wilmes. and ludwig

Benedict Wilmes / University of Düsseldorf / Germany

Mini-Implants in the Anterior Palate:

How to improve Stability in the Long-term

Björn Ludwig / Traben-Trarbach / Germany

1 2 3 4 5 6 7 8 9 Weeks

Sta

bility

Primarystability

Secondarystability

Phaseof low stability

Stability of Mini-implants

Stability of Mini-implants

How to measure primary stability:

- Insertion Torque(in vivo / in vitro)

- Resonance Frequency Analysis (RFA)(in vivo / in vitro)

- Periotest(in vivo / in vitro)

- Lateral loading / Pull Out Test(in vitro)

Nienkemper M, Pauls A, Wilmes B, Drescher D. Development of mini-implant stability

over the initial healing period: A prospective clinical pilot study. Angle Orthod. 2013

Nienkemper M, Pauls A, Wilmes B, Drescher D. Effect of implant length on mini-implant stability

during the initial healing period: A prospective clinical study, Head and Face Med 2013

Nienkemper M, Pauls A, Ludwig B, Drescher D. Stability of paramedian inserted palatal mini-

implants at the initial healing period: a controlled clinical study. Clin Oral Implants Res. 2013

No difference between median

and paramedian insertion

Insertion site?

paramedian

median

**

*

*

ns

ns

0

5

10

15

20

25

30

35

40

0 2 4 6

paramedianmedian

Resonance

Frequency

Analysis

ISQ

Weeks

Stability of Mini-implants

1. Low failure rate2. No root damage3. Tad´s not in the path

Karagkiolidou A, Ludwig B, Pazera P, Gkantidis

N, Pandis N, Katsaros C. Survival of palatal

miniscrews used for orthodontic appliance

anchorage: A retrospective cohort study.

Am J Orthod Dentofacial Orthop. 2013

Success rate in the anterior palate: 97.9%

Stability of Mini-implants

Stability of Mini-implants

Ludwig B, Glasl T, Bowman J, Wilmes B, Kinzinger G, Lisson G. Anatomical Guidelines for Miniscrew Insertion: Palatal Sites. J Clin Orthod. 2011:45(8):433-441

Optimal

site

-Thick Bone

-Thin Mucosa

Restricted

site

Stability of Mini-implants

Coupling with the appliance

Mini-implant Abutments

Mini-Implants with Abutments

Mini-Implants with Abutments

BenefitPSM

OrthoeasyForestadent

Dual TopJeil

Screwed Bonded Bonded

Spider ScrewHDC

Screwed

Wilmes B, Drescher, D. A mini-implant system with interchangeable abutments. J Clin Orthod 2008; 42:574-580

Benefit System Beneplate System

Wilmes B, Drescher, D. Nienkemper M. A miniplate system for improved stability of skeletal anchorage.J Clin Orthod 2009; 43:494-501

Mini-Implants with Abutments

Orthodontist could insert

Handpiece

Pre-drilling in adults

Insertion

Mini-Implants with Abutments

Stability of Mini-implants

Consider angle of insertion!

Molar mesialization

Molar distalization

Beneslider Pendulum B

T-Bow Mesialslider

RPE / Class IIIHybridhyrax

Alignment ofretained teeth

MolarIntrusion

Molar anchorage

Mechanics with palatal TAD´s

Beneslider

Benetube

Beneplate

Wilmes B, Drescher, D. Nienkemper M. Beneplate - A miniplate system for improved stability of skeletal anchorage. J Clin Orthod 2009; 43:494-501Wilmes B, Drescher D. Application and effectiveness of the Beneslider molar distalization device. World J Orthod. 11:331–34

… conventional braces

… lingual braces

… Aligners

Combination of distalization mechanics and…

Beneslider

Beneslider

Beneslider

Beneslider & Aligner

J Clin Orthod 2012:390-8

Beneslider & Aligner

Beneslider & Aligner

Beneslider & Aligner

Beneslider & Aligner

Beneslider & Aligner

Beneslider & Aligner

Beneslider & Aligner

Beneslider & Aligner

Beneslider & Aligner

- Moderate implant tipping in 2 cases

- Distalization effect: 3.6 mm (+/- 1.9 mm)

Study:

Nienkemper M, Wilmes B, Yamaguchi S, Pauls A, Drescher D. Treatment efficiency of Mini-implant borne distalization depending on age and eruption of the second molars. J Orofac Orthop 2014

N=51

- Distalization speed: 0.6 mm/month

Beneslider, Efficiency?

