ORIGINAL ARTICLE

Comparison of the loading behavior of

self-drilling and predrilled miniscrews
throughout orthodontic loading
Yu-Chih Wanga and Eric J. W. Lioub
Taipei, Taiwan

Introduction: A predrilled miniscrew, when used as a temporary anchorage device in the infrazygomatic
crest of the maxilla, can be displaced under orthodontic loading. The purpose of this retrospective
cephalometric study was to compare the loading behavior of predrilled and self-drilling miniscrews placed in
the infrazygomatic crest of the maxilla. Methods: The subjects were 32 women who had miniscrews in the
infrazygomatic crest of the maxilla as skeletal anchorage for en-masse anterior retraction and intrusion; 16
had predrilled miniscrews, and 16 had the self-drilling type. The miniscrews were all 2 mm in diameter and
10 to 17 mm long. They were loaded with nickel-titanium closed-coil springs 2 weeks after placement. All the
miniscrews remained stable, without detectable mobility or loosening, throughout the treatment period.
Cephalometric radiographs were taken immediately before force application (T1) and at least 5 months later
(T2). The T1 and T2 cephalometric tracings were superimposed to determine whether any displacement of
the miniscrews had occurred. Results: The predrilled and self-drilling miniscrews were all significantly
displaced in accordance with the force direction of the nickel-titanium coil springs. The amounts of miniscrew
displacement were similar between the predrilled and self-drilling miniscrews, and were correlated to the
length of the loading period. The displacements were 0.0 to 1.6 mm with extrusion, 1.5 mm with forward or
backward tipping at the screw tail, and 1.5 mm with forward tipping at the screw head. Conclusions: The
loading behaviors of predrilled and self-drilling miniscrews were similar in the infrazygomatic crest of the
maxilla. These miniscrews were all subject to displacement under orthodontic loading, and the amount of
the displacement was correlated to the length of the loading period, although they remained stable without
detectable mobility or loosening. (Am J Orthod Dentofacial Orthop 2008;133:38-43)

