# A Brief Review on Micro-Implants and Their Use in Orthodontics and Dentofacial Orthopaedics
## 3 Results
### Patients' and Practitioners' Compliance  
Another important issue besides investigating the efficiency of the use of micro-implants was the determination of patients' compliance with their use and the perception of pain while performing the insertion procedures. An article from 2008 [67] showed by using a visual analog scale (VAS) that the patients who underwent micro-implant surgery were expected to experience significantly greater pain than they endured. The postinterventional pain decreased continuously from the first to day seven after the surgical procedure. Pain experienced in the initial tooth alignment phase was significantly greater than in extraction procedures, micro-implants' insertion, or tooth or the insertion of separators. Patients' expectations of pain were greater in the case of micro-implants' insertion than in insertion of separators and tooth alignment but not statistically different than in extractions. Patients' pain significantly decreased seven days after the insertion of the micro-implants. Most patients reported little or no pain during micro-implant's insertion and overestimated first overestimated before the intervention the pain and trauma that would have been endured. The only problems caused by micro-implants were the accumulation of food waste around the screws (86%) and minor speech disturbances (37%). A large percentage of patients were satisfied with the implant surgery (76%) and said they would recommend it to others (78%). Another similar article that investigated pain perception on maxillary OMIs insertion found that VAS score 1 day after placement was significantly less than that 1 day after first premolar extraction for orthodontic purpose or that one day after the fixed appliance was bonded. The results indicated that interidental micro-implants did not produce greater pain than other orthodontic interventions [68]. A questionnaire-based study from 2010 [69] evaluated the pain experienced by orthodontic patients during tooth extractions, maxillary OMIs insertions, and gingival tissue removal before placing the maxillary implants. The pain felt during extractions was significantly greater than during tissue removal or micro-implant placement. The micro-implant placement caused no pain in 30% of patients and was the least painful procedure; the transginguival placement was significantly preferred. Orthodontic mini implants (OMIs) provide anchorage without depending on the collaboration of patients, they are effective and can be used for various treatment objectives; still, surveys have shown that many orthodontists never or rarely use them [70]. The barriers to implement OMIs in clinical practice are: the need to perform surgical procedures for their placement and risk factors associated, implant failure, costs, numerous implementation issues. Conducting surgical interventions in orthodontic offices is still very uncommon and can be conditioned by variables such as the lack of knowledge and skills of clinicians; the lack of knowledge-management skills of pertinent stakeholders, lack of organization, lack of time and resources, attitudes towards new knowledge, and resistance from the patient. Limitations depend more on the medical staff than on patients [70]. Retrieved OMIs exhibited different degrees of chemical changes on surface characteristics and mechanical behavior. The thread edges and tips were worn out and thin deposits were seen on their surfaces. Traces of foreign elements like iron, sulfur, and calcium, were detected on their surfaces. The maximum insertion torque and the insertion time of retrieved OMIs were increased compared to the initial use. The maximum insertion torque was increased in all OMIs put with the insertion angle of 45\({}^{\circ}\) compared with 90\({}^{\circ}\). The reuse for immediate relocation in the same patient may be acceptable; postponed relocation and allogeneic reuse of OMIs are not recommended in clinical practice [71].