Master of Science (M.S.) in Dentistry
College of Dental Medicine
Publication Date / Copyright Date
Nova Southeastern University
Ira Rothstein. 2011. Effects of synthetic cortical bone thickness and force vector application on temporary anchorage device pull-out strength as related to clinical perspectives of practicing orthodontists. Master's thesis. Nova Southeastern University. Retrieved from NSUWorks, College of Dental Medicine. (56)
A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry.
Background: Temporary anchorage devices (TADs) provide a versatile means by which orthodontic anchorage can be established without the need for patient compliance and complex force systems. Their use is predicated on their ability to remain stable throughout the course of treatment in which they are needed. This has been shown to be the result of "primary stability" which is achieved through mechanical interlocking of the screw threads with the surrounding bone immediately upon placement. Therefore, evaluating the factors that can either enhance or detract from the primary stability of TADs can serve to improve the predictability of their success. Objectives: The objectives of this study were to describe how variations in synthetic cortical bone thickness and the angle of force applied in relation to the long axis of TADs affects their stability in terms of pull-out strength, and to ascertain the perspectives of practicing orthodontists in the state of Florida on their experiences with temporary anchorage devices with regards to success and failure. Methods: For the bench top study, 90 1.5x8mm long neck Orthotechnology Spider Screws were randomly allocated to 9 groups of 10 TADs each. The 9 groups were established based on both the thickness of synthetic cortical bone (1.0, 1.5, and 2.0mm) and the angle of force vector applied relative to the long axis of the TADs (45, 90, and 1800). Pull-out testing was carried out by applying a force to the TADs via a universal testing machine (Instron, Canton, MA) at a rate of 2.0mm/minute. Real-time graphical and digital readings were recorded, with the forces being recorded in Newtons (N). Each miniscrew was subjected to the pull force until peak force values were obtained. For the 450 and 1800 tests, the force registered at the time-point of pull-out, or screw head movement of 1.5mm within the synthetic bone blocks. The determination of 1.5mm of movement was made due the dramatically erratic deflection observed by the digital and graphical readouts at precisely this point. For the survey portion of this study, A customized survey was developed for this study. The survey was composed of 12 questions, some of which were obtained from a questionnaire that was created by Buschang et al.54 The additional questions were devised by the members of this research project, with the aim of answering questions regarding the clinical experiences that practicing orthodontists experienced with TADs. Results: For the bench top study: Implants placed in 2.0mm of synthetic cortical bone and pulled at an angle of 1800 had the highest pull-out strength among all groups (258.38N), while those placed in 1.0mm of synthetic cortical bone and pulled at an angle of 900 exhibited the lowest (67.11N). When evaluated separately, a cortical bone thickness of 2.0 mm displayed the highest pull-out forces for the three angles of force application, and 1800 angle of force displayed the highest-pull-out forces for the three cortical bone thicknesses. Conversely, 1.0mm of cortical bone thickness displayed the lowest pull-out forces for the three angles of force application, and 900 angle of force displayed the highest-pull-out forces for the three cortical bone thicknesses. For the survey: The most important factor associated with TAD failure was cited as placement location by 45.7% (n=16) of respondents, while root proximity was cited as the least important factor by 35.3% (n=12) of respondents. For the site from which practitioners indicated that they experience the greatest success, 81.8% cited the palate, while 51.9% responded that they experience the highest failure rates for the posterior maxilla (distal to the cuspids). Conclusions: A synthetic cortical bone thickness of 2mm and pull forces applied parallel to the long axis of TADs resulted in the greatest resistance to pull-out.
Dentistry | Orthodontics and Orthodontology
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