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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Analysis of time to failure of orthodontic mini-implants after insertion or loading</title><author><name sortKey="Jeong, Jong Wha" sort="Jeong, Jong Wha" uniqKey="Jeong J" first="Jong-Wha" last="Jeong">Jong-Wha Jeong</name><affiliation><nlm:aff id="A1">Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.</nlm:aff></affiliation></author><author><name sortKey="Kim, Jong Wan" sort="Kim, Jong Wan" uniqKey="Kim J" first="Jong-Wan" last="Kim">Jong-Wan Kim</name><affiliation><nlm:aff id="A2">Department of Orthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.</nlm:aff></affiliation></author><author><name sortKey="Lee, Nam Ki" sort="Lee, Nam Ki" uniqKey="Lee N" first="Nam-Ki" last="Lee">Nam-Ki Lee</name><affiliation><nlm:aff id="A2">Department of Orthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.</nlm:aff></affiliation></author><author><name sortKey="Kim, Young Kyun" sort="Kim, Young Kyun" uniqKey="Kim Y" first="Young-Kyun" last="Kim">Young-Kyun Kim</name><affiliation><nlm:aff id="A3">Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.</nlm:aff></affiliation></author><author><name sortKey="Lee, Jong Ho" sort="Lee, Jong Ho" uniqKey="Lee J" first="Jong-Ho" last="Lee">Jong-Ho Lee</name><affiliation><nlm:aff id="A4">Department of Oral and Maxillofacial Surgery and Oral Cancer Center, School of Dentistry and Dental Research Institute, Seoul National University Dental Hospital, Seoul, Korea.</nlm:aff></affiliation></author><author><name sortKey="Kim, Tae Woo" sort="Kim, Tae Woo" uniqKey="Kim T" first="Tae-Woo" last="Kim">Tae-Woo Kim</name><affiliation><nlm:aff id="A1">Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26568925</idno><idno type="pmc">4641214</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641214</idno><idno type="RBID">PMC:4641214</idno><idno type="doi">10.5125/jkaoms.2015.41.5.240</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000353</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000353</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Analysis of time to failure of orthodontic mini-implants after insertion or loading</title><author><name sortKey="Jeong, Jong Wha" sort="Jeong, Jong Wha" uniqKey="Jeong J" first="Jong-Wha" last="Jeong">Jong-Wha Jeong</name><affiliation><nlm:aff id="A1">Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.</nlm:aff></affiliation></author><author><name sortKey="Kim, Jong Wan" sort="Kim, Jong Wan" uniqKey="Kim J" first="Jong-Wan" last="Kim">Jong-Wan Kim</name><affiliation><nlm:aff id="A2">Department of Orthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.</nlm:aff></affiliation></author><author><name sortKey="Lee, Nam Ki" sort="Lee, Nam Ki" uniqKey="Lee N" first="Nam-Ki" last="Lee">Nam-Ki Lee</name><affiliation><nlm:aff id="A2">Department of Orthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.</nlm:aff></affiliation></author><author><name sortKey="Kim, Young Kyun" sort="Kim, Young Kyun" uniqKey="Kim Y" first="Young-Kyun" last="Kim">Young-Kyun Kim</name><affiliation><nlm:aff id="A3">Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.</nlm:aff></affiliation></author><author><name sortKey="Lee, Jong Ho" sort="Lee, Jong Ho" uniqKey="Lee J" first="Jong-Ho" last="Lee">Jong-Ho Lee</name><affiliation><nlm:aff id="A4">Department of Oral and Maxillofacial Surgery and Oral Cancer Center, School of Dentistry and Dental Research Institute, Seoul National University Dental Hospital, Seoul, Korea.</nlm:aff></affiliation></author><author><name sortKey="Kim, Tae Woo" sort="Kim, Tae Woo" uniqKey="Kim T" first="Tae-Woo" last="Kim">Tae-Woo Kim</name><affiliation><nlm:aff id="A1">Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of the Korean Association of Oral and Maxillofacial Surgeons</title><idno type="ISSN">2234-7550</idno><idno type="eISSN">2234-5930</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>Objectives</title><p>This study was performed to evaluate patterns of failure time after insertion, failure rate according to loading time after insertion, and the patterns of failure after loading.</p></sec><sec><title>Materials and Methods</title><p>A total of 331 mini-implants were classified into the non-failure group (NFG) and failure group (FG), which was divided into failed group before loading (FGB) and failed group after loading (FGA). Orthodontic force was applied to both the NFG and FGA. Failed mini-implants after insertion, ratio of FGA to NFG according to loading time after insertion, and failed mini-implants according to failed time after loading were analyzed.</p></sec><sec><title>Results</title><p>Percentages of failed mini-implants after insertion were 15.79%, 36.84%, 12.28%, and 10.53% at 4, 8, 12, and 16 weeks, respectively. Mini-implant failure demonstrated a peak from 4 to 5 weeks after insertion. The failure rates according to loading time after insertion were 13.56%, 8.97%, 11.32%, and 5.00% at 4, 8, 12, and 16 weeks, respectively. Percentages of failed mini-implants after loading were 13.79%, 24.14%, 20.69%, and 6.9% at 4, 8, 12, and 16 weeks, respectively.