The Orthodontic Mini-implant Clinical Handbook

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Richard Cousley. The Orthodontic Mini-implant Clinical Handbook

Table of Contents

List of Tables

List of Illustrations

Guide

Pages

The Orthodontic Mini‐Implant Clinical Handbook

Preface to Second Edition

1 Orthodontic Mini‐implant Principles and Potential Complications

1.1 The Origins of Orthodontic Bone Anchorage

1.2 The Evolution of Mini‐implant Biomechanics

1.3 3D Anchorage Indications

1.4 Using the Right Terminology

1.5 Principal Design Features

1.6 Clinical Indications for Mini‐implants

1.6.1 Routine Cases

1.6.2 Complex Cases

1.6.3 Direct and Indirect Anchorage

1.7 Benefits and Potential Mini‐implant Complications

1.8 Mini‐implant Success and Failure

1.9 Medical Contraindications

1.10 Root/Periodontal Damage

1.11 Perforation of Nasal and Maxillary Sinus Floors

1.12 Damage to Neurovascular Tissues

1.13 Mini‐implant Fracture

1.14 Pain

1.15 Soft Tissue Problems

1.16 Mini‐implant Migration

1.17 Biomechanical Side‐effects

1.18 Factors Affecting Mini‐implant Success

References

2 Maximising Mini‐implant Success: Patient (Anatomical) Factors

2.1 Cortical Bone Thickness and Density

2.2 Interproximal Space

2.3 Soft Tissue and Oral Hygiene

2.4 Maxillomandibular Planes Angle

2.5 Age

2.6 Cigarette Smoking

2.7 Body Mass Index

References

3 Maximising Mini‐implant Success: Design Factors. 3.1 Mini‐implant Design Factors

3.2 The Infinitas™ Mini‐implant System

3.2.1 Infinitas Mini‐implant Design Features

3.2.2 Infinitas Guidance System

3.3 Digital Stent Fabrication Processes

References

4 Maximising Mini‐implant Success: Clinical Factors. 4.1 Clinical Technique Factors. 4.1.1 Insertion Technique

4.1.2 Root Proximity

4.1.3 Force Application

4.2 Introducing Mini‐implants to your Clinical Practice

4.3 Patient Consent

4.4 Key Points to Consider for Valid Consent. 4.4.1 Rationale for Mini‐implant Anchorage

4.4.2 Patient Discomfort

4.4.3 Mini‐implant Instability

4.4.4 Periodontal/Root Contact

4.4.5 Mini‐implant Fracture

4.4.6 Mini‐implant Displacement

4.4.7 Written Information

4.5 Staff Training

4.6 Patient Selection

References

5 Mini‐implant Planning

5.1 Mini‐implant Planning. 5.1.1 Treatment Goals and Anchorage Requirements

5.2 Mini‐implant Location

5.3 Hard Tissue Anatomy and Radiographic Imaging

5.4 Soft Tissue Anatomy

5.5 Vertical Location and Inclination

5.6 Insertion Timing

5.7 Guidance Stent

5.8 Mini‐Implant Dimensions

References

6 Mini‐implant Insertion

6.1 Mini‐implant Kit Sterilisation

6.2 Superficial Anaesthesia

6.3 Antibacterial Mouthwash

6.4 Stent Application (Optional)

6.5 Soft Tissue Removal

6.6 Cortical Perforation

6.7 Mini‐implant Insertion

6.8 Mini‐implant Fracture

6.9 Postoperative Instructions

6.10 Force Application

6.11 Biomechanics

6.12 Explantation

6.13 Summary of Mini‐implant Insertion Steps

6.14 Maximising Mini‐implant Success: Ten Clinical Tips

References

7 Retraction of Anterior Teeth

7.1 Clinical Objective

7.2 Treatment Options

7.3 Key Treatment Planning Considerations

7.4 Biomechanical Principles

7.5 Midtreatment Problems and Solutions

7.6 Clinical Steps for a Posterior Mini‐implant. 7.6.1 Preinsertion

7.6.2 Mini‐implant Selection

7.6.3 Insertion

7.6.4 Postinsertion

7.7 Biomechanical Options for Anterior Teeth Retraction

7.8 Case Examples

References

8 Molar Distalisation. 8.1 Alternatives to Mini‐Implant Distalisation

8.1.1 Class II Growth Modification Treatment, Involving Mini‐implant Anchorage (Figure 8.1)

