Kaohsiung Journal of Medical Sciences (2017) 33, 96e101

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ORIGINAL ARTICLE

Evaluation of mechanical strengths of three types

of mini-implants in artificial bones
Yu-Chuan Tseng a,b, Ju-Hui Wu c, Chun-Chan Ting a, Hong-Sen Chen c,
Chun-Ming Chen a,d,*

a
School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan
b
Department of Orthodontics, Dental Clinics, Kaohsiung Medical University Hospital,
Kaohsiung, Taiwan
c
Faculty of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University,
Kaohsiung, Taiwan
d
Department of Oral and Maxillofacial Surgery, Dental Clinics, Kaohsiung Medical University
Hospital, Kaohsiung, Taiwan

Received 11 July 2016; accepted 9 November 2016

Available online 10 December 2016

KEYWORDS Abstract We investigates the effect of the anchor area on the mechanical strengths of infrazy-
Anchor area; gomatic mini-implants. Thirty mini-implants were divided into three types based on the material
Infrazygomatic mini- and shape: Type A (titanium alloy, 2.0  12 mm), Type B (stainless steel, 2.0  12 mm), and Type C
implant; (titanium alloy, 2.0  11 mm).The mini-implants were inserted at 90 and 45 into the artificial
Insertion torque; bone to a depth of 7 mm, without predrilling. The mechanical strengths [insertion torque (IT),
Removal torque; resonance frequency (RF), and removal torque (RT)] and the anchor area were measured. We hy-
Resonance frequency pothesized that no correlation exists among the mechanical forces of each brand. In the 90 tests,
the IT, RF, and RT of Type C (8.5 N cm, 10.2 kHz, and 6.1 N cm, respectively) were significantly
higher than those of Type A (5.0 N cm, 7.7 kHz, and 4.7 N cm, respectively). In the 45 test,
the RFs of Type C (9.2 kHz) was significantly higher than those of Type A (7.0 kHz) and Type B
(6.7 kHz). The anchor area of the mini-implants was in the order of Type C (706 mm2) > Type B
(648 mm2) > Type A (621 mm2). Type C exhibited no significant correlation in intragroup compar-
isons, and the hypothesis was accepted. In the 90 and 45 tests, Type C exhibited the largest an-
chor area and the highest mechanical strengths (IT, RF, and RT) among the three types of mini-
implants. The anchor area plays a crucial role in the mechanical strength of mini-implants.
Copyright ª 2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an open
access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/
4.0/).

Conflicts of interest: All authors declare no conflicts of interest.

* Corresponding author. Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Number 100, Tzyou 1st Road,
Kaohsiung 80756, Taiwan.
E-mail address: komschen@gmail.com (C.-M. Chen).

http://dx.doi.org/10.1016/j.kjms.2016.11.001
1607-551X/Copyright ª 2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Mechanical strengths of mini-implant 97

Introduction

Studies investigating the stability of mini-implants have

focused on measures of mechanical strength, including
insertion torque (IT) [1,2], removal torque (RT) [3], and
pullout strength [4e6]. The procedures used to analyze
these measures are nonrepeated, invasive, and destruc-
tive. Resonance frequency (RF) analysis is noninvasive,
nondestructive, and objective, and can be applied
repeatedly and continuously. Resonance is a phenomenon
in which a continuous external force drives the oscillation
of a vibrating system. For example, when an external force
exhibits a periodic function with a frequency approximately
equal to the natural frequency (or a specific preferential
Figure 1. The mini-implants were inserted at 90 and 45 .
frequency) of a vibrating system, the vibration amplitude of
the system increases rapidly to its maximum and then de-
creases suddenly after the frequency is reached. The fre- et al. [8]. Both 90 and 45 tests could include and interpret
quency at which the amplitude of the vibrating system is the degrees of insertion of the clinical condition.
the maximum is referred to as RF. Thus, providing a force Each mini-implant was weighted using analytical bal-
that excites external frequencies for measurement of the ances (AS 220/C1; Radwag, Radom, Poland). The di-
RF of an implant can indicate the stiffness of the implant mensions and shapes of the mini-implants were measured
and surrounding bone, which is a measure of using scanning electron microscopy (SU8010; Hitachi,
osseointegration. Tokyo, Japan) (Figures 3 and 4). The infrazygomatic crest
Meredith et al. [7] revealed that a high RF indicates high was simulated with artificial bones (Sawbone; Pacific
stiffness. RF analysis of dental implants revealed a close Research Laboratories, WA, USA), where a 2-mm cortical
correlation between in vivo and in vitro findings. Measuring bone (40 pcf) was used as the cortical bone, whereas bone
the stiffness of dental implants and surrounding bone, marrow (20-pcf cellular foam) was used as the medullary
which indicates the stability of the implants, can help cli- bone. According to anatomic consideration, five mini-
nicians to effectively diagnose and evaluate the osseoin- implants of each brand were inserted to a depth of 7 mm
tegration of dental implants and determine the time of in the 90 and 45 tests. All mini-implants were manually
dental implant loading, thereby ensuring the success of inserted into Sawbone without pilot drilling. A digital tor-
dental implants. Therefore, RF analysis can also be applied que meter (Lutron, Taipei, Taiwan) was used to measure IT
to assess the stability of orthodontic mini-implants to and RT. The degree of primary stability was tested using an
reduce the risk of failure. RF analyzer (Implomate; BioTech One, Inc., Taipei, Taiwan)
When an infrazygomatic mini-implant is inserted, the following the impulse force method (Figure 5).
corresponding soft tissue thickness at the insertion position
must be considered. The available implant length of the
infrazygomatic crest influences the primary stability of the
mini-implant. Moreover, the thread design of a mini-
implant considerably affects primary stability. The anchor
area of the mini-implant may also contribute to primary
stability but has never been studied. Therefore, this study
investigated the relationship between the anchor area and
mechanical strengths (IT, RF, RT) by using mini-implants
with different designs.

