ORIGINAL ARTICLE

Analysis of stress in bone and microimplants

during en-masse retraction of maxillary
and mandibular anterior teeth with different
insertion angulations: A 3-dimensional finite
element analysis study
Issa Fathima Jasmine. M,a A. Arif Yezdani,b Faisal Tajir,c and R. Murali Venud
Chennai, India

Introduction: The proper angle of microimplant insertion is important for cortical anchorage, patient safety, and
biomechanical control. However, the actual impact of different insertion angulations on stability is unknown.
Methods: To perform 3-dimensional finite element analysis, finite element models of a maxilla and
a mandible with types D3 and D2 bone quality, and of microimplants with a diameter of 1.3 mm and lengths
of 8 and 7 mm were generated. The microimplants were inserted at 30 , 45 , 60 , and 90 to the bone
surface. A simulated horizontal orthodontic force of 200 g was applied to the center of the microimplant head,
and stress distribution and its magnitude were analyzed with a 3-dimensional finite element analysis
program. Results: The maximum von Mises stresses in the microimplant and the cortical bone decreased as
the insertion angle increased. Analysis of the stress distribution in the cortical and cancellous bones showed
that the stress was absorbed mostly in the cortical bone, and little was transmitted to the cancellous bone.
The maximum von Mises stress was higher in type D3 bone quality than type D2 bone quality. Conclusions:
Placement of microimplants at a 90 angulation in the bone reduces the stress concentration, thereby increasing
the likelihood of implant stabilization. Perpendicular insertion offers more stability to orthodontic loading. (Am J
Orthod Dentofacial Orthop 2012;141:71-80)