</p></sec><sec><title>Conclusion</title><p>Mini-implant stability is typically acquired 12 to 16 weeks after insertion, and immediate loading can cause failure of the mini-implant. Failure after loading was observed during the first 12 weeks.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Suh, Hy" uniqKey="Suh H">HY Suh</name></author><author><name sortKey="Lee, Sj" uniqKey="Lee S">SJ Lee</name></author><author><name sortKey="Park, Hs" uniqKey="Park H">HS Park</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kanomi, R" uniqKey="Kanomi R">R Kanomi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, Hj" uniqKey="Lee H">HJ Lee</name></author><author><name sortKey="Lee, Ks" uniqKey="Lee K">KS Lee</name></author><author><name sortKey="Kim, Mj" uniqKey="Kim M">MJ Kim</name></author><author><name sortKey="Chun, Ys" uniqKey="Chun Y">YS Chun</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Herrmann, I" uniqKey="Herrmann I">I Herrmann</name></author><author><name sortKey="Lekholm, U" uniqKey="Lekholm U">U 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Ddos</name></author><author><name sortKey="Morea, C" uniqKey="Morea C">C Morea</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Robling, Ag" uniqKey="Robling A">AG Robling</name></author><author><name sortKey="Niziolek, Pj" uniqKey="Niziolek P">PJ Niziolek</name></author><author><name sortKey="Baldridge, La" uniqKey="Baldridge L">LA Baldridge</name></author><author><name sortKey="Condon, Kw" uniqKey="Condon K">KW Condon</name></author><author><name sortKey="Allen, Mr" uniqKey="Allen M">MR Allen</name></author><author><name sortKey="Alam, I" uniqKey="Alam I">I Alam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Klein Nulend, J" uniqKey="Klein Nulend J">J Klein-Nulend</name></author><author><name sortKey="Van Der Plas, A" uniqKey="Van Der Plas A">A van der Plas</name></author><author><name sortKey="Semeins, Cm" uniqKey="Semeins C">CM Semeins</name></author><author><name sortKey="Ajubi, Ne" uniqKey="Ajubi N">NE Ajubi</name></author><author><name sortKey="Frangos, Ja" uniqKey="Frangos J">JA Frangos</name></author><author><name sortKey="Nijweide, Pj" uniqKey="Nijweide P">PJ Nijweide</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Forwood, Mr" uniqKey="Forwood M">MR Forwood</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tatsumi, S" uniqKey="Tatsumi S">S Tatsumi</name></author><author><name sortKey="Ishii, K" uniqKey="Ishii K">K Ishii</name></author><author><name sortKey="Amizuka, N" uniqKey="Amizuka N">N Amizuka</name></author><author><name sortKey="Li, M" uniqKey="Li M">M Li</name></author><author><name sortKey="Kobayashi, T" uniqKey="Kobayashi T">T Kobayashi</name></author><author><name sortKey="Kohno, K" uniqKey="Kohno K">K Kohno</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Yk" uniqKey="Kim Y">YK Kim</name></author><author><name sortKey="Ahn, Kj" uniqKey="Ahn K">KJ 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article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Korean Assoc Oral Maxillofac Surg</journal-id><journal-id journal-id-type="iso-abbrev">J Korean Assoc Oral Maxillofac Surg</journal-id><journal-id journal-id-type="publisher-id">JKAOMS</journal-id><journal-title-group><journal-title>Journal of the Korean Association of Oral and Maxillofacial Surgeons</journal-title></journal-title-group><issn pub-type="ppub">2234-7550</issn><issn pub-type="epub">2234-5930</issn><publisher><publisher-name>The Korean Association of Oral and Maxillofacial Surgeons</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26568925</article-id><article-id pub-id-type="pmc">4641214</article-id><article-id pub-id-type="doi">10.5125/jkaoms.2015.41.5.240</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Analysis of time to failure of orthodontic mini-implants after insertion or loading</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Jeong</surname><given-names>Jong-Wha</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Kim</surname><given-names>Jong-Wan</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Nam-Ki</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Young-Kyun</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Jong-Ho</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Tae-Woo</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea.</aff><aff id="A2"><label>2</label>Department of Orthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.</aff><aff id="A3"><label>3</label>Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.</aff><aff id="A4"><label>4</label>Department of Oral and Maxillofacial Surgery and Oral Cancer Center, School of Dentistry and Dental Research Institute, Seoul National University Dental Hospital, Seoul, Korea.