Brochure for AbsoAnchor® Orthodontic Microimplant

Brochure for
AbsoAnchor®
Orthodontic
Microimplantwith the best experts in orthodontics
7th ed. (Feb. 2023)

SHIFT OF PARADIGMS IN
ORTHODONTICS

Microimplant(AbsoAnchor®) for orthodontic anchorage
AbsoAnchor® Microimplant is a titanium alloy screw for orthodontic anchorage

that is implanted on maxillary and mandibular bone, and acts as a ﬁxing agent,
providing a ﬁxed anchorage point for attachment of orthodontic appliances tofacilitate the orthodontic movement of teeth.

Hole

Various head types
Hexagonal shape

Biocompatible neck

Best pitch & valley
Knife edge

02

Self-drillingBrochure for AbsoAnchor® Orthodontic MicroimplantContents
1. Introduction

2. Terms used in skeletal anchorage

3. Types of AbsoAnchor Microimplant

4. Terms used in Microimplant surgicalprocedures

04
06
06
08

- According to the path of Microimplant insertion

placement- In Maxillary zone

- In Mandibular zone

- Selection of Drill or Drill free placement method- Drilling

8. Clinical management
10- Postoperative patient management

29- Factors for success- Orthodontic Force application- According to the Diameter of Microimplant

6. Various clinical sites for Microimplant- Aseptic Preparation- Advice for Microimplant driving- According to the Driving methods- According to the Length of Microimplant- Anesthesia

20- Microimplant Driving- According to head exposure

5. Selection of Microimplants

7. Surgical Procedures

13- Instruction to the patients- Management of Microimplants with minor mobility- Microimplant removal

9. Concluding remarks

33

03

1. Introduction
The control of anchorage is one of the most critical factors in orthodontic treatment. Historically, many intraoral

anchorage devices were used and showed adverse reactive side effects, anchorage loss, inevitably according to
Newton�s Third Law. Extraoral anchorage appliances can minimize adverse reactive mechanics but depends onpatient compliance.

Long ago Gainsforth and Higley (1945) tried skeletal anchorage by placing metallic vitallium screws in dog�sramus as anchors and applied elastics to the maxillary arch wire for distalization of maxillary dentition. However,all screws failed in three weeks. Thereafter the attempts were made to utilize the dental implants as orthodontic
anchorage and install prosthesis on after orthodontic treatment.

Clinical case report of Linkow (1970), who used mandibular blade-vent implants in a patient to apply Class II

elastics. The osseointegrated implants (Sherman, 1978� Roberts et al., 1994� Wehrbein et al, 1999) have been used

as intraoral orthodontic anchorage, but these have many limitations for routine orthodontic practice. First of all,it is difficult to place into the arch because of bulky size and this makes indication narrow. Also, long waiting time

for osseointegration, high cost, extensiveness of surgery, etc. are other reasons not to be used widely. Regarding
screws as orthodontic anchorage, Creekmore & Eklund (1983) reported the use of a vitallium bone screw asanchorage for the intrusion of maxillary incisors. The screw was inserted into the bone below the anterior nasal
spine, and worked as anchorage for intrusion of upper incisors and successful intrusion was obtained. Kanomi(1997) placed 1.2 mm microscrew with mini-plate into the chin to intrude the lower incisors and showed successful
intrusion.

Since 1998, Park & Bae (Park, 1999a,b, 2000� Park et al, 2001� Bae et al, 2002� Bae et al, 2002) have started touse surgical microscrews (1.2mm in diameter) as anchorage to retract maxillary anterior teeth after placing those
into interradicular bone between the upper second premolars and first molars. The treatment was very successful

without any complications. They also developed effective and efficient microimplant treatment mechanics for all

kinds tooth movement including whole dentition movement, molar intrusion, molar protraction, canted occlusal
plane correction, and minor tooth movement.

Originally, microscrew was used to fix mini-plate into the bone in surgical fields. So, it was difficult to apply

orthodontic elastomers onto the screw head, and a ligature hook was tied on the neck of screws for elastomericthread or NiTi coil spring. Thus, there was a chance of gingival tissue impingement by elastomeric thread or aligature hook itself. This tended to cause soft tissue inflammation and discomfort to the patients.

To overcome the drawbacks, we developed orthodontic Microimplant (AbsoAnchor), which has been designed

specifically for orthodontic purpose and has a button-like head with a small hole. The special feature, tapered

shape of trunk below the button, allows natural movement of elastomers from gingiva to minimize soft tissue
impingement. A hole on the neck provides easy application of elastomer such as elastomeric thread and/or ligature
wire (Fig.1) and guarantees early loading by applying force to clockwise direction. The AbsoAnchor microimplants

is made of high biocompatible titanium alloy (Ti6Al4Va) and come in various lengths and diameter ranging from

5mm to 20 mm, 1.2mm to 2.7mm, respectively, and have many types of head for different applications and sites(Fig.1-1).

04

Brochure for the AbsoAnchor® Orthodontic Microimplant

The microimplants are accepted as an inevitable tool for routine orthodontic treatment. many orthodontists,

however, are still hesitating to use because of potential risks from surgical intervention and post-surgicalcomplications. But unlike surgical mini-plate, the surgical procedure for microimplants is simple and easy enoughto be placed by every dentists including orthodontists without long training session. Hence, we would like tointroduce and suggest AbsoAchor microimplant system to you for successful orthodontic treatment.

Fig. 1. A typical surgical microscrew (left) and the newly designed AbsoAnchor microimplant with nickel titanium coil spring attached(middle & right).

01. Small Head(SH) Type
Series

13 Series
14 Series
15 Series
16 Series
20 Series
13 Series
14 Series

Diameter
(∅)
∅1.3
∅1.4
∅1.5
∅1.6
∅2.0
∅1.3
∅1.4

5mm
SH 1312-05
SH 1413-05
SH 1514-05
SH 1615-05
SH 2018-05
SH 13-05
SH 14-056mm
SH 1312-06
SH 1413-06
SH 1514-06
SH 1615-06
SH 2018-06
SH 13-06
SH 14-06

Code
7mm
8mm
SH 1312-07
SH 1312-08
SH 1413-07
SH 1413-08
SH 1514-07
SH 1514-08
SH 1615-07
SH 1615-08
SH 2018-07
SH 2018-08
SH 13-07
SH 13-08
SH 14-07
SH 14-08

02. No Head(NH) Type
Series

13 Series
14 Series

Diameter
(∅)
∅1.3
∅1.4

13 Series
14 Series
15 Series
16 Series

Diameter
(∅)
∅1.3
∅1.4
∅1.5
∅1.6

5mm
LH 13-05
LH 1413-05
LH 1514-05
LH 1615-05

6mm
LH 13-06
LH 1413-06
LH 1514-06
LH 1615-06

Series

13 Series
14 Series
15 Series
16 Series

Diameter
(∅)
∅1.3
∅1.4
∅1.5
∅1.6

6mm
CH 1312-06
CH 1413-06
CH 1514-06
CH 1615-06

7mm
CH 1312-07
CH 1413-07
CH 1514-07
CH 1615-07

05. Power Head(PH) Type
Series

13 Series
14 Series
15 Series
16 Series

Diameter
(∅)
∅1.3
∅1.4
∅1.5
∅1.6

5mm
PH 1312-05
PH 1413-05
PH 1514-05
PH 1615-05

6mm
PH 1312-06
PH 1413-06
PH 1514-06
PH 1615-06

7mm
NH 1312-07
NH 1413-07*Commonly used sizes

Code
7mm
8mm
LH 13-07
LH 1413-07
LH 1413-08
LH 1514-07
LH 1514-08
LH 1615-07
LH 1615-08

