Preface

Prof. Damaso Caprioglio

Orthodontics moved its first italian steps as a pioneers’ game in the roaring ‘fifties with some Masters (Muzi, May, Hoffer), then could develop with the first italian orthodontic study group (GISO – 1967), with the SIDO (Italian Orthodontic Society – 1968) and the first university school (Cagliari – 1973), followed by many others, then the ‘master’ courses and so on: started with a spoonful of pioneers, now it’s grown to gather thousands and thousands of professionals.

I was lucky in knowing, getting in touch and admiring the first masters in both clinical and scientific work; more, in being present at all phases of growth and development of italian orthodontics.

After editing many books and monographies on the topic, I greatly felt the need of preparing and developing an orthodontics collection, able to collect armoniously contributions from italian orthodontic schools or by single practitioners; it’s the first time this happens in Italy, and it’s directed primarily to undergraduate and postgraduate students, and to professionals who intend to go in depth into orthodontics.
Each book will hold a monography characteristic, varying in extension following the issue.

Iconography will receive as much space as possible, in order to favour its use also under the viewpoint of professional clinical application. Text and bibliography will usually be both kept short and strictly scientific, with clinical side in light, in order to maximize the ease of consultation.

I’d like to thank the Casa Editrice Martina, that was able to give green light to this chain, likely to obtain great success, also because almost every University school is joining and providing the best of their results in each specific research field.

My personal duty will consequently be to utterly raise the selection level of single issues, while that of the publisher will be to improve extension and graphics.

I would also like to thank the authors and schools, as in 20-years-space we will be able to offer a complete chain of about 40 monographies, useful and practical, representative of italian orthodontic quality at its best: particularly, I refer to dr. Alfredo Martina, the publisher, always knowingly near to me in tough moments and when hard decisions were to be taken.

That’s why I am specially glad our chain reached number 30 and will proceed to further achievements, really in the mist when we started it all in 1996 with book n°1!

There’s something special about this new book, since it comes from one of the best and wellrenowned international Orthodontics school, namely the Aahrus school, in Denmark, directed by prof. Birte Melsen.

I’m so grateful to her, to prof. Carlalberta Verna and to dr. Cesare Luzi, jr., who accepted my invitation in joining us with an exceptional monography, extremely up-to-date, this way giving our chain an international feature.

Prof. Melsen’s name is too worldwide known as to only try to trace even a short CV, I would only like to underline some peculiar features I have come to appreciate because of a friendship which was born over thirty years ago and of which I am so proud of.

Among these features stand scientific deepness, accuracy and extreme research precision, her firm will always be to express the truth underlying every research, the struggle to determine the importance of Evidence Based Medecine; she has constantly tried to share these characteristics with every member of her school, developing a fantastic international ‘club’ of pupils coming from abroad, able to produce fundamental research and clinical works of the greatest interest: among them, professor Carlalberta Verna and doctor Cesare Luzi, jr., who in their long stay at Aahrus University, first as postgraduate students and then as teachers, could train and specialize in this new and very, very important field of skeletal anchorage through the use of miniscrews, providing an excellent, precise and well-documented series of clinical cases.

That is not all, as I feel particularly proud of having Cesare as an author in this chain from the gratefulness I owe to his granpa, prof. Cesare Luzi, sr., founder and first S.I.D.O. President, who was my great teacher and master not only in the study years in Cagliari, but also for many decades, master of life and friend.

His seriousness, his rigorous sense of precision in research, his life ethics came to a new life in his excellent nephew.
From these premises it comes out as a logical conclusion that the monography I’m presently presenting representts one of the most outstanding contributions to this chain, as you can easily realize by following how the focus of interest passes from hystologic studies to the biomechanic ones, supporting the rich and multifold series of clinical cases, thus illustrating principles of scientific evidence.

I am confident this book will constitute a fundamental support for students approaching this field, but also for expert professionals who can find here material with which to confront themselves and therefore improve their techniques.
As a conclusion, let me thank again the publisher, dr. Alfredo Martina, for his neverending energy and enthusiasm generously poured in order to always improve this chain.

Prof. Damaso Caprioglio
già Direttore Cattedra di Ortognatodonzia e Gnatologia
e dei
Corsi di Perfezionamento in Ortodonzia Intercettiva
ed Ortodonzia Pre e Post-Chirurgica
Docente di Etica e Traumatologia Dentale
Università degli Studi di Parma

Preface

Prof.ssa Birte Melsen

It was in a moment of unrealistic confidence that I agreed to write a book on Mini-implants and it is only thanks to Carlalberta Verna and Cesare Luzi that we finally managed the task. In Aarhus, we have been using Skeletal Anchorage since the late seventies and Mini-implants since 1991. The experience was there, at Aarhus, the development of the present anchorage system was founded in collaboration between Medicon eG and our team starting in 2000. The understanding of the tissue reaction adjacent to the “screw” was based on the stress strain calculations performed by Michel Dalstra.

This book, however, would never have been completed had it not been for my colleagues and friends, Cesare Luzi and Carlalberta Verna. Whereas Cesare contributed his experience by means of the cases incorporate herein, Carlalberta edited the original Italian manuscript and added many valuable sections. Without her keen work, this contribution to the use and understanding of Mini-implants might never have become a reality. It is my hope that clinicians will benefit from the practical advice and be inspired by the cases presented in this book.

Prof.ssa Birte Melsen
D.D.S. Dr. Odont Chairman
Department of Orthodontics
School of Dentistry
University of Aarhus
Denmark

Index

1. Introduction

2. Indications

3. Contra-indications

4. Patient Profile

5. Mini-implants/Screws

5.a. Material

5.b. Thread Type – General Characteristics

5.c. Intra-osseous Components

5.c.i. Form

5.c.ii. Diameter

5.c.iii. Length

5.c.iv. Cut

5.c.v. Tip

5.d. Extra-osseous Components

5.d.i. Transmucosal Collar

5.d.ii. Neck

5.d.iii. Head Designs

5.e. Driver System

6. Placement and Insertion Protocols

6.a. Patient Information

6.a.i. Insertion site selection

6.a.ii. Soft tissue evaluation

6.b. Selection of head design

6.c. Selection of diameter

6.d. Selection of thread length

6.e. Insertion of the Mini-implants

7. Post insertion Protocols

8. Removal of Mini-implants

9. Potential damages related to Skeletal Anchorage

10. Failures of Mini-implants

10.a. Mini-implant-related failures

10.b. Patient-related failures

10.c. Orthodontist-related failures

11. Clinical cases

11.a. Molar Disatlization

11.b. Bicuspid and Cuspid Distalization

11.c. Asymmetric Cuspid Distalization

11.d. Upper Molar Mesialization

11.e. Lower Molar Mesialization

11.f. Upper Incisor Intrusion and Retraction

11.g. Lower Incisor Intrusion

11.h. Upper Molar Intrusion

11.i. Lower Molar Intrusion

11.l. Extrusion

11.m. Molar Uprighting

12. References

Apendix A. Mini-implants as Bone Maintainers

Apendix B. Patient Information

Apendix C. Bone Types