title: Direct versus indirect loading of orthodontic miniscrew implants-an FEM analysis.
abstract: OBJECTIVE
  The mesialization of molars in the lower jaw represents a particularly demanding scenario for the quality of orthodontic anchorage. The use of miniscrew implants has proven particularly effective; whereby, these orthodontic implants are either directly loaded (direct anchorage) or employed indirectly to stabilize a dental anchorage block (indirect anchorage). The objective of this study was to analyze the biomechanical differences between direct and indirect anchorage and their effects on the primary stability of the miniscrew implants.
  
  
  METHODS
  For this purpose, several computer-aided design/computer-aided manufacturing (CAD-CAM)-models were prepared from the CT data of a 21-year-old patient, and these were combined with virtually constructed models of brackets, arches, and miniscrew implants. Based on this, four finite element method (FEM) models were generated by three-dimensional meshing. Material properties, boundary conditions, and the quality of applied forces (direction and magnitude) were defined. After solving the FEM equations, strain values were recorded at predefined measuring points. The calculations made using the FEM models with direct and indirect anchorage were statistically evaluated.
  
  
  RESULTS
  The loading of the compact bone in the proximity of the miniscrew was clearly greater with direct than it was with indirect anchorage. The more anchor teeth were integrated into the anchoring block with indirect anchorage, the smaller was the peri-implant loading of the bone.
  
  
  CONCLUSIONS
  Indirect miniscrew anchorage is a reliable possibility to reduce the peri-implant loading of the bone and to reduce the risk of losing the miniscrew. The more teeth are integrated into the anchoring block, the higher is this protective effect.
  
  
  CONCLUSIONS
  In clinical situations requiring major orthodontic forces, it is better to choose an indirect anchorage in order to minimize the risk of losing the miniscrew.
authors.affiliation: Department of Orthodontics, University of Munich, Goethestrasse 70, 80336, Munich, Germany, cholberg@med.uni-muenchen.de.
authors.forename: C
authors.initials: C
authors.lastname: Holberg
authors.forename: P
authors.initials: P
authors.lastname: Winterhalder
authors.forename: N
authors.initials: N
authors.lastname: Holberg
authors.forename: I
authors.initials: I
authors.lastname: Rudzki-Janson
authors.forename: A
authors.initials: A
authors.lastname: Wichelhaus
mesh_terms: D000328:Adult; D001863:Bone Screws; D015921:Dental Implants; D020342:Finite Element Analysis; D006801:Humans; D009970:Orthodontics; D055815:Young Adult
chemical_list: D015921:Dental Implants