04. Circle Head(CH) Type

Code
8mm
CH 1312-08
CH 1413-08
CH 1514-08
CH 1615-08

10mm

LH 1413-10
LH 1514-10
LH 1615-10

10mm
CH 1312-10
CH 1413-10
CH 1514-10
CH 1615-10

Code
7mm
8mm
PH 1312-07
PH 1312-08
PH 1413-07
PH 1413-08
PH 1514-07
PH 1514-08
PH 1615-07
PH 1615-08

Series5mm

Series20 Series

IZC (Infra-Zygomatic Crest)

SeriesDiameter
(∅)
∅1.4
∅1.5
∅1.6
∅1.7
∅1.8
∅2.7

LH 1413-12
LH 1514-12
LH 1615-12

12mm
CH 1312-12
CH 1413-12
CH 1514-12
CH 1615-12*Commonly used sizes

10mm
PH 1312-10
PH 1413-10
PH 1514-10
PH 1615-10

12mm
PH 1312-12
PH 1413-12
PH 1514-12
PH 1615-12*Commonly used sizes

Code
Diameter
(∅)
6mm
7mm
8mm
9mm
10mm
12mm
∅1.7
FH 1716-06 FH 1716-07 FH 1716-08 FH 1716-09 FH 1716-10 FH 1716-12∅1.8
FH 1817-06 FH 1817-07 FH 1817-08 FH 1817-09 FH 1817-10 FH 1817-12

Series

14 Series
15 Series
16 Series
17 Series
18 Series
27 Series

Diameter
(∅)
∅1.4
∅1.5
∅1.6
∅1.7
∅1.8
∅2.7

Diameter
(∅)
∅2.0

10mm

5mm

BH 2722-05

6mm
BH 1413-06
BH 1514-06
BH 1615-06
BH 1716-06
BH 1817-06
BH 2722-06

12mm
FH 2018-12

Code

14mm

5mm

6mm
BH 1413-06-L
BH 1514-06-L
BH 1615-06-L
BH 1716-06-L
BH 1817-06-L
BH 2722-05-L BH 2722-06-L

09. Hook Head(HH) Type
Series15 Series
16 Series
17 Series
18 Series
20 Series

Diameter
(∅)
∅1.5
∅1.6
∅1.7
∅1.8
∅2.0

Series15 Series
16 Series
17 Series
18 Series
20 Series

Diameter
(∅)
∅1.5
∅1.6
∅1.7
∅1.8
∅2.0

SeriesDiameter
(∅)
∅1.3
∅1.4
∅1.5
∅1.6
∅1.7
∅1.8
∅2.0

10mm
BH 1413-10-L
BH 1514-10-L
BH 1615-10-L
BH 1716-10-L
BH 1817-10-L*Commonly used sizes

10mm
HH 1514-10
HH 1615-10
HH 1716-10
HH 1817-10
HH 2018-10

12mm
HH 1514-12
HH 1615-12
HH 1716-12
HH 1817-12
HH 2018-12

5mm
DH 1514-05
DH 1615-05
DH 1716-05
DH 1817-05
DH 2018-05

6mm
DH 1514-06
DH 1615-06
DH 1716-06
DH 1817-06
DH 2018-06

Code
7mm
8mm
DH 1514-07
DH 1514-08
DH 1615-07
DH 1615-08
DH 1716-07
DH 1716-08
DH 1817-07
DH 1817-08
DH 2018-07
DH 2018-08

10mm
DH 1514-10
DH 1615-10
DH 1716-10
DH 1817-10
DH 2018-10

12mm
DH 1514-12
DH 1615-12
DH 1716-12
DH 1817-12
DH 2018-12

5mm
GH 1312-05
GH 1413-05
GH 1514-05
GH 1615-05
GH 1716-05
GH 1817-05
GH 2018-05

6mm
GH 1312-06
GH 1413-06
GH 1514-06
GH 1615-06
GH 1716-06
GH 1817-06
GH 2018-06

Code
7mm
8mm
GH 1312-07
GH 1312-08
GH 1413-07
GH 1413-08
GH 1514-07
GH 1514-08
GH 1615-07
GH 1615-08
GH 1716-07
GH 1716-08
GH 1817-07
GH 1817-08
GH 2018-07
GH 2018-08

10mm
GH 1312-10
GH 1413-10
GH 1514-10
GH 1615-10
GH 1716-10
GH 1817-10
GH 2018-10

12mm
GH 1312-12
GH 1413-12
GH 1514-12
GH 1615-12
GH 1716-12
GH 1817-12
GH 2018-12*Commonly used sizes*Commonly used sizes*Commonly used sizes

12. Tube Head(TH) Type
Series

18 Series
20 Series

Code
Diameter
(∅)
5mm
6mm
7mm
8mm
9mm
10mm
11mm
12mm
∅1.8 TH 1817-05 TH 1817-06 TH 1817-07 TH 1817-08 TH 1817-09 TH 1817-10 TH 1817-11 TH 1817-12∅2.0 TH 2018-05 TH 2018-06 TH 2018-07 TH 2018-08 TH 2018-09 TH 2018-10 TH 2018-11 TH 2018-12

13. Joint Head Type - Lower(JL)
Series16 Series
Lower 17 Series
Type 18 Series
20 Series

17mm*Commonly used sizes

Code
Diameter
(∅)
5mm
6mm
7mm
8mm
10mm
12mm
∅1.6 JH 1615-05 JH 1615-06 JH 1615-07 JH 1615-08 JH 1615-10 JH 1615-12∅1.7 JH 1716-05 JH 1716-06 JH 1716-07 JH 1716-08 JH 1716-10 JH 1716-12∅1.8 JH 1817-05 JH 1817-06 JH 1817-07 JH 1817-08 JH 1817-10 JH 1817-12∅2.0 JH 2018-05 JH 2018-06 JH 2018-07 JH 2018-08 JH 2018-10 JH 2018-12*Commonly used sizes

14. Joint Head Type - Upper(JU)
Code
7mm
8mm
BH 1413-07
BH 1413-08
BH 1514-07
BH 1514-08
BH 1615-07
BH 1615-08
BH 1716-07
BH 1716-08
BH 1817-07
BH 1817-08
BH 2722-07

10mm
BH 1413-10
BH 1514-10
BH 1615-10
BH 1716-10
BH 1817-10

12mm
BH 1413-12
BH 1514-12
BH 1615-12
BH 1716-12
BH 1817-12

12mm
BH 1413-12-L
BH 1514-12-L
BH 1615-12-L
BH 1716-12-L
BH 1817-12-L

Code
7mm
8mm
HH 1514-07
HH 1514-08
HH 1615-07
HH 1615-08
HH 1716-07
HH 1716-08
HH 1817-07
HH 1817-08
HH 2018-07
HH 2018-08

11. Golf Head(GH) Type
13 Series
14 Series
15 Series
16 Series
17 Series
18 Series
20 Series

Code
7mm
8mm
BH 1413-07-L BH 1413-08-L
BH 1514-07-L BH 1514-08-L
BH 1615-07-L BH 1615-08-L
BH 1716-07-L BH 1716-08-L
BH 1817-07-L BH 1817-08-L
BH 2722-07-L

6mm
HH 1514-06
HH 1615-06
HH 1716-06
HH 1817-06
HH 2018-06

5mm
HH 1514-05
HH 1615-05
HH 1716-05
HH 1817-05
HH 2018-05

10. Double Head(DH) Type*Commonly used sizes

07. Bracket Head(BH-Right handed screw) Type
14 Series
15 Series
16 Series
17 Series
18 Series
27 Series

12mm*Commonly used sizes

06. Fixation Head(FH) Type

17 Series
18 Series

12mm
SH 1312-12
SH 1413-12
SH 1514-12
SH 1615-12
SH 2018-12
SH 13-12
SH 14-12*Commonly used sizes

Code
6mm
NH 1312-06
NH 1413-06

5mm
NH 1312-05
NH 1413-05

03. Long Head(LH) Type
Series

08. Bracket Head(BH-Left handed screw) Type10mm
SH 1312-10
SH 1413-10
SH 1514-10
SH 1615-10
SH 2018-10
SH 13-10
SH 14-10

Joint Bracket
Head(JBH) Type
SeriesUpper Type

16 Series

Joint Hook
Head(JHH) Type
Diameter(∅)∅1.6

Joint Fixation
Head(JFH) TypeJBH 16-17

JHH16-17

Joint Golf
Head(JGH) TypeCode

JFH 16-17

JGH 16-17

Joint No
Head(JNH) TypeJNH 16-17*Commonly used sizes

Fig. 1-1. Orthodontic AbsoAnchor microimplants developed by Dentos Inc.