S
keletal anchorage provided by temporary anchor-
age devices has attracted great attention in recent
years because of its versatility, minimal surgical
invasiveness, and low cost.1,2
The proper angle of insertion is important for cortical
anchorage, patient safety, and biomechanical control.
The use of a proper insertion angle reduces the risk of
From the Department of Orthodontics, Sree Balaji Dental College and Hospital,
Chennai, India.
a
Lecturer.
b
c
Professor.
Reader.
d
Professor and head.
The authors report no commercial, proprietary, or financial interest in the prod-
ucts or companies described in this article.
Reprint requests to: Issa Fathima Jasmine. M, Department of Orthodontics &
Dentofacial Orthopedics, SRM Dental College, Bharathi Salai, Ramapuram, Chen-
nai - 600 089, India; e-mail, issafathima@ymail.com.
Submitted, June 2010; revised and accepted, June 2011.
0889-5406/$36.00
Copyright Ó 2012 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2011.06.031
damaging the dental roots of adjacent teeth and also
provides increased surface contact area between the mi-
croimplant and the bone. But the actual impact of dif-
ferent insertion angulations on microimplant stability
is unknown.3
It is virtually impossible to measure stress accurately
around microimplants in vivo. Also, it is difficult to
achieve an analytical solution for problems involving
complicated geometries such as the maxilla and the
mandible, which are exposed to various kinds of loads.
Finite element analysis provides an approximate so-
lution for the response of the 3-dimensional (3D) struc-
tures to the applied external loads under certain
boundary conditions. It appears to be suitable for simu-
lating complex mechanical stress situations in the max-
illofacial region.4
The objectives of this study were to generate finite
element models of the maxilla, the mandible, and the
microimplant, to simulate orthodontic loading for
en-masse retraction, and to evaluate the stress patterns
in the bone and the microimplant immediately after
71
72
loading with different insertion angulations of the
microimplant.
MATERIAL AND METHODS
Three-dimensional finite element models were cre-
ated for the following components after scanning
them with computed tomography with a slice thickness
of 1.5 mm: (1) the maxilla and the mandible in denti-
tions with the first premolars extracted, (2) the periodon-
tal ligament, (3) the alveolar bone, (4) a standard
preadjusted edgewise bracket (slot size, 0.018 3 0.025
in), (5) a stainless steel archwire (0.016 3 0.022 in), (6)
a stainless steel power arm, (7) a nickel-titanium
closed-coil spring, and (8) AbsoAnchor microimplants
(SH1312-08 and SH1312-07; Dentos, Taegu, Korea).
The images were obtained in a DICOM (digital imag-
ing and communication in medicine) data format. These
images were then reconstructed to a 3D model by using
Pro/ENGINEER software (Parametric Technology, Need-
ham, Mass). All these components were individually
modeled and then assembled to create 3D finite element
models of the maxilla and the mandible depicting en-
masse retraction of 6 anterior teeth (Figs 1 and 2). The
entire assembly was then exported for analysis with
ANSYS Workbench (version 11.0; ANSYS, Canonsburg,
Pa) through a bidirectional understandable translated
system called initial graphics exchange specification.
A 3D finite element model of each tooth was con-
structed according to the method of Wheeler,5 and all
teeth were aligned with reference to the facial axis point
of Andrews.6 The labiolingual and buccolingual inclina-
tions of the teeth were simulated based on the studies of
Kim et al.7 The maxillary and mandibular dentitions were
established according to the normal arch shapes of Roth
(Tru-arch forms, medium size; Ormco, Orange, Calif).
The 3D finite element models of the periodontal lig-
ament were constructed to fit outside the root. Based on
the studies of Kronfeld8 and Coolidge,9 the thickness of
the periodontal ligament was considered to be 0.25 mm
evenly, although periodontal ligament thickness is dif-
ferent according to age, position, and individual varia-
tions. The 3D finite element models of the alveolar
bone were fabricated to fit the teeth and the periodontal
ligament.
Three-dimensional finite element models of 0.018 3
0.025-in standard preadjusted edgewise brackets (3M
Unitek, Monrovia, Calif) were made and attached to
the crown so that the facial axis point was at the center
of the bracket slot.
Three-dimensional finite element models of the arch-
wires (0.016 3 0.022 in) were designed according to
Roth’s normal arch shapes and cinched at the distal
part of the first molar tube.
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Jasmine et al
Three-dimensional finite element models of 4 power
arms were generated and attached to the archwire dis-
tally to the lateral incisor bilaterally and perpendicularly
to the archwire.
Three-dimensional finite element models of a nickel-
titanium closed-coil spring were designed and stretched
between the microimplant and the hook between the
lateral incisor and the canine to deliver 200 g of force.
Three-dimensional finite element models of 2 types
of AbsoAnchor microimplants were constructed (Fig 3).
The microimplants had similar diameters and varied
only in length: (1) (small head) SH1312-08, self-drilling,
tapered type for the maxilla and (2) (small head)
SH1312-07, self-drilling, tapered type for the mandible.
Since these implants had small dimensions and to
ensure greater accuracy in constructing these finite ele-
ment models, the dimensions and measurements of the
implants (Table I) were obtained from the AbsoAnchor
company (Fig 4).
The microimplants were placed 5 to 8 mm from the
alveolar crest in the interradicular space between the first
molar and the second premolar in the maxilla, and 11
mm from the alveolar crest in the interradicular space
between the first molar and the second premolar in the
mandible based on studies by Poggio et al.10 The micro-
implants were inserted at 30 , 45 , 60 , and 90 to the
bone surface.
The finite element models were considered to have
linear elasticity and isometric properties of the same
quality. Young’s modulus and Poisson’s ratio for the
teeth, periodontal ligament, bracket, and wire were cal-
culated according to the methods of Vollmer et al11 and
Reimann et al.12
Young’s modulus and Poisson’s ratio for the trabec-
ular bone varied depending on the bone quality available
where the microimplant was placed (Table II). Type 3
(D3) bone quality was present in the posterior maxilla
with a thin layer (1 mm) of cortical bone surrounding
a core of dense trabecular bone of favorable strength.
Type 2 (D2) bone quality was present in the posterior
mandible with a thick layer (2 mm) of compact bone sur-
rounding a core of dense trabecular bone.13 Hence, the
implant length also varied depending on the thickness
of the cortical bone.
Three-dimensional quadrangular and hexagonal ele-
ments were used for the tooth and standard preadjusted
edgewise bracket models. The periodontal membrane
was constructed with thin shell elements and the arch-
wires with 3D beam elements. The number of nodes
and elements are shown in Table III.
To simplify the model and reduce the time for anal-
ysis, a bone block was modeled for the study. The
bone block, measuring about 8 3 14 3 10 mm (height,
Jasmine et al 73

Fig 1. Three-dimensional finite element model of the maxilla with dentition, brackets, archwire, power
arm, nickel-titanium closed coil-spring, and microimplant, front view.