</aff><author-notes><corresp>Corresponding author: Jong-Wan Kim. Department of Orthodontics, Section of Dentistry, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. TEL: +82-31-787-2787, FAX: +82-31-787-4140, <email>kimjongwan@hotmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>10</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>20</day><month>10</month><year>2015</year></pub-date><volume>41</volume><issue>5</issue><fpage>240</fpage><lpage>245</lpage><history><date date-type="received"><day>08</day><month>4</month><year>2015</year></date><date date-type="rev-recd"><day>07</day><month>6</month><year>2015</year></date><date date-type="accepted"><day>26</day><month>6</month><year>2015</year></date></history><permissions><copyright-statement>Copyright © 2015 The Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link>) 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>Objectives</title><p>This study was performed to evaluate patterns of failure time after insertion, failure rate according to loading time after insertion, and the patterns of failure after loading.</p></sec><sec><title>Materials and Methods</title><p>A total of 331 mini-implants were classified into the non-failure group (NFG) and failure group (FG), which was divided into failed group before loading (FGB) and failed group after loading (FGA). Orthodontic force was applied to both the NFG and FGA. Failed mini-implants after insertion, ratio of FGA to NFG according to loading time after insertion, and failed mini-implants according to failed time after loading were analyzed.</p></sec><sec><title>Results</title><p>Percentages of failed mini-implants after insertion were 15.79%, 36.84%, 12.28%, and 10.53% at 4, 8, 12, and 16 weeks, respectively. Mini-implant failure demonstrated a peak from 4 to 5 weeks after insertion. The failure rates according to loading time after insertion were 13.56%, 8.97%, 11.32%, and 5.00% at 4, 8, 12, and 16 weeks, respectively. Percentages of failed mini-implants after loading were 13.79%, 24.14%, 20.69%, and 6.9% at 4, 8, 12, and 16 weeks, respectively.</p></sec><sec><title>Conclusion</title><p>Mini-implant stability is typically acquired 12 to 16 weeks after insertion, and immediate loading can cause failure of the mini-implant. Failure after loading was observed during the first 12 weeks.</p></sec></abstract><kwd-group><kwd>Dental implant</kwd><kwd>Orthodontic anchorage procedure</kwd><kwd>Immediate dental implant loading</kwd></kwd-group><funding-group><award-group><funding-source country="KR">Seoul National University Dental Hospital</funding-source><award-id>04-2011-0056</award-id></award-group></funding-group></article-meta></front><body><sec><title>I. Introduction</title><p>Small-sized mini-implants have been applied for skeletal orthodontic anchorage<xref rid="B1" ref-type="bibr">1</xref>. Orthodontic mini-implants have a smaller diameter and a shorter length than the implants used for prosthodontic treatment<xref rid="B2" ref-type="bibr">2</xref><xref rid="B3" ref-type="bibr">3</xref>. Therefore, orthodontic mini-implants tend to demonstrate a higher failure rate than conventional implants<xref rid="B4" ref-type="bibr">4</xref>. The frequent failures of orthodontic mini-implants during treatment is a weak point of their use and can affect treatment plans and duration<xref rid="B5" ref-type="bibr">5</xref>. Other studies have reported 0% to 30% failure rates of orthodontic mini-implants inserted into alveolar bone<xref rid="B6" ref-type="bibr">6</xref><xref rid="B7" ref-type="bibr">7</xref>.</p><p>Because the size and surface of a mini-implant are small and the initial stability of it might be week, healing time is needed after insertion<xref rid="B8" ref-type="bibr">8</xref>. However, immediate loading on prosthodontic implants has shown a good success rate<xref rid="B9" ref-type="bibr">9</xref><xref rid="B10" ref-type="bibr">10</xref>. Other studies have reported that loading time did not affect the success rate of prosthetic implants<xref rid="B11" ref-type="bibr">11</xref>. In orthodontic mini-implants, an immediate, light orthodontic load did not affect the bone healing process<xref rid="B12" ref-type="bibr">12</xref>. Loading can reduce the sclerostin level<xref rid="B13" ref-type="bibr">13</xref> and result in release of prostaglandin<xref rid="B14" ref-type="bibr">14</xref>. These changes can enhance bone formation<xref rid="B15" ref-type="bibr">15</xref> and inhibit bone resorption<xref rid="B16" ref-type="bibr">16</xref>. There was no significant difference in marginal bone loss between immediate loading and delayed loading in such implants<xref rid="B17" ref-type="bibr">17</xref>.