probable risk of root damage while
insertion can be high. 1-8
There are several suggested methods for determining implant
locations from the two dimensional radiographs. A bent stainless Fig 1. Mesh Frame with “T” design
steel wire9,10 or a brass wire11 has been placedover the dentoalveolar
areas of the selected implant site as a radiopaque marker, but these
do not completely avoid the risk of root contact. Various methods,
stents and guides have been designed and developed in recent
times for accurate inter-radicular placement of mini implants,12-17
but most of those requires laboratory fabrication which adds to
number of appointments.
Ideally, inter-radicular insertion of the miniscrews should be
into thin, attached gingiva,to obtain favorable soft tissue health
for attaining stationary anchorage during force loading.9If the
miniscrewsis inserted in the loose alveolar tissue the risk of
inflammation, peri-implantitis, soft-tissue overgrowth, and Fig 2. Mesh Frame with Crimpable Hook
aphthous ulceration increases which thereby raises the likelihood
of miniscrew failure by 30%.10 That is why a clinical evaluation of
attached gingiva is of prime importance to decide the height at 1. Weld a 0.019x0.025 inch straight wire in a “T” design at the
which the implant is to be inserted. center of the lower border of the mesh(Figure 1) or
The present article describes a simple Mesh guide that 2. Weld a Crimpable hook at the center of the lower border of the
permits accurate miniscrew placement in the septal bone area while mesh. (Figure 2)
preventing root damage.
Placement of the Jig:

Fabrication: Place the Mesh Jig with the ‘0.019x0.025 inch’ attachment can be
placed into the bracket slot and tied either with a ligature wire or
1. Clinically measure the mucosal height (till the attached gingiva)
elastomeric module (Figure 1) or if a ‘Crimpable’ attachment
using periodontal probe or a divider and measure it on a scale.
was used place the mesh on the main arch wire.
2. Take a piece of stainless-steel mesh with internal dimension of
1mm each side of the mesh unit (easily available in the market) Implant placement:
3. The total height of the mesh frame should be 2-3 mm greater than
the measured mucosal height and · After placing the Jig in the desired area, use a radiograph to
4. Width of the mesh frame should be of the width of two adjacent identify the number of grid deciding the best site for micro-
teeth between which implant has to be placed implant placement, based on root locations and bone levels
5. Once the dimensions of the mesh frame are decided make the · IOPA X-Ray will show the meshwork covering the root
border of the mesh using a 0.018 brass wire and weld it with the surface.(Figure 3)
meshwork, using a spot welder, commonly available at every clinical · Check the desired implant position (between the roots) & count
setup. the grids from the border of the frame over the desired row
(Height - as measured clinically)
· Once the grid is decided, make a small punch hole either with a
a
Reader. Department of Orthodontics & Dentofacial Orthopedics, sharp probe or with a round bur using a micro-motor.(Figure 4)
Rajasthan Dental College and Hospitan, Jaipur
b · Remove the mesh assembly and place the implant over the
Professor. Department of Orthodontics & Dentofacial Orthopedics, Sibar
Institute of Dental Sciences, Guntur marked area at the desired angle.(Figure 5)
c
Reader. Department of Oral & Maxillofacial Surgery, Ahmedabad Dental · After placing the Micro-implant, take an IOPA X-ray again to
College & Hospital, Ahmedabad check the accuracy of the micro-implant placement.(Figure 6)
d
Senior Lecturer. Department of Orthodontics & Dentofacial Orthopedics,
Rajasthan Dental College and Hospitan, Jaipur
Divyaroop Rai et al 68

Conclusion:
This versatile Mesh Guide can be used in the upper and lower
buccal segments, in the upper midline (H), or in the mandibular
symphyseal region (I). We have found it simple and safe to use and
easy to fabricate for individual patients and can be easily autoclaved
to be re-used. A supply of the Mesh Guide can be prepared in
advance with few common sizes seen in the patients, for added
convenience, which can help reduce the clinical chair-side time
along with an accurate placement of the Micro-Implant.

Referances:

1. Creekmore, T.D. and Eklund, M.K.: The possibility of skeletalanchorage, J. Clin.


Orthod. 17:266-269, 1983.
2. Kanomi, R.: Mini-implant for orthodontic anchorage, J. Clin.Orthod. 31:763-767,
1997.
3. Kyung, H.M.; Park, H.S.; Bae, S.M.; Sung, J.H.; and Kim, I.B.:Development of
orthodontic micro-implants for intraoralanchorage, J. Clin. Orthod. 37:321-329, 2003.
4. Bae, S.M.; Park, H.S.; Kyung, H.M.; Kwon, O.W.; and Sung,J.H.: Clinical
application of micro-implant anchorage, J. Clin.Orthod. 36:298-302, 2002.
Fig 3. IOPA X-Ray with the meshwork covering the root surface 5. Carano, A.; Velo, S.; Leone, P.; and Siciliani, G.: Clinical applicationsof the
miniscrew anchorage system, J. Clin. Orthod.39:9-24, 2005.
6. Lin, J.C. and Liou, E.J.: A new bone screw for orthodonticanchorage, J. Clin.
Orthod. 37:676-681, 2003.
7. Schnelle, M.A.; Beck, F.M.; Jaynes, R.M.; and Huja, S.S.: Aradiographic evaluation
of the availability of bone for placementofminiscrews, Angle Orthod. 74:832-837, 2004.
8. Somchai, M.: Titanium mini-implant for orthodontic anchorage,J. Thai Orthod.
3:41-46, 2004.
9. Lee, J.S.; Kim, D.H.; Park, Y.C.; Kyung, S.H.; and Kim, T.K.: The efficient use of
midpalatalminiscrew implants, Angle Orthod. 74:711-714, 2004.
10. Miyawaki, S.; Koyama, I.; Inoue, M.; Mishima, K.; Sugahara, T.; and Takano-
Yamamoto, T.: Factors associated with the stability of titanium screws placed in the
posterior region for orthodontic anchorage, Am. J. Orthod. 124:373-378, 2003.
11. Liou, E.J.; Pai, B.C.; and Lin, J.C.: Do miniscrews remain stationary under
orthodontic forces? Am. J. Orthod. 126:42-47, 2004.
12. Suzuki, E.Y. and Buranastidporn, B.: An adjustable surgical guide for miniscrew
placement, J. Clin. Orthod. 39:588-590, 2005.
13. Morea, C.; Dominquez, G.C.; Wuo, A.V.; and Tortamano, A.: Surgical guide for
Fig 4. Punch hole with a sharp probe optimal positioning of mini-implants, J.Clin. Orthod. 39:317-321, 2005.
14. Cousley, R.R. and Parberry, D.J.: Surgical stents for accurate miniscrew insertion,
J. Clin. Orthod. 40:412-417, 2006.
15. Estelita C.B., S.; Janson, G.; Chiqueto, K.; de Freitas, M.R.; Henriques, J.F.; and
Pinzan, A.: A three-dimensional radiographic- surgical guide for mini-implant placement,
J. Clin. Orthod. 40:548-554, 2006.
16. Kravitz ;Kusnoto and Hohlt: A Simplified Stent for Anterior Miniscrew Insertion,
J. Clin. Orthod. 41:224-226, 2007
17. Hemanth M.; G.S. Patil and SudhanshuVerma: Micro-Implant Positioning Guide,
J. Clin. Orthod. 46:37-38, 2012

Fig 5. Mark for Micro-Implant placement

Fig 6. IOPA X-Ray with Micro-Implant accurately placed

November 2016 Vol 1 Issue 1 Journal of Contemporary Orthodontics

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