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Clinical Science and Techniques

Minor Tooth Movements Using Microimplant Anchorage: Case Reports

Sohn, Dong-Seok DDS, PhD*; Lee, Jung-Kwang DDS; An, Kyung-Mi DDS, MSD

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doi: 10.1097/ID.0b013e318166da1d
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Successful orthodontic tooth movement requires stable anchorage. Anchorage control is one of the most important aspects of orthodontic treatment. Traditionally, extraoral anchorage as with headgear could be effective, but the use of extraoral anchorage ideally demands full cooperation of the patients as well as having to wear the appliance more than 12 hours per day of scheduled wearing. Therefore, it is very difficult to undertake orthodontic treatment without compromising anchorage.

For these situations, orthodontic microimplants can be the best choice. For years, many dentists and researchers have tried to use dental implants as orthodontic anchorage.1–5 Various types of dental implants have been chosen for orthodontic anchorage, but among these types the microimplant is small enough to place in any area of alveolar bone.6 The surgical procedure, and removal after treatment, are easier.7,8

The use of microimplants as orthodontic anchorage has broadened treatment possibilities. Anchorage control with microimplants has become an important part of the clinical management of orthodontic patients. Microimplants provide orthodontic clinicians with several advantages, e.g., the elimination of interarch mechanics for correcting sagittal discrepancies, the reduction of treatment time, the simplification of treatment mechanics, the correction of midline discrepancies without interarch mechanics, and the ability to move entire quadrants rather than individual teeth. Orthodontic space closure in the mandibular arch by protraction, space gaining with molar distalization, obtaining interarch space with molar intrusion, and molar uprighting, arch constriction are also possible with microimplants.7

This article will present several cases demonstrating how efficiently the movement of teeth can be achieved by microimplants. Each patient was treated without using full-arch edgewise techniques, but rather using microimplants and a small number of brackets when needed.

Case 1

A 24-year-old female patient lost her teeth—the first and second molar of the right maxilla and left mandible—by accident. The patient visited our clinic 1 year after the accident and her opposing teeth were extruded because of delayed treatment (Fig. 1). The patient wanted to restore the missing teeth with implants but the interocclusal space was insufficient. We planned to intrude the opposing teeth to regain the appropriate interocclusal space9 for prosthesis.

Fig. 1.:
Initial photographs show extrusion of molars and deficiency of interocclusal space to reconstruct opposing teeth in case 1. A, Extruded upper left molars; B, Extruded lower right molars.Fig. 2. After 6 months of treatment, sufficient intrusion is achieved in case 1.Fig. 3. Missing teeth were rehabilitated with implant-prosthesis in case 1. Posttreatment panoramic radiograph.

Dental implants (Seven; MIS Implants Technologies Ltd., Shlomi, Israel) were placed in the edentulous areas of maxilla and mandible. To correct for supereruption of the maxillary left first and second molars, 2 microimplants (Anchor Plus; KJ Meditech Co., Ltd, Kwangju, Korea; 1.4 mm in diameter and 8 mm in length) were placed on the palatal and buccal surfaces between left first and second molars of maxilla. 016 × 022 stainless steel wire was applied on the buccal and lingual side and tied with the microimplant using elastic thread. Elastic thread was tied only from microimplants to the main arch-wire.

For the mandible, 1 buccal and 1 lingual microimplant (Anchor Plus) was used for the intrusion of an extruded lower right first molar and second molar. A small piece of 016 × 022 stainless steel rectangular wire was bonded on the occlusal surface of the right mandibular secondary molar, which was extended to the occlusal surface of right first molar. The stainless steel wire was bonded only to the second molar by acrylic resin, and the first molar was not bonded to permit individual tooth movement. Then, elastic thread was connected buccolingually across the wire bonded on the occlusal surface.

After 3 months, slight intrusion was observed. Satisfactory intrusion had been achieved to facilitate a dental implant prosthesis in 6 months (Fig. 2). The edentulous area was restored prosthodontically (Fig. 3). Approximately 3 mm intrusion of the upper and lower molars was observed.

