A digital volumetric tomography (DVT) study in the mandibular molar region for miniscrew placement during mixed dentition
Identifieur interne : 000278 ( Pmc/Corpus ); précédent : 000277; suivant : 000279A digital volumetric tomography (DVT) study in the mandibular molar region for miniscrew placement during mixed dentition
Auteurs : Mayur S. Bhattad ; Sudhindra Baliga ; Pavan VibhuteSource :
- Dental Press Journal of Orthodontics [ 2176-9451 ] ; 2015.
Abstract
To assess bone thickness for miniscrew placement in the mandible during mixed dentition by using digital volumetric tomograph (DVT).
A total of 15 healthy patients aged 8-10 years old, with early exfoliated mandibular second deciduous molar, were included. DVT images of one quadrant of the mandible were obtained using Kodak extraoral imaging systems and analyzed by Kodak dental imaging software. The error of the method (EM) was calculated using Dahlberg's formula. Mean and standard deviation were calculated at 6 and 8 mm from the cementoenamel junction (CEJ).Paired t-test was used to analyze the measurements.
Buccal cortical bone thickness, mesiodistal width and buccolingual bone depth at 6 mm were found to be 1.73 + 0.41, 2.15 + 0.49 and 13.18 + 1.22 mm, respectively; while at 8 mm measurements were 2.42 + 0.34, 2.48 + 0.33 and 13.65 + 1.25 mm, respectively. EM for buccal cortical bone thickness, mesiodistal width and buccolingual bone depth was 0.58, 0.40 and 0.48, respectively. The difference in measurement at 6 and 8 mm for buccal cortical plate thickness (P < 0.05) and buccolingual bone thickness (P < 0.05) was found to be significant, whereas for mesiodistal width it was insignificant (P > 0.05).
Bone thickness measurement has shown promising evidence for safe placement of miniscrews in the mandible during mixed dentition. The use of miniscrew is the best alternative, even in younger patients.
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DOI: 10.1590/2176-9451.20.2.055-060.oar
PubMed: 25992988
PubMed Central: 4445226
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">A digital volumetric tomography (DVT) study in the mandibular molar
region for miniscrew placement during mixed dentition</title><author><name sortKey="Bhattad, Mayur S" sort="Bhattad, Mayur S" uniqKey="Bhattad M" first="Mayur S." last="Bhattad">Mayur S. Bhattad</name><affiliation><nlm:aff id="aff1">Senior lecturer, Sharad Pawar Dental College and Hospital, Department of Pedodontics and Preventive Dentistry, Sawangi, Wardha, Maharashtra, India</nlm:aff></affiliation></author><author><name sortKey="Baliga, Sudhindra" sort="Baliga, Sudhindra" uniqKey="Baliga S" first="Sudhindra" last="Baliga">Sudhindra Baliga</name><affiliation><nlm:aff id="aff2">Professor, Sharad Pawar Dental College and Hospital, Department of Pedodontics and Preventive Dentistry, Sawangi, Wardha, Maharashtra, India</nlm:aff></affiliation></author><author><name sortKey="Vibhute, Pavan" sort="Vibhute, Pavan" uniqKey="Vibhute P" first="Pavan" last="Vibhute">Pavan Vibhute</name><affiliation><nlm:aff id="aff3">Associate professor, Sharad Pawar Dental College and Hospital, Department of Orthodontics, Sawangi, Wardha, Maharashtra, India</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25992988</idno><idno type="pmc">4445226</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445226</idno><idno type="RBID">PMC:4445226</idno><idno type="doi">10.1590/2176-9451.20.2.055-060.oar</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000278</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000278</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A digital volumetric tomography (DVT) study in the mandibular molar
region for miniscrew placement during mixed dentition</title><author><name sortKey="Bhattad, Mayur S" sort="Bhattad, Mayur S" uniqKey="Bhattad M" first="Mayur S." last="Bhattad">Mayur S. Bhattad</name><affiliation><nlm:aff id="aff1">Senior lecturer, Sharad Pawar Dental College and Hospital, Department of Pedodontics and Preventive Dentistry, Sawangi, Wardha, Maharashtra, India</nlm:aff></affiliation></author><author><name sortKey="Baliga, Sudhindra" sort="Baliga, Sudhindra" uniqKey="Baliga S" first="Sudhindra" last="Baliga">Sudhindra Baliga</name><affiliation><nlm:aff id="aff2">Professor, Sharad Pawar Dental College and Hospital, Department of Pedodontics and Preventive Dentistry, Sawangi, Wardha, Maharashtra, India</nlm:aff></affiliation></author><author><name sortKey="Vibhute, Pavan" sort="Vibhute, Pavan" uniqKey="Vibhute P" first="Pavan" last="Vibhute">Pavan Vibhute</name><affiliation><nlm:aff id="aff3">Associate professor, Sharad Pawar Dental College and Hospital, Department of Orthodontics, Sawangi, Wardha, Maharashtra, India</nlm:aff></affiliation></author></analytic><series><title level="j">Dental Press Journal of Orthodontics</title><idno type="ISSN">2176-9451</idno><idno type="eISSN">2177-6709</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>OBJECTIVE:</title><p> To assess bone thickness for miniscrew placement in the mandible during mixed