</p><p>However, the bone remodeling process involving bone resorption and apposition after insertion of a mini-implant needs time to heal in order to provide stable support of the mini-implant<xref rid="B18" ref-type="bibr">18</xref>.</p><p>Because of the high failure rates of orthodontic mini-implants, loading time is believed to be important. Analysis regarding the failure time of orthodontic mini-implant after insertion and loading could help guide clinical practice when using orthodontic mini-implants. This study was conducted to evaluate the pattern of failure time after insertion, failure rate according to loading time after insertion, and the pattern of failure after loading.</p></sec><sec><title>II. Materials and Methods</title><p>Subjects included 134 patients (mean age, 20.08±7.52 years) with 331 inserted mini-implants (Miangan; Biomaterials Korea, Seoul, Korea) with a diameter of 1.2 mm and length of 7.0 mm. This study was done from July 2006 to June 2010 in dental clinic of Seoul National University Bundang Hospital (Seongnam, Korea). The surfaces of the mini-implants were machined but not treated. All mini-implants were installed on the buccal alveolar bone between the first premolar and the second molar of the maxilla and mandible.</p><p>Mini-implants were inserted by 1 operator using a self-drilling method after orthodontic leveling and alignment.</p><p>The mini-implants were classified into the failure group (FG) and non-failure group (NFG). The FG was divided into the failed group before loading (FGB) and failed group after loading (FGA). Orthodontic force was applied to both the NFG and FGA.</p><p>The failure rate was calculated for FG and NFG. To evaluate the pattern of failure time after insertion of mini-implant, the failed mini-implants were analyzed according to the failure time (weeks) after insertion in the FG.(<xref ref-type="fig" rid="F1">Fig. 1</xref>) For evaluation of failure rate according to loading time after insertion, the failure rate, calculated as the ratio of FGA to NFG, was analyzed according to loading time (weeks) after insertion. To analyze the patterns of failure after loading, the failed mini-implants were analyzed according to failure time (weeks) after loading. The statistic analysis was done using SPSS 12.0 for Windows (SPSS Inc., Chicago, IL, USA).</p><p>This study was approved by the Ethics Committee for Research (Seoul National University Bundang Hospital Ethical Board, B-1011-115-110).</p></sec><sec><title>III. Results</title><p>In this study, 57 of 331 inserted mini-implants experienced failure. Of these, 29 were in the FGA, and 28 were in the FGB. The mean age of the subjects was 22.08±7.52 years (NFG, 22.39±7.54 years; FG, 20.89±7.33 years).(<xref ref-type="table" rid="T1">Table 1</xref>)</p><p>Failure rates were 15.79%, 36.84%, 12.28%, and 10.53% after 4, 8, 12, and 16 weeks, respectively.(<xref ref-type="table" rid="T2">Table 2</xref>, <xref ref-type="fig" rid="F2">Fig. 2</xref>) In the failed mini-implant group, 75.44% of failures occurred within 16 weeks after insertion. The failure of mini-implants had a peak from 4 to 5 weeks.(<xref ref-type="fig" rid="F2">Fig. 2</xref>) The mini-implants loaded during the first 4 weeks after insertion showed the highest failure rate.(<xref ref-type="table" rid="T3">Table 3</xref>, <xref ref-type="fig" rid="F3">Fig. 3</xref>) The failure rates in relation to loading time after insertion were 13.56%, 8.97%, 11.32%, and 5.00% at 4, 8, 12, and 16 weeks, respectively. Mini-implants loaded during the first week after insertion showed a 42.50% failure rate.(<xref ref-type="fig" rid="F3">Fig. 3</xref>) Percentages of failed mini-implants after loading in this group were 13.79%, 24.14%, 20.69%, and 6.90% at 4, 8, 12, and 16 weeks, respectively.(<xref ref-type="table" rid="T4">Table 4</xref>, <xref ref-type="fig" rid="F4">Fig. 4</xref>) Mini-implant failures after loading in this group occurred mostly during the first 12 weeks after loading. From 4 to 12 weeks after loading, the failure rate of mini-implants in this group was 58.62%. Failures were observed intermittently until 44 weeks after loading.(<xref ref-type="fig" rid="F4">Fig. 4</xref>) <xref ref-type="table" rid="T2">Tables 2</xref>, <xref ref-type="table" rid="T3">3</xref>, <xref ref-type="table" rid="T4">4</xref> illustrate the data in 4-week intervals. <xref ref-type="fig" rid="F2">Fig. 2</xref>, <xref ref-type="fig" rid="F3">3</xref>, <xref ref-type="fig" rid="F4">4</xref> present the data in 1-week intervals to provide greater detail.</p></sec><sec><title>IV. Discussion</title><p>The results of this study showed some initial failures after insertion. About 75% of failed mini-implants occurred during the 16 weeks after insertion.