Ten Tips For Mini Implant Success

By Richard Cousley

1 Consent - use patient friendly terms and provide an information sheet.

2 Direct or indirect anchorage? Determine the optimum insertion site and related biomechanics at the outset.

3 "Expand" the insertion space - diverge the adjacent roots, e.g. distally tip the upper 2nd premolar to increase the distance between its root and the first molar. Start this process by altering the bracket tip at bond-up.

4 Use a stent – especially useful for inexperienced users and for awkward (e.g. palatal) locations.

5 Superficial anesthesia only.

6 Loading - light initial forces or even leave unloaded for the first month in adolescents.

7 Don't panic about slight mini-implant mobility – tighten it by clockwise rotation, even using a tucker as a screwdriver.

8 Distalise up to 1/2 unit by U5-6 palatal mini-implant insertion and then direct traction to palatal hooks.

9 Consider desirable and undesirable biomechanics in 3 dimensions - eg. control the transverse dimension with a TPA in molar intrusion cases.

10 Prevent intrusive ‘roller-coaster’ (lateral openbite) side-effects

- minimise traction on light archwires

- use a powerarm on a 19 x 25 steel archwire.