dentition by using digital volumetric tomograph (DVT). </p></sec><sec><title>MATERIAL AND METHODS:</title><p> A total of 15 healthy patients aged 8-10 years old, with early exfoliated
mandibular second deciduous molar, were included. DVT images of one quadrant of
the mandible were obtained using Kodak extraoral imaging systems and analyzed by
Kodak dental imaging software. The error of the method (EM) was calculated using
Dahlberg's formula. Mean and standard deviation were calculated at 6 and 8 mm from
the cementoenamel junction (CEJ).Paired t-test was used to analyze the
measurements. </p></sec><sec><title>RESULTS:</title><p> Buccal cortical bone thickness, mesiodistal width and buccolingual bone depth at
6 mm were found to be 1.73 + 0.41, 2.15 + 0.49 and 13.18 + 1.22 mm, respectively;
while at 8 mm measurements were 2.42 + 0.34, 2.48 + 0.33 and 13.65 + 1.25 mm,
respectively. EM for buccal cortical bone thickness, mesiodistal width and
buccolingual bone depth was 0.58, 0.40 and 0.48, respectively. The difference in
measurement at 6 and 8 mm for buccal cortical plate thickness (P < 0.05) and
buccolingual bone thickness (P < 0.05) was found to be significant, whereas for
mesiodistal width it was insignificant (P > 0.05). </p></sec><sec><title>CONCLUSION:</title><p> Bone thickness measurement has shown promising evidence for safe placement of
miniscrews in the mandible during mixed dentition. The use of miniscrew is the
best alternative, even in younger patients. </p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Laing, E" uniqKey="Laing E">E Laing</name></author><author><name sortKey="Ashley, P" uniqKey="Ashley P">P Ashley</name></author><author><name sortKey="Naini, Fb" uniqKey="Naini F">FB Naini</name></author><author><name sortKey="Gill, Ds" uniqKey="Gill D">DS Gill</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ngan, P" uniqKey="Ngan P">P Ngan</name></author><author><name sortKey="Randy, Ga" uniqKey="Randy G">GA Randy</name></author><author><name sortKey="Fields, Jrh" uniqKey="Fields J">JRH Fields</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dincer, M" uniqKey="Dincer M">M Dincer</name></author><author><name sortKey="Haydar, S" uniqKey="Haydar S">S Haydar</name></author><author><name sortKey="Unsal, B" uniqKey="Unsal B">B 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Dental Press J Orthod</journal-id><journal-id journal-id-type="iso-abbrev">Dental Press J Orthod</journal-id><journal-id journal-id-type="publisher-id">dpjo</journal-id><journal-title-group><journal-title>Dental Press Journal of Orthodontics</journal-title></journal-title-group><issn pub-type="ppub">2176-9451</issn><issn pub-type="epub">2177-6709</issn><publisher><publisher-name>Dental Press International</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25992988</article-id><article-id pub-id-type="pmc">4445226</article-id><article-id pub-id-type="doi">10.1590/2176-9451.20.2.055-060.oar</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>A digital volumetric tomography (DVT) study in the mandibular molar
region for miniscrew placement during mixed dentition</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bhattad</surname><given-names>Mayur S.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Baliga</surname><given-names>Sudhindra</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Vibhute</surname><given-names>Pavan</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label>Senior lecturer, Sharad Pawar Dental College and Hospital, Department of Pedodontics and Preventive Dentistry, Sawangi, Wardha, Maharashtra, India</aff><aff id="aff2"><label>2</label>Professor, Sharad Pawar Dental College and Hospital, Department of Pedodontics and Preventive Dentistry, Sawangi, Wardha, Maharashtra, India</aff><aff id="aff3"><label>3</label>Associate professor, Sharad Pawar Dental College and Hospital, Department of Orthodontics, Sawangi, Wardha, Maharashtra, India</aff><author-notes><corresp id="c01"><bold>Contact address:</bold> Mayur S Bhattad Department of Pedodontics and
Preventive Dentistry HSRSSM Dental College and Hospital Hingoli, Maharashtra, India -
Ph. No. 09860273039 Email: <email>mayur_b99@yahoo.co.in</email></corresp></author-notes><pub-date pub-type="epub-ppub"><season>Mar-Apr</season><year>2015</year></pub-date><pmc-comment>Fake ppub date generated by PMC from publisher
pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub"><season>Mar-Apr</season><year>2015</year></pub-date><volume>20</volume><issue>2</issue><fpage>55</fpage><lpage>60</lpage><history><date date-type="received"><day>21</day><month>1</month><year>2014</year></date><date date-type="accepted"><day>13</day><month>10</month><year>2014</year></date></history><permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an Open Access article distributed under the terms of the Creative
Commons Attribution Non-Commercial License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the
original work is properly cited.</license-p></license></permissions><abstract><sec><title>OBJECTIVE:</title><p> To assess bone thickness for miniscrew placement in the mandible during mixed
dentition by using digital volumetric tomograph (DVT). </p></sec><sec><title>MATERIAL AND METHODS:</title><p> A total of 15 healthy patients aged 8-10 years old, with early exfoliated
mandibular second deciduous molar, were included. DVT images of one quadrant of
the mandible were obtained using Kodak extraoral imaging systems and analyzed by
Kodak dental imaging software. The error of the method (EM) was calculated using
Dahlberg's formula. Mean and standard deviation were calculated at 6 and 8 mm from
the cementoenamel junction (CEJ).Paired t-test was used to analyze the
measurements. </p></sec><sec><title>RESULTS:</title><p> Buccal cortical bone thickness, mesiodistal width and buccolingual bone depth at
6 mm were found to be 1.73 + 0.41, 2.15 + 0.49 and 13.18 + 1.22 mm, respectively;
while at 8 mm measurements were 2.42 + 0.34, 2.48 + 0.33 and 13.65 + 1.25 mm,
respectively. EM for buccal cortical bone thickness, mesiodistal width and
buccolingual bone depth was 0.58, 0.40 and 0.48, respectively. The difference in
measurement at 6 and 8 mm for buccal cortical plate thickness (P < 0.05) and
buccolingual bone thickness (P < 0.05) was found to be significant, whereas for
mesiodistal width it was insignificant (P > 0.05). </p></sec><sec><title>CONCLUSION:</title><p> Bone thickness measurement has shown promising evidence for safe placement of
miniscrews in the mandible during mixed dentition. The use of miniscrew is the
best alternative, even in younger patients. </p></sec></abstract><trans-abstract xml:lang="pt"><sec><title>OBJETIVO:</title><p> avaliar, por meio de tomografia volumétrica digital (TVD), a espessura óssea
necessária para a instalação de mini-implante na arcada inferior durante a fase de
dentição mista. </p></sec><sec><title>MÉTODOS:</title><p> um total de 15 pacientes saudáveis, com idades entre 8 e 10 anos, com segundo
molar inferior decíduo irrompido recentemente, foram incluídos no presente estudo.
Imagens de TVD da hemiarcada inferior foram obtidas utilizando sistemas de imagens
extrabucais Kodak. As imagens foram analisadas por meio do programa de imagens
Kodak. O erro do método (EM) foi calculado utilizando a fórmula de Dahlberg.
Médias e desvios-padrão foram calculados de 6 a 8mm aquém da junção
amelocementária. O teste <italic>t</italic> foi utilizado para a análise das
medidas. </p></sec><sec><title>RESULTADOS:</title><p> a espessura do osso cortical vestibular, largura mesiodistal e profundidade óssea
vestibulolingual, a 6mm, foram de 1,73 + 0,41; 2,15 + 0,49; e 13,18 + 1,22 mm,
respectivamente. Já a 8mm, os valores foram de 2,42 + 0,34; 2,48 + 0,33; e 13,65 +
1,25mm. O EM para a espessura do osso cortical vestibular, largura mesiodistal e
profundidade óssea vestibulolingual foi de 0,58, 0,40 e 0,48mm, respectivamente. A
diferença entre as medidas a 6 e 8mm para a espessura do osso cortical vestibular
(p < 0,05) e a espessura óssea vestibulolingual (p < 0,05) foi
significativa, embora não tenha sido significativa para a largura mesiodistal (p
< 0,05). </p></sec><sec><title>CONCLUSÃO:</title><p> a mensuração da espessura óssea demonstra evidências promissoras para a segura
instalação de mini-implantes na arcada inferior e na fase de dentição mista. O uso
de mini-implantes tem se mostrado a melhor alternativa, mesmo nos casos de
pacientes mais jovens. </p></sec></trans-abstract><kwd-group><kwd>Miniscrews</kwd><kwd>Digital volumetric tomograph</kwd><kwd>Inter-radicular bone</kwd><kwd>Cortical bone</kwd></kwd-group><counts><fig-count count="5"></fig-count><table-count count="3"></table-count><equation-count count="0"></equation-count><ref-count count="34"></ref-count><page-count count="6"></page-count></counts></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>Maintenance of arch length during the primary, mixed and permanent dentition is of great
significance for the normal development of future occlusion because premature loss of
