Int. J. Oral Maxillofac. Surg.

2009; 38: 363–368

doi:10.1016/j.ijom.2009.02.011, available online at http://www.sciencedirect.com

Clinical Paper
Orthodontic Implants

Bone stress for a mini-implant M. Motoyoshi1, S. Ueno2,

K. Okazaki2, N. Shimizu1
1
Department of Orthodontics, Division of

close to the roots of adjacent

Clinical Research, Dental Research Center,
Nihon University School of Dentistry, Tokyo,
Japan; 2Department of Orthodontics, Nihon
University School of Dentistry, Tokyo, Japan

teeth - 3D finite element

analysis§
M. Motoyoshi, S. Ueno, K. Okazaki, N. Shimizu: Bone stress for a mini-implant close
to the roots of adjacent teeth - 3D finite element analysis. Int. J. Oral Maxillofac. Surg.
2009; 38: 363–368. # 2009 International Association of Oral and Maxillofacial
Surgeons. Published by Elsevier Ltd. All rights reserved.

Abstract. This study aimed to evaluate stress in the bone when an orthodontic mini-
implant is close to the roots of adjacent teeth using finite element models (FEMs),
and to investigate the causes of the high implant failure rate in the mandible. Four
FEMs were used: the implant touches nothing; the implant touches the surface of the
periodontal membrane; part of the screw thread is embedded in the periodontal
membrane; and the implant touches the root. The effect of cortical bone thickness
was evaluated using values of 1, 2 and 3 mm. Maximum stress value and stress
distribution on the bone elements was determined. Maximum stress on the bone
increased when the mini-implant was close to the root. When the implant touched
the root, stress increased to 140 MPa or more, and bone resorption could be
Keywords: temporary anchorage devices; an-
predicted. Stress was higher for a cortical bone thickness of 2 mm than for other
chorage; finite element method; bone resorp-
thicknesses. Cortical bone 2 mm thick had a higher risk for bone resorption. A tion.
mandible with an average cortical bone thickness of 2 mm may have a higher risk
for implant loosening than a maxilla with the same degree of root proximity, which Accepted for publication 9 February 2009
may be related to the lower success rate in the mandible. Available online 9 March 2009

During orthodontic treatment, areas of
tooth movement and regions that resist
orthodontic force are frequently encoun-
§
We thank the staff of the Department of
Radiology, Nihon University School of Den-
tistry, for their assistance with the computed
tomography. This study was supported by
grants from Nihon University Individual
Research Grant 2007 and Grant-in-Aid for
Scientific Research (C) 2007.
tered. Teeth can be moved in a predicable
manner only when an anchorage is suffi-
ciently strong to resist orthodontic force.
Titanium screw-type mini-implants
have been used in orthodontic treatment
to strengthen the anchorage1,6,10,14,22.
They also ensure that teeth move predic-
tably and without reciprocal move-
ment7,11,25,27.
Mini-implants have been used in clin-
ical practice10,22, but some loosen during
orthodontic treatment4,24. Research into
the risk factors for mini-implant failure
has been carried out to improve the suc-
cess rate. The stability of the mini-implant
is related to the degree of inflammation
accompanying local irritation, the excess
orthodontic force17, the quality and quan-
tity of the cortical bone20, the design and
shape of the screw thread9, and the proxi-
mity of the mini-implant to the roots of
adjacent teeth13.