Case 2

A 57-year-old male patient who was experiencing severe adult periodontitis visited our clinic for a consult about the restoration of his left maxillary posterior edentulous area. Severe adult periodontitis caused the extraction of the left maxillary posterior teeth and the supereruption of the left mandibular posterior teeth (Fig. 4). First of all, to treat chronic periodontitis, general periodontal procedures, i.e., scaling, curettage, and flap operations, were performed. After evaluating the patient’s periodontal health condition, it was planned for the patient to get treatment of the extruded teeth to achieve the available interocclusal space for implant prosthesis. One buccal and 1 lingual microimplant (Anchor Plus) was used to correct the overerupted lower left first and second molars. Before we started to intrude the molars, those teeth were almost in contact on the left maxillary posterior edentulous ridge according to the intraoral view. Brackets were bonded to buccal and lingual surfaces of the left first and second molars on mandible. 016 × 022 stainless steel wire was adjusted, and elastic thread was used to tie from the microimplant to wire.

Fig. 4.:
Overerupted molars on the left mandible are shown for case 2 on clinical photograph.Fig. 5. After 6 months, the satisfactory interocclusal space was obtained in case 2.Fig. 6. Final restorations were placed in case 2.

Six months after intrusion, a sufficient interocclusal space was achieved for the prosthodontic treatment of upper molars (Fig. 5).

Three dental implants (Ankylos; Friadent GmbH, Mannheim, Germany) were placed on left maxillary edentulous area with a direct sinus bone graft. At the same time when the sutures were removed, microimplants were removed. In comparison between pretreatment and posttreatment, approximately 4 mm intrusion of the lower left first molar and the second molar was observed. The final implant prosthesis was placed after 4 months (Fig. 6).

Case 3

A 17-year-old man was referred by his private dentist for evaluation and treatment of the lower right second molar that was tilted lingually (Fig. 7).

Fig. 7.:
Initial intraoral photograph of case 3. Note the lingually tilted lower right second molar.Fig. 8. One microimplant (Microscrew; OsteoMed Corp., Dallas, TX; 1.4 mm in diameter and 6 mm in length) was placed at buccal alveolar bone of case 3. Elastic thread was connected between microimplant and lingual button.Fig. 9. After 8 months of orthodontic treatment (case 3).

One microimplant (Microscrew; OsteoMed Corp., Dallas, TX; 1.4 mm in diameter and 6 mm in length) was placed in the buccal alveolar bone of the second molar, and elastomeric thread was connected from the microimplant to the buccal button (Fig. 8). After 3 months, uprighting of the second molar was achieved, and the microimplant was removed. But the second molar was still positioned under the condition of infraocclusion. Therefore, buccal brackets and orthodontic 016 × 022 stainless steel wire were used to correct the position of the tooth. Orthodontic treatment was completed and the second molar seemed to be in harmony with the adjacent teeth in only 8 months (Fig. 9).

Case 4

A 38-year-old man was referred from his private dental clinic for consultation regarding reconstruction of missing teeth. In the right mandible, the patient had a medially tilted second premolar (Fig. 10) and he wanted to save the tooth with dental implant placement at the first premolar area. But, because there was little space at the first premolar area with tipped lower second premolar, distal uprighting of second premolar was planned. But the anchor that was needed for distal movement of the tooth was absent in the posterior area. In addition, this was not a favorable condition to place a dental implant or microimplant for anchorage because a bone graft was performed on the edentulous area. So, 1 microimplant (AbsoAnchor, Dentos Inc., Daegu, Korea; 1.4 mm in diameter and 6 mm in length) was placed in labial alveolar bone between right lateral incisor and canine. Microimplant and canine got a rigid connection to use the canine as indirect anchorage (Fig. 11). Buccal brackets were bonded on the canine and second premolar. And L-loop arch wire, which was made of rectangular wire (016 × 022 TMA), was applied for uprighting the second premolar. After 4 months of orthodontic treatment, the sufficient interdental space between the lower right canine and second premolar for implant placement was retrieved.