05

2. Terms used in skeletal anchorage
There are many terms used in orthodontic skeletal anchorage, such as, skeletal anchorage system (SAS), mini-screw, micro-screw, mini-implant, micro-implant, mini-screw implant, micro-screw implant, Temporary Anchorge
Device (TAD) etc. A prefix of micro- comes from Greek and mini- comes from English. The terms, micro- and mini-,
have the same meaning of being small when they are used as adjective. Generally, however, the term micro is used

to express a size that is a little bit smaller than mini-, such as mini- car and micro-car, mini-scan disk and microscan disk. Academically the term of micro- is used more rather than mini-, for example, micrognathia, microglossia,

microdontia, etc. Also, implantologists already used the term mini-implant, which is a kind of temporary implant
to make temporary crown during osseointegration of implant. The diameter of prosthodontic mini-implant is a bit
larger than orthodontic implants. The term skeletal anchorage can include all kinds of skeletal anchorage devices
including prosthodontic implant and onplant. Many doctors are using the term TAD, however, almost all kinds ofconventional anchorage, such as transpalatal bar, lingual arch, etc. can be classified into temporary anchorage
device. Prosthodontic implants vary from screw implants to non-screw type implants. Usually, however, we do notdifferentiate them as screw-implant or non- screw implant. Every orthodontic implant has screw portion. For thesame reason, we do not need to put the term screw, such as micro-screw implant. Therefore, we prefer to use theterm microimplant for orthodontic screw.

3. Types of AbsoAnchor MicroimplantFig. 2. Various types of AbsoAnchor microimplants.
Length: 5mm ~ 12 mm, Diameter: 1.2mm ~ 2.7mm

06

Brochure for AbsoAnchor® Orthodontic Microimplant

Various types of AbsoAnchor microimplants are available for different purposes and sites (Fig. 2). Different

types of head structures can be chosen depending on kinds of elastomers, biomechanics, sites of placement andindividual preference. In Bracket head type, right handed and left handed screws are available for use dependingon the driving directions. Left handed screw should turn counterclockwise during driving. (Fig. 3 and 4). When you
apply moment to the microimplant head with a wire, you can choose proper screw type (Right or left) dependingon the applied reactive moment to the microimplant.

When strong reactive moment is anticipated, joined microimplants in which two microimplants are joined withligature wire and composite, can be used. And this provides the anchorage for all kinds of movement without any
failure (Fig. 4).

In the Joint Head type, many different kinds of upper head shape can be joined with the lower part the screw

portion (Fig. 2). Also, non-invasive mini-plate can be joined without surgical flap (Fig. 5).

Right handed screw

Left handed screw

Right handed screw

Left handed screw

Right handed screw

Left handed screw

Right handed screw

Left handed screw

Rt-Handed Screw

Lt-Handed Screw

Rt-Handed Screw

Lt-Handed Screw

Fig. 3. Possible applications of right-handed and left-handed Bracket Head (BH) type screws

07

Fig. 4. Clinical applications of Joined microimplants

Fig. 5. Clinical applications of non-invasive mini-plate using Joint Head type microimplants(Courtesy of Dr. Corrodi Ritto).

4. Terms used in Microimplant surgical procedures
Microimplant Anchorage (MIA) in orthodontics is a relatively new field in orthodontic treatment. So weare going to introduce some descriptive terms used in this brochure.

1. According to head exposure (Fig. 6)(1) Open Method

For open method, the head of microimplant is exposed in the oral cavity. Usually, this method is possible whenthe microimplant is placed in a thick and tight soft tissue area like the attached gingiva.

(2) Closed Method

For closed method, the head of the microimplant is embedded under the soft tissue. When the microimplantis placed in a movable soft tissue area with the open method, the soft tissue will grow around and embed themicroimplant head during treatment. Instead of trying to have the microimplant head sufficiently away fromthe growing soft tissue, it is better to have the microimplant head under the soft tissue, and make ligature hookextension.

08

Brochure for AbsoAnchor® Orthodontic MicroimplantFig. 6. Open (left) and closed (right) method of microimplant insertion.

2. According to the Driving methods(1) Drill (Pre-Drilling, Self-tapping) method (Fig. 7)

A hole is drilled into the bone first with a bone drill, and the microimplant can be driven into the formed hole.
This method is used in thick cortical bone area and for angular placement.

(2)Drill-Free (Self-Drilling) method (Fig. 8)

The implant itself drills into the bone as it is being driven. This method is used into thin cortical bone area.

Fig. 7. Pre-Drill (Self-tapping) procedures. When the corticalbone is too dense, it is better to redrill the corticalbone with a slightly larger sized drill (lower).

Fig. 8. One-step (upper) and two-step (lower) self-drilling
procedures. When the microimplant is inserted in a
diagonal direction, it is better to make an indentation
first in the cortical bone using a round bur or a drill
with angular approach (two-step protocol) to prevent
slippage of the microimplant during driving.

09

3. According to the path of Microimplant insertion (Fig. 9)(1) Diagonal (or Oblique) direction

The microimplant can be inserted into the bone in an oblique direction to the bone surface. This method canbe used when placing the microimplants into the interradicular bone. The microimplant is inserted at an angleof 30�60 degrees to the long axes of the teeth, both buccally and lingually. Such angulated placement can
reduce the risk of contacting the adjacent root during implant placement and distalization of whole dentitions.

(2) Perpendicular direction

The microimplant can be inserted into the bone perpendicularly. Although this is the easier than diagonalplacement, it can be used only in sites with a sufficient space between the roots of the teeth.

Fig. 9. Diagonal (left) and perpendicular (middle & right) insertion of microimplants

5. Selection of Microimplants
1. According to the Length of Microimplant

The length of screw portion ranges from 5mm to 14mm. Longer microimplants lead to better mechanicalstability like dental prosthetic implants, but increased possibilities of invading adjacent anatomical structures,such as roots, maxillary sinus and nerves. According to our clinical experiences, 6mm of screw penetration depth
into the bone is sufficient for maxillary bone, and 5mm is sufficient for the mandible. However, you should always
take into consideration of the thinkness of soft tissue when choosing proper length of microimplants. Especially forpalatal mucosa, it may be very thick according to sites. If soft tissue is 6mm thick, in order to place 6mm of screw
portion into the bone, the microimplant with at least 12 mm length should be used. This protocol requires that thesoft tissue thickness as well as the bone quality must be evaluated at the location of placement.