Fig 2. Three-dimensional finite element model of the mandible with dentition, brackets, archwire,
power arm, nickel-titanium closed coil-spring, and microimplant, front view.

width, and depth), represented the sections of the max-
illa and the mandible in the interradicular spaces be-
tween the first molar and the second premolar where
the microimplant was inserted at 4 different angula-
tions. The section of bone contained the outer cortical
bone and the inner trabecular bone. Since the cortical
bone thickness in the insertion areas of the maxilla
and the mandible is between 1 and 2 mm, respectively,
4 models for the maxilla and the mandible were devel-
oped for varying the insertion angulations, because the
implant lengths were 8 mm in the maxilla and 7 mm
in the mandible. Hence, 8 finite element models with 2
implant lengths, 2 cancellous bone types, and 4 insertion
angulations were generated for the study (Table IV).
The retraction force was applied bilaterally to the
center of the microimplants through the closed-coil
springs from the microimplant anchorage to each power
arm. A simulated retraction force of 200 g was loaded
mesiodistally to the center of the microimplants, and
stress distribution and its magnitude were analyzed by

American Journal of Orthodontics and Dentofacial Orthopedics January 2012  Vol 141  Issue 1
74
Fig 3. Three-dimensional finite element models of micro-
implants: A, SH1312-08; B, SH1312-07.
ANSYS Workbench, a 3D finite element analysis pro-
gram. An assessment of the stress on the bone elements
was performed by using von Mises equivalent stress.
RESULTS
A color scale with 9 stress values was used to evaluate
quantitatively the stress distribution in the bone and the
microimplant (Figs 5, C, and 6, C). The scale for stress
runs from 0 MPa (blue) to the highest stress values
(red). Red indicates areas with the highest stress, and
blue indicates areas with the lowest stress.
The stress distributions on the implant-bone-inter-
face with 30 insertion angulation as an example is
shown in Figures 5 and 6. Stress was highly concentrated
in the head and neck of the implant, the contact point
between the implant thread and cortical bone, and the
cortical bone surrounding the implant. The cortical
bone was subjected to higher stress levels than the can-
cellous bone irrespective of the insertion angle of the mi-
croimplant. The cortical bones around the threads of the
implant were the most stressed areas. Little stress was
transmitted to the cancellous bone. The maximum von
Mises stress values induced in the microimplant, cortical
bone, and cancellous bone at the 4 insertion angulations
in the maxilla and the mandible are shown in Table V,
and the comparison of the maximum von Mises stress
values are depicted in Figures 7 and 8.
In the maxilla, the maximum von Mises stress in the
microimplant was 77.49 MPa when the microimplant
was inserted at an angle of 30 . The stress values grad-
ually decreased to 60.51, 60.12, and 16.8 MPa as the
insertion angle increased from 45 to 60 and 90 ,
January 2012  Vol 141  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Jasmine et al
Table I. Dimensions of the microimplants
Maxilla Mandible
Implant parameters SH1312-08 SH1312-07
External diameter 1.3 mm 1.3 mm
Head size 2.5 mm 2.5 mm
Implant body length 8 mm 7 mm
Overall length 10.5 mm 9.5 mm
Pitch 0.5 mm 0.5 mm
respectively. The maximum von Mises stress in the corti-
cal bone was 60.13 MPa when the microimplant was in-
serted at an angle of 30 . The stress values gradually
decreased to 55.17, 32.59, and 12.5 MPa as the insertion
angle increased from 45 to 60 and 90 , respectively.
Thus, the von Mises stresses observed in the cortical
bone and the microimplant were the highest when the
insertion angle was 30 and decreased with increases
in the insertion angle from 30 to 90 ; the stress was
the lowest when the insertion angle was 90 . Minimal
stress was transmitted to the cancellous bone.
In the mandible, the maximum von Mises stress in the
microimplant was 58.66 MPa when the microimplant
was inserted at an angle of 30 . The stress values grad-
ually decreased to 57.9, 39.33, and 17.26 MPa as the in-
sertion angle increased from 45 to 60 and 90 ,
respectively. The maximum von Mises stress in the corti-
cal bone was 56.88 MPa when the microimplant was in-
serted at an angle of 30 . The stress values gradually
decreased to 42.4, 22.6, and 10.74 MPa as the insertion
angle increased from 45 to 60 and 90 , respectively.
Thus, the von Mises stresses observed in the cortical
bone and the microimplant were the highest when the
insertion angle was 30 and decreased with the increases
in the insertion angle from 30 to 90 ; the stress was the
lowest when the insertion angle was 90 . Minimal stress
was transmitted to the cancellous bone.
DISCUSSION
In this study, finite element models of the maxilla, the
mandible, and the microimplant were generated; ortho-
dontic loading for en-masse retraction was simulated;
and the stress patterns generated by the implants at
the bone-implant interface were evaluated under differ-
ent insertion angulations (30 , 45 , 60 , and 90 ) by us-
ing the 3D finite element method.
Finite element analysis is a computerized numeric
method for solving complex problems by dividing com-
plex structures into many small interconnected simple
structures. It is an approximation method to represent
both the deformation and the 3D stress distribution in
bodies that are exposed to stress. The first step is to
subdivide the complex geometry into a suitable set of
Jasmine et al 75