Fig. 10.:
Initial intraoral photograph of case 4.Fig. 11. Microimplant (AbsoAnchor; Dentos Inc., Daegu, Korea; 1.4 mm in diameter and 6 mm in length) and canine got a rigid connection in case 4. L-loop arch wire (016 × 022 TMA) was applied for uprighting premolar.

Case 5

A 31-year-old woman visited our hospital for evaluating the discomfort of upper right first premolar. There was severe dental caries on the first premolar of right maxilla and the second premolar was positioned palatally (Fig. 12). Because of severe caries, saving the right first premolar was deemed to be impossible. The treatment plan was to extract the decayed tooth and align the ectopic second premolar orthodontically.

Fig. 12.:
Initial intraoral photograph of case 5.Fig. 13. Rigid connection between microimplant (AbsoAnchor; Dentos Inc., Daegu, Korea; 1.48 mm in diameter and 6 mm in length) and canine was established in case 5. Rectangular stainless steel wire was applied for traction of second premolar using elastic thread.Fig. 14. In case 5, 9 months after treatment, the second premolar was in proper position and the treatment is in progress to close the space between the canine and premolar.

At 1 week after extracting the upper left first premolar, microimplant (AbsoAnchor) was placed at the labial alveolar bone between right lateral incisor and canine. Rigid connection between microimplant and canine was established and the canine was used as indirect anchorage. Buccal brackets were bonded to upper left canine and first molar. After initial leveling using nickel-titanium wire, rectangular 016 × 022 stainless steel wire was applied for traction of second premolar using elastic thread (Fig. 13). Nine months after treatment, the second premolar was in proper position and the treatment is in progress to close the space between canine and premolar (Fig. 14).


Anchorage control10 has been considered an important factor in the success of orthodontic treatments. To provide acceptable anchorage, the use of endosseous implants has been suggested. After Brånemark and co-workers11,12 reported the successful osseointegration of implants in human bone, clinicians became interested in the use of implants as a form of orthodontic anchorage. There have been many studies to evaluate the possibility of endosseous implants and screws as orthodontic anchorage.3,12–17 In 1994, Roberts et al presented the clinical application of an implant which was placed in the mandibular retromolar area and used to close the extracted lower molar space.15 Umemori et al18 reported the use and treatment of surgical miniplates in open-bite cases. Recently, Kanomi8 and Costa et al19 introduced the use of titanium miniscrews as orthodontic anchorage.

The use of an osseointegrated dental implant for orthodontic anchorage has been limited by space, cost, and the long waiting time for osseointegration.20 On the other hand, microimplant has many advantages such as small size, easy application, less cost, and a short interval between placement and force application.

Microimplants can be used not only in the intrusion of teeth, but also in extensive retraction, entire arch retraction, protraction, molar distalization, molar uprighting and correcting scissors bite. Even though it is not possible to get 100% success rate of microimplants, we must give careful consideration to the morphology of root, location of the microimplant, its size and path of insertion, and the quality of the overlying soft tissue. We may then approximate 100% success rate.21 In this study, there were no failures of microimplants, nor were there any other complications.

In 3 cases of intruding overerupted molars, the intrusion force was applied on both the buccal and lingual sides, so the force was able to pass through the center of resistance and no tipping of the molars was observed.

In case 2, though the patient had experienced severe adult periodontitis, there was no periodontal relapse or bone loss after completing the molar intrusion. There are controversies about the intrusion of periodontally involved teeth,22–27 but in some reports authors concluded that if the inflammation would be well controlled, intrusion of teeth would not result in loss of the marginal bone level.28 So it was concluded that microimplants are a very fascinating device for intrusion of supererupted teeth even if the patient has had periodontal disease.