Also, in choosing the proper length of a microimplant, the path of insertion of the microimplant must be

considered. A microimplant can be placed either in a diagonal or a perpendicular direction depending on thecortical bone condition. It is better and easier to place microimplant in a perpendicular direction, but, there aremany situations in which the microimplant should be placed in a diagonal direction so as to avoid injury to an

adjacent tooth root or not to block movement of teeth. For diagonal placement, a longer microimplant can bechosen (Fig. 10).
10

Brochure for AbsoAnchor® Orthodontic MicroimplantFig. 10. Perpendicular (left) and Diagonal (right) insertion of microimplants. When the microimplant is placed in a diagonal direction, it
is better to select a longer microimplant.

2. According to the Diameter of Microimplant
There are various diameters of AbsoAnchor microimplants which range from 1.2mm to 2.7mm for placement

anywhere in the oral cavity. Depending on the inter-radicular distance, the quality of bone, and the site ofplacement, we can choose different diameters of microimplants.

Larger the diameter of the microimplant, the greater mechanical retention is expected. However, the thicker

microimplants do not always guarantee higher success. There is even a report showing higher success withsmaller diameter microimplants over larger diameter ones (Kuroda et al, 2007-a). When placing microimplantsinterradicularly, the thicker microimplants have the higher possibility of root contacts, relating to the higher failure(Kuroda et al, 2007-b).

The followings are general tips for selecting proper diameter of microimplants depending on the inserting sites�
a. buccal & labial areas of maxilla (Fig. 11) : Cortical bone in these areas is not thick, so use tapered

microimplant with neck of 1.3-1.4mm thick and tip of 1.2�1.3mm thick. Microimplants made by titanium alloys ofthis thickness can be inserted safely without pre-drilling on maxillary buccal and labial areas.

b. buccal & labial areas of mandible (Fig. 11) : Cortical bone of mandible is denser than maxilla, so a thicker

microimplants (1.4�1.6mm) are better for preventing breakage, especially for self-drilling (drill-free) method.

Fig. 11. Buccal & labial anterior microimplants for anterior en masse retraction in extraction case.

11

c. Palatal areas of maxilla (Fig. 12) : Soft tissue is thick, and the microimplants longer than 10mm in length isneeded. When using longer microimplants with drill-free placement, thicker microimplants (1.4�1.6 mm of neck)can be chosen to eliminate chance of fracture. As the distance between roots is wider in palatal side than buccal
side, there is less possibility of root contact even with thicker microimplants.

Fig. 12. Palatal alveolar microimplants for en masse retraction in lingual fixed appliance and for intrusion force application to molars.

d. Midpalatal and para-midpalatal suture (Fig. 13) : Microimplants of diameter larger than 1.6mm is

recommended for sutural area. Even 2.7mm diameter microimplant can be used for younger patients.

Fig. 13. Various clinical applications of the midpalatal and para-midpalatal microimplants.
(Courtesy of Dr. Carlo Marassi & Alfredo Alvarez)

e. Infrazygomatic arch (Fig. 14) : Longer microimplants (12-14mm) should be used to locate head near to

gingiva. To reduce breakage, thicker microimplants (1.8 mm) are better to be used.

Fig. 14. Microimplants into infrazygomatic arch for retraction of anterior teeth and intrusion force application.

f. Retromolar or mandibular buccal shelf (Fig. 15) : 8 mm long and 1.5-1.8 mm of micromplants can berecommended.

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Brochure for AbsoAnchor® Orthodontic Microimplant

6. Various clinical sites for Microimplant
placement

The followings are our recommended guidelines of microimplant sites, and recommended sizes fororthodontic anchorage purpose.

1. In Maxillary zone
(1) Infrazygomatic crest area (Fig. 15)

Purpose : Retraction or retraction with intrusion of the entire maxillary dentition or anterior teeth.
Intrusion of the maxillary molars or the maxillary whole dentition.

Recommended Microimplants : Diameter : 1.6-1.8mm, Length : 12-14mm

Fig. 15. Microimplants placement into the infrazygomatic crest area.

(2) Maxillary tuberosity area (Fig. 16)

Purpose : Distalization of the maxillary posterior teeth or maxillary dentition.
Intrusion of the maxillary molar.

Recommended Microimplants : Diameter : 1.3 - 1.5mm, Length : 8-12mm

Fig. 16. Microimplants placed in the maxillary tuberosity area for en masse retraction (left) and for molar intrusion (middle & right),
intrusion of the second molar13

(3) Between the maxillary 1st & 2nd molars buccally (Fig. 17)
Purpose : Retraction of the maxillary anterior teeth.
Intrusion of the maxillary molars.

Recommended Microimplants : Diameter : 1.3-1.4mm, Length : 8-10mm

Fig. 17. The microimplants in between the maxillary 1st & 2nd molars for molar intrusion (left & middle). The microimplant for
retraction force application, the hook of the 1st molar tube is used to prevent gingival impingement by the coil spring (right).

(4) Between the maxillary 2nd premolar & 1st molar buccally (Fig. 18 & 19)
Purpose : Retraction of the maxillary anterior teeth in extraction treatment,
Distalization of whole maxillary dentition

Intrusion of the maxillary buccal teeth. Intermaxillary elastics.

Recommended Microimplants : Diameter : 1.3-1.4mm, Length : 7- 8mm

Fig. 18. As the midpoints between roots are slight mesial to contact point at crowns owing to curvature of the 1st molar mesial root,
placement should be done 0.5mm mesial to contact point to avoid root contact.

Fig. 19. Although this is rare, but for a very narrow inter-radicular space, the microimplant can be placed after making adequate spaceby moving the roots apart, although this is rare.

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Brochure for AbsoAnchor® Orthodontic Microimplant(5) Between the maxillary canine & premolar buccally (Fig. 20)
Purpose : protraction of the maxillary molars.

Intrusion & extrusion of maxillary teeth or correction of transverse occlusal cant.

Recommended Microimplants : Diameter : 1.3mm, Length : 7-8mm

Fig. 20. The microimplants in between maxillary canine & 1st premolar for intrusion (left) and extrusion force application (right).

(6) Between the maxillary incisors facially (Fig. 21)

Purpose : Intrusion & torque control of the maxillary incisors.
Surgical fixation after orthognathic surgery

Recommended Microimplants : Diameter : 1.3 - 1.6mm, Length : 7- 10mm

Fig. 21. The microimplants between maxillary incisors for intrusion force application and surgical fixation.

(7) Between maxillary 2nd premolar, 1st molar & 2nd molars palatally (Fig. 22)
Purpose : Retraction of the maxillary anterior teeth (Lingual ortho. Tx.).
Intrusion of the maxillary molars.

Recommended Microimplants : Diameter : 1.4-1.6mm, Length : 8-12mm

Fig. 22. Palatal implants for en masse retraction in lingual treatment (left). Molar intrusion by combination of palatal and buccal
microimplants.

15

(8) Midpalatal and para-midpalatal (Fig. 23)

Purpose : Unilateral constriction Lateral movement of the molars
Molar movement with transpalatal arch.

Recommended Microimplants : Diameter : 1.4- 2.7mm, Length : 5-7mm

Fig. 23. Microimplants on the midpalatal & para-midpalatal area (courtesy of Dr. Skander Ellouze & Alfredo Alvarez).

(9) Anterior palate (Fig. 24)

Purpose : Protraction of the maxillary molars

Recommended Microimplants : Diameter : 1.4-1.6mm, Length : 8-12mm

Fig. 24. Microimplants on the anterior palate for protraction of molars, forced eruption of canine

2. In Mandibular zone
(1) Retromolar area (Fig. 25)

Purpose : Uprighting of the tipped mandibular molar.