8.1.2 Mandibular Distalisation Using Miniplate Anchorage (Figure 8.3)

8.2 Clinical Objectives of Molar Distalisation

8.3 Treatment Options

8.4 Key Treatment Planning Considerations

8.5 Biomechanical Principles

8.6 Midtreatment Problems and Solutions

8.7 Mandibular Arch Distalisation

8.7.1 Clinical Steps for Mandibular Distalisation. 8.7.1.1 Preinsertion

8.7.1.2 Mini‐implant Selection

8.7.1.3 Insertion

8.7.1.4 Postinsertion

8.7.2 Case Examples

8.8 Maxillary Arch Distalisation

8.8.1 Clinical Steps for Palatal Alveolar Distalisation. 8.8.1.1 Preinsertion

8.8.1.2 Mini‐implant Selection

8.8.1.3 Insertion

8.8.1.4 Postinsertion

8.8.2 Case Examples

8.9 Midpalatal Distaliser Options

8.9.1 Pushcoil Distaliser

8.9.2 Traction Distaliser

8.9.3 Clinical Steps for a Midpalatal Distaliser. 8.9.3.1 Preinsertion

8.9.3.2 Laboratory Distaliser Fabrication

8.9.3.3 Mini‐implant Selection

8.9.3.4 Insertion

8.9.3.5 Postinsertion

8.9.4 Case Examples

References

9 Molar Protraction

9.1 Clinical Objective

9.2 Treatment Options

9.3 Key Treatment Planning Considerations

9.4 Biomechanical Principles

9.5 Midtreatment Problems and Solutions

9.6 Clinical Steps for Molar Protraction Using Alveolar Site Anchorage. 9.6.1 Preinsertion

9.6.2 Mini‐implant Selection

9.6.3 Insertion

9.6.4 Postinsertion

9.7 Case Examples

9.8 Clinical Steps for Midpalate (Indirect) Anchorage (Figure 9.3) 9.8.1 Preinsertion

9.8.2 Mini‐implant Selection

9.8.3 Insertion

9.8.4 Postinsertion

9.9 Direct Palatal Anchorage Example (Figure 9.15)

References

10 Intrusion and Anterior Openbite Treatments

10.1 Single‐Tooth and Anterior Segment Intrusion Treatments. 10.1.1 Clinical Objectives

10.1.2 Treatment Options

10.1.3 Relevant Clinical Details

10.1.4 Biomechanical Principles

10.1.5 Clinical Tips and Technicalities

10.1.6 Clinical Steps. 10.1.6.1 Preinsertion

10.1.6.2 Mini‐implant Selection

10.1.6.3 Insertion

10.1.6.4 Postinsertion

10.1.7 Case Examples

10.2 Anterior Openbite Treatment

10.2.1 Clinical Objectives

10.2.2 Treatment Options

10.2.3 Relevant Clinical Details

10.2.4 Biomechanical Principles

10.2.5 Clinical Tips and Technicalities

10.2.6 Simultaneous Mandibular Molar Intrusion

10.2.7 Clinical Steps for Maxillary Molar Intrusion. 10.2.7.1 Preinsertion

10.2.7.2 Intrusion TPA Fabrication (Figure 10.12)

10.2.7.3 Mini‐implant Selection

10.2.7.4 Insertion

10.2.7.5 Postinsertion

10.2.8 Case Examples

References

11 Transverse and Asymmetry Corrections. 11.1 Asymmetry Problems

11.2 Dental Centreline Correction. 11.2.1 Clinical Objective

11.2.2 Treatment Options

11.2.3 Relevant Clinical Details

11.2.4 Biomechanical Principles

11.2.5 Clinical Tips and Technicalities

11.2.6 Midtreatment Problems and Solutions

11.2.7 Clinical Steps for Centreline Correction. 11.2.7.1 Preinsertion

11.2.7.2 Mini‐implant Selection

11.2.7.3 Insertion

11.2.7.4 Postinsertion

11.2.8 Case Examples

11.3 Unilateral Intrusion (Vertical Asymmetry Correction) 11.3.1 Clinical Objective

11.3.2 Treatment Options

11.3.3 Relevant Clinical Details

11.3.3.1 Unilateral Intrusion, to Correct a Scissors Bite, and Centreline Correction (Figure 11.5)

11.3.4 Biomechanical Principles

11.3.5 Clinical Tips and Technicalities

11.3.6 Midtreatment Problems and Solutions

11.3.7 Clinical Steps for Unilateral Intrusion. 11.3.7.1 Preinsertion

11.3.7.2 Mini‐implant Selection

11.3.7.3 Insertion

11.3.7.4 Postinsertion

11.3.8 Case Example (Figure 11.7)

12 Ectopic Teeth Anchorage

12.1 Clinical Objectives

12.2 Treatment Options

12.3 Relevant Clinical Details

12.4 Biomechanical Principles

12.5 Clinical Tips and Technicalities