Pendulum B 0.8 mm TMA

Wilmes B. Clinical management of the Beneslider and the Pendulum B appliances formaxillary molar distalization. In: Moschos Papadopoulus: Skeletal anchorage in orthodontictreatment of Class II malocclusion: Contemporary applications of orthodontic implants, miniscrew implants and mini plates. Amsterdam. Mosby, Elsevier (in press)

Pendulum B

Upper molar mesialization

T-Bow Mesialslider

Direct

Anchorage

Indirect

Anchorage

Upper molar mesialization

If missing 3,4,5 or 6: no brackets needed

Mesialslider

T-Mesialslider

Wilmes B, Nienkemper M, Drescher D. Application and effectiveness of a new mini-implant and tooth-borne rapid palatal expansion device. World J Orthod.2010

Wilmes B, Fields of Application of Mini-Implants. In: Ludwig, Baumgaertel, Bowman: Mini-Implants in orthodontics. Innovative anchorage concepts. London, Berlin etc. Quintessence. 2008: 91- 122

Hybrid-Hyrax

Baumgaertel S, Ludwig B, Kinzinger G, Zorkun B, Glasl B, Wilmes B. Application of a new visco-elastic FEM-Model and analysis of miniscrew supported Hybrid-Hyrax treatment. Am J Orthod Dentofacial Orthop 2013

Force near the CR of the maxilla

Hybrid-Hyrax

Wilmes B. Fields of Application of Mini-Implants. In: Ludwig B, Baumgaertel S, Bowman JS, editor.

Mini-Implants in Orthodontics Innovative Anchorage Concepts. London: Quintessence Publishing

Co Ltd;2008. p. 91-122

Goal 1:

No load on the bicuspids/

deciduous molars

No/less tipping of the teeth

Hybrid-Hyrax

011351

FTransfer of the force

to the bone

Maxillary advancement using a Facemask

Mesial migration of the dentitionGoal 2:

Avoid mesial migration

of the teeth

Just skeletal maxillary

advancement

Ngan P, Yiu C, Hu A, Hagg U, Wei SH, Gunel E. Cephalometric and occlusal changes following

maxillary expansion and protraction. Eur J Orthod 1998;20:237-254.

Williams MD, Sarver DM, Sadowsky PL, Bradley E. Combined rapid maxillary expansion and

protraction facemask in the treatment of Class III malocclusions in growing children: a prospective long-

term study. Semin Orthod 1997;3:265-274.

Hybrid-Hyrax

Mini-Implants with abutments

Hyrax Expander

Hybrid-Hyrax / Facemask

Hybrid-Hyrax / Facemask

Nienkemper M, Wilmes B, Pauls A, Drescher D. Maxillary protraction using a

hybrid hyrax - facemask combination. Prog Orthod 2013

Hybrid-Hyrax / Facemask

Hybrid-Hyrax / Facemask + Alt-Ramec

Wilmes B, Ngan P, Liou E, Franchi L, Drescher B,

Early Class III Facemask Treatment with the Hybrid Hyrax and Alt-RAMEC Protocol

J Clin Orthod 2014

Hybrid-Hyrax / Facemask Alt-Ramec

WITS -8.2 mm WITS -1.1 mm

Hybrid-Hyrax / Facemask Alt-Ramec

Clinical Studies needed….

Hybrid-Hyrax / Facemask

Wilmes B, Kau CH, Ludwig B, Drescher D. Early Class III Treatment with a Hybrid Hyrax-Mentoplate Combination, J Clin Orthod 2011

Mentoplate

Hybridhyrax

Hybridhyrax and Mentoplate

Hybridhyrax and Mentoplate

Peter Ngan, Hong He, and Benedict Wilmes. Early Treatment of Class III Malocclusion.In: Peter Ngan, Class III Malocclusion: Craniofacial Biology and Treatment Strategies" Oak Park. Bentham eBooks (in press)

Hybridhyrax and Mentoplate

WITS: -8.3 mm WITS: -2.8 mm

Before After8 months

Hybridhyrax and Mentoplate

17 years

Overview early class III treatment

Conv.RPE +Facemask

Hybrid Hyrax+ Facemask

4 Bollard Plates

Surgery?

Skeletal Efficiency?

No 2 mini-implants2 mini-implants1 miniplate

4 miniplates

Hybrid Hyrax+ Mentoplate

Molar anchorage

Molar anchorage

J Clin Orthod 2013

Molar intrusion

Molar intrusion

Forced eruption of retained teeth

Forced eruption of impacted teeth

Outlook: Multipurpose appliances…

Wilmes B, Ludwig, B, Katyal V, Nienkemper M, Rein A, Drescher D. The Hybrid Hyrax Distaliser, a new all-in-one appliance for rapid palatal expansion, early class III treatment and upper molar distalisation. J Orthod (in press)

Ludwig B, Glasl T, Bowman J, Wilmes B, Kinzinger G, Lisson G. Anatomical Guidelines for Miniscrew Insertion: Palatal Sites. J Clin Orthod. 2011:45(8):433-441

Conclusions: 1. Anterior palate is the best insertion site

Molar mesialization

Molar distalization

Beneslider Pendulum B

T-Bow Mesialslider

RPE / Class IIIHybridhyrax

Alignment ofretained teeth

MolarIntrusion

Molar anchorage

Conclusions: 2. Tad´s with abutments for the palate

Conclusions: 3. No difference between median and lateral

Conclusions: 4.

Courage!

Insertion of mini-implants in the palate is very easy!!!

Orthdontists can do it

Just do it !

Palatal Mini-implants

Thank you very much for your attention!

wilmes@med.uni-duesseldorf.dewww.uniklinik-duesseldorf.de/kieferorthopaedie