Mandibular anterior intrusion using miniscrews for skeletal anchorage: A 3-dimensional finite element analysis

Mauricio González Del Castillo McGrath, Víctor Manuel Araujo-Monsalvo, Noriko Murayama, Marcos Martínez-Cruz, Roberto Justus-Doczi, Víctor Manuel Domínguez-Hernández, Ricardo Ondarza-Rovira
American Journal of Orthodontics and Dentofacial Orthopedics 2018, 154 (4): 469-476

INTRODUCTION: Deepbites can be corrected by intrusion of mandibular anterior teeth. Direct anchorage with miniscrews simplifies complex tooth movements; however, few studies have reported their use for mandibular anterior intrusion. The purpose of this study was to evaluate, by means of the finite element method, initial tooth displacement and periodontal stress distribution using various mandibular anterior intrusion mechanics. Miniscrews were used as skeletal anchorage devices.

METHODS: Cone-beam computed tomography scans were used for 3-dimensional reconstruction of the mandible and the mandibular anterior dentition. Models included the 4 incisors with or without the canines. After all surrounding periodontal and bony structures were determined brackets, segmental archwires, and miniscrews were added. Finite element studies were performed to assess initial tooth displacement and periodontal stress distribution with multiple intrusion force vectors. Changes in the location of the miniscrews and loading points on the archwire created 14 scenarios.

RESULTS: Minimum buccolingual displacements, a uniform distribution of periodontal stress, and overall group intrusion for both 4-tooth and 6-tooth scenarios were best achieved when applying distointrusive vectors. The highest peaks of periodontal stress were observed when the force was directed at the corners of the segmental archwire. It was found that, in addition to distointrusive vectors, 4 loading points on the archwire were necessary for pure intrusion and uniform distribution of periodontal stress in the 6-tooth scenarios.

CONCLUSIONS: The simulations in this study suggest that group intrusion of all 6 mandibular anterior teeth might be achieved by applying distointrusive vectors. Inserting a pair of miniscrews distal to the canine roots, 1 screw per side, and directing 4 loading points on the archwire generates uniform periodontal stress distribution and minimum buccolingual displacements. Local conditions, such as narrow bone width and attached gingiva level, play significant roles in the clinical viability of the proposed virtual scenarios.

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