In cases 4 and 5, the canine was used as anchorage with wire attached to a microimplant. This type of stabilization is called “indirect anchorage”.13 Stabilizing the canine allowed movement of a malpositioned or tipped tooth without any movement of the other teeth.


The result of orthodontic treatment shows a satisfactory amount of tooth movement using the microimplants without any observed side effects.

In all cases, it was possible to treat the patients by using microimplants without full-arch edgewise technique. Also, patients were satisfied with the more invisible treatment compared with conventional full arch technique or other intraoral appliances.

To achieve absolute orthodontic anchorage has been a goal of most orthodontic clinicians, and, using the microimplants have given us the most effective, powerful way to get the anchorage we want to achieve. Therefore, application of microimplants will make the treatment procedure easier. It is one of the most useful methods to provide absolute orthodontic anchorage.


The authors claim to have no financial interest, directly or indirectly, in any entity that is commercially related to the products mentioned in this article.


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Abstract Translations


AUTOR(EN): Dong-Seok Sohn, Jung-Kwang Lee, Kyung-Mi An. Schriftverkehr: Kyung-Mi An, DDS, MSD, Abteilung für Zahnheilkunde und Orthodontie (Dept. of Dentistry and Orthodontics), Daegu katholisches Universitätshospital (Daegu Catholic University Hospital), 3056-6 Daemyung 4-Dong, Nam-Gu, Daegu, Republik von Korea 705-034. Telefon: 82-53650-4291, Fax: 82-53622-7067, eMail:[email protected]

Geringfügige Zahnbewegungen durch Anwendung von Mikroimplantatverankerung; eine Beschreibung von Krankheitsfällen

ZUSAMMENFASSUNG: Zur Behandlung herausgezogener oder gekippter Mahlzähne finden verschiedene konventionelle Techniken Anwendung. Diese Methoden können allerdings zu unerwünschten Nebenwirkungen in Form von Bewegungen der Ankerelemente führen und die Behandlungsdauer aufgrund des begrenzten zahneigenen Verankerungspotentials erhöhen. Die Einführung von Mikroimplantaten als Gebissverankerungsmöglichkeiten führte aufgrund der vielen Vorteile zu einer Erweiterung der Behandlungsoptionen. Einige Vorteile sind in der bei weitem weniger komplexen Struktur des chirurgischen Vorgehens, der Reduzierung der Behandlungskosten, der Option der unmittelbaren Belastung sowie der Möglichkeit der Einpflanzung in jedem beliebigen Bereich des Alveolarknochens zu finden. Dieser Artikel wird die klinischen Erfahrungen bei Patienten beleuchten, die mit der Intrusion zu weit durchgebrochener Mahlzähne, der Aufrichtung geneigter Mahlzähne sowie anderen klinischen Anwendungen zur Behandlung kleinerer Zahnbewegungen behandelt wurden. Eine Verankerungskontrolle wurde durch die chirurgische Einpflanzung von Mikroimplantaten aus Titan in das alveolare Knochengewebe erzielt. Eine unmittelbare Belastung wurde hierbei vorgenommen. Sofern erforderlich wurden minimale feste Apparaturen verwendet und die zahnmedizinische Behandlung konnte ohne weitere Komplikationen erfolgreich abgeschlossen werden.

SCHLÜSSELWÖRTER: Mikroimplantat, molare Intrusion, minimale Zahnbewegungen, Verankerung


AUTOR(ES): Dong-Seok Sohn, Jung-Kwang Lee, Kyung-Mi An. Correspondencia a: Kyung-Mi An, DDS, MSD, Dept. of Dentistry and Orthodontics, Daegu Catholic University Hospital, 3056-6 Daemyung 4-Dong, Nam-Gu, Daegu, Republic of Korea 705-034. Teléfono: 82-53-650-4291, Fax: 82-53-622-706. Correo electrónico:[email protected]

Movimientos menores del diente usando sujetadores con microimplantes: Informes de casos