0901-5027/040363 + 06 $36.00/0 # 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
364 Motoyoshi et al.
Fig. 1. Design of the commercial mini-
implant. (a) Diameter 1.6 mm, length 8 mm.
(b) Design of the screw thread.
Mini-implants can be placed in small
gaps between the roots of adjacent teeth
because of their small screw diameter and
length. This risks touching a root. Kuroda
et al.13 noted that the proximity of mini-
implants to adjacent roots is a major factor
in implant failure, and they found that this
tendency is more common in the mand-
ible. This may be related to the high failure
rate in mandibular alveolar bone3,13.
Finite element models (FEMs) have
been used in biomechanics research.
Recent developments have made it possi-
ble to simulate a variety of clinical situa-
tions. In this study, the authors evaluated
stress distribution in the bone surrounding
mini-implants when the implant place-
ment was close to the root and investigated
the causes of the high failure rate in the
mandible using the FEM.
Material and methods
Preparation of the FEM
For the purposes of this study, the authors
assumed a commercial mini-implant
1.6 mm in diameter and 8 mm long, with
the height of the thread ridge fixed at
0.2 mm and a thread pitch of 0.6 mm
(Fig. 1). Placement location was assumed
to be mesial to the mandibular first molar,
Table 1. Material properties of constituent materials
Materials Young’s modulus (MPa)
Titanium
Cortical bone
Cancellous bone
Tooth
Periodontal membrane
and the implant was slanted 308 based on a
morphometric study5. The geometry of the
FEM was determined using the mandibu-
lar bone of an East Indian skeletal speci-
men from the Department of Orthodontics
at Nihon University School of Dentistry,
and 1 mm computed tomogram slices
were digitized. The thickness of period-
ontal membrane in the FEM was fixed at
0.2 mm. The authors created four types of
FEM to evaluate the stress distribution in
the bone during the terminal occlusal
phase when the mini-implant is close to
the root. These four types were: a model in
which the implant is 1 mm from the sur-
face of the periodontal membrane; a
model in which the implant touches the
periodontal membrane surface; a model in
which part of the screw thread is
embedded in the periodontal membrane;
and a model in which the implant touches
the root. To evaluate the effects of cortical
bone thickness, models with cortical bone
thicknesses of 1, 2 and 3 mm were used.
The FEM is composed of an aggregate of
small elements that are sufficient to
describe the geometry of the subjects. This
Fig. 2. (a) Finite element model consisting of (b) mini-implant, (c) tooth, (d) periodontal
membrane and bone elements.
Poisson’s ratio
110000 0.35
14000 0.30
300 0.30
18600 0.31
69 0.45
is called ‘creating the mesh’ or ‘meshing’.
The mesh intersections are called nodes.
The geometry of the FEM used in this
study was constructed using a three-
dimensional computer-aided design pro-
gram (SolidWorks; COSMOS Japan,
Tokyo, Japan). The mini-implant was
assumed to be made of pure titanium.
The bone, tooth, periodontal membrane
and implant elements were assumed to
be homogeneous, isotropic and linearly
elastic. The material properties of the
elements in the models were based on
published data2,12,16,23 (Table 1). Each
model was meshed automatically using
the SolidWorks software. Each model
consisted of approximately 120,000 nodes
and 80,000 elements (Fig. 2).
Boundary conditions and solution
The interface between the mini-implant
and the bone elements was fixed to dis-
tinguish it mathematically from the inter-
face between the mini-implant, the
periodontal membrane and the root ele-
ments. The gap elements between the
 Bone stress for a mini-implant close to teeth roots 365

the cancellous bone at the lower margin of

the implant hole in all the models, regard-
less of how close the mini-implant was to
the root, or the cortical bone thickness.
The maximum von Mises stress in mod-
els A–D for various cortical bone thick-
nesses is shown in Fig. 4. The stress
increased as the distance between the
implant and the root decreased in models
A–C. In model D, the model with the mini-
implant touching the root, the stress was
much greater than in the other models. To
evaluate the effects of cortical bone thick-
ness, the stress curves were represented
graphically to show the results for various
thickness values (Fig. 5). In all the models,
the stress for a cortical bone thickness of
2 mm was larger than that for a thickness
of 1 or 3 mm. Unexpectedly, thin cortical
bone did not necessarily increase the stress
on the bone surrounding the mini-implant.
To evaluate the load in the cancellous
Fig. 3. von Mises stress distribution in the bone elements of the FEM for model C with the screw bone supporting the implant body, the
thread of the mini-implant embedded in the periodontal membrane. authors calculated the total amount of
stress for each model on the section in
the middle of the implant hole correspond-
ing to the section shown in Fig. 3. The total
stress increased with the proximity of the
mini-implant to the root, and the total
stress was less in thicker cortical bone
(Fig. 6). The maximum displacement
values of the implant element were
observed at the apex of the screw in all
the models. The maximum displacement
of the implant element decreased as the
cortical bone became thicker (Fig. 7).