Retraction of the mandibular posterior teeth or whole dentition.

Recommended Microimplants : Diameter : 1.4-1.6mm, Length : 7-10mm

Fig. 25. Microimplant in the retromolar area for uprighting molar (left) and for retraction of the entire mandibular dentition (right).

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Brochure for AbsoAnchor® Orthodontic Microimplant(2) Buccal to the mandibular second molar (Fig. 26)

Purpose : Buccal uprighting of the lingual tipped mandibular molar or scissor�s bite correction and intrusion ofmandibular second molar

Recommended Microimplants : Diameter : 1.4-1.6mm, Length : 6-7mm

Fig. 26. Microimplant used for lingually tipped 2nd mandibular molar. It can be placed just buccal to the second molar because of thickbone and available distance between cortical bone and root.

Fig. 27. Microimplants for uprighting of the lingual tipped mandibular molars.

(3) Between the mandibular 1st & 2nd molars buccally (Fig. 28)

Purpose : Retraction of the mandibular anterior teeth. Intermaxillary elastics.
Intrusion & distal movement of the mandibular molars.

Recommended Microimplants : Diameter : 1.4-1.6mm, Length : 5-7mm

Fig. 28. The microimplants between the mandibular 1st & 2nd molars buccally.

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(4) Between the mandibular 1st premolar and 2nd premolar, 2nd premolar and 1st molar buccally (Fig. 29)
Purpose : Retraction of mandibular anterior teeth.
Intrusion of mandibular buccal teeth.

Buccal uprighting of the lingual tipped mandibular posterior teeth.

Recommended Microimplants : Diameter : 1.4-1.6mm, Length : 6-7mm

Fig. 29. The microimplants between the mandibular 1st premolar, 2nd premolar and 1st molar buccally.

(5) Between the mandibular canine & premolar buccally (Fig. 30)
Purpose : Protraction of the mandibular molars.

Recommended Microimplants : Diameter : 1.4-1.6mm, Length : 6-7mm

Fig. 30. Microimplants between the mandibular canine & 1st premolar for protraction force and intrusion force application.

(6) Mandibular symphysis or interradicular bone on mandibular anterior teeth area (Fig. 31)
Purpose : Intrusion of the mandibular anterior teeth. Surgical fixation

Recommended Microimplants : Diameter : 1.3-1.4mm, Length : 5-6mm for intrusion
Diameter : 1.5-1.6mm, Length : 7-8mm for surgical fixation

Fig. 31. Microimplants placed in the mandibular symphysis for intrusion force application, and placed in anterior teeth area for surgical fixation18

Brochure for AbsoAnchor® Orthodontic Microimplant(7) Edentulous area (Fig. 32)

Purpose : Controlling the adjacent teeth of edentulous area including molar uprighting, distalization,
mesialization, intrusion, extrusion & torque (*using joined microimplants)

Recommended Microimplants : Diameter : 1.4-1.6mm, Length : 8-10mm

Fig. 32. Joined microimplants are placed in the edentulous area for bracket attachment.
And sectional edgewise wire was used to move adjacent teeth three dimensionally.

(8) Others (Fig. 33, 34)

The AbsoAnchor microimplant system is available in variable diameters and lengths of screws for orthodontic

anchorage in any area of the mouth, if there is bone present. For example, the mandibular tori and the bone
adjacent to residual roots that will be extracted at a later date can be used for the placement of the microimplants.

Fig.33. A microimplant which are placed on a torus (left) lower lingual alveolar bone for intrusion and lingual tipping of lower incisors (right).

Fig.34. Microimplants were used for temporary implants (left) and molar uprighting (right). (Courtesy of Dr. Corrodi Ritto & Maria E.Cabana)19

7. Surgical Procedures

Most failure of the microimplants occurs first 3-4 months after placement, meaning that the surgicalprocedure is utmost important. The maintaining of the cortical bone integrity is one of key issues

for successful placement. For easiness and simplicity of procedures, drill-free method are used more
frequently. However, drill method showed higher success in some area because of less bone damage.

1. Anesthesia
Small amount of local anesthetic is sufficient for the simple surgical procedure to insert the AbsoAnchor

microimplant. It is not necessary for the clinician to achieve profound anesthesia of the teeth� rather only thesoft tissue need be anesthetized. Only one-fourth of a local anesthetic ampule is needed for enough anesthesia.

Occasionally, topical anesthetic agent (Dentipatch , Mucopain , Painless patch , Lidocaine spray etc) can provide

anesthesia for microimplant placement. If the patient feels some sensitivity during drilling or microimplant driving,
this may be a sign of root contact, and the drill or microimplant should be redirected away.

When anesthetizing the palatal mucosa, the needle also can be used to probe and measure the mucosal

thickness, which helps to determine the screw length necessary for anchorage (Fig.35). When the palate isanesthetized, the position of the greater palatine artery and nerve should be reviewed so as to avoid injuring them(Fig. 35).

When planning the use of one or more microimplants in extraction treatment patients, the microimplants canbe placed at the appointment of teeth extraction.

Fig. 35. Sometimes, only topical anesthesic agent is enough for microimplant placement. Palatal mucosa varies greatly in thickness,
which requires measurement during or after local anesthesia in order to select the proper length microimplant. Review thepositions of the greater palatine artery and nerve so as to avoid them.

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Brochure for AbsoAnchor® Orthodontic Microimplant

2. Aseptic Preparation
Zepherin (benjalkorium chloride) sponge or other common disinfecting agent can be used to prepare an

intraoral & extraoral scrub for keeping the surgical area aseptic (Fig. 36).

Fig. 36. Aseptic intraoral and extraoral preparation with disinfecting agent.

3. Selection of Drill or Drill free placement method
Drill method can be used for thick and dense cortical bone area, such as mandiblular posterior teeth area andmandibular buccal shelf. For diagonal placement into thick cortical bone area, the drill method should be used toreduce surface bone fracture during placement.

Drill-free method can be used into the area with thin alveolar bone. Even in the thick cortical bone area, if

placement angle is perpendicular to the bone, drill-free method can be used without surface bone fracture. For

easiness of placement, drill-free method tends to be used more frequently. For the diagonal placement into thethick cortical bone area, however, drill method should be used not to cause surface bone fracture. Recommended
areas for drill method are mandibular posterior teeth area, maxillary palatal slope, and mandibular buccal self.

Recommended areas for drill-free method are the maxillary posterior teeth, maxillary and mandibular anterior

teeth area, maxillary and mandibular premolar areas, maxillary tuberosity and retromolar area, and palatal area.

4. DrillingMark the implant sites by using brass wires as shown in Figs. 38 & 40. For making an entry into the bone, roundbur or pilot drill can be used. Making of a small indentation on the bony surface can be done with a #2 round bur(0.9mm diameter) or pilot drill with perpendicular approach. Small indentation on the bone surface can prevent
slippage of pilot drill especially when drilling diagonally. The indentation is useful especially to the extremely
dense cortical bone (Fig. 7&8). Using round bur can also help to reduce the blunting of pilot drill since the pilot

drill is much more expensive than the bur. Clinicians should use a speed-reduction contra angle hand piece (64:1
or 20:1 etc.) to reduce drill speed to 600-100 rpm (Fig. 37).

21

Fig. 37. Various types of drill bits (left) and speed-reduction contra angle : 64:1 (Right).

It is recommended to extend the drill to the full length of the screws.
The diameter of the pilot drill should be 0.2/0.3mm smaller than that of the selected microimplant. The

clinician should check the drill first for any unwanted bends in the shaft that might cause wobbling while drilling,

resulting in unduly large opening. Early stability of the microimplant depends almost entirely upon mechanicalretention within the bone and must have a slightly tight fit to ensure its retention.