Fig 4. Schematic representation of the dimensions of the microimplants: A, SH1312-08; B, SH1312-07.

Table II. Material properties of various components Table III. Number of nodes and elements generated
used in the study for each model
Young’s Poisson’s Bone Insertion Number of Number of
Materials modulus (MPa) ratio model angulation nodes elements
Tooth 20,000 0.30 Maxilla 30 13,242 6976
Periodontal ligament 0.05 0.30 Maxilla 45 13,454 7173
Alveolar bone 2,000 0.30 Maxilla 60 14,200 7597
Bracket/archwire/powerarm 200,000 0.30 Maxilla 90 13,986 7541
Closed-coil spring 110,000 0.35 Mandible 30 10,471 5342
Microimplant 110,000 0.35 Mandible 45 11,616 6066
Cortical bone 13,700 0.30 Mandible 60 11,570 6141
Cancellous bone (D3) 1,600 0.30 Mandible 90 11,917 6367
Cancellous bone (D2) 5,500 0.30

however, were different. For instance, it is well docu-

smaller elements of finite dimensions, all of which, when
combined, form the mesh model of the investigated
structures. Each element can be a specific geometric
shape (ie, triangle, square, tetrahedron, and so on)
with a specific internal strain function. By using these
functions and the actual geometry of the element, the
equilibrium equations between the external forces act-
ing on the element and the displacements occurring
on its nodes can be determined. Although finite element
analysis is a useful technique, it has certain limitations.
The finite element analysis technique is based on several
assumptions.
Several assumptions were made in the development
of the model in this study. The structures in the model
were all assumed to be homogenous and isotropic and
to have linear elasticity. The properties of the materials
modeled in this study, particularly the living tissues,
mented that the cortical bone of the mandible is trans-
versely isotropic and nonhomogenous, the mechanical
properties of the materials are nonlinear and compli-
cated, and it might be impossible to include ideal prop-
erties in the model. The material properties and the
geometry of the model change from 1 person to another.
This makes the problem even more complex. The stress
distribution patterns simulated also might be different,
depending on the materials and properties assigned to
each layer of the model used in the experiments. These
are inherent limitations of this study.14
Analytical results of the finite element models highly
depend on the models developed, so they must be con-
structed to be equivalent to a real object in various as-
pects. For a more accurate model, more nodes would
be needed. Generating more sophisticated models is la-
borious. Despite these limitations and assumptions,