(<xref ref-type="table" rid="T2">Table 2</xref>) Specifically, when the loading time after insertion was less than 12 weeks, the failure rates of mini-implant were high. These results signify that the stability of the mini-implant is acquired 12 to 16 weeks after insertion. They indicate that the bone remodeling process after insertion occurs during the first 3 to 4 months after insertion. For implant success, loading time is important. Time for bone healing of tissue damaged through the process of implantation is needed. Therefore, delayed loading has been suggested by other studies focusing on implant stability<xref rid="B19" ref-type="bibr">19</xref><xref rid="B20" ref-type="bibr">20</xref>.</p><p>Before loading, the failure rate during the first 4 to 5 weeks was the highest.(<xref ref-type="fig" rid="F2">Fig. 2</xref>) It is possible that bone resorption in the bone remodeling process is most active around 4 weeks after insertion in humans, and that bone apposition is achieved 3 to 4 months after insertion.</p><p>Some studies have reported that immediate or early loading of mini-implants shows good stability<xref rid="B21" ref-type="bibr">21</xref><xref rid="B22" ref-type="bibr">22</xref><xref rid="B23" ref-type="bibr">23</xref>. A previous animal study has suggested no significant differences in success rate or histological findings between immediate loading and delayed loading<xref rid="B24" ref-type="bibr">24</xref>. However, the failure rate in relation to loading time after insertion in the present study was highest during the first week.(<xref ref-type="fig" rid="F3">Fig. 3</xref>) This might indicate that immediate loading after insertion activates bone resorption and results in mini-implant failure<xref rid="B25" ref-type="bibr">25</xref>.</p><p>Because mini-implants have a smaller diameter, shorter length, and less surface area contacting the bone compared to conventional implants, mechanical stability in the early stages could be affected and reduced by limited bone resorption around the mini-implant<xref rid="B26" ref-type="bibr">26</xref>.</p><p>In this study, the failure of loaded mini-implants happened in case of the load was applied during the first 12 weeks after insertion except 37 weeks. This suggests that the load until 12 weeks after insertion affects the stability of a mini-implant, and loading is thus recommended at approximately 12 weeks after insertion.</p><p>Failure after loading occurred frequently until 13 weeks (<xref ref-type="fig" rid="F4">Fig. 4</xref>), with a high failure rate from 6 to 13 weeks. It is recommended that the clinician should be careful until 3 months after loading to sustain the mini-implant because of failure. Additionally, failure after loading was observed intermittently until 35 weeks. This suggests that the stability of the miniimplant is affected by bone remodeling after tooth movement through the end of treatment. This might be the result of insufficient surface area of the mini-implant in contact with bone in order to obtain sufficient surrounding support<xref rid="B27" ref-type="bibr">27</xref>.</p><p>Failure of the mini-implant results in difficulties and affects the treatment plan. Although there are various causes of miniimplant failure, selection of loading time after insertion is an important factor for avoiding failure. Immediate loading is not recommended, and delayed loading of the mini-implant is suggested until 12 to 16 weeks after insertion.</p><p>For more stable use of mini-implants in clinics, further studies regarding surface treatment of mini-implants are needed because implant surface might influence osseointegration time and implant failure. Additionally, if other factors, such as loading time, can be controlled in future studies, the more detailed results would be helpful to clinicians.</p></sec><sec><title>V. Conclusion</title><p>1. Approximately 75% of mini-implant failures occurred within 16 weeks of insertion. When the loading time after insertion was less than 12 weeks, the failure rate of the mini-implant was high. Proper stability of the mini-implant is acquired about 3 to 4 months after insertion.</p><p>2. The failure rate according to loading time after insertion was highest when the mini-implants were loaded during the first week after insertion. Immediate loading could cause failure of a mini-implant.</p><p>3. Failure after loading was frequently observed in the mini-implant until 13 weeks. 