Int. J. Oral Maxillofac. Surg.

2011; 40: 521–525

doi:10.1016/j.ijom.2011.01.002, available online at http://www.sciencedirect.com

Research Paper
Orthodontic Implants

Horizontal and vertical J.-H. Wu1, P.-C. Lu2, K.-T. Lee1,

J.-K. Du3, H.-C. Wang3,
C.-M. Chen4

resistance strength of
1
Department of Family Dentistry; Kaohsiung
Medical University Hospital, Taiwan;
2
Department of Conservative Dentistry,
Kaohsiung Medical University Hospital,

infrazygomatic mini-implants Taiwan; 3Graduate Institute of Dental

Sciences, College of Dental Medicine,
Kaohsiung Medical University, Taiwan;
4
Faculty of Dentistry, College of Dental
Medicine, Kaohsiung Medical University
J.-H. Wu, P.-C. Lu, K.-T. Lee, J.-K. Du, H.-C. Wang, C.-M. Chen: Horizontal and Hospital, Taiwan
vertical resistance strength of infrazygomatic mini-implants. Int. J. Oral Maxillofac.
Surg. 2011; 40: 521–525. # 2011 International Association of Oral and Maxillofacial
Surgeons. Published by Elsevier Ltd. All rights reserved.
Key words: infrazygomatic mini-implant; resis-
tance strength; orthodontic anchorage.
Abstract. This study assessed the adequacy of anchorage strength of infrazygomatic
mini-implants in vertical and horizontal directions. Each brand of infrazygomatic Accepted for publication 12 January 2011
mini-implant tested provided acceptable skeletal anchorage. Available online 18 February 2011

Successful orthodontic treatment depends
on consistent anchorage. In certain situa-
tions, maximum anchorage is needed for
adequate control of teeth movement.
Orthodontic treatment is easily impeded
by anchorage loss that occurs with limited
intro-oral anchorage or when extra-oral
appliances are not readily accepted by
the patient. In the 1960s, Brånemark and
co-workers introduced the titanium
implant to dentistry. Success rates for such
implants are more than 90% in the maxilla
and mandible. Dental implants have been
accepted as a reliable and useful treatment
for oral rehabilitation.
Orthodontistshaverecentlybecomeinter-
ested in skeletal anchorage using mini-
implants. Mini-implant anchorages4,9,11,12
provide more stable anchorage and
improve the quality of orthodontic treat-
ment. They enhance the efficiency of
orthodontic procedures and confirm the
treatment outcome. In Asia, orthodontists
consider mini-implant anchorage an alter-
native anchorage option in orthodontic
treatment. Infrazygomatic mini-implants
are a new form of skeletal anchorage in
orthodontic treatment that involve the use
of a small, 2-mm mini-implant instead of
flap surgery. No data have been reported
concerning the resistance strength of
infrazygomatic mini-implants. This study
aimed to determine the adequacy of the
anchorage strength of infrazygomatic
mini-implants, in vertical and horizontal
directions.
Materials and methods
The authors evaluated 30 infrazygomatic
mini-implants (Fig. 1) from the following
three brands: AbsoAnchor1 (Dentos Inc.,
Taegu, Korea), Bioray1 (Bio-Ray Biotech
Corp, Taipei, Taiwan), and Lomas1
(Mondeal, Tuttlingen, Germany). Ten
mini-implants per brand were equally
divided for testing vertical and horizontal
resistance strengths. The length of the
mini-implants (2 mm diameter) was either
12 mm (AbsoAnchor1 and Bioray1) or
13 mm (Lomas1) (Fig. 2). AbsoAnchor1
and Lomas1 were of the cylindrical type,
composed of a parallel thread along the
whole length of the thread part. Bioray1
was a taper-type implant composed of
increasing inner and outer diameters at
the end of the thread part. Instead of
animal bone, artificial bone (Sawbones1;
Pacific Research Laboratories, Vashon,
WA, USA) was used for the experiments
(Fig. 3). To simulate the infrazygomatic
crest, a 40-pcf (0.64 g/cm3) cellular rigid
polyurethane sheet (cortical bone; 2 mm
thickness) was attached to a 20-pcf
(0.32 g/cm3) block (cancellous bone;
20 mm thickness) with an acrylate bond
(Scotch, 3M). A custom-fabricated clamp-
ing apparatus was used to hold the artifi-
cial bone in place. The infrazygomatic
mini-implants were placed perpendicular
to the artificial bone and self-drilled to a
depth of 5 mm into the bone. The insertion
torque was measured with a digital torque
metre (Lutron, Taiwan) (Fig. 4). Vertical
and horizontal (Fig. 5) resistance tests
were performed using a material testing
machine (Lloyd, USA). An orthodontic
wire (0.018 in.) was passed through the
hole of the implant and tied to the pulling
apparatus. Five power chains (Ormco,
Glendora, USA) were used to estimate
the peak breaking force (Fig. 6). The
Kruskal–Wallis test was used to evaluate
differences between the implant types.