primary teeth due to caries, trauma, ectopic eruption, or other causes may lead to
undesirable tooth movements of primary and/or permanent teeth including loss of arch
length.<xref rid="B01" ref-type="bibr">1</xref> Space management is a key
responsibility of dental practitioners who are concerned about monitoring the developing
dentition, as the loss of arch length may lead to problems, such as crowding, dental
impaction, crossbite formation, and dental midline discrepancies.<xref rid="B02" ref-type="bibr">2</xref> The use of space maintainers/retainers are advocated to maintain
or regain lost arch length and may potentially obviate the need for later extractions
and/or complex orthodontic treatment, hence space management continues to play a vital
role in Dentistry.<xref rid="B03" ref-type="bibr">3</xref> However, these space
maintaining devices in routine practice have shown appreciable adverse effects, such as
plaque accumulation, dental caries, dislodged or broken appliances, interference with
successor eruption, undesirable tooth movement and soft tissue impingement.<xref rid="B02" ref-type="bibr">2</xref><sup>,</sup><sup>45</sup></p><p>In recent years, a new treatment method using miniscrews has been developed and applied
to clinical orthodontic treatment. This technique enabled tooth movement that was
impossible with conventional orthodontic treatment and served as an alternative method
for absolute orthodontic anchorage.<xref rid="B06" ref-type="bibr">6</xref><sup>,</sup><xref rid="B07" ref-type="bibr">7</xref> Thus, miniscrews may have the potential to aid
comprehensive space management and to overcome the disadvantages of conventional space
maintaining devices.</p><p>Miniscrews offer the advantages of lower cost, smaller size, easy surgical
placement/removal procedure, no additional laboratory work and minimum waiting period
for osseointegration.<xref rid="B07" ref-type="bibr">7</xref><sup>,</sup><xref rid="B08" ref-type="bibr">8 </xref>Numerous anatomic sites for miniscrew placement
have been proven in adults; however, very few data are available for the mixed dentition
age group.<xref rid="B06" ref-type="bibr">6</xref> The scope of miniscrews in Pediatric
Dentistry for space maintenance and as an anchorage device in the late mixed dentition
period may be possible and needs to be evaluated. Hence, this study aimed to assess the
mesiodistal bone width, buccal cortical plate thickness and buccolingual bone thickness
in the posterior region of the mandible for placement of miniscrews during mixed
dentition.</p></sec><sec sec-type="materials|methods"><title>MATERIAL AND METHODS</title><p>The study protocol was approved by DMIMS, Sawangi, Wardha, Mahrashtra state, India
Institutional Review Board and an informed consent form was signed by parents/guardians
accompanying the patients prior to the digital volumetric tomographic (DVT) scan. A
total of 15 healthy patients, aged 8-10 years old, with early or recently exfoliated
mandibular second deciduous molar and 2-4 mm bone covering erupting mandibular second
premolar were included in the study. Patients with severe facial or dental asymmetries,
systemic diseases or bone abnormalities, significant medical or dental history, vertical
or horizontal periodontal bone loss were excluded.<xref rid="B06" ref-type="bibr">6</xref><sup>,</sup><xref rid="B09" ref-type="bibr">9</xref><sup>,</sup><xref rid="B10" ref-type="bibr">10</xref></p><p>Digital volumetric tomographic images of one quadrant of the mandible in all 15 patients
were obtained using Kodak 9000 extraoral imaging system. Either the right or left
quadrant of the mandible was randomly chosen for measurement taking, as it was
previously proven that there were no differences in cortical bone thickness between
sides of the jaws.<xref rid="B11" ref-type="bibr">11</xref><sup>,</sup><xref rid="B12" ref-type="bibr">12</xref></p></sec><sec><title>DATA ANALYSIS</title><p>The images obtained were analyzed by Kodak dental imaging software (3D module V 2.2). At
the time of measurements, scanned images were oriented in all three planes: sagittal,
axial and coronal. In the posterior inter-radicular areas of the mandible, the sagittal
slice was used to locate the inter-radicular area of interest for measurements (<xref ref-type="fig" rid="f01">Fig 1</xref>). The vertical reference plane was made
parallel to the long axes of the roots, and the horizontal reference plane was marked
along the cementoenamel junction (CEJ) of permanent mandibular first molar<xref rid="B10" ref-type="bibr">10</xref> (<xref ref-type="fig" rid="f02">Fig 2</xref>).
Measurements were carried out at 6 and 8 mm apical to the cementoenamel junction.