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person-group-type="author"><name><surname>Lee</surname><given-names>SJ</given-names></name><name><surname>Ahn</surname><given-names>SJ</given-names></name><name><surname>Lee</surname><given-names>JW</given-names></name><name><surname>Kim</surname><given-names>SH</given-names></name><name><surname>Kim</surname><given-names>TW</given-names></name></person-group><article-title>Survival analysis of orthodontic mini-implants</article-title><source>Am J Orthod Dentofacial Orthop</source><year>2010</year><volume>137</volume><fpage>194</fpage><lpage>199</lpage><pub-id pub-id-type="pmid">20152674</pub-id></element-citation></ref><ref id="B26"><label>26</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kim</surname><given-names>SH</given-names></name><name><surname>Cho</surname><given-names>JH</given-names></name><name><surname>Chung</surname><given-names>KR</given-names></name><name><surname>Kook</surname><given-names>YA</given-names></name><name><surname>Nelson</surname><given-names>G</given-names></name></person-group><article-title>Removal torque values of surface-treated mini-implants after loading</article-title><source>Am J Orthod Dentofacial Orthop</source><year>2008</year><volume>134</volume><fpage>36</fpage><lpage>43</lpage><pub-id pub-id-type="pmid">18617101</pub-id></element-citation></ref><ref id="B27"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kim</surname><given-names>JW</given-names></name><name><surname>Ahn</surname><given-names>SJ</given-names></name><name><surname>Chang</surname><given-names>YI</given-names></name></person-group><article-title>Histomorphometric and mechanical analyses of the drill-free screw as orthodontic anchorage</article-title><source>Am J Orthod Dentofacial Orthop</source><year>2005</year><volume>128</volume><fpage>190</fpage><lpage>194</lpage><pub-id pub-id-type="pmid">16102403</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label><caption><title>The diagram to explain 'failed time after insertion', 'loading time after insertion', and 'failed time after loading'.</title></caption><graphic xlink:href="jkaoms-41-240-g001"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label><caption><title>The number of failed mini-implants as to the time after insertion.</title></caption><graphic xlink:href="jkaoms-41-240-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><title>Failure rate as to the loading time after insertion.</title></caption><graphic xlink:href="jkaoms-41-240-g003"></graphic></fig><fig id="F4" orientation="portrait" position="float"><label>Fig. 4</label><caption><title>The number of failed mini-implants as to the failed time after loading.</title></caption><graphic xlink:href="jkaoms-41-240-g004"></graphic></fig><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><title>Number of mini-implants and age in the non-failed group (NFG) and failure group (FG)</title></caption><alternatives><graphic xlink:href="jkaoms-41-240-i001"></graphic><table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="center" rowspan="1" colspan="1"></th><th valign="middle" align="center" rowspan="1" colspan="1">Value</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Number of inserted mini-implants</td><td valign="top" align="center" rowspan="1" colspan="1">331</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> NFG</td><td valign="top" align="center" rowspan="1" colspan="1">274 (82.78)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> FG</td><td valign="top" align="center" rowspan="1" colspan="1">57 (17.22)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Failed group before loading</td><td valign="top" align="center" rowspan="1" colspan="1">28</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Failed group after loading</td><td valign="top" align="center" rowspan="1" colspan="1">29</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Age (yr)</td><td valign="top" align="center" rowspan="1" colspan="1">22.08±7.52</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> NFG</td><td valign="top" align="center" rowspan="1" colspan="1">22.39±7.54</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> FG</td><td valign="top" align="center" rowspan="1" colspan="1">20.89±7.33</td></tr></tbody></table></alternatives><table-wrap-foot><fn><p>Values are presented as number only, number (%), or mean±standard deviation.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" orientation="portrait" position="float"><label>Table 2</label><caption><title>Failed mini-implants according to time after insertion</title></caption><alternatives><graphic xlink:href="jkaoms-41-240-i002"></graphic><table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="center" rowspan="1" colspan="1">Time after insertion (wk)</th><th valign="middle" align="center" rowspan="1" colspan="1">Failed group before loading</th><th valign="middle" align="center" rowspan="1" colspan="1">Failed group after loading</th><th valign="middle" align="center" rowspan="1" colspan="1">Total</th><th valign="middle" align="center" rowspan="1" colspan="1">Accumulated total</th></tr></thead><tbody><tr><td valign="top" align="right" rowspan="1" colspan="1">4</td><td valign="top" align="center" rowspan="1" colspan="1">9 (32.14)</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">9 (15.79)</td><td valign="top" align="center" rowspan="1" colspan="1">9 (15.79)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">8</td><td valign="top" align="center" rowspan="1" colspan="1">17 (60.71)</td><td valign="top" align="center" rowspan="1" colspan="1">4 (13.79)</td><td valign="top" align="center" rowspan="1" colspan="1">21 (36.84)</td><td valign="top" align="center" rowspan="1" colspan="1">30 (52.63)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">12</td><td valign="top" align="center" rowspan="1" colspan="1">2 (7.14)</td><td valign="top" align="center" rowspan="1" colspan="1">5 (17.24)</td><td valign="top" align="center" rowspan="1" colspan="1">7 (12.28)</td><td valign="top" align="center" rowspan="1" colspan="1">37 (64.91)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">16</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">6 (20.69)</td><td valign="top" align="center" rowspan="1" colspan="1">6 (10.53)</td><td valign="top" align="center" rowspan="1" colspan="1">43 (75.44)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">20</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">1 (3.45)</td><td valign="top" align="center" rowspan="1" colspan="1">1 (1.75)</td><td valign="top" align="center" rowspan="1" colspan="1">44 (77.19)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">24</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">2 (6.90)</td><td valign="top" align="center" rowspan="1" colspan="1">2 (3.51)</td><td valign="top" align="center" rowspan="1" colspan="1">46 (80.70)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">28</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">2 (6.90)</td><td valign="top" align="center" rowspan="1" colspan="1">2 (3.51)</td><td valign="top" align="center" rowspan="1" colspan="1">48 (84.21)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">32</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">1 (3.45)</td><td valign="top" align="center" rowspan="1" colspan="1">1 (1.75)</td><td valign="top" align="center" rowspan="1" colspan="1">49 (85.96)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">36</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">2 (6.90)</td><td valign="top" align="center" rowspan="1" colspan="1">2 (3.51)</td><td valign="top" align="center" rowspan="1" colspan="1">51 (89.47)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">40</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">4 (13.79)</td><td valign="top" align="center" rowspan="1" colspan="1">4 (7.02)</td><td valign="top" align="center" rowspan="1" colspan="1">55 (96.49)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">44</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">1 (3.45)</td><td valign="top" align="center" rowspan="1" colspan="1">1 (1.75)</td><td valign="top" align="center" rowspan="1" colspan="1">56 (98.25)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">48</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">56 (98.25)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">52</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">1 (3.45)</td><td valign="top" align="center" rowspan="1" colspan="1">1 (1.75)</td><td valign="top" align="center" rowspan="1" colspan="1">57 (100.00)</td></tr></tbody></table></alternatives><table-wrap-foot><fn><p>Values are presented as number (%).</p></fn></table-wrap-foot></table-wrap><table-wrap id="T3" orientation="portrait" position="float"><label>Table 3</label><caption><title>Failed mini-implants according to loading time after insertion</title></caption><alternatives><graphic xlink:href="jkaoms-41-240-i003"></graphic><table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="center" rowspan="2" colspan="1">Loading time after insertion (wk)</th><th valign="middle" align="center" rowspan="1" colspan="3">Loaded mini-implant (n)</th><th valign="middle" align="center" rowspan="2" colspan="1">Failure rate (%)</th></tr><tr><th valign="middle" align="center" rowspan="1" colspan="1">Failed group after loading</th><th valign="middle" align="center" rowspan="1" colspan="1">Non-failure group</th><th valign="middle" align="center" rowspan="1" colspan="1">Total</th></tr></thead><tbody><tr><td valign="top" align="right" rowspan="1" colspan="1">4</td><td valign="top" align="right" rowspan="1" colspan="1">8</td><td valign="top" align="right" rowspan="1" colspan="1">51</td><td valign="top" align="right" rowspan="1" colspan="1">59</td><td valign="top" align="center" rowspan="1" colspan="1">13.56</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">8</td><td valign="top" align="right" rowspan="1" colspan="1">13</td><td valign="top" align="right" rowspan="1" colspan="1">132</td><td valign="top" align="right" rowspan="1" colspan="1">145</td><td valign="top" align="center" rowspan="1" colspan="1">8.97</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">12</td><td valign="top" align="right" rowspan="1" colspan="1">6</td><td valign="top" align="right" rowspan="1" colspan="1">47</td><td valign="top" align="right" rowspan="1" colspan="1">53</td><td valign="top" align="center" rowspan="1" colspan="1">11.32</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">16</td><td