Methods

In this study, we used 30 mini-implants of three brands

commonly used by Taiwanese orthodontists to evaluate the
effects of their design characteristics on the mechanical
properties of artificial bone. The mini-implants were made
of titanium alloy and stainless steel. These mini-implants
were divided into three types based on the material and
shape: Type A (titanium alloy, 2  12 mm), Type B (stainless
steel, 2  12 mm), and Type C (titanium alloy, 2  11 mm).
The mechanical strengths of the three types were
measured in 90 and 45 (Figure 1). Moreover, the anchor Figure 2. The mini-implants manufactured with three
area of the mini-implants was measured using a planimeter designed types, from left to right: Type A (2.0  12 mm), Type
(X-PLAN 460dIII; Ushikata, Japan) (Figure 2). The anchor B (2.0  12 mm), and Type C (2.0  11 mm). Red line area:
area measurement was according to the method of Aydemir anchor area in the insertion 7 mm depth.
98 Y.-C. Tseng et al.

Figure 3. Scanning electron microscope analysis (15 kV  30; SU8010; Hitachi, Japan): apical thread of mini-implants (from left
to right: Type A, Type B, and Type C).

comparisons. Spearman’s rho correlation coefficient was

used to investigate the correlation between the three
experimental values (IT, RF, and RT) in the intragroup
comparison.

Results

Table 1 lists the diameters of the threads. The inner di-

Figure 4. Dimensions of mini-implant.
Statistical analyses were conducted using SPSS. A p value
of <0.05 was considered significant. We hypothesized that
no correlation exists among the mechanical forces of each
type. One-way analysis of variance with a post hoc Tukey
honest significant difference test was used for intergroup
ameters (mm) of the mini-implants were in the order of
Type C (1.55) > Type A (1.50) > Type B (1.45). The thread
depths of the mini-implants were in the order of Type B
(0.32) > Type C (0.27) > Type A (0.25). The inner/outer
diameter ratios of the mini-implants were in the order of
Type A (0.75) > Type C (0.74) > Type B (0.70). The anchor
areas of the mini-implants were in the order of Type C
(706 mm2) > Type B (648 mm2) > Type A (621 mm2). Type A
had an apical cutting design (Figure 3).
Table 2 summarizes the IT, RF, and RT of the mini-
implants. In the 90 test, the IT, RF, and RT of Type C
(8.5 N cm, 10.2 kHz, and 6.1 N cm, respectively) were
significantly higher than those of Type A (5.0 N cm, 7.7 kHz,
and 4.7 N cm, respectively). The weights of the mini-
implants were in the order of Type B (283.3 mg) > Type C
(161.5 mg) > Type A (118.4 mg). In the 45 test, the IT of
type C (9.3 N cm) was significantly higher than that of Type
A (6.8 N cm). The RF of Type C (9.2 kHz) was significantly
higher than those of Type A (7.0 kHz) and Type B (6.7 kHz).
No significant difference was observed in RT among the
three types. Intragroup comparisons also revealed no sig-
nificant difference between 90 and 45 tests.
As shown in Table 3, Spearman’s rho rank correlation
used for intragroup comparison revealed no significant
correlation among the three experimental values (IT, RF,

Table 1 Parameters (mm) of mini-implants.