The drill can penetrate the mucosa, attached gingiva and underlying bone without a surgical flap (Fig. 38).

However, when making an entrance in the movable soft tissue, a small vertical incision (less than 4mm) will
prevent a soft tissue roll-up around the drill (Fig. 39). If you do not want to make an incision, you can use drill
guide to prevent rolling of soft tissue (Fig. 40).

30~60°

30~60°

10~60°

Fig. 38. Placement procedures for maxillary and mandibular microimplants in the attached gingiva(pre-drilling method).

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Brochure for AbsoAnchor® Orthodontic MicroimplantFig. 39. Small stab vertical incision for placement of the microimplant into the movable soft tissue (pre-drilling method).

Fig. 40. Fabrication and application of a drill guide to reduce root contact.

To reduce heat production, not too much pressure and abundant cool saline irrigation need to be applied

during speed. When drilling into dense cortical bone, move the drill carefully up and down as well as stop andgo strokes to minimize the heat. To increase torque with reduced rpm, prosthetic implant engine is a good but
expensive choice, so speed reduction contra angle (64:1 or 20:1, Fig. 37) would be a reasonable alternative. Nonspeed reduced low speed (1:1) contra-angle gives high rotation speed (maximum 30,000rpm) which leads toexcessive heat production.

A final drill caveat-do not use excessive force with the drill. Any great resistance after passing through thecortical plate is probably due to root contact. The drill angulation needs to be changed.

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5. Microimplant Driving
For drill method, the microimplants can be turned into the prepared hole. For drill-free method, an indentation

can be formed with the microimplant itself by applying it perpendicularly to the bone surface, and it can be turnedin the bone with an angle. The microimplants can be angulated with 30-60 degrees to the long axis of the teeth inbuccal or palatal sides of the maxillary premolars and molars sites (Fig. 38). Such angulation augments the surface
area contact between the microimplant and the cortical bone and also increases retention while lowering the riskof the root contact.

In case of bulky alveolar bone, the microimplants can be placed with more vertical angulation, but the

microimplants need to be placed with horizontal angulation in the shrinked alveolar bone. For whole arch
distalization of maxillary dentition, the buccal teeth can be distalized with vertically angulated microimplants

without interference of movement, but the distal movement may be blocked by the microimplant placed withhorizontal angulation, and the repositioning the microimplant to distal position needs to be considered, if any
interference exists. Or the infrazygomatic placement mighy be considered. Clinicians, however, should be aware ofmore inflammations and/or cheek irritations from infrazygmatic microimplants over microimplants placed into theattached gingiva.

Fig. 41. Microimplant angulation according to bone shape; vertical angulation into bulky alveolar bone (left) and more horizontal
angulation into shrinked alveolar bone (right).

In the mandible, the bone has a thicker cortex and a higher density than the maxilla. The alveolar bone,

however, is shaped more vertical or shrinked (Fig. 45). Thus, the microimplant is usually inserted more

perpendicular to the long axis of the teeth. In the 2nd molar area, more bone exists on buccal side, and themicroimplant can be placed in a more oblique direction (Fig. 38). Nevertheless, doctors should remember thatcortical bone density and volume will vary from patient to patient, and from side to side even in the same patient.

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Brochure for AbsoAnchor® Orthodontic MicroimplantFig. 42. Maxillary microimplant placement into the attached gingiva (pre-drilling method).

Fig. 43. Maxillary microimplant placement into the movable soft tissue with an incision and pre-drilling method.

Fig. 44. Maxillary microimplant placement into the palatal slope with a pre-drilling method. Note that more space exists between
palatal roots than buccal ones.

Incisors

Canine

1st premolar

2nd premolar

1st molar

2nd molar

Fig. 45. Mandibular microimplant placement into the attached gingiva (pre-drilling method). Note the thickness of the cortical bone in
the mandibular labial and buccal area.

25

Fig. 46. Mandibular microimplant placement into the movable soft tissue with an incision and a pre-drilling technique.

Fig. 47. Two types of drill-free procedures. One-step (above) & two-step drill-free procedures after round bur indentation (below).

6. Advice for Microimplant driving
There are 2 types of driver: hand drivers and engine drivers (Fig. 48).
A clinician may use engine driven method to insert microimplant, using speed reduction contra angle (256:1�

about 30rpm) like prosthetic implants (Fig. 49), but this may lead to increased possibility of microimplant breakage

because of root contacts or too dense bone, thus it is safer to use hand driver to feel resistance of microimplant

driving torque. One should never give excessive force when placing a microimplant. If microimplant is broken
during driving, it may be difficult to remove.

A long hand driver may be used on buccal areas of mandible and maxilla. For the sites where the long handdriver cannot be used (ex, palatal or retromolar area, etc), a Hand-driven contraangle driver (Fig. 49) or a short
hand driver may be used instead (Fig. 48). Hand- Driven Contraangle driver is more convenient over a short handdriver. The hand-driven contraangle driver can be connected to low speed contraangle handpiece (1:1). Engine
driver of appropriate size can be attached to the contraangle, and then microimplant should be fixed to engine
driver (Fig. 50).

26

Brochure for AbsoAnchor® Orthodontic MicroimplantFig. 48. Two kinds of Hand drivers (left) & Engine drivers (right)

Fig. 49. Speed reduction contraangle (256:1) for motor driven (Lt) and Hand-Driven (Rt) contraangle (1:1) driver.

Fig. 50. On the sites where long hand driver is not accessible, like maxillary tuberosity area and palatal area,
mandibular retromolar areas etc, it is better to use Hand-driven contrangle driver.

The breakage of the titanium alloy microimplants is very rare, but to eliminate any chance of fracture, theclinicians should tighten the microimplants slowly with no wobbling and be aware of the maximun tolerable
torque-resisting force of microimplants according to the diameters (Fig. 53).

The light tightening forces (less than 1.3Kgf.cm) while driving microimplants can avoid microimplant fracture.

The clinicians can use finger force rather than wrist force for turning the microimplants in, not to apply heavy force
and not to wobble, and not to have following breakage. When encountering heavy resistance reaching to fracture
resistance or feeling spring back-action, the microimplant should be withdrawn and then re-drill the bone with

the next larger drill and resume the microimplant driving. For example, if 0.9 mm diameter of drill was used at thefirst time, then 1.0mm diameter of pilot drill should be used for redrilling. At this time, redrilling should be done

only in the cortical bone area (Fig. 7 : Two-step drilling). For drill free method, the resistance is too high enoughto reaching fracture resistance, and check the direction for possible root contact. If root contact is anticipated,
withdraw the microimplant and change direction and place. For no anticipated root contact, stop tightening anduse, or remove and retighten after providing an escape way for bone debris.

27

Fig. 51. Sterilization package for AbsoAnchor microimplant (left). The package can be cut with scissors just before use and the driver
can engage the microimplant in its package (middle & right). Keep the microimplant without contamination with fingers orother objects.

Fig. 52. Pre-sterilized ( -radiation) package of AbsoAnchor microimplant.

Fig. 53. The torque resisting force of microimplants of Dentos Inc. (Daegu, Korea) depend on the diameters. (*1kgf=9.8N)

If a drill or a microimplant touches the root during driving, an increased resistance is felt and often patients

will complain of a pain, if shallow anesthesia was given to patients. In this situation, the microimplant can be

redirected after redrilling or a shorter length of microimplant with a size larger in diameter (rescue microimplant)

can be used. Slight injury to the root surface by the microimplants is not so harmful to teeth, but root contactof microimplant is one of the main reasons for the failure of the implants. The mastication induces the micromovement of the teeth, that brings about the movement of the microimplant through a root contact and an
eventual loosening of the microimplants may follow.

