Cortical bone microdamage affects primary stability of orthodontic miniscrew.

BACKGROUND: The aim of this study was to investigate the effects of orthodontic miniscrew pitch and thread shape on microdamage in cortical bone. The relationship between the microdamage and primary stability was also examined. METHODS: Ti6Al4V orthodontic miniscrews and 1.0-mm-thick cortical bone pieces from fresh porcine tibia were prepared. The orthodontic miniscrews had custom-made thread height (H) and pitch (P) size geometries, and were classified into three groups: control geometry; HCPC (HC; thread height = 0.12 mm, PC; pitch size = 0.60 mm), geometry with a narrower pitch; HCPN (HC; thread height = 0.12 mm, PN; pitch size = 0.30 mm), and geometry with a taller thread height; HTPC (HT; thread height = 0.36 mm, PC; pitch size = 0.60 mm). The orthodontic miniscrews were inserted into a pilot hole in the cortical bone, and maximum insertion torque and Periotest value were measured. After insertion, the samples were stained with basic fuchsin. Histological thin sections were obtained and the bone microdamage parameters, i.e., total crack length and total damage area, and insertion state parameters, i.e., orthodontic miniscrew surface length and bone compression area were calculated. RESULTS: The orthodontic miniscrews with the taller thread height resulted in lower primary stability with minimal bone compression and microdamage; however, the narrower thread pitch led to maximum bone compression and extensive bone microdamage. CONCLUSIONS: A wider thread pitch reduced microdamage, and decreased thread height resulted in increased bone compression, ultimately resulting in increased primary stability.

Evaluation of Cortical Bone Microdamage and Primary Stability of Orthodontic Miniscrew Using a Human Bone Analogue.

Orthodontic miniscrews have gained popularity; however, they have some drawbacks, including screw loosening that results from bone resorption caused by excess microdamage created during screw insertion. Pilot hole preparation through the cortical bone is considered beneficial to avoid such microdamage, while an overly large pilot hole impairs primary stability. Hence, we used a human bone analogue to evaluate the microdamage and primary stability to estimate the optimal pilot hole size that would minimize the screw loosening risk. Ti6Al4V orthodontic miniscrews and 1.0-mm-thick synthetic cortical bone pieces were prepared. Various compressive loads were applied in indentation tests to test pieces' surfaces, and the microdamaged areas were confirmed as stress-whitening zones. Screw insertion tests were performed in which a miniscrew was inserted into the test pieces' pilot hole with a diameter of 0.7-1.2 mm in 0.1-mm intervals, and the stress-whitening area was measured. The insertion and removal torque were also measured to evaluate primary stability. The stress-whitening areas of the 1.0-1.2 mm pilot hole diameter groups were significantly smaller than those of the other groups (p < 0.05), whereas the 0.9 and 1.0 mm pilot hole diameter groups showed higher primary stability than other groups. In conclusion, the bone analogue could be utilized to evaluate microdamage in cortical bones and the primary stability of miniscrews.

Development of novel bone-like nanocomposite coating of hydroxyapatite/collagen on titanium by modified electrophoretic deposition.

Electrophoretic deposition (EPD) is a simple, rapid, and inexpensive technique to accomplish uniform coatings with controlled thicknesses. The EPD using binders that do not require a thermal degreasing process, which also eliminates the polymer components of the composite, are required for coating polymer-ceramic composites. This study demonstrated the application of a modified EPD technique utilizing Mg2+ ions to coat a bone-like hydroxyapatite/collagen nanocomposite (HAp/Col) on a titanium (Ti) substrate. The coating thickness was successfully controlled by varying the applied voltage and/or the treatment time. The adhesive strength of the modified EPD coating, evaluated by the tape test, showed class 0 (coating was not peeled off) and drastically increased in comparison to that of the non-Mg2+ EPD coating, class 5 (coating was completely peeled off). The MG63 cells on the HAp/Col-coated Ti demonstrated similar proliferation to and superior alkaline phosphatase activity to that on the bare Ti. Thus, the HAp/Col-coated Ti is expected to facilitate the surrounding bone formation than the bare-Ti. The results of the study indicated the HAp/Col-coated Ti prepared by the modified EPD is effective for applications in novel instruments, such as, subperiosteal temporary anchorage devices, which strongly requires rapid osseointegration at the bone-implant surface.