M
iniscrews have recently been introduced as a
temporary anchorage device in orthodontics
for various purposes, such as canine retrac-
tion, anterior retraction, en-masse anterior retraction,
molar uprighting, distalization, and protraction.1-6 They
have the advantages of small size, more implant sites
and indications, simpler to place surgically and connect
orthodontically, short or even no waiting period, no
need for laboratory work, easier removal after treat-
ment, and lower cost than implants, onplants, or
miniplates.
Two types of miniscrew have been introduced in
orthodontics. The predrilled miniscrew needs a pilot
hole drilled before its placement, whereas the self-
From the Department of Orthodontics and Craniofacial Dentistry, Chang Gung
Memorial Hospital, Taipei, Taiwan.
a
Attending staff.
b
Assistant professor.
Reprint requests to: Eric J. W. Liou, Chang Gung Memorial Hospital,
Department of Orthodontics and Craniofacial Dentistry, 199 Tung-Hwa North
Road, 105 Taipei, Taiwan; e-mail, lioueric@ms19.hinet.net.
Submitted, August 2005; revised and accepted, January 2006.
0889-5406/$34.00
Copyright © 2008 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2006.01.042
38
drilling miniscrew is directly driven into the placement
site without a pilot hole. No matter whether the mini-
screw is predrilled or self-drilling, it remains in the
placement site primarily by mechanical retention in-
stead of osseous integration.1,7 It was reported in an
experimental study that the self-drilling miniscrew has
less mobility and more bone-to-metal contact than the
predrilled miniscrew.8
In a previous clinical study, we showed that
predrilled miniscrews in the infrazygomatic crest of the
maxilla might be subject to displacement under orth-
odontic loads, although they had no clinically detect-
able mobility or loosening.9 However, the loading
behavior of self-drilling miniscrews under orthodontic
loading has not been clear. The hypothesis of this
retrospective study was that both predrilled and self-
drilling miniscrews are not absolute anchorage and are
subject to displacement during continuous static orth-
odontic loading.
MATERIAL AND METHODS
Thirty-two consecutive female patients who had
miniscrews in the infrazygomatic crest of the max-
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 133, Number 1
Fig 1. Examination of the miniscrew for mobility or
loosening. An L-shaped 0.018 X 0.025-in stainless steel
wire was made, and its horizontal leg was inserted into
the mesial opening of the auxiliary tube on the maxillary
first molar; its vertical leg was then adjusted to rest on
the distal aspect of the miniscrew. The miniscrew was
connected to an orthodontic tension gauge with a
ligature wire, and the tension gauge was then pulled
mesially by 400 g of force to detect any miniscrew
loosening from the vertical leg of the L-shaped stainless
steel wire.
illa6,9,10 as the temporary anchorage device for maxil-
lary en-masse anterior retraction and intrusion were
included in this study. Their ages ranged from 18 to 48
years. The inclusion criteria were no systemic or bone
disease and no clinically observed or recorded peri-
miniscrew soft-tissue inflammation, and the miniscrews
remained stable without detectable mobility or loosen-
ing at the beginning (T1) and at least after 5 months of
the maxillary en-masse anterior retraction and intrusion
(T2). The miniscrews were examined clinically at T1
and T2 for mobility or loosening by the method
described in Figure 1.9
All patients signed informed consent for the tem-
porary anchorage devices, the miniscrew placement
procedures, and the risks of failure, irritation, local
inflammation, and miniscrew loosening. The first 16
patients had predrilled miniscrews (Leibinger, Tuttlin-
gen, Germany), and the other 16 patients had self-
drilling miniscrews (LOMAS; Mondeal, Tuttlingen,
Germany).6 The predrilled miniscrews were 2 mm in
diameter and 17 mm in length, and the self-drilling
miniscrews were 2 mm in diameter and 10 to 14 mm in
length (Fig 2).
The miniscrews were all placed under local anes-
thesia. For the predrilled miniscrews, a 2 to 3 mm
vertical incision was made with a #15 surgical blade at
Wang and Liou 39
Fig 2. The self-drilling (left) and predrilled (right) mini-
screws used in this study.
the mucogingival junction above the maxillary second
premolar and first molar. The mucoperiosteal flap was
elevated to expose the infrazygomatic crest of the
maxilla. After locating the turning point of the infrazy-
gomatic crest of the maxilla, a 1.5-mm spiral drill was
used for the pilot hole under normal saline-solution
irrigation. The drilling speed was kept at 500 to 800
rpm. The pilot hole was irrigated thoroughly with
normal saline solution. The miniscrew was then driven
into the pilot hole by using a screwdriver. The wound
was irrigated with normal saline solution thoroughly.
The surgical procedures were performed on both sides.
One week of antibiotics and 2% chlorhexidine mouth
rinse was prescribed, and the patients were instructed to
maintain their oral hygiene. The en-masse anterior
retraction and intrusion began 2 weeks after miniscrew
placement (Fig 3).
The self-drilling miniscrews were placed in a sim-
ilar method as the predrilled miniscrews except that
they were driven directly into the infrazygomatic crest
of the maxilla without a pilot hole. The surgical proce-
dures were performed on both sides. The en-masse ante-
rior retraction and intrusion also began 2 weeks after
miniscrew placement.
Lateral cephalometric radiographs were taken at T1
and T2. All T1 and T2 lateral cephalometric radio-
graphs were traced with a 0.3-mm pencil. The images
of the right and left miniscrews were averaged to
eliminate errors from head posture differences during
x-ray taking.10 The landmark screw tail was the mid-
point between the pointed tips of the right and left
miniscrews, the landmark screw head was the midpoint
between the blunt ends (the end that fits into the
screwdriver) of the right and left miniscrews, and
the landmark screw body was the midpoint between the
40 Wang and Liou
Fig 3. The appliances and mechanics for the en-masse
anterior retraction and intrusion were a 0.016 X 0.022-in
stainless steel basal archwire with incisor palatal root
torque, two 0.017 X 0.025 beta-Ni-Ti lever arms for the
en-masse anterior intrusion, and 2 heavy-force Ni-Ti
coil springs for the en-masse anterior retraction.
screw tail and screw head (Fig 4). The force magnitude
of the nickel-titanium (Ni-Ti) coils (loading force) was
measured and recorded with an orthodontic tension
gauge (Tomy, Tokyo, Japan) at T1, and the angle
between the miniscrew and the Ni-Ti coil spring (force
direction) was measured and recorded on the T1 lateral
cephalogram.
The cephalometric tracings at T1 and T2 were
superimposed for an average best fit among the ana-
tomical structures of the maxilla, the cranial base, and
the cranial vault.11-14 They were registered on sella and
oriented on the anterior cranial base to obtain an
anatomic best fit on the maxilla by using the outline of
the cranial vault for final confirmation.14 A horizontal
reference line through sella was then constructed down
anteriorly 7° to the sella-nasion line, and a perpendic-
ular line through sella was constructed as the vertical
American Journal of Orthodontics and Dentofacial Orthopedics
January 2008
Fig 4. The cephalometric landmarks of screw head,
screw body, and screw tail.
reference line. The intragroup differences of the verti-
cal and horizontal changes of the miniscrews from T1
to T2 of the screw tail, screw body, and screw head
were measured and analyzed by paired t tests (P ⬍.05).
Eight subjects in each group were randomly selected,
traced, superimposed, and measured again 2 months
later for the method error (P ⬍.01).15
The intergroup comparisons of age, loading period,
loading force, and the vertical and horizontal changes
of the miniscrews from T1 to T2 of the screw tail,
screw body, and screw head were analyzed with the
Student t test (P ⬍.05). The miniscrew displacement in
both groups, if any, was correlated to the loading period
(T1-T2), force direction, and loading force magni-
tude at T1 by the Pearson linear correlation analysis
(P ⬍.05). The miniscrew displacement, if any, was
cataloged into certain patterns, such as controlled tip-
ping, bodily movement, and uncontrolled tipping, and
the percentages were calculated accordingly.
RESULTS
The method error showed no significant difference
between the first and second measurements for the
vertical and horizontal changes of the screw tail, screw
body, and screw head (P ⬍.01). The method errors of
the vertical and horizontal measurements ranged from
0.0 to 0.3 mm. The predrilled and the self-drilling
miniscrews were not significantly different by patient’s
age, loading period, and magnitude of the loading force
(Table I).
Both miniscrews showed significant displacement
(P ⬍.05) from T1 to T2, except for the horizontal
measurement of screw tail (Table II). For the predrilled
miniscrews, the tails were extruded and tipped from
⫺1.0 mm backward to 1.5 mm forward; the bodies
American Journal of Orthodontics and Dentofacial Orthopedics Wang and Liou 41
Volume 133, Number 1