The success with microimplants largely depends upon initial stability. If there is no initial mechanical tightnessof the microimplant after placement, choose one size larger microimplant or redirect the microimplants to evaderoot contacts. Occasionally, a new site adjacent to the original site may be needed.

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Brochure for AbsoAnchor® Orthodontic Microimplant

8. Clinical management
1. Postoperative patient management
There is a very little chance of pain or side effect like infection after microimplant placement. Antibiotics

prescription is not necessary, if the microimplant is paced without incision. Also analgesics or NSAIDs is notnecessary since small diameter microimplant rarely induces pain or swelling. The patients, however, should be told

to revisit the clinic when feeling pain during mastication. The pain may be usually derived from the root contact. If
it is diagnosed to be root contact, the root should be moved away from microimplant early. If slight mobility is felt,
retighten the microimplant instead of removing it.

Although patients seldom need any medication, doctors should make prescriptions of antibiotics and otherpain medications available for them on a needed basis.

2. Factors for success
Factors affecting failure can be divided� host, surgical, and management factors. The success rate of

microimplants is low in patients with heavy smoking, diabetes, osteoporosis. In patients with low bone density,a great care should be given during placement and management, and orthodontic force should be very light toensure a better success.

Low success is anticipated in the bone with high metabolism, for instance grafted bone, osteotomy sites, andbone near to recently extracted tooth. Local bone density is a important factor for success, therefore clinicians
should feel the resistance of the bone during placement and it should be feedback to decide the level oforthodontic force. In weak bone area, the force should be light initially and can be increased gradually.

Age of the patients is also a factor. Young patients tend to have lower success than adult patients. In young

patients, combination of small diameter of mcroimplants and light force is good. Regarding lower limit of age
for microimplants, we have experiences of good successful treatment with microimplants in age of 10. In young
patients, it is recommended to use a small diameter microimplants and load a light force. And tightening should
be done if there is slight mobility on the microimplants.

Regarding implant factor, big and long microimplants provide higher success in vitro study. In vivo, however,

it is different because of root proximity, and thickness, density, and shape of the local bone. Therefore we havesuggested suitable length and diameter of the microimplants.

As most failure occurs first three to four months after placement, surgical factor is a very important for successof microimplants. It is important to maintain integrity of the cortical bone during surgical placement. Thus, we use

different methods, drill or drill-free, according to sites and placement angle. Please look at surgical procedure indetails.

29

The proximity of microimplants to the roots of teeth is one of the causes of the failure. To prevent this, there

have been many methods. Two to three periapical X- rays taken by tube shift technique can help determine if
adequate space exists for the implant between teeth. CT scans offer 3-D images for precise interpretation (Fig. 54),
but this brings up the issues of radiation exposure and extra expense. To date, consequences from root contact

of root damage is trivial. Roots typically demonstrate good recuperative power, even when severely challenged
as it happens during apicoectomies. The big consequence is failure of microimplants that are stirred up by the

movement of teeth by mastication. Thus, a diagonal path of microimplant insertion will help to avoid root injury

when placing the microimplant between roots. If there is not enough inter-radicular space, the roots can be moved
apart orthodontically before placing the implants (Fig. 18).

Fig. 54. Review root approximation by microimplant with a conventional radiographs or CT scans.

Management factor causing the failure are accidental excessive force, infection and oral hygiene. The accidental

force from the clinician or patient may endanger the microimplants. The retrieved mandibular microimplants

showed bending compared to the maxillary microimplants and the mandible has lower success rate. This meansthat hard food may be crushed down to the mandibular microimplants and this lowers success rate. The heavy
accidental force from the clinician during change of elastomers and from the patients may be detrimental to themicroimplants placed in the weak bone.

As inflammation induces bone loss around microimplants, it should be controlled well for success. Moreinflammation is evident to the microimplants placed into oral mucosa over attached gingiva, and placed into thedeep vestibule. The microimplants placed into infrazygomatic crest induce inflammation inevitably.

3. Orthodontic Force application
There have been a concept that waiting time of 2 months for osseointegration for prosthetic implants.

Orthodontic force, however, can be loaded immediately because the force level is so low enough not to produce
any problem related to stability. When a stab incision is done during placement, it is better to wait about 2 weeks
for soft tissue healing before applying force. There were no differences in failure rate between immediate loading

and delayed loading, when the applied the force was kept to less than 300gm. Initial stability of the mciroimplants
comes from mechanical interlocking and gradually bone remodeling produce uniform bone contacts between thebone and microimplants. If the force is light, this will hamper early stability of the microimplants. Light continual
forces as generated by nickel titanium coils are favored over chain elastomerics that often have excessive initialforces.

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Brochure for AbsoAnchor® Orthodontic Microimplant

4. Instruction to the patients
The microimplant and surrounding soft tissue should be cleaned well with soft brushing and water irrigation

by waterpik. If there is a first sign of inflammation around microimplants, chemotherapeutic rinses need to

be prescribed to block gingival inflammation. Once gingival enlargement formed, it is very difficult to control
inflammation.

The patients should be warned not to touch microimplant by their fingers, spoons, and any objects. These

accidental forces are one of causes for delayed failure, because these force can reach to several kilograms whileorthodontic force is only less than 300 gm. A hard food, like almond, can be one cause of failure, as it exerts highdetrimental force to microimplants, particularly in the mandibular posterior teeth area.

Microimplant has a failure rate of 5�15% depending on the placement sites, operaters� technique, and patient

type. Usually more failures occur in mandible than maxilla. The patients should be fully aware with the possibilityof failure before starting microimplant treatment and properly instructed for care of microimplants. .

5. Management of microimplants with minor mobility
If the clinicians have the microimplants with minor mobility, clinicians can tighten the microimplants withdriver tip and load by tying elastic thread in clockwise direction after passing it through a hole on the neck. This

procedure is very useful in young patients, who have active bone remodeling activity and tend to have more

microimplants with minor mobility. By this procedure, the clinicians can save about 50% of a slightly mobile
microimplants.

6. Microimplant removal
The removal of the microimplants is not difficult because of smooth machined surface texture. As an initial turnoffers some resistance, turn gently to break the interface of bone and microimplant. The removal torque for the
microimplants with diamters of 1.3-1.5, ranges 3-7 Ncm, and this guarantee easy removel without complications.

In the open method, a clinician can easily remove the microimplant by engaging the microimplant head with thedriver and turn it in the opposite direction of the insertion. Local needle-stick anesthesia is not needed during thisprocedure.

Patients may have some minor discomfort when the implant irritates the soft tissue during its removal, but thisgives far less discomfort than an anesthetic needle-prick. Topical anesthesia is enough to avoid any pain during

removal of microimplant, if it is requested from patients. In the closed method, small incision is made over thehead portion of microimplant to expose after local anesthesia.

31Fig. 55. Removal of microimplant (AbsoAnchor , Dentos Inc.) using hand driver on the buccal (upper row) and palatal slope (lower row)of the maxilla. There is no need of needle-stick anesthesia for its removal. Only a topical anesthesia is recommended.

Fig. 56. Removal of microimplant using a speed reduction engine driver on the palatal side without needle-stick anesthesia (above).
Hand-Driven contraangle drive is also very useful to remove the microimplant (below).