Enhanced bone formation onto the bone surface using a hydroxyapatite/collagen bone-like nanocomposite.

The process of bone formation onto the bone surface using a hydroxyapatite/collagen bone-like nanocomposite (HAp/Col) was investigated. Immersion tests were performed to evaluate the impact of pH on the degradation of the specimens in an aqueous environment. The specimens were soaked in aqueous solutions of pH 4.0, 5.0, and 7.0. Using standardized images, the top-view areas of the specimens were measured. Animal experiments were performed to investigate the bone formation process onto the bone surface. The specimens were placed under the rat calvarial periosteum, and µCT image analysis and histological observation were performed on samples harvested on postoperative Days 3, 5, and 7. In all experiments, ß-tricalciumphosphate (ß-TCP) was adopted as the control. HAp/Col turned to gel in acidic environments below pH 5.0. In contrast to the ß-TCP, the HAp/Col specimens placed under the periosteum expanded and attained a hollow structure with a gel-filled center, accompanied by larger volume of new bone and appearance of TRAP-positive multinucleated cells on postoperative Day 5. Therefore, HAp/Col can enhance bone formation onto the bone surface via induction of TRAP-positive multinucleated cells, and may have clinical applications.

Shape Optimization of Bone-Bonding Subperiosteal Devices with Finite Element Analysis.

Subperiosteal bone-bonding devices have been proposed for less invasive treatments in orthodontics. The device is osseointegrated onto a bone surface without fixation screws and is expected to rapidly attain a bone-bonding strength that successfully meets clinical performance. Hence, the device's optimum shape for rapid and strong bone bonding was examined in this study by finite element analyses. First, a stress analysis was performed for a circular rod device with an orthodontic force parallel to the bone surface, and the estimate of the bone-bonding strength based on the bone fracture criterion was verified with the results of an animal experiment. In total, four cross-sectional rod geometries were investigated: circular (Cr), elliptical (El), semicircular (Sc), and rectangular (Rc). By changing the height of the newly formed bone to mimic the progression of new bone formation, the estimation of the bone-bonding strength was repeated for each geometry. The rod with the Rc cross section exhibited the best performance, followed by those with the Sc, El, and Cr cross sections, from the aspects of the rapid acquisition of strength and the strength itself. Thus, the rectangular cross section is the best for rod-like subperiosteal devices for rapid bone bonding.

Hydroxyapatite/collagen nanocomposite-coated titanium rod for achieving rapid osseointegration onto bone surface.

This article proposes less-invasive subperiosteal bone-bonding devices capable of realizing rapid osseointegration and the acquisition of fundamental knowledge required for their development. Three candidates were prepared: titanium rod specimens with a machined surface (Bare), hydroxyapatite (HAp) coating, and hydroxyapatite/collagen (HAp/Col) nanocomposite coating. To investigate bone formation around these rods, each specimen was placed under the periosteum of a male Sprague-Dawley rat calvarium. Four weeks after surgery, the samples were evaluated via histomorphometrical analyses and bonding strength tests. All the Bare specimens and more than half of the HAp specimens were encapsulated with fibrous tissue, whereas all the HAp/Col specimens were almost completely surrounded by new bone tissue without encapsulation. Histomorphometrical analyses showed that the HAp/Col group had the greatest bone contact ratio among all candidates (p < 0.05). Further, a bonding strength test indicated that the HAp/Col group exhibited the greatest bonding strength to bone (p < 0.05). Thus, HAp/Col-coated rods are considered as the best candidate materials for achieving rapid osseointegration onto a bone surface.