ABSTRACTO: Para el tratamiento de molares extrudidos o inclinados, se han usado varias técnicas convencionales. Pero dichos métodos podrían llevar a movimientos no deseados de las unidades sujetadoras y prolongar el período de tratamiento debido al potencial limitado del sujetador del diente. La introducción de microimplantes como sujetadores de ortodoncia, ha expandido las posibilidades de tratamiento debido a sus muchas ventajas. Algunas ventajas son un procedimiento quirúrgico menos complicado, reducción en el costo, carga inmediata, y la capacidad de ser colocados en cualquier lugar del hueso alveolar. Este artículo ilustrará las experiencias clínicas en pacientes que fueron tratados con la intrusión de molares con sobreerupción, el enderezamiento de molares inclinados y otras aplicaciones clínicas en los movimientos menores del diente. Se logró el control del sujetador con la colocación quirúrgica de microimplantes de titanio para la carga inmediata en el hueso alveolar. Cuando fue necesario, se usaron aparatos fijos mínimos y tratamiento de ortodoncia sin ninguna otra complicación.

PALABRAS CLAVES: microimplante, intrusión molar, movimiento menor del diente, sujetador


AUTOR(ES): Dong-Seok Sohn, Jung-Kwang Lee, Kyung-Mi An. Correspondência para: Kyung-Mi An, DDS, MSD, Dept. of Dentistry and Orthodontics, Daegu Catholic University Hospital, 3056-6 Daemyung 4-Dong, Nam-Gu, Daegu, Republic of Korea 705-034. Telefone: 82-53-650-4291, Fax: 82-53-622-7067,E-mail:[email protected]

Movimentos Dentários Menores Usando-se Ancoragem de Microimplante; Relatos de Caso

RESUMO: Para o tratamento de molares projetados ou pontudos, diversas técnicas convencionais foram usadas. Mas esses métodos podem levar ao movimento indesejável das unidades de ancoragem e prolongar o tempo de tratamento por causa do limitado potencial de ancoragem nascido no dente. A introdução de microimplantes como ancoragem ortodôntica expandiu as possibilidades de tratamento devido a suas muitas vantagens. Algumas vantagens são um procedimento cirúrgico menos complexo, diminuição do custo, carga imediata e sua capacidade de serem colocados em qualquer área do osso alveolar. Este artigo ilustrará experiências clínicas em pacientes que foram tratados com a intrusão de molares supernascidos, o aprumo de molares inclinados e outras aplicações clínicas para movimentos dentários menores. O controle da ancoragem foi obtido com a inserção cirúrgica de microimplantes de titânio para carga imediata no osso alveolar. Quando necessário, aparelhos fixos mínimos foram usados e o tratamento ortodôntico foi completado sem nenhuma outra complicação.

PALAVRAS-CHAVE: microimplante, intrusão do molar, movimento dentário menor, ancoragem



АВТОРЫ: Dong-Seok Sohn, Jung-Kwang Lee, Kyung-Mi An. Адр= eс для корр= eспонд= eнции: Kyung-Mi An, DDS, MSD, Dept. of Dentistry and Orthodontics, Daegu Catholic University Hospital, 3056–6 Daemyung 4-Dong, Nam-Gu, Daegu, Republic of Korea 705–034. Т= eл= eфон: 82–53- 650-4291, Факс: 82–53- 622-7067, Адр= eс эл= eктронной почты:[email protected]

Н= eзначит= eльны= e п= eр= eм= eщ= eния зубов с использовани= eм микро-имплантата в кач= eств= e опоры; Описани= e историй бол= eзни

РEЗЮМE: Для л= eч= eния вытолкнуты= x или отклон= eнны= x моляров, используются различны= e традиционны= e м= eтоды. Но эти м= eтоды могут прив= eсти к н= eж= eлат= eльному п= eр= eм= eщ= eнию опорны= x эл= eм= eнтов и ув= eлич= eнию продолжит= eльности л= eч= eния в связи с огранич= eнными возможностями опоры, располож= eнной на зуб= e.