0901-5027/050521 + 05 $36.00/0 # 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
[()TD$FIG]
522 Wu et al.

Statistical significance was set at

P < 0.05. Pearson’s correlation coeffi-
cient was used to predict the relationship
between the insertion torque and resis-
tance strength for all the mini-implants.

Results
The results of insertion torque and vertical
resistance strength testing are summarized
in Table 1. Insertion torque strength ran-
ged from 6.2 N cm (AbsoAnchor1) to
10.8 N cm (Lomas1). The differences in
insertion torque amongst the three brands
were not statistically significant. For ver-
tical resistance testing, the average
Fig. 1. Bioray1 (2  12 mm) inserted into the right infrazygomatic crest. strength of the Bioray1, Lomas1 and
[()TD$FIG] AbsoAnchor1 mini-implants was 129.3,
142.4 and 142.5 N cm, respectively. There
was no significant difference in the ver-
tical resistance strength between the three
brands. There were no significant correla-
tions between the insertion torque and
vertical resistance strength.
The results of insertion torque and hor-
izontal resistance strength testing are sum-
marized in Table 2. Insertion torque
strength ranged from 6.7 N cm (AbsoAn-
chor1) to 11.5 N cm (Lomas1). The dif-
ferences in insertion torque between the
three brands were not statistically signifi-
cant. For horizontal resistance testing, the
average strength of the AbsoAnchor1,
Lomas1 and Bioray1 mini-implants
was 149.7, 150.8 and 178.1 N cm, respec-
tively. There was no significant difference
in horizontal resistance strength between
the three brands. There were no significant
Fig. 2. From left to right: Bioray1(2  12 mm), AbsoAnchor1 (2  12 mm), and Lomas1
(2  13 mm) mini-implants.
correlations between insertion torque and
[()TD$FIG] horizontal resistance strength. The mean
peak breaking force of the power chains
was 21.9 N cm.