Mesiodistal bone width in the mandibular first molar region was measured in sagittal
slice (<xref ref-type="fig" rid="f03">Fig 3</xref>) whereas the thickness of the buccal
cortical plate (<xref ref-type="fig" rid="f04">Fig 4</xref>) and buccolingual bone
thickness or depth was measured in the areas between the second premolar and first molar
in the coronal slice (<xref ref-type="fig" rid="f05">Fig 5</xref>).</p><p><fig id="f01" orientation="portrait" position="float"><label>Figure 1 -</label><caption><title>Sagittal, coronal and axial slices.</title></caption><graphic xlink:href="dpjo-20-02-00055-gf01"></graphic></fig></p><p><fig id="f02" orientation="portrait" position="float"><label>Figure 2 -</label><caption><title>Vertical and horizontal reference plane.</title></caption><graphic xlink:href="dpjo-20-02-00055-gf02"></graphic></fig></p><p><fig id="f03" orientation="portrait" position="float"><label>Figure 3 -</label><caption><title>Mesiodistal bone width at 6 and 8 mm.</title></caption><graphic xlink:href="dpjo-20-02-00055-gf03"></graphic></fig></p><p><fig id="f04" orientation="portrait" position="float"><label>Figure 4 -</label><caption><title>Buccal cortical bone thickness at 6 mm and 8 mm.</title></caption><graphic xlink:href="dpjo-20-02-00055-gf04"></graphic></fig></p><p><fig id="f05" orientation="portrait" position="float"><label>Figure 5 -</label><caption><title>Buccolingual bone depth at 6 mm and 8 mm.</title></caption><graphic xlink:href="dpjo-20-02-00055-gf05"></graphic></fig></p></sec><sec><title>STATISTICAL ANALYSIS</title><p>Data obtained for measurements at 6 mm and 8 mm were statistically analyzed by means of
paired t-test. The scanned images were measured by the same observer after a two week
interval. The error of the method (EM) calculations were carried out by means of
Dahlberg's formula.<xref rid="B06" ref-type="bibr">6</xref></p></sec><sec sec-type="results"><title>RESULTS</title><p>Of the 15 images obtained, three were discarded due to poor image quality. Mean and
standard deviation for each of the variables were calculated. Mesiodistal bone width
measurements at 6 mm and 8 mm ranged from 1.3 to 2.9 mm. Results for buccal cortical
plate thickness and buccolingual bone depth ranged between 1.5 - 2.9 mm and 11.9 - 15.4
mm, respectively. Mean values for mesiodistal bone width, buccal cortical plate
thickness and buccolingual bone depth at 8 mm were found to be sufficient for miniscrews
placement with a diameter of 1.2 - 1.4 mm and length of 10 - 14 mm (<xref ref-type="table" rid="t01">Table 1</xref>).</p><p><table-wrap id="t01" orientation="portrait" position="float"><label>Table 1 -</label><caption><title>Mean and standard deviation for mesiodistal bone width, buccal cortical
plate thickness and buccolingual bone depth measurements.</title></caption><table frame="hsides" rules="groups" style="border-top: 1px solid black; border-bottom: 1px solid black; width: 100%"><thead><tr><th rowspan="2" colspan="1"> Patient</th><th colspan="2" rowspan="1"> Mesiodistal width</th><th colspan="2" rowspan="1"> Buccal cortical plate</th><th colspan="2" rowspan="1"> Buccolingual bone thickness</th></tr><tr><th rowspan="1" colspan="1"> 6 mm</th><th rowspan="1" colspan="1"> 8 mm</th><th rowspan="1" colspan="1"> 6 mm</th><th rowspan="1" colspan="1"> 8 mm</th><th rowspan="1" colspan="1"> 6 mm</th><th rowspan="1" colspan="1"> 8 mm</th></tr></thead><tbody><tr><td rowspan="1" colspan="1"> 1</td><td rowspan="1" colspan="1"> 2.3 mm</td><td rowspan="1" colspan="1"> 2.6 mm</td><td rowspan="1" colspan="1"> 2.0 mm</td><td rowspan="1" colspan="1"> 2.9 mm</td><td rowspan="1" colspan="1"> 13.1 mm</td><td rowspan="1" colspan="1"> 13.7 mm</td></tr><tr><td rowspan="1" colspan="1"> 2</td><td rowspan="1" colspan="1"> 2.7 mm</td><td rowspan="1" colspan="1"> 2.6 mm</td><td rowspan="1" colspan="1"> 1.5 mm</td><td rowspan="1" colspan="1"> 2.6 mm</td><td rowspan="1" colspan="1"> 11.9 mm</td><td