12.6 Midtreatment Problems and Solutions

12.7 Clinical Steps for Ectopic Tooth Alignment. 12.7.1 Preinsertion

12.7.2 Mini‐implant Selection

12.7.3 Insertion

12.7.4 Postinsertion

12.7.5 Case Examples

13 Bone‐anchored Maxillary Expansion. 13.1 Conventional Rapid Maxillary Expansion

13.2 Expansion Forces and Speed

13.3 Potential Advantages of Mini‐implant Anchored RME

13.3.1 Greater Basal Skeletal Expansion

13.3.2 Basal Expansion in Older Aged Patients (Postpuberty)

13.3.3 Greater Posterior Palatal Expansion

13.3.4 Increased Nasal Airflow

13.3.5 Fewer Dental and Periodontal Side‐effects

13.4 Clinical Objective

13.5 Treatment Options

13.6 Relevant Clinical Details

13.7 Design Options for Mini‐implant Expanders

13.8 Hybrid RME

13.8.1 Mini‐implant Assisted Rapid Palatal Expansion (MARPE)

13.8.2 Hybrid Hyrax RME Appliance

13.8.2.1 Case Example

13.8.3 Biomechanical Principles for Hybrid RME Appliances

13.8.4 Clinical Steps for Hybrid RME. 13.8.4.1 Preinsertion

13.8.4.2 Mini‐implant Selection

13.8.4.3 Insertion

13.9 Non‐tooth Borne Mini‐Implant Only RME

13.9.1 Case Examples

13.10 Biomechanical Principles

13.10.1 Clinical Steps for OMI‐borne RME. 13.10.1.1 Preinsertion

13.10.1.2 Mini‐implant Selection

13.10.1.3 Insertion

13.11 Haas‐type (Mucosa) and Mini‐implant RME

13.11.1 Clinical Steps for Mucosa‐OMI Borne RME. 13.11.1.1 Preinsertion

13.11.1.2 Mini‐implant Selection

13.11.1.3 Insertion

13.11.2 Case Example

13.12 Summary of RME Design Selection

References

14 Orthognathic Surgical Uses

14.1 Clinical Objectives

14.2 Treatment Options

14.3 Relevant Clinical Details

14.4 Biomechanical Principles

14.5 Clinical Tips and Technicalities

14.6 Clinical Steps. 14.6.1 Preinsertion

14.6.2 Mini‐implant Selection

14.6.3 Insertion

14.6.4 Postinsertion

14.7 Case Examples

References

Index. a

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Отрывок из книги

Second Edition

Richard Cousley

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Any irreversible effect from mini‐implant–tooth proximity is on the mini‐implant: it fails (by becoming mobile), not the tooth.

Concerns have been raised in the literature that mini‐implant perforation of the nasomaxillary cavities (Figure 1.3) may result in either infection or the creation of a fistula. However, the consensus based on dental implant research is that a soft tissue lining rapidly forms over the end of a perforating fixture, and that mini‐implant sites heal by bone infill because of the narrow width of the explantation hole. Motoyoshi et al. [51] investigated clinical effects in a retrospective study where 82 mini‐implants had been inserted mesial and buccal to the maxillary first molar [51]. They found perforation of the maxillary sinus in 10% of the sites, but with no sinusitis symptoms, nor differences in insertion torque and secondary stability. In contrast, a study of infrazygomatic insertions showed that 78% penetrated the maxillary sinus at this site [52]. Whilst these were apparently asymptomatic, mucosal thickening was seen on cone beam computed tomography (CBCT) in 88% of these sites where the mini‐implant penetrated by at least 1 mm. Therefore, in order to maximise bone engagement and minimise both patient discomfort and possible sinus disease, it is generally recommended that maxillary alveolar insertion sites should be within 8 mm of the alveolar crest in dentate areas, and at a more coronal level where maxillary molars are absent. The infrazygomatic crest is not recommended for this reason.

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