Появл= eни= e м= eтодики использования микро-имплантататов в кач= eств= e ортодонтич= eской опоры расширило возможности л= eч= eния благодаря многочисл= eнным пр= eимущ= eствам. Вот лишь н= eкоторы= e из таки= x пр= eимущ= eств: м= eн= e= e сложная = xирургич= eская проц= eдура, ум= eньш= eни= e стоимости, возможность н= eм= eдл= eнной нагрузки и возможность устанавливать и= x в любой части альв= eолярной кости. В стать= e описаны клинич= eски= e наблюд= eния на паци= eнта= x, которым проводили л= eч= eни= e м= eтодом вн= eдр= eния чр= eзм= eрно выдающи= xся моляров, выпрямл= eния наклон= eнны= x моляров и други= x клинич= eски= x м= eтодов, прим= eня= eмы= x в случая= x н= eзначит= eльны= x п= eр= eм= eщ= eний зубов. Опора об= eсп= eчивалась пут= eм = xирургич= eского пом= eщ= eния в альв= eолярную кость титановы= x микро-имплантатов для н= eм= eдл= eнной нагрузки. При н= eоб= xодимости использовался минимум фиксирующи= x приспособл= eний, и ортодонтич= eско= e л= eч= eни= e зав= eршалось б= eз каки= x-либо осложн= eний.

КЛЮХEВЫE СЛОВА: микро-имплантат, вн= eдр= eни= e моляра, н= eзначит= eльно= e п= eр= eм= eщ= eни= e зуба, опора


YAZARLAR: Dong-Seok Sohn, Jung-Kwang Lee, Kyung-Mi An. Yazýþma için: Kyung-Mi An, DDS, MSD, Dept. of Dentistry and Orthodontics, Daegu Catholic University Hospital, 3056–6 Daemyung 4-Dong, Nam-Gu, Daegu, Republic of Korea 705–034. Telefon: 82–53- 650-4291, Faks: 82–53- 622-7067. E-posta:[email protected]

Mikro Ýmplant Ankrajý Kullanýlarak Minör Diþ Hareketleri: Olgu Raporlarý

ÖZET: Ekstrüde olmuş ya da yatık azı dişlerinin tedavisinde çeşitli geleneksel yöntemler kullanılmıştır. Ancak bu yöntemler, ankraj ünitelerinin istenmeyen bir şekilde hareketine yol açabildiği gibi, sınırlı diş üzeri ankraj potansiyeli nedeniyle tedavi süresinin uzamasına da yol açabilir. Mikro implantların ortodontik ankraj olarak kullanımı, bunların çeşitli avantajları nedeniyle tedavi olanaklarını arttırmıştır. Avantajların bazıları arasında, daha az düzeyde karmaşık bir cerrahi prosedürü, düşük maliyet, hemen yükleme ve alveolar kemiğin herhangi bir yerine yerleştirilebilme olanağı sayılabilir. Bu yazının amacı, aşırı derecede erüpsiyon gösteren azı dişlerinin intrüzyonu, eğik molarların dikleştirilmesi ve minör diş hareketleri için diğer klinik uygulamalar için tedavi görmüş hastalardaki klinik deneyimleri anlatmaktır. Ankraj kontrolü, titanyum mikro implantların alveolar kemiğe hemen yükleme için cerrahi yöntemle yerleştirilmesi ile gerçekleştirilmiştir. Gerektiğinde minimum düzeyde sabit aletler kullanılmış ve ortodonti tedavisi başka herhangi bir komplikasyon olmadan tamamlanmıştır.

ANAHTAR KELÝMELER: mikro implant, molar intrüzyonu, minör diçs hareketi, ankraj







microimplant; molar intrusion; minor tooth movement; anchorage

© 2008 Lippincott Williams & Wilkins, Inc.