rowspan="1" colspan="1"> 12.1 mm</td></tr><tr><td rowspan="1" colspan="1"> 3</td><td rowspan="1" colspan="1"> 1.3 mm</td><td rowspan="1" colspan="1"> 2.2 mm</td><td rowspan="1" colspan="1"> 1.9 mm</td><td rowspan="1" colspan="1"> 1.9 mm</td><td rowspan="1" colspan="1"> 15.4 mm</td><td rowspan="1" colspan="1"> 15.4 mm</td></tr><tr><td rowspan="1" colspan="1"> 4</td><td rowspan="1" colspan="1"> 2.3 mm</td><td rowspan="1" colspan="1"> 2.8 mm</td><td rowspan="1" colspan="1"> 1.8 mm</td><td rowspan="1" colspan="1"> 2.4 mm</td><td rowspan="1" colspan="1"> 12.4 mm</td><td rowspan="1" colspan="1"> 12.8 mm</td></tr><tr><td rowspan="1" colspan="1"> 5</td><td rowspan="1" colspan="1"> 2.4 mm</td><td rowspan="1" colspan="1"> 2.9 mm</td><td rowspan="1" colspan="1"> 2.1 mm</td><td rowspan="1" colspan="1"> 2.5 mm</td><td rowspan="1" colspan="1"> 13.5 mm</td><td rowspan="1" colspan="1"> 14.8 mm</td></tr><tr><td rowspan="1" colspan="1"> 6</td><td rowspan="1" colspan="1"> 1.9 mm</td><td rowspan="1" colspan="1"> 2.6 mm</td><td rowspan="1" colspan="1"> 1.9 mm</td><td rowspan="1" colspan="1"> 2.2 mm</td><td rowspan="1" colspan="1"> 12.8 mm</td><td rowspan="1" colspan="1"> 13.1 mm</td></tr><tr><td rowspan="1" colspan="1"> 7</td><td rowspan="1" colspan="1"> 2.0 mm</td><td rowspan="1" colspan="1"> 2.8 mm</td><td rowspan="1" colspan="1"> 1.8 mm</td><td rowspan="1" colspan="1"> 2.6 mm</td><td rowspan="1" colspan="1"> 13.4 mm</td><td rowspan="1" colspan="1"> 15.1 mm</td></tr><tr><td rowspan="1" colspan="1"> 8</td><td rowspan="1" colspan="1"> 2.1 mm</td><td rowspan="1" colspan="1"> 2.7 mm</td><td rowspan="1" colspan="1"> 2.2 mm</td><td rowspan="1" colspan="1"> 2.7 mm</td><td rowspan="1" colspan="1"> 13.6 mm</td><td rowspan="1" colspan="1"> 14.3 mm</td></tr><tr><td rowspan="1" colspan="1"> 9</td><td rowspan="1" colspan="1"> 1.9 mm</td><td rowspan="1" colspan="1"> 2.4 mm</td><td rowspan="1" colspan="1"> 1.9 mm</td><td rowspan="1" colspan="1"> 2.5 mm</td><td rowspan="1" colspan="1"> 13.4 mm</td><td rowspan="1" colspan="1"> 13.7 mm</td></tr><tr><td rowspan="1" colspan="1"> 10</td><td rowspan="1" colspan="1"> 2.4 mm</td><td rowspan="1" colspan="1"> 2.8 mm</td><td rowspan="1" colspan="1"> 1.8 mm</td><td rowspan="1" colspan="1"> 2.3 mm</td><td rowspan="1" colspan="1"> 13.1 mm</td><td rowspan="1" colspan="1"> 13.5 mm</td></tr><tr><td rowspan="1" colspan="1"> 11</td><td rowspan="1" colspan="1"> 2.3 mm</td><td rowspan="1" colspan="1"> 2.5 mm</td><td rowspan="1" colspan="1"> 2.0 mm</td><td rowspan="1" colspan="1"> 2.0 mm</td><td rowspan="1" colspan="1"> 12.9 mm</td><td rowspan="1" colspan="1"> 12.5 mm</td></tr><tr><td rowspan="1" colspan="1"> 12</td><td rowspan="1" colspan="1"> 2.2 mm</td><td rowspan="1" colspan="1"> 2.5 mm</td><td rowspan="1" colspan="1"> 1.5 mm</td><td rowspan="1" colspan="1"> 2.4 mm</td><td rowspan="1" colspan="1"> 12.7 mm</td><td rowspan="1" colspan="1"> 12.8 mm</td></tr><tr><td rowspan="1" colspan="1"> Mean ± SD</td><td rowspan="1" colspan="1"> 2.15 ± 0.49</td><td rowspan="1" colspan="1"> 2.48 ± 0.33</td><td rowspan="1" colspan="1"> 1.73 ± 0.41</td><td rowspan="1" colspan="1"> 2.42 ± 0.34</td><td rowspan="1" colspan="1"> 13.18 ± 1.22</td><td rowspan="1" colspan="1"> 13.65 ± 1.25</td></tr></tbody></table></table-wrap></p><p>Differences in measurement at 6 and 8 mm for buccal cortical plate thickness (P <
0.05) and buccolingual bone thickness (P < 0.05) were found to be significant,
whereas for mesiodistal width it was insignificant (P > 0.05) (<xref ref-type="table" rid="t02">Table 2</xref>). The error of the method (EM) for mesiodistal bone width,
buccal and palatal cortical plate thickness and buccopalatal bone depth measurements
were found to be 0.40, 0.58 and 0.48, respectively (<xref ref-type="table" rid="t03">Table 3</xref>).</p><p><table-wrap id="t02" orientation="portrait" position="float"><label>Table 2 -</label><caption><title>Paired t-test for mesiodistal bone width, buccal and palatal cortical plate