American Journal of Orthodontics and Dentofacial Orthopedics January 2012  Vol 141  Issue 1
76 Jasmine et al

the maxilla and the mandible as suggested by Kyung

Table IV. Models simulated for stress analysis
et al23 and Ishii et al.24
Bone Cortical bone Implant Insertion The results showed that the stresses decreased in the
Model model thickness length angulation microimplant and the cortical bone with increases in in-
1 Maxilla 1 mm 8 mm 30 sertion angulations from 30 , 45 , 60 , to 90 . Similar
2 Maxilla 1 mm 8 mm 45
3 Maxilla 1 mm 8 mm 60
results were shown in a study by Zhang et al,25 who an-
4 Maxilla 1 mm 8 mm 90 alyzed the influence of different tilted angles including
5 Mandible 2 mm 7 mm 30 30 , 40 , 50 , 60 , 70 , 80 , and 90 on the biomechan-
6 Mandible 2 mm 7 mm 45 ical characteristics of orthodontic anchorage at the
7 Mandible 2 mm 7 mm 60 implant-bone interface. In this study, we elucidated
8 Mandible 2 mm 7 mm 90
the relationship between microimplant angulation and
stress in different bone qualities (D2 and D3); this was
previous studies by DeTolla et al15 and Geng et al16 have not done in the study of Zhang et al.
shown that the finite element analysis technique is rea- Stress was highly concentrated in the head and neck
sonably reliable for stress analysis. of the implant, the contact point between the implant
In this study, the microimplants used were the self- thread and cortical bone, and the cortical bone sur-
drilling type with the same diameter (1.3 mm) and 2 rounding the implant. The stress concentration was
lengths (7 and 8 mm). Drill-free screws have more greater at the implant neck. This was because greater re-
bone contact than predrilling screws. However, in thick, sistance is exerted at the implant entrance into the can-
dense cortical bone, it has been suggested that screws cellous and cortical bones. This result is consistent with
should be placed with a predrilling method.17 the study of van Staden et al.26
Chen et al18 concluded that self-drilling microim- The proper angle of insertion is important for
plants have high initial stability and can be used in the cortical anchorage, patient’s safety, and biomechanical
maxilla and at thin cortical bone areas of the mandible. control. To prevent root injury, some clinicians have ad-
The drill-free implants showed less mobility and more vised inserting microimplants at angles of 30 to 40 in
histomorphometric bone-metal contact. This might be the maxilla and 10 to 20 in the mandible, instead of
because drill-free insertion produces little bone debris perpendicular to the bone.23 It is generally recommen-
and less thermal change. Based on these studies, ded to apically incline the insertion path to prevent pos-
self-drilling microimplants were chosen for en-masse sible root injuries and increase cortical bone support.
retraction in the maxilla and the mandible. Since the mi- However, the clinician should consider 3 risk factors.
croimplant used in this study had a self-drilling capacity, First, excessive angulation on the bone surface might
pilot drilling was not needed. not be easy because the miniscrew tip tends to slip on
Miyawaki et al19 and Lim et al20 reported that diam- the bone surface, especially when the buccal alveolar
eter affected the success rates, but Park et al21 reported ridge is thin and lingually inclined with regard to the
that it had no effect. Miniscrews with a smaller diameter occlusal plane. Second, the cortical bone on the buccal
would decrease the chance of root damage. Miyawaki side is “wedged” by the miniscrew shaft; therefore, the
et al reported no success with 1.0-mm diameter minis- superficial layer of the cortical bone might be weak-
crews; therefore, this size is not suitable for clinical ened. Third, regarding bone-miniscrew contact, the
use. However, miniscrews with diameters of 1.2, 1.3, buccal surface of the miniscrew will exhibit less bone
and 1.5 mm had similar or higher success rates than contact than the lingual surface, and some of the
the 1.6-mm miniscrew.19,21,22 Since our study was threaded portion might be exposed and unsupported
confined to 1.3-mm diameter microimplants, we could by the bone proper, because of the angulation of the
not compare the effect of their diameter with the success miniscrew.
rate. In a previous study, Noble et al27 found that removal
Lim et al20 reported that the maintenance of the of a temporary anchorage device that had been inserted
miniscrew relies more on the diameter than on the at an angle exerted greater stress on the bone than when
length of the miniscrew. The cortical surfaces of the the miniscrew was placed perpendicular to the bone.
maxillary buccal area are thinner and less compact This indicates that stress levels decrease as the insertion
than those of the mandible and require longer microim- angle increases from 30 to 90 . Moon et al28 reported
plants.23 Hence, an 8-mm long microimplant was used that miniscrews should be inserted at 70 to 80 to the
for the maxilla, and a 7-mm one was used for the man- long axis of the teeth for better stability and success of
dible. The implants were placed in the interdental space the microimplant in the posterior buccal region of the
between the second premolar and the first molar in both maxilla and the mandible. These 2 studies agree that