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Brochure for AbsoAnchor® Orthodontic Microimplant

9. Concluding remarks
The AbsoAnchor microimplant system was developed specifically for orthodontic anchorage and is provided

with variable sizes and lengths for wide application. Microimplants are small enough to be placed virtually in any

area of the mouth, if there is bone available. A microimplant can be placed without mucoperiosteal incision orflap, so there is almost no pain or swelling after implantation. Routine placement of a microimplant takes only aminutes. Orthodontists and general dentists can easily place the microimplants in their practices.

The microimplants showed comparatively high success as compared to other medical devices. The success ratevaries according to sites, loading direction, and purposes. Maxillary microimplants have had a high success rate ofover 94%, while mandibular microimplants has less than 90% of success rate. When considering replacement orother adjacent sites for placement, success of orthodontic treatment with microimplants is 100%. It is our mission
to find ways to increase the success rate of microimplant placement, although the success rate is already high.

Microimplant anchorage has become one of the most effective and powerful tool for absolute anchorage, which

up until now was one of the biggest dreams of the practicing orthodontist. This treatment approach can bringabout a paradigm shift in orthodontic treatment planning in contemporary orthodontic world, from one by one
step movement to one stage en masse movement, from sequential treatment to one stage whole treatment, from
impossible movement to ordinary movement. By adding this new type of anchorage system to the armamentariumof the practicing orthodontists, we can broaden the domain of orthodontic treatment possibilities. Many otherapplications for microimplant anchorage will be developed by creative orthodontists without cessation.

33

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09. Cacciafesta V, Bumann A, Cho HJ, Graham JW, Paquette DE, Park HS, Scheffler N. Skeletal anchorage part1. J Clin
Orthod. 2009�43:303-317.

10. Cacciafesta V, Bumann A, Cho HJ, Graham JW, Paquette DE, Park HS, Scheffler N. Skeletal anchorage part1. J Clin
Orthod. 2009�43:365-378.

11. Chen Y, Shin HI, Kyung HM. Biomechanical and histological comparison of self-drilling and self-tapping orthodontic
microimplants in dogs. Am J Orthod Dentofacial Orthop, 2008:133(1): 44-50.

12. Chen Y, Kyung HM, Sung JH. Critical factors for the success of orthodontic mini-implants: a systematic review. Am J Orthod
Dentofacial Orthop, 2009�135(3):284-291.

13. Chen Y, Kang ST, Bae SM, Kyung HM. Clinical and histologic analysis of the stability of microimplants with immediate
orthodontic loading in dogs. Am J Orthod Dentofacial Orthop, 2009:135(2):260-267.

14. Chen Y, Kyung HM, Gao L, Yu W, Bae EJ, Kim SM. Mechanical properties of self-drilling orthodontic micro-implants withdifferent diameters. Angle Orthod. 2010�80(5)�821-827.

15. Cho UH, Yu W, Kyung HM. Root contact during drilling for microimplant placement: Affect of surgery site and operator
expertise. Angle Orthod. 2010�80(1)�130-136.

16. Creekmore TD, Eklund MK. The possibility of skeletal anchorage. J Clin Orthod. 0983:17:266-269.

17. Gainsforth BL, Higley LB. A study of orthodontic anchorage possibility in basal bone. Am J Orthod. 1945:31�406-417.

18. Hung BQ, Yu W, Park HS, Kyung HM, Hong M. Correlation between insertion torque and peri-implant bone strain during

placement of orthodontic mini-implants: A finite element study. Am J Orthod Dentofac Orthop. 2022:161(2)�248-254. DOI:
10.1016/j.ajodo.2020.07.042

19. Kang ST, Sung JH, Kyung HM, Park HS, Kwon OW. Comparison of histologic observation and insertional and removal
torque values between titanium grade 2 and 4 microimplants. Kor J Orthod. 2006�36(3):171-177.

34

Brochure for AbsoAnchor® Orthodontic Microimplant

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23. Kim HJ, Jang WS, Park HS. Anatomical limits for distalization of lower posterior molars with Micro-implant Anchorage. J Clin
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36

Brochure for AbsoAnchor® Orthodontic Microimplant

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Textbooks

01. Park HS. Orthodontic treatment using Microimplants, Clinical applications of mi-croimplants. (Korean) Daehan Nare Pub.
Co. Seoul 2001.

02. Sung JH, Kyung HM, Bae SM, HS Park, Kwon OW, McNamara JA. Microimplants in Orthodontics, Daegu, Dentos Inc., 200603. Park HS. Minor tooth movement with microimplants. (Korean) Daehan Nare Pub. Co. Seoul, 2008.

04. Park HS. Minor tooth movement with microimplants for prosthetic treatment. (English) Dentos Co, Ltd Daegu, Korea 2009.
05. Park HS. Microimplants in orthognathic surgical orthodontics (English). Dentos Co. Ltd Daegu, Korea 201506. Park HS. Microimplants in orthodontic treatment, surgical placement and management, biomechanics and extraction
treatment (English). Dentos Co. Ltd, Daegu, Korea 201507. Park HS. Efficient use of microimplants in Orthodontics Openbite, Deepbite, Class III treatment, Nonextraction treatment,
and various clinical applications (English). Dentos, Co, Ltd, Daegu, Korea 2015.

Article request: https://www.researchgate.net/profile/Hyo-Sang-Park-2

38

Microimplant Course

��Comprehensive�Treatment�Course���3�days����Advanced�Microimplant�Course���2�days��
��Minor�Tooth�Movement�Course���1�day��*�Visiting�Associate�Professor���Dept��of�Orthodontics��
���Oklahoma�University��USA*�Reviewer���AJODO��Angle�Orthod��EJO��Orthodontics�and�

Prof. Hyo-Sang Park � DDS, MSD, PhD.

�� Craniofacial�Research��J�of�Orthodontics��KJO��etc�

Professor and Chair,

He did pioneer work and extensive research on the development

Dept. of Orthodontics. School of Dentistry,of microimplants since 1999. He is using microimplants for 24 years

Kyungpook National University (KNU)(as of 2022) and wrote more than 100 international articles,

seven text books, and eight chapters dealing with Orthodontic Microimplants.
His articles were cited in the orthodontic journals over 9,500 times(google scholar as of 2022), and his three articles ranked 2nd, 45th,
and 65th in �The 100 most-cited articles in orthodontic
journals in the last 20 years� by AJODO in 2021.

Email � parkhs@knu.ac.kr

Learn�from�Experts

Hands�on�courses�are�regularly�held�twice�a�year��spring�and�fall���in�Daegu��Korea��For�course�queries��
feel�free�to�ask�us�

Lingual Orthodontic Tx.

��Set�up�Model�&�Indirect�Bonding�Course���3�days����Basic�Wire�Bending�Course���3�days��*�Visiting�Professor���Dept��of�Orthodontics��Osaka�University��Japan*�Visiting�Professor���Dept��of�Orthodontics��
���British�Columbia�University��Canada*�Professor��40�years����Dept��of�Orthodontics��School�of�Dentistry��KNU��Korea*�Ex�Dean���School�of�Dentistry��KNU
Prof. Hee-Moon Kyung � DDS, MSD, PhD.
Honorary Professor,

Dept. of Orthodontics. School of Dentistry,
Kyungpook National University (KNU)*�Ex�President���Korean�Association�of�Orthodontists��KAO�

*�Ex�President���Korean�Association�of�Lingual�Orthodontists��KALO�*�Ex�President���World�Society�of�Lingual�Orthodontists��WSLO�*�Active�member���Angle�Society��East�

He was ranked No.18 in �The 31 Most Common Authors of the Top 100 Cited
Articles in Orthodontics� from 1946 to 2016. Angle Orthodontist 2018�88(6).
Email � hmkyung@knu.ac.kr

39

Brochure for AbsoAnchor® Orthodontic Microimplant

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