thickness and buccolingual bone depth measurements.</title></caption><table frame="hsides" rules="groups" style="border-top: 1px solid black; border-bottom: 1px solid black; width: 100%"><thead><tr><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"> Mesiodistal width</th><th rowspan="1" colspan="1"> Buccal cortical plate thickness</th><th rowspan="1" colspan="1"> Buccolingual depth</th></tr></thead><tbody><tr><td rowspan="1" colspan="1"> T-test value</td><td rowspan="1" colspan="1"> 1.76</td><td rowspan="1" colspan="1"> 3.37</td><td rowspan="1" colspan="1"> 2.51</td></tr><tr><td rowspan="1" colspan="1"> P value</td><td rowspan="1" colspan="1"> 0.13 (N.S., P > 0.05)</td><td rowspan="1" colspan="1"> 0.021 (Sig, P < 0.05)</td><td rowspan="1" colspan="1"> 0.044 (Sig, P < 0.05)</td></tr></tbody></table></table-wrap></p><p><table-wrap id="t03" orientation="portrait" position="float"><label>Table 3 -</label><caption><title>Error of the method for mesiodistal bone width, buccal and palatal cortical
plate thickness and buccolingual bone depth measurements at 6 and 8 mm.</title></caption><table frame="hsides" rules="groups" style="border-top: 1px solid black; border-bottom: 1px solid black; width: 100%"><thead><tr><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"> Mesiodistal width</th><th rowspan="1" colspan="1"> Buccal cortical plate thickness</th><th rowspan="1" colspan="1"> Buccolingual depth</th></tr></thead><tbody><tr><td rowspan="1" colspan="1"> Error of the method</td><td rowspan="1" colspan="1"> 0.40</td><td rowspan="1" colspan="1"> 0.58</td><td rowspan="1" colspan="1"> 0.48</td></tr></tbody></table></table-wrap></p></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>Miniscrews<xref rid="B13" ref-type="bibr">13</xref><sup>-</sup><xref rid="B17" ref-type="bibr">17</xref> are now frequently used for establishing
absolute anchorage for orthodontic tooth movement. They are easily inserted and removed
without a mucoperiosteal flap, and can be loaded immediately after insertion.<xref rid="B18" ref-type="bibr">18</xref> Their potential applications include improving
anchorage, increasing the horizontal component of force applied during space closure,
posterior intrusion in open-bite cases, distalization of molars, extrusion of impacted
teeth, molar uprighting and correction of midline diastema.<xref rid="B07" ref-type="bibr">7</xref><sup>,</sup><xref rid="B08" ref-type="bibr">8</xref><sup>,</sup><xref rid="B18" ref-type="bibr">18</xref></p><p>The mandibular buccal region had the thickest cortical bone of all evaluated regions.
Thicker cortical bone has been previously reported in the mandible than in the
maxilla.<xref rid="B12" ref-type="bibr">12</xref><sup>,</sup><xref rid="B19" ref-type="bibr">19</xref> Increased cortical bone thickness and higher
bone mineral density have been shown in the mandibular buccal region when compared to
the maxillary buccal and lingual regions,<xref rid="B20" ref-type="bibr">20</xref><sup>-</sup><xref rid="B23" ref-type="bibr">23</xref> as the mandible is found to be always under
torsional and bending strains or forces, whereas the maxilla is generally subjected to
more compressive forces.<xref rid="B24" ref-type="bibr">24</xref> Also, in animal
experiments, it has been demonstrated that regions which experience higher strain during
function develop thicker cortical bones.<xref rid="B25" ref-type="bibr">25</xref></p><p>Thus, in humans, cortical bone in the mandibular buccal region was found to be thicker
posteriorly, and it becomes progressively thinner anteriorly.<xref rid="B12" ref-type="bibr">12</xref><sup>,</sup><xref rid="B26" ref-type="bibr">26</xref> This pattern might also be explained by the
higher functional demands placed on posterior teeth. Van Eijden<xref rid="B24" ref-type="bibr">24</xref> reported an increase in the longitudinal elastic modulus
(increase in stress per unit of strain) between the molar region and the symphysis.
