Preface

The content is selected from Dr. John Jin-Jong Lin’s academic monograph, Creative Orthodontics, Blending the Damon System and TADs to Manage Difficult Malocclusions. If you have interest in purchasing it, please don’t hesitate to contact us.

Textbook

Chapter 1 Material compare

Titanium alloy VS Stainless steel

Conventional dental implants are designed for long-lasting prostheses. They require osseointegration so the material with which they are manufactured is pure titanium or titanium alloy, orthodontic implants do not need for osseointegration, because they will remove after treatment. Their retention via mechanical lock means that immediate loading following insertion is possible without the need for osseointegration. In this case Stainless steel is better than titanium alloy, in most situation, Stainless steel’s penetration and strength are strong enough to self-drilling. But to consider some people with bad bone quality or allergic to stainless steel. Doctors can choice titanium alloy. Remember, titanium alloy should predrill a hole before implanting a screw.

(1) fractures caused by appliances that are too small

The early vision of MIA mini-screws were made of pure titanium in diameters of only 1.2mm. Mini-screws of such small diameters are quite sensitive to torqueing force, which make them fracture quite frequently in the alveolar bone. It is not only frustrating but also time-consuming to remove a fracture mini-screw from bone. Stainless steel mini-screw with diameters of 2.0mm can totally avoid the headache of fracture problems.

(1.1) Deformed tip

If an A-1 screw is found deformed in the tip when it is penetrating into the bone initially, it is because the bone density of patient is harder than the screw. As a result, doctors have to predrill rather than implant the screw once again; otherwise, it will take the high risk in fracturing the screw and will be very annoying to take the fractured screw out of the bone.

1. One is the UN-USED normal screw that has smooth appearance and very sharp tip.
2. Another is the UN-USED screw with also smooth appearance but with a malformed tip due to mechanical false cut, all of which will be checking out and throwing away before leaving the factory.
3. The other is USED screw that has rough appearance and bending tip because of exerting.

(2) Peri-implantitis around mini-screw

The LOMAS and Spider screw, et al. have a special platform for better adaptation of soft tissue contact but the author finds if the mini-screw platform comes too close to the gingiva, it can easily cause peri-implantitis. To reduce the frequency of peri-implantitis, instruct patients to clean the mini-screw daily with a small brush and cotton buds moistened with 0.1% chlorhexidine. If the mini-screw is inserted over in the mucosa, even the head of mini-screw can be away from mucosa, mini-screw can easily irritate movable mucosa and cause peri-implantitis so the author recommends placing mini-screws in non-movable attached gingiva whenever possible.

(3) Heavy force

Since the author uses mini-screws with diameters of 2mm, stability is not an issue if the force load is appropriate to the arch－no greater than 300gm in the maxilla and no greater than 500gm in the mandible. If the force is greater than these specifications, the mini-screw might become loose.

(4) Injuries of roots

Studies done on research animals indicate that mini-screw-related root injuries can heal by itself; however, the author recommends avoiding root injuries because of limited research in this area. Demonstrates a case in which a root injury occurred while the patient was undergoing pilot drilling. The patient remained completely unaware of the occurrence. The best method for preventing root injuries is to reduce the use of pilot drilling and to refrain from inserting mini-screws in tooth-bearing areas.

(5) Quality of bone

Misch categorizes the density of bone into four types: D1, D2, D3 and D4. D3 and D4 bone types are the least dense of the four bone types. D1 and D2 bone types are more suitable for mini-screw placement. In rare cases, the bone quality of D1 and D2 is not sufficient. Easy insertion at the beginning of the placement often indicates a poor outcome.

(5.1) Improvement suggestions

Due to poor bone quality of patients, there are three placements more suitable for implanting
(a) hard palatal : use 2.0 X 8 , 2.0 X 10, 2.0 X 12 A-1 P screw
(b) infrazygomatic crest : use 2.0 X 8, 2.0 X 10, 2.0 X 12 A-1 P screw
(c) infrazygomatic crest (in higher position): use 2.0 X 14 or 17 IZC screw
(d) buccal shelf : use 2.0 X 8 , 2.0 X 10, 2.0 X 12 A-1 P screw
(e) modified buccal shelf : use 2.0 X 14 or 17 IZC screw

To avoid mini-screw loosen, doctors need to cosider patient's bone quality and situation of placement in advance. There are two situations which should be avoided
(a) low sinus floor
(b) movable gingiva

(a) Doctors can choose miniplate instead of mini-screw for bad bone quality. There are L-shape and Y-shape miniplates as picture illustrated.For more details please contact us

Mini-screw insertion requires anesthetization; however, removal requires no anesthesia if the head of the mini-screw is sufficiently exposed. If the head of mini-screw is close to the gingiva, use topical anesthetization. If the head of mini-screw is completely covered by soft tissue, use some anesthesia to remove it.

A-1 C I Type
(designed for Coil spring)

Recommended by Dr. Ming-Guey Tseng. Suitable for general coil spring.

Suggestion:
(1) The special thread of titanium screw is designed for children and adults with bad bone quality.
(2) If patients are allergic to stainless steel, dentists can change to use titanium alloy screw.

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

A-1 C II Type
(designed for Coil spring)

Suitable for general coil spring. Simple Design, Cheaper Price.

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

A-1 P I Type
(designed for Power chain & Rubber band)

Recommended by Dr. Johnny Joung-Lin Liaw.Suitable for power chain & rubber band.

Suggestion:
(1) The special thread of titanium screw is designed for children and adults with bad bone quality.
(2) If patients are allergic to stainless steel, dentists can change to use titanium alloy screw.

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

A-1 P II Type
(designed for triple layer Power chains)

Recommended by Dr. Patricia Vergara .Suitable for triple layer power chains.

