Midpalatal miniscrew insertion: The accuracy of digital planning and surgical placement

Adli M Q Al-Gazzawi; Vanessa Knode; Bjorn Ludwig; Alaa Othman; Angelo Salamini; Nikolaos Pandis; Padhraig S Fleming

doi:10.1016/j.ajodo.2024.02.014

Midpalatal miniscrew insertion: The accuracy of digital planning and surgical placement

Am J Orthod Dentofacial Orthop. 2024 Apr 20:S0889-5406(24)00132-X. doi: 10.1016/j.ajodo.2024.02.014. Online ahead of print.

Authors

Adli M Q Al-Gazzawi¹, Vanessa Knode², Bjorn Ludwig³, Alaa Othman¹, Angelo Salamini⁴, Nikolaos Pandis⁵, Padhraig S Fleming⁶

Affiliations

¹ Private practice, Amman, Jordan.
² Private practice, Traben-Trarbach, Germany.
³ Private practice, Traben-Trarbach, Germany; Department of Orthodontics, University of Homburg, Saar, Germany.
⁴ Henry-Schein Krugg, Milan, Italy.
⁵ Department of Orthodontics and Dentofacial Orthopedics, Medical Faculty, Dental School, University of Bern, Bern, Switzerland.
⁶ Division of Public and Child Dental Health, Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland. Electronic address: padhraig.fleming@dental.tcd.ie.

PMID: 38647514
DOI: 10.1016/j.ajodo.2024.02.014

Abstract

Introduction: The objective of this study was to investigate the accuracy of palatal miniscrew insertion, evaluating the effect of guide fabrication and surgical placement.

Methods: Guided insertion of bilateral paramedian palatal miniscrews was undertaken using Appliance Designer software (3Shape, Copenhagen, Denmark). A resin surgical guide (P Pro Surgical Guide; Straumann AG, Basel, Switzerland) was used. Superimposition of the miniscrew position relative to the digital design was undertaken using bespoke software (Inspect 3D module, OnyxCeph; Image Instruments GmbH, Chemnitz, Germany) to assess surgical inaccuracy. Miniscrew position relative to the surgical guide was also assessed to isolate the effect of planning inaccuracies. Both horizontal and vertical discrepancies were evaluated at both implant locations.

Results: Twenty-seven patients having bilateral palatal insertions were examined. Mean discrepancies were <0.5 mm, both in the horizontal and vertical planes. The mean overall horizontal and vertical discrepancy between the digital design and final miniscrew position on the left side was 0.32 ± 0.15 mm and 0.34 ± 0.17 mm, respectively. The maximum horizontal discrepancy observed was 0.72 mm. No significant differences were observed in relation to the accuracy of mini-implant positioning on the basis of sidedness, either for horizontal (P = 0.29) or vertical (P = 0.86) discrepancy.

Conclusions: High levels of accuracy associated with guided insertion of paramedian palatal implants were recorded with mean discrepancies of less than 0.5 mm both in the horizontal and vertical planes. No difference in accuracy was noted between the left and right sides. Very minor levels of inaccuracy associated both with surgical techniques and surgical guide fabrication were recorded.