Discussion
CHENG et al.3 noted that the mini-implant
in the mandible, often in narrow-width
keratinized gingiva, had a lower success
Fig. 4. Maximum von Mises stress in the bone for models A–D with various degrees of root rate. They suggested that an implant
proximity of the mini-implant: Model A, not touching; Model B, touching periodontal placed in non-keratinized mucosa signifi-
membrane; Model C, embedded in periodontal membrane; and Model D, touching the root. cantly increased the risk of the failure due
CBT, cortical bone thickness. to infection. In a previous clinical study,
the authors determined a recommended
placement torque to improve the success
mini-implant, the periodontal membrane (COSMOS Japan). rate19. Cortical bone in the mandible is
and the root elements, and friction were thicker, and the placement torque can
considered negligible in the models in The von Mises stress easily be higher in the mandible, than in
which the mini-implants touch the per- the maxilla. The authors suggested that
iodontal membrane and the root. Nodes ¼ 1=2½ðs 1  s 2 Þ2 þ ðs 2  s 3 Þ2 over-torque could be related to the low
at the bottom of the cortical bone ele- þ ðs 3  s 1 Þ2  success rate in the mandible. KURODA
ments were restricted to three degrees et al.13 investigated the correlation
of freedom. A vertical load of 300 N where s1, s2, s3, is the principal stress between the success rate and the proximity
was applied to the occlusal surface and s1 > s2 > s3 of the mini-implant to the root. They
of the first molar to represent the occlu- concluded that the proximity of a mini-
sal force on the lower first molar in implant to the roots of adjacent teeth was a
Results
normal function 8,18. The authors calcu- major risk factor in implant failure, and
lated the von Mises stress, defined by the Fig. 3 shows the stress distribution on the this tendency was more prevalent in the
following equation, at each node and bone elements in the FEM. The maximum mandible. This could contribute to the low
evaluated the stress distribution on the von Mises stress was observed on the success rate of implants in the mandible.
bone elements using COSMOS/Works boundary between the cortical bone and KURODA et al.13 also surmised that the
366 Motoyoshi et al.
Fig. 5. Maximum von Mises stress in the bone for each model according to cortical bone
thickness: Model A, not touching; Model B, touching periodontal membrane; Model C,
embedded in periodontal membrane; Model D, touching the root.
reason for the lower success rate in the
mandible could be related to the surgical
difficulty caused by the anatomical struc-
ture of the mandible. If their hypothesis
were true, the rate of occurrence of root
proximity in the mandible would be higher
than in the maxilla, but their data did not
support this.
Fig. 6. Total von Mises stress at the section in the middle of the implant hole corresponding to the
section shown in Fig. 3 in the cancellous bone: Model A, not touching; Model B, touching
periodontal membrane; Model C, embedded in periodontal membrane; Model D, touching the root.
No previous study has examined the
relationship between implant failure and
the biomechanical effect of mini-implant
proximity to the root. This study investi-
gated the biomechanical influences of the
bone around the mini-implant using a
FEM and examined the stress distribution
as a function of root proximity and cortical
bone thickness in an attempt to find the
causes of the high failure rate in the
mandible. The precision of the results
derived from mathematical simulation
are directly related to the precision of
the models constructed. Errors can be
reduced by reproducing constituent ele-
ments, material properties and boundary
conditions with precision.
Apart from the case of the mini-implant
1 mm away from the periodontal mem-
brane, the occlusal force was transmitted
to the mini-implant, and the authors
observed a maximum von Mises stress
of less than 20 MPa in the cortical bone
around the implant. The stress increased as
the distance between the implant and the
root decreased. When the implant touched
the root, the stress increased dramatically
to 140 MPa or more, and bone resorption
could be predicted. In this case, the bone
could no longer hold the mini-implant, and
it loosened. This simulation confirmed
that the implant touching the root is a
major factor in implant failure. In a clin-
ical setting, if the implant touches the root,
the patient often has occlusal pain once the
effect of the local anesthetic has worn off
and/or bleeding from the implant hole
after the placement26. These signs are an
indicator for clinical reimplantation.
When the implant touches the surface of
the periodontal membrane, or a part of the
screw thread becomes embedded in the
periodontal membrane, this might not be
obvious, because the patient may exhibit
few, if any, symptoms or signs. In a case
when part of the implant was embedded in
the periodontal membrane (model C), a
point existed in which the stress reached
25 MPa or more, corresponding to the
stress related to bone resorption. Overload
bone resorption was simulated and the
critical stress curves for overload and
underload resorption have been deter-
mined15. According to these curves, over-
load cortical bone resorption would be in
areas with von Mises stresses greater than
25–28 MPa. The authors’ mathematical
simulation suggests that a mini-implant
that injures the periodontal membrane
without touching the root could be a cause
of implant loosening.
To evaluate the effects of the difference
in cortical bone thickness on the stresses in
the bone surrounding the mini-implants,
the authors developed three types of FEM
with cortical bone thicknesses of 1, 2 and
3 mm. In all of the models, the stress for a
cortical bone thickness of 2 mm was larger
than those for 1 and 3 mm, indicating that
a 2 mm thickness has a higher risk for
bone resorption and failure of the mini-
implant compared with greater or lesser