valign="top" align="right" rowspan="1" colspan="1">1</td><td valign="top" align="right" rowspan="1" colspan="1">19</td><td valign="top" align="right" rowspan="1" colspan="1">20</td><td valign="top" align="center" rowspan="1" colspan="1">5.00</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">20</td><td valign="top" align="right" rowspan="1" colspan="1">0</td><td valign="top" align="right" rowspan="1" colspan="1">7</td><td valign="top" align="right" rowspan="1" colspan="1">7</td><td valign="top" align="center" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">24</td><td valign="top" align="right" rowspan="1" colspan="1">0</td><td valign="top" align="right" rowspan="1" colspan="1">9</td><td valign="top" align="right" rowspan="1" colspan="1">9</td><td valign="top" align="center" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">28</td><td valign="top" align="right" rowspan="1" colspan="1">0</td><td valign="top" align="right" rowspan="1" colspan="1">4</td><td valign="top" align="right" rowspan="1" colspan="1">4</td><td valign="top" align="center" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">32</td><td valign="top" align="right" rowspan="1" colspan="1">0</td><td valign="top" align="right" rowspan="1" colspan="1">0</td><td valign="top" align="right" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">36</td><td valign="top" align="right" rowspan="1" colspan="1">0</td><td valign="top" align="right" rowspan="1" colspan="1">2</td><td valign="top" align="right" rowspan="1" colspan="1">2</td><td valign="top" align="center" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">40</td><td valign="top" align="right" rowspan="1" colspan="1">1</td><td valign="top" align="right" rowspan="1" colspan="1">3</td><td valign="top" align="right" rowspan="1" colspan="1">4</td><td valign="top" align="center" rowspan="1" colspan="1">25.00</td></tr></tbody></table></alternatives></table-wrap><table-wrap id="T4" orientation="portrait" position="float"><label>Table 4</label><caption><title>Failed mini-implants according to failed time after loading</title></caption><alternatives><graphic xlink:href="jkaoms-41-240-i004"></graphic><table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="center" rowspan="2" colspan="1">Time after loading (wk)</th><th valign="middle" align="center" rowspan="1" colspan="2">Failed mini-implant after loading</th></tr><tr><th valign="middle" align="center" rowspan="1" colspan="1">Number (%)</th><th valign="middle" align="center" rowspan="1" colspan="1">Accumulated number (%)</th></tr></thead><tbody><tr><td valign="top" align="right" rowspan="1" colspan="1">4</td><td valign="top" align="center" rowspan="1" colspan="1">4 (13.79)</td><td valign="top" align="center" rowspan="1" colspan="1">4 (13.79)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">8</td><td valign="top" align="center" rowspan="1" colspan="1">7 (24.14)</td><td valign="top" align="center" rowspan="1" colspan="1">11 (37.93)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">12</td><td valign="top" align="center" rowspan="1" colspan="1">6 (20.69)</td><td valign="top" align="center" rowspan="1" colspan="1">17 (58.62)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">16</td><td valign="top" align="center" rowspan="1" colspan="1">2 (6.90)</td><td valign="top" align="center" rowspan="1" colspan="1">19 (65.52)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">20</td><td valign="top" align="center" rowspan="1" colspan="1">1 (3.45)</td><td valign="top" align="center" rowspan="1" colspan="1">20 (68.97)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">24</td><td valign="top" align="center" rowspan="1" colspan="1">2 (6.90)</td><td valign="top" align="center" rowspan="1" colspan="1">22 (75.86)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">28</td><td valign="top" align="center" rowspan="1" colspan="1">1 (3.45)</td><td valign="top" align="center" rowspan="1" colspan="1">23 (79.31)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">32</td><td valign="top" align="center" rowspan="1" colspan="1">1 (3.45)</td><td valign="top" align="center" rowspan="1" colspan="1">24 (82.76)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">36</td><td valign="top" align="center" rowspan="1" colspan="1">4 (13.79)</td><td valign="top" align="center" rowspan="1" colspan="1">28 (96.55)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">40</td><td valign="top" align="center" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">28 (96.55)</td></tr><tr><td valign="top" align="right" rowspan="1" colspan="1">44</td><td valign="top" align="center" rowspan="1" colspan="1">1 (3.45)</td><td valign="top" align="center" rowspan="1" colspan="1">29 (100.00)</td></tr></tbody></table></alternatives></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix 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