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Jasmine et al 77

Fig 5. A, Microimplant inserted at 30 to the bone surface in a maxillary bone block; B, force
application; C, von Mises stress distribution at the implant-bone interface.

Fig 6. A, Microimplant inserted at 30 to the bone surface in a mandibular bone block; B, force
application; C, von Mises stress distribution at the implant-bone interface.

the microimplant should be inserted as perpendicular to
the bone possible; this is also evident from the results of
our study.
The thickness of the cortical bone is a decisive pa-
rameter for the stability of mini-implants. Our results
showed that stress was highly absorbed in the cortical
bone, and very little stress was transmitted to the can-
cellous bone. This agrees with the findings of Byoun
et al.29 They reported that the maximum von Mises
stress in cortical bone was more significantly related
to the contact point of the mini-implant in the corti-
cal bone surface than the insertion angle to the bone
surface and the maintenance of the mini-implant is
more closely related with its diameter and contact
point into the cortical bone surface than the insertion
angle.
Although various authors have reported high failure
rates associated with microimplants, the relationship be-
tween microimplant angulation and stress on bone has
not been extensively discussed in the literature. In me-
chanically retained orthodontic miniscrews, the direct
contact with the bone is responsible for primary me-
chanical stability. However, there are areas that show
gaps hundreds of micrometers in size between the screw

American Journal of Orthodontics and Dentofacial Orthopedics January 2012  Vol 141  Issue 1
78 Jasmine et al

Table V. Maximum von Mises stress values induced at various insertion angulations
Maximum von Mises stress values

Bone Insertion angle Microimplant Cortical bone Cancellous bone

Model model of the microimplant (MPa) (MPa) (MPa)
1 Maxilla 30 77.49 60.13 0.23
2 Maxilla 45 60.51 55.17 0.30
3 Maxilla 60 60.12 32.59 0.30
4 Maxilla 90 16.80 12.50 0.47
5 Mandible 30 58.66 56.88 0.14
6 Mandible 45 57.90 42.40 0.16
7 Mandible 60 39.33 22.60 0.19
8 Mandible 90 17.26 10.74 0.17

Fig 7. Maximum von Mises stress values induced at var- Fig 8. Maximum von Mises stress values induced at var-
ious insertion angulations in the maxilla. ious insertion angulations in the mandible.

and the bone. In areas with direct contact, the biologic
response shows no invasion of inflammatory cells; in-
stead, within 1 day of insertion, not only mineralized
bone tissue contact can be seen, but also osteoblasts
are seen attached firmly to the titanium implant surface.
After 1 to 2 weeks, in areas of direct bone contact, bone
is resorbed and replaced with newly formed viable bone.
Despite the temporary loss of hard bone contact, the
mini-implants remain clinically stable, and the process
does not seem to be affected if the screw is immediately
loaded.
The finding of significantly more stress on bone with
microimplant insertion at 30 than at 90 supports this
hypothesis. Clinically increased stress might draw more
cytokines, macrophages, and inflammatory mediators
to the site, possibly resulting in a higher risk of microim-
plant failure through loss of primary stability. Most
dental implant failures have been attributed to biome-
chanical stresses and strains at the bone-implant inter-
face, resulting in peri-implant inflammation that can
lead to bone loss.27
Cortical bone, having a higher modulus of elasticity
than trabecular bone, is stronger and more resistant to
deformation. For this reason, cortical bone will bear
more load than trabecular bone in clinical situations.14
The smaller the angle, the greater the cortical bone con-
tact to the miniscrew in both jaws. Compared with plac-
ing implants perpendicular to the long axis of the teeth,
angulating the implant at approximately 30 would in-
crease contact with as much as 1.5 times more cortical
bone.30
In this study, the material properties of the D3 and D2
types of bone were designated for the maxilla and the
mandible, respectively. There was type 3 (D3) bone qual-
ity in the posterior maxilla with a thin layer (1 mm) of
cortical bone surrounding a core of dense trabecular
bone of favorable strength. There was type 2 (D2)
bone quality in the posterior mandible with a thick layer
(2 mm) of cortical bone surrounding a core of dense
trabecular bone.
The relationship between microimplant angulation
and stress in different bone qualities has not been