Fig. 7. Maximum displacement in the mini-implant for each model according to cortical bone
thickness: Model A, not touching; Model B, touching periodontal membrane; Model C,
embedded in periodontal membrane; Model D, touching the root.
thicknesses. Ono et al.21 measured cortical
bone in cross-sections of the placement
site in alveolar bone mesial to the first
molar using computed tomography (CT),
and found that the average thickness was
approximately 1 mm in the maxilla and
2 mm in the mandible. The present study
indicates that an implant in the mandible
may have a greater probability of loosen-
ing than in the maxilla with the same
degree of root proximity, and this could
be related to the low success rate in the
mandible.
The authors hypothesized that the rea-
son why the stress was highest in 2 mm
thick cortical bone was related to the
buffer function of cancellous bone. To
verify this, they calculated the total stress
on the section in the middle of the implant
hole in the cancellous bone for each
model, and found that it increased with
thinner cortical bone. When the total bone
thickness is fixed, the cancellous bone
becomes thicker as the cortical bone
becomes thinner, and the load in the
thicker cancellous bone supporting the
implant body increases, reducing the load
Bone stress for a mini-implant close to teeth roots
in the thin cortical bone. The maximum
stress would then be less in the model of
1 mm cortical bone than in 2 mm bone. If
this hypothesis is true, the maximum stress
in the models with a cortical bone thick-
ness of 3 mm would be greater than those
with a thickness of 2 mm. The opposite
occurred, and the stress was less for a
thickness of 3 mm. To explain this contra-
diction, the authors calculated the maxi-
mum displacement of the mini-implant.
The displacement of the mini-implant
spearhead decreased with thicker cortical
bone. This is caused by the thicker cortical
bone’s enhanced retentive force for the
mini-implant. The stress in the cortical
bone would then be reduced in the models
with the greater cortical bone thickness.
The authors observed the opposite, and
thinner cortical bone reduced the load in
the cortical bone because of the buffering
function of the thicker cancellous bone.
It is easy to understand that the thicker
cortical bone (more than 2 mm) ensures
rigid support for the mini-implant and
increases implant stability. The thinner
cortical bone (less than 2 mm) induces
367
the cancellous bone support and this might
reduce the stress in the cortical bone.
These two opposing physical phenomena
both act on the bone around the mini-
implant, and the highest stress would be
detected in the model with a cortical bone
thickness of 2 mm.
In a clinical setting, to reduce the chance
of failure, especially in the mandible, it is
important to ensure that the implant does
not touch an adjacent root. Diagnostic ima-
ging using CT before placement would help
to reduce this chance of failure. Deguchi
et al. 5 suggested that damaging the roots
could be avoided in most cases by using