Discussion
Anchorage control is one of the primary
concerns of orthodontic treatment. Ortho-
dontists utilize different skeletal ancho-
rage devices for reinforcing anchorage.
The retention strength of a miniplate is
designed to resist the compressive and
tension forces that occur physiologically.
Miniplate osteosyntheses possess ade-
quate strength and rigidity to withstand
the masticatory forces generated imme-
diately after craniofacial or maxillofacial
bone fracture and osteotomy. Miniplates
have been used as skeletal anchorage,
with significant improvements in treat-
ment outcomes3,10. CHEN et al.2 reported
a 95% success rate with the use of
miniplates for skeletal anchorage. Mini-
plate anchorage needs fixation and
Fig. 3. Lomas1 (2  13 mm) manually driven into Sawbone1 to a depth of 5 mm. flap removal operations, which cause
[()TD$FIG]
Fig. 4. Digital torque metre (Lutron, Taipei, Taiwan).
[()TD$FIG]
Fig. 5. The vertical resistance test machine (Lloyd, Pennsylvania, USA). An orthodontic wire
(0.018 in.) passed through the hole of the mini-implant and tied to the material testing machine.
moderate postoperative swelling with
intense pain. Infrazygomatic mini-
implants are easy to insert and remove
without flap surgery, therefore infrazygo-
matic mini-implants are gradually being
substituted for miniplates for anchorage
using the zygomatic crest.
LIOU et al.7 used computed tomography
to investigate the bone thickness of the
infrazygomatic crest. The infrazygomatic
crest thickness above the maxillary first
molar ranged from 5.2  1.1 to
8.8  2.3 mm, measured at 40–758 to
the maxillary occlusal plane. They sug-
Infrazygomatic mini-implant 523
gested that injury to the molar root and
perforation of the maxillary sinus could be
avoided by inserting the mini-implant
above the maxillary first molar at a 55–
708 angle to the maxillary occlusal plane.
ONO et al.8 investigated cortical bone
thickness in the posterior buccal regions,
medial and distal to the first molar, where
mini-implants are often placed. They
found that the average thickness of the
cortical bone of the maxilla was 1.09–
2.12 mm and that the thickness increased
with increasing height. According to pre-
vious studies, the authors used a cortical
bone thickness of 2 mm and an insertion
depth of 5 mm. Based on clinical situa-
tions, the minimum length of infrazygo-
matic mini-implants was set at 12 mm in
the present study. Artificial bone (Saw-
bone1) can consistently simulate the
mechanical properties of human bone
(including density and rigidity). The prop-
erties of Sawbone1 exhibit low variabil-
ity, and its physical characteristics are
identical to those of human bone (trabe-
cular bone and compact bone), therefore
artificial bone is now commonly used in
mechanical testing.
To avoid irreversible damage to dento-
alveolar tissue, appropriate orthodontic
force is needed, but this can lead to
unexpected teeth movement in the
absence of adequate control. In cases
requiring minimum or moderate ancho-
rage, dental anchorage may be suitable.
When maximum anchorage is required,
extra-oral appliances are used, which
allow the distal movement of segmental
teeth. Variable patient compliance is a
significant disadvantage of extra-oral
appliances. Extra-oral anchorage (such
as headgear) can be obtained with a
5 N orthopaedic force. In the present
experiment, the average breaking force
of the power chains was 21.9 N cm,
which was four-fold greater than the
orthopaedic force. The resistance
strength of the infrazygomatic mini-
implant should be able to sustain vertical
and horizontal pullout forces. In this
study, the lowest resistance force was
129.3 N cm in the vertical pullout test,
which was more than 25-fold greater than
the orthopaedic force. All infrazygomatic
mini-implants in this experiment could
provide adequately stable skeletal
anchorage.KIM et al.6 compared the
effects of taper shapes on the mechanical
properties of mini-implants. They found
that a cylindrical shape had the lowest
maximum insertion torque and maximum
removal torque. In the present study,
AbsoAnchor1 and Lomas1 were cylind-
rical. Lomas1 had the largest insertion
[()TD$FIG]
524 Wu et al.

the maxillary first molar. In this study,

mini-implants locked into the bone at
5 mm depth could adequately support
anchorage throughout the treatment.
In conclusion, the insertion torque can-
not be considered reliable for predicting
the pullout strength. All brands of infra-
zygomatic mini-implants tested provided
acceptable skeletal anchorage. This study
has certain limitations, because it involved
in vitro experiments on artificial bone and
had a small sample size. The results should
be interpreted and applied clinically with
great caution.

Competing interests
None declared.

Fig. 6. Power chain (Ormco, Glendora, USA) breaking test. Funding

None.
Table 1. The mean insertion torque, resistance strength and their standard deviation (SD) in the
vertical direction of the measurements (including n = 5). Ethical approval
Insertion torque (N cm) Pullout strength (N cm) Not required.
Correlation
Mean SD Mean SD coefficient
AbsoAnchor 1
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