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Jasmine et al
previously discussed in the literature. The results of our
study showed that the stress in the cortical bone of the
maxilla was comparatively more than the stress in the
cortical bone of the mandible—ie, lower stresses for D2
bone quality compared with D3 bone quality. This is
most likely due to the difference in the moduli of elastic-
ity in cortical and cancellous bones as well as to the
greater cortical bone thickness of the mandible.14
A previous study by Kronfeld8 showed a close associ-
ation between bone density and the failure rate of dental
implants. The failure rate of dental implant was 3% for
bone types 1, 2, and 3, but 35% for bone type 4 in the
study of Lekholm and Zarb.13 Additionally, areas with
dense cortical bone and minimal trabecular bone have
been reported to experience more implant failures com-
pared with areas with dense cortical bone and dense tra-
becular bone, or thin cortical bone and dense trabecular
bone. Similar to the relationship between bone density
and the dental implant failure rate, the success of
mini-implants can be influenced by bone quality.31
In both the maxilla and the mandible, little stress was
transmitted to the cancellous bone. The stress values did
not show much difference between the maxilla and the
mandible. The stress in different bone qualities can be
influenced greatly by the material properties of each
layer. The material properties of cancellous bone varied
according to its density in the posterior regions of the
maxilla and the mandible.
The clinical implication obtained by the evaluation of
stress patterns in this study is to increase the angulation of
the implant from 30 to 90 to keep the stress levels as low
as possible to prevent failure of the microimplant. The in-
crease of the insertion angle can efficaciously enhance the
stability, implicating that the implant can bear a mesiodis-
tal orthodontic force optimally well. Therefore, as long as
root damage can be avoided, microimplants should be
placed as perpendicular to the bone as possible.
The limitations of this study include some basic as-
sumptions for the purpose of simulation. Although the
mechanical behavior of the structures is understood to
be nonlinearly elastic, many investigators assigned linear
mechanical properties because of the lack of scientific
quantitative data. This lack of information is a source
of error in computer simulations of orthodontic tooth
movements. Models reflecting the true situation were
used as much as possible, but the simulation of
heterogeneity and anisotropy of bone and the properties
of the implant surface must be considered in future
clinical studies.
In clinical situation, the amount of torque induced
while inserting the microimplant, the soft tissue sur-
rounding the implant, and the time between implanta-
tion and loading of the microimplant could also
American Journal of Orthodontics and Dentofacial Orthopedics
79
influence the distribution of stress in the implant and
the bone when orthodontic forces are applied. All of
these factors should be included in future studies of fi-
nite element models to simulate as nearly as possible
clinical conditions and elucidate the stress patterns. Fu-
ture improvements in software and updated versions
could help in the refinement of the meshing process to
create a more accurate 3D finite element model.
CONCLUSIONS
Within the limitations of this study, the following
conclusions were drawn.
1. The comparison of the maximum von Mises stress in
the microimplant showed that, as the insertion an-
gle increased from 30 to 90 , stress decreased.
2. The comparison of the maximum von Mises stress in
the cortical bone showed that, as the insertion angle
increased from 30 to 90 , stress decreased.
3. The comparison of the maximum von Mises stress in
the cancellous bone showed that, as the insertion
angle increased from 30 to 90 , little stress was
transmitted to the cancellous bone.
4. In the analysis of the maximum von Mises stress ac-
cording to the bone quality, stress was higher in type
D3 bone quality than in type D2 bone quality.
5. Microimplants should be placed as perpendicular to
the bone as possible for better stability.
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