Mini-implants Type A Type B Type C
Inner diameter 1.50 1.45 1.55
Outer diameter 2.00 2.09 2.09
Inner diameter/outer 0.75 0.70 0.74
diameter
Thread depth 0.25 0.32 0.27
Figure 5. Resonance frequency analysis. The mini-implant’s Thread pitch 0.9 0.8 0.8
head was impacted by the tapping rod of Implomate (BioTech Anchor area (mm2) 621 648 706
One, Inc., Taipei, Taiwan).
Mechanical strengths of mini-implant 99

Table 2 Insertion torque (IT), resonance frequency (kHz), removal torque (N cm), and weight (mg) analysis of mini-implants.
Mini-implants Insertion torque Resonance frequency Removal torque Weight
Mean SD Mean SD Mean SD Mean SD

90
Type A 5.0 0.70 7.7 1.64 4.7 0.46 118.4 0.41
Type B 7.2 1.74 8.0 0.89 5.1 0.96 283.3 2.50
Type C 8.5 1.67 10.2 1.48 6.1 0.90 161.5 0.96
45
Type A 6.8 0.96 7.0 0.53 5.7 0.44 118.7 0.42
Type B 7.6 1.37 6.7 1.38 6.3 1.16 283.7 0.49
Type C 9.3 1.38 9.2 1.35 7.5 2.18 161.7 0.36
Intragroup comparison
90 vs. 45 d d d d
Intergroup comparison
90 Type C > Type A Type C > Type A Type C > Type A Type B>
Type C > Type A
45 Type C > Type A Type C > Type A d Type B>
Type C > Type A
Type C > Type B
Tukey HSD post comparison test: statistical significance was set at p < 0.05.
d: not significant.
HSD Z honest significant difference; SD Z standard deviation.

and RT) of Type C in the 90 and 45 tests. In the 90 test,
Type A and Type B exhibited significant correlations be-
tween IT and RT (0.900) and IT and RF (0.900), respectively.
In the 45 test, Type A exhibited a significant correlation
between IT and RT (0.889). Type B presented significant
correlations (IT vs. RF: 0.975; IT vs. RT: 0.895). The weights
of the mini-implants were not significantly correlated with
their mechanical strengths (IT, RF, and RT). Therefore, the
hypothesis was accepted.
Discussion
Uribe et al. [9] reported a failure rate of 21.8% for mini-
implants placed in the infrazygomatic region, which was
higher than that of mini-implants placed in other max-
illomandibular regions. Therefore, bone depth and cortical
thickness are crucial factors influencing the insertion length
of mini-implants. Farnsworth et al. [10] assessed the
cortical bone thickness of the infrazygomatic crest and
found no significant difference between adults (1.58 mm)
and adolescents (1.44 mm). Baumgaertel and Hans [11]
investigated the bone depth at the infrazygomatic crest
for orthodontic mini-implant insertion. The mean maximum
bone depth (7.05 mm) was present at the lowest mea-
surement level.
Moreover, insertion depth is influenced by the degree of
mini-implant placement. Liou et al. [12] reported that
infrazygomatic crest thickness above the maxillary first
molar ranged from 5.2  1.1 mm to 8.8  2.3 mm when
measured at 40e75 to the maxillary occlusal plane and
13e17 mm above the maxillary occlusal plane. Mini-
implants can thus be inserted to a maximum depth of
7 mm at the infrazygomatic crest without penetrating into
the maxillary sinus. Therefore, the present study used
Sawbone with a 2-mm cortex and inserted mini-implants at
90 and 45 to a depth of 7 mm.
Yoo et al. [13] compared tapered and cylindrical mini-
implant stability and reported that tapered mini-implants
had higher initial stability than cylindrical mini-implants.
However, the clinical success rates and RTs were similar
between tapered and cylindrical mini-implants. They found

Table 3 Intragroup comparison by Spearman’s rho rank correlation coefficient test.