mini-implants with a diameter of less than
1.5 mm. Miyawaki et al.17 reported that all
the 1 mm diameter screws loosened, while
84% of 1.5 mm diameter screws and 85%
of 2.3 mm diameter screws survived. The
authors think that mini-implants with a
diameter of 1.5–2.0 mm improve implant
stability and reduce the chance of touching
a root. Slanting the mini-implant reduces
the placement depth as well as the chance of
contacting a root. They also recommend
using a pilot drill and a stent with a drilling
guide.
Acknowledgments. We thank the staff of
the Department of Radiology, Nihon Uni-
versity School of Dentistry, for their assis-
tance with CT. This study was supported
by grants from Sato Fund (society) of the
Nihon University School of Dentistry
2006, 2007, Nihon University Individual
Research Grant 2007 and Grant-in-Aid for
Scientific Research (19592369) from the
Ministry of Education, Culture, Sports,
Science and Technology of Japan.
References
1. Bac SM, Park HS, Kyung HM, Kwon
OW, Sung JH. Clinical application of
microimplant anchorage. J Clin Orthod
2002: 36: 298–302.
2. Benzing UR, Gall H, Weber H. Bio-
mechanical aspects of two different
implant-prosthetic concepts for edentu-
lous maxillae. Int J Oral Maxillofac Impl
1995: 10: 188–198.
3. Cheng SJ, Tseng IY, Lee JJ, Kok SH. A
prospective study of the risk factors asso-
ciated with failure of mini-implants used
for orthodontic anchorage. Int J Oral
Maxillofac Impl 2004: 19: 100–106.
4. Costa A, Raffaini M, Melsen B. Min-
iscrews as orthodontic anchorage: a pre-
liminary report. Int J Adult Orthod
Orthogna Surg 1998: 13: 201–209.
5. Deguchi T, Nasu M, Murakami K,
Yabuuchi T, Kamioka H, Takano-
Yamamoto T. Quantitative evaluation
of cortical bone thickness with computed
368 Motoyoshi et al.
tomographic scanning for orthodontic
implants. Amer J Orthod Dentofac
Orthop 2006: 129 721.e7-12.
6. Freudenthaler JW, Bantleon HP,
Haas R. Bicortical titanium screws for
critical orthodontic anchorage in the
mandible: a preliminary report on clinical
applications. Clin Oral Impl Res 2001:
12: 358–363.
7. Herman RJ, Currier GF, Miyake A.
Mini-implant anchorage for maxillary
canine retraction: a pilot study. Amer J
Orthod Dentofac Orthop 2006: 130: 228–
235.
8. Hirabayashi M, Motoyoshi M, Ishi-
maru T, Kasai K, Namura S. Stresses
in mandibular cortical bone during mas-
tication: biomechanical considerations
using a three-dimensional finite element
method. J Oral Sci 2002: 44: 1–6.
9. Holmgren EP, Seckinger RJ, Kilgren
LM, Mante F. Evaluating parameters of
osseointegrated dental implants using
finite element analysis–a two-dimen-
sional comparative study examining the
effects of implant diameter, implant
shape, and load direction. J Oral Implan-
tol 1998: 24: 80–88.
10. Kanomi R. Mini-implant for orthodontic
anchorage. J Clin Orthod 1997: 31: 763–
767.
11. Kim TW, Kim H, Lee SJ. Correction of
deep overbite and gummy smile by using
a mini-implant with a segmented wire in a
growing Class II Division 2 patient. Amer
J Orthod Dentofac Orthop 2006: 130:
676–685.
12. Ko CC, Chu CS, Chung KH, Lee MC.