Stress and strain differences could give rise to the differences in cortical thickness
in this region.</p><p>Age-related differences between younger, adolescent and older patients in cortical bone
thickness might be explained by changes in functional capacity, because maximum bite
forces, masticatory muscle size, and muscle activity have the tendency to increase with
age. Changes in the functional capacity, which alter biomechanical stresses and strains,
have shown to manipulate cortical bone thickness and bone density because increased
strains and stresses within a certain limit increase cortical bone thickness and bone
mineral density.<xref rid="B10" ref-type="bibr">10</xref></p><p>In the mandible, the safest sites for miniscrew insertion have been found to be between
the first and second molars, first and second premolars, first molar and first premolar
and first premolar and canine. These sites provide moderate inter-radicular space and
sufficient cortical plate thickness. However, due to root proximity, the area suitable
for miniscrew insertion is over 8 mm from the alveolar crest.<xref rid="B06" ref-type="bibr">6</xref></p><p>In this study, the CEJ was selected as the starting point for measurements, as compared
to other studies in which alveolar crest was used, which could be affected by different
periodontal problems.<xref rid="B27" ref-type="bibr">27</xref><sup>,</sup><xref rid="B28" ref-type="bibr">28 </xref>The maximum level of measurement in this study
was selected to be 6 and 8 mm from CEJ because miniscrew placement is most commonly
advised in the area of attached gingiva.<xref rid="B29" ref-type="bibr">29</xref></p><p>The selection of proper miniscrew diameter and length is important as it may hamper
eruption or deflect erupting premolars during mixed dentition. Hence, selection will
depend upon inter-radicular mesiodistal bone width, buccal cortical plate thickness and
bucco-lingual bone depth.<xref rid="B28" ref-type="bibr">28</xref> Currently, most
miniscrews have diameters ranging from 1.2 to 2 mm. Presently, there are no relative
data available on the amount of bone that is to be present between miniscrews and dental
roots for both periodontal health and miniscrew stability. Considering that the width of
the periodontal ligament is approximately 0.25 mm, it is assumed that a minimum
clearance of 1 mm of alveolar bone around the screw could be sufficient for periodontal
health.<xref rid="B06" ref-type="bibr">6</xref><sup>,</sup><xref rid="B28" ref-type="bibr">28</xref> Combining this value with our data, the safe
zone for a miniscrew 1.2 mm in diameter, placed in the inter-radicular spaces have been
identified to be at 8 mm.</p><p>Radiographic analysis is a pre-requirement in determining anatomic sites for implant
placement. Three-dimensional imaging techniques, such as CT or MRI imaging, have turned
into important diagnostic imaging in the head and neck.<xref rid="B30" ref-type="bibr">30</xref> CT involves a considerably higher radiation dose<xref rid="B31" ref-type="bibr">31</xref> in comparison to conventional radiography, as well as high
working costs and considerable investment in equipment.<xref rid="B32" ref-type="bibr">32</xref> Digital volume tomograph (DVT) is a new imaging technique which produces
three-dimensional images similar to CT, but at a low radiation dose which is comparable
with panoramic radiograph, and at a lesser cost. DVT technology in clinical practice has
numerous advantages, such as image accuracy, rapid scan time and display modes which are
unique to maxillofacial imaging. Three-dimensional volumetric tomograph is also well
suited for imaging the craniofacial area because it provides clear images of highly
contrasted structures which are extremely useful for evaluating bone.<xref rid="B33" ref-type="bibr">33</xref><sup>,</sup><xref rid="B34" ref-type="bibr">34</xref> Hence, in this study, three-dimensional
digital volumetric tomograph (DVT) was used to assess mesiodistal bone width, cortical
bone thickness and buccolingual bone depth.</p><p>In the mandibular molar region, mini-implants placement between premolars is not
recommended due to the presence of mental foramen.<xref rid="B29" ref-type="bibr">29</xref> Hence, the proximity of the mental foramina and bone density in the
posterior region needs to be assessed in mixed dentition in order to provide a
three-dimensional analysis for miniscrew placement. However, the results of the present
study need to be correlated with clinical assessment so as to maintain optimum
periodontal health and miniscrew stability.</p></sec><sec sec-type="conclusions"><title>CONCLUSION</title><p>After evaluating the amount of bone thickness in the inter-radicular spaces of the
mandibular posterior region, the results of the present study show promising evidence
for safe miniscrews placement in the mixed dentition period. This results need to be
reevaluated in a larger scale.</p><p>Miniscrew has proved to be the best alternative to routinely use clinical appliances for
space management, uprighting and distalization of molars, and intrusion and extrusion of
teeth. It can also be used as a temporary prosthesis abutment in younger patients.</p></sec></body><back><fn-group><fn fn-type="conflict"><p>» The authors report no commercial, proprietary or financial interest in the products
or companies described in this article.</p></fn><fn fn-type="other"><p>» Patients displayed in this article previously approved the use of their facial and
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