Suggestion:
(1) The special thread of titanium screw is designed for children and adults with bad bone quality.
(2) If patients are allergic to stainless steel, dentists can change to use titanium alloy screw.

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

A-1 H I Type
(The Hook is designed for both power chain and coil spring.)

Designed for both coil spring and power chain.

Suggestion:
(1) The special thread of titanium screw is designed for children and adults with bad bone quality.
(2) If patients are allergic to stainless steel, dentists can change to use titanium alloy screw.

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

A-1 H II Type
(The double Hooks are designed for both power chain and coil spring.)

Designed for both coil spring and power chain.

Suggestion:
(1) The special thread of titanium screw is designed for children and adults with bad bone quality.
(2) If patients are allergic to stainless steel, dentists can change to use titanium alloy screw.

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

A-1 Torque Screw

The function of Torque Screw is similar with the bracket screw but its hole is designed rectangular in order to put 17-21 x 25 wires. It can replace for the buccal tube.

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

Bracket Screw

A bracket is welded on the head of screw. It is suitable for patients who have difficulties to stick brackets on their teeth

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

Anterior Subapical Screw

Instruction provided by Dr. Johnny Joung-Lin, Liaw. Click here to see youtube!!

    “In the past, we usually had problems in using mini-screw anchorage to intrude incisors because the exposed part of mini-screw will cause mucosal ulcerations. The closed technique of the mini-screw insertion can reduce the possibilities of soft tissue ulceration. At first, a vertical incision about 2 mms was made in the neighborhood of the labial frenum before mini-screw insertion. After drilling about 2 or 3 threads of the screw into the cortical bone, change the inserting angle, about 45 degree to the occlusal plane to keep it from damaging the roots. The ligature wire should be tied on when the mini-screw is inserted to the level of the mucosal surface, and then keep on inserting the screw until it is imbedded under the mucosa. The twisted ligature wire was then placed into the slot on the platform of the mini-screw so that the ligature wire will not impinge the prominent dentoalveolus. Here are the two ways to hang power chain between extension hook and arch wire. One is using ligature wire to lead the last ring of the power chain pass through the first ring, letting the power chain tie on the arch wire, and then hang it on the hook with appropriate length. The other way is to hang one end of the power chain on the hook, and then tie the other end to the arch wire by ligature wire.”

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

IZC Screw

The IZC Screw is designed for Infrazygomatic Crest site. When the screw is locked into this site, it usually needs to penetrate thick soft tissue. In order to avoid unnecessary injure and make patients more comfortable, we substitute half smooth surface of screw for half thread.

Half-Thread TADs
No inflammation on soft-tissue

Whole Thread TADs
obviousely seen there's an inflammation on soft-tissue

modified buccal shelf
use 2.0 X 14 or 17 IZC screw

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

M Screw

1.Fitted between roots
2.For coil spring
3.The design of cylinder thread makes it very stable and firm.
4.Made by stainless steel and stronger than other system.

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

V Screw

1.The design of circular head and thin platform hardly irritates patients.
2.For general power chain. (We also provide special coil spring for V Screw.)
3.The design of cylinder thread makes it very stable and firm.
4.The design of square platform makes implant very easy.

Suggestion:
(1) The special thread of titanium screw is designed for children and adults with bad bone quality.
(2) If patients are allergic to stainless steel, dentists can change to use titanium alloy screw.

Warning:
(1) It should be avoided to over-bend the screw before using. Otherwise, it will make it broken.
(2) It should predrill a hole before implanting a screw if patients have hard bone density.
(3) Please sterilize this product before using.
(4) SINGLE USE ONLY.

-This article by courtesy of Dr. HONG-PO CHANG

     Mini-implant Assisted Rapid Maxillary Expansion (MARME) device is used to correct transverse maxillary deficiency and arch-length discrepancy in an adult. The Skeletal Maxillary Expander with Screw (SMES) is a MARME device, specially designed to deliver the expansion force to 4 mini-implants inserted deeply, engaging both layers of the cortical bone (palatal and nasal layers) for bicortical anchorage; the first molars are used to stabilize the position of the jackscrew during expansion rather than anchorage. SMES protocol is a non-surgical treatment alternative in adult maxillary transverse deficiency with excellent post-retention stability and minimum buccal tooth tipping effect.

1、SMES Device Introduction

1.1、 As the illustration of 2.2, in order not to use strength over 30kg, it is better to do some micro perforation to damage some cortical bone for adult patients.

1.2、 If the force used is greater than 30KG, the key may be deformed, so we offer extra key for backup for 3rd Generation expander device. Remember the bending 120 degrees key should give to patients and the straight key should keep in doctors themselves.

1.3、Due to the nearer the anteriors, the better the bone quality, put the expansion device as close to the anteriors as possible, if you can.

1.4、In order to make whole expansion device stable and avoid dislocation when putting the device into the bone. It’s better for you to put the band in the molars to connect with the device.

1.5、We suggest you can put 2x12 in the hole of device that near anteriors and 2x10 in the back because according to CBCT under normal situation, the bone plate near the anteriors is thicker.

2、Second generation SMES Device Introduction

2.1、The direction of arrow in the device have to point towards the anteriors, so that the device can match the key to work.

2.2、The maximum torqueing force that central screw can withstand is 305 newton (30kg), if it is over that specification, the wrench will get disengagement from the central screw or damage the structure of central screw, the function of expansion won’t work. The remedy is to use the needle key to insert into the hole of central screw for the try of expansion.

2.3、According to our engineer’s test, the maximum expansion amount for #9 is 7mm. the maximum expansion amount for #11 is 9mm. This is only for reference. The real expansion amount is according to clinical performance of different patient.