Mini-implants (Correlation coefficient) Type A Type B Type C
    
90 45 90 45 90 45
Insertion torque/resonance frequency 0.400 0.553 0.900* 0.975* 0.051 0.100
Insertion torque/removal torque 0.900* 0.889* 0.100 0.895* 0.718 0.872
Insertion torque/weight 0.051 0.205 0.200 0.000 0.763 0.359
Resonance frequency/removal torque 0.624 0.444 0.500 0.872 0.300 0.410
Resonance frequency/weight 0.805 0.359 0.100 0.154 0.205 0.667
Removal torque/Weight 0.434 0.000 0.400 0.263 0.410 0.132
* Statistical significance was set at p < 0.05.
100
that long-term stability was not directly affected by the
mini-implant design. Based on the investigation of the
material and shape of mini-implants, Type B was made of
stainless steel and had a tapered shape, whereas the
remaining types were made of titanium alloys and had a
cylindrical shape. For most of the mechanical strengths (IT,
RF, and RF), values for Type B were in the median range in
the 90 and 45 tests. Therefore, we found that the ma-
terial and shape did not influence the mechanical
strengths. Although Type B had the smallest inner diameter
and inner/outer diameter ratio (0.70), its IT was higher
than that of Type A. Scanning electron microscopy revealed
that Type A has a cutting design in the first three threads,
whereas the remaining types do not have this design.
Nevertheless, Type A had the lowest IT in the 90 (5.0 N cm)
and 45 (6.8 N cm) tests. From our findings (90 and 45
tests), the values of IT and the anchor area are in the
following order: Type C > Type B > Type A. Therefore, the
cutting thread design and a smaller anchor area contribute
to lower IT in the mini-implant.
The long-term stability of dental implants is achieved in
primary and secondary stages. Primary stability is of para-
mount concern for mini-implants, which is a mechanical
engagement with bone. In physics, RF is the natural fre-
quency of a vibrating system. Resonance can occur when a
vibrating system oscillates at a specific preferential fre-
quency. The frequency response transducer can excite vi-
bration, transfer frequency waveform, and measure the
responses to determine the stiffness of an implant in the
surrounding tissues. Since 1998, many studies [14e16] have
reported that RF analysis is a reliable, noninvasive method
for detecting the stability of dental implants. Therefore, RF
analysis is also an efficient and safe method for assessing
the primary stability of mini-implants.
Walter et al. [17] investigated the effects of mini-
implant design characteristics on the mechanical proper-
ties of artificial bone. They found that outer and inner
diameters are the most crucial factors for primary sta-
bility at the same implantation depth. Lee et al. [18]
evaluated the effect of thread depth on the primary sta-
bility of mini-implants in low-density bone. They showed
that mini-implants with larger thread depth produced
improved primary stability and higher RF value at the
same inner diameter. However, Chang et al. [4] reported
that lateral force would cause higher stress on the thread
neck, causing larger displacement of mini-implants, thus
reducing the RF value at larger thread depths. We also
found that Type B had the largest thread depth, but its RF
was not the greatest. Therefore, whether a larger thread
depth improves primary stability remains controversial.
Moreover, we found that Type C had the largest anchor
area and the highest RF. The anchor area was a noticeable
issue on the primary stability of mini-implants. Although
Type C had the smallest length (11 mm), it had the largest
inner diameter and was inserted at the same depth
(7 mm). Therefore, Type C had the largest anchor area
and the highest mechanical strengths in the 90 and 45
tests. However, the mini-implant is a three-dimensional
feature. Anchor volume is a better option than anchor
area to explain the mechanical strength of mini-implants.
Therefore, the anchor volume of mini-implants deserves
to be investigated in a future study.
Y.-C. Tseng et al.
The RT involves movement counterclockwise to the
rotation of insertion. In our study, the types (stainless steel
and titanium alloy) and the thread (inner/outer diameter
ratio, thread depth, and pitch) were not correlated with
the RT value. However, we found that the types with a
smaller anchor area had lower RT values. Nienkemper et al.
[19] investigated the relationship between IT and RF and
reported no significant correlation between them. In the
present study, Type B exhibited a significant correlation
between IT and RF in the 90 test. Type A and Type C
exhibited no significant correlation between IT and RF in
both tests. Therefore, our finding is similar to that of
Nienkemper et al. [19], implying that higher IT does not
significantly contribute to higher RF. Type A exhibited a
significant correlation between IT and RT in the 90 and 45
tests. This result implies that the thread design of the mini-
implant and the direction of manipulation may significantly
contribute to the relationship between IT and RT. All types
of mini-implants exhibited no significant correlation
between RF and RT in the 90 and 45 tests. This finding
implies that RF is not correlated with the magnitude of
RT. We found no significant correlation between mini-
implant weights and mechanical strengths (IT, RF, and
RT) in intragroup comparisons. This finding implies
that mini-implant weights do not contribute to primary
stability.
Conclusion
Type C has the largest anchor area and the highest me-
chanical strengths (IT, RF, and RT) among the three types of
mini-implants in the 90 and 45 tests. The anchor area
plays a crucial role in the mechanical strengths of mini-
implants. The material, shape, and weight of mini-implants
do not affect the mechanical strengths.
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