Effect of posts on dentin stress distribu-
tion in pulpless teeth. J Prosth Dent 1992:
67: 421–427.
13. Kuroda S, Yamada K, Deguchi T,
Hashimoto T, Kyung HM, Takano-
Yamamoto T. Root proximity is a major
factor for screw failure in orthodontic
anchorage. Amer J Orthod Dentofac
Orthop 2007: 131: S68–S73.
14. Lee JS, Park HS, Kyung HM. Micro-
implant anchorage for lingual treatment
of a skeletal class II malocclusion. J Clin
Orthod 2001: 35: 643–647.
15. Li J, Li H, Shi L, Fok ASL, Ucer C,
Devlin H, Horner K, Silikas N. A
mathematical model for simulating the
bone remodeling process under mechan-
ical stimulus. Dent Mater 2007: 23:
1073–1078.
16. Middleton J, Jones M, Wilson A. The
role of the periodontal ligament in bone
modeling: the initial development of a
time dependent finite element model.
Amer J Orthod Dentofac Orthop 1996:
109: 155–162.
17. Miyawaki S, Koyama I, Inoue M, Mis-
hima K, Sugawara T, Yamamoto T.
Factors associated with the stability of
titanium screws placed in the posterior
region for orthodontic anchorage. Amer J
Orthod Dentofac Orthop 2003: 124: 373–
378.
18. Morikawa A. Investigation of occlusal
force on lower first molar in function.
Kokubyo Gakkai Zasshi 1994: 61: 250–
274 (in Japanese).
19. Motoyoshi M, Hirabayashi M,
Uemura M, Shimizu N. Recommended
placement torque when tightening an
orthodontic mini-implant. Clin Oral Impl
Res 2006: 17: 109–114.
20. Motoyoshi M, Yoshida T, Ono A,
Shimizu N. Effect of cortical bone thick-
ness and implant placement torque on
stability of orthodontic mini-implants.
Int J Oral Maxillofac Impl 2007: 22:
779–784.
21. ONO A, MOTOYOSHI M, SHIMIZU N. Corti-
cal bone thickness in the buccal posterior
region for orthodontic mini-implants. Int
J Oral Maxillofac Surg 2008: 37: 334–
340.
22. Park HS, Kyung HM, Sung JH. A
simple method of molar uprighting with
microimplant anchorage. J Clin Orthod
2002: 36: 592–596.
23. Rho JY, Ashman RB, Turner CH.
Young’s modulus of trabecular and cor-
tical bone material: ultrasonic and micro-
tensile measurements. J Biomec 1993:
26: 111–119.
24. Sawa Y, Goto K, Suzuki N, Kamo N,
Kamo K. The new method for the max-
illary retraction of the anterior teeth using
a titanium microscrew as anchorage.
Orthod Waves 2001: 60: 328–331.
25. Sugawara J, Daimaruya T, Umemori
M, Nagasaka H, Takahashi I, Kawa-
mura H, Mitani H. Distal movement of
mandibular molars in adult patients with
the skeletal anchorage system. Amer J
Orthod Dentofac Orthop 2004: 125:
130–138.
26. Sung JH, Kyung HM, Bae SM, Park
HS, Kwon OW, McNamara Jr JA.
Microimplants in Orthodontics. New
York: Great Lakes 2006: p. 1-178.
27. Umemori M, Sugawara J, Mitani H,
Nagasaka H, Kawamura H. Skeletal
anchorage system for open-bite correc-
tion. Amer J Orthod Dentofac Orthop
1999: 115: 166–174.
Address:
Mitsuru Motoyoshi
Department of Orthodontics
Division of Clinical Research
Dental Research Center
Nihon University School of Dentistry
1-8-13
Kanda-Surugadai
Chiyoda-ku
Tokyo 101-8310
Japan
Tel.: +81 3 3219 8105
Fax: +81 3 3219 8312
E-mail: motoyoshi@dent.nihon-u.ac.jp