Table I. Intergroup comparisons (Student t test, P ⬍.05) of the patient’s age, loading period, and loading force
between the predrilled (n ⫽ 16) and self-drilling (n ⫽ 16) groups
Predrilled Self-drilling

Mean ⫾ SD Range Mean ⫾ SD Range Intergroup comparison

Patient’s age (y) 29.9 ⫾ 9.3 18-48 26.9 ⫾ 7.4 18-48 NS

Loading period (mo) 13.4 ⫾ 6.8 5-26 10.5 ⫾ 3.6 5-17 NS
Loading force (g) 289.2 ⫾ 72.0 200-400 325.9 ⫾ 71.4 200-425 NS

NS, not significant.

Table II. Intragroup (paired t test, P ⬍.05) and intergroup (Student t test, P ⬍.05) comparisons of miniscrew
displacement from T1 to T2 of the predrilled (n ⫽ 16) and self-drilling (n ⫽ 16) groups
Predrilled (mm) Self-drilling (mm)

Mean ⫾ SD Range Mean ⫾ SD Range Intergroup comparisons

Screw tail
Horizontal 0.3 ⫾ 0.7 ⫺1.0-1.5 0.2 ⫾ 0.6 ⫺1.5-1.0 NS
Vertical 0.5 ⫾ 0.5* 0.0-1.5 0.7 ⫾ 0.5* 0.0-1.5 NS
Screw body
Horizontal 0.5 ⫾ 0.5* 0.0-1.5 0.4 ⫾ 0.5* ⫺1.0-1.0 NS
Vertical 0.6 ⫾ 0.4* 0.0-1.5 0.8 ⫾ 0.5* 0.0-1.6 NS
Screw head
Horizontal 0.7 ⫾ 0.6* 0.0-2.0 0.8 ⫾ 0.5* 0.0-1.0 NS
Vertical 0.6 ⫾ 0.4* 0.0-1.5 0.8 ⫾ 0.5* 0.0-1.6 NS

Positive value, forward or downward movement; negative value, backward or upward movement.
*P ⬍.05.
NS, not significant.

Table III. Miniscrew displacement patterns and their percentages of the predrilled (n ⫽ 16) and the self-drilling
(n ⫽ 16) groups from T1 to T2
Predrilled Self-drilling Total (n ⫽ 32)

No displacement 12.5% (2/16) 12.5% (2/16) 12.5% (4/32)

Extrusion and controlled tipping 56.3% (9/16) 31.3% (5/16) 43.8% (14/32)
Extrusion and bodily movement 18.7% (3/16) 37.5% (6/16) 28.1% (9/32)
Extrusion and uncontrolled tipping 12.5% (2/16) 18.7% (3/16) 15.6% (5/32)

were extruded and displaced forward from 0.0 to 1.5
mm; the heads were extruded and tipped forward from
0.0 to 2.0 mm. For the self-drilling miniscrews, the tails
were extruded and tipped from ⫺1.5 mm backward to
1.5 mm forward; the bodies were extruded and tipped
from ⫺1.0 mm backward to 1.6 mm forward; the heads
were extruded and tipped forward from 0.0 to 1.6 mm.
Miniscrew displacement in the predrilled and self-
drilling groups was not significantly different in both
horizontal and vertical displacements (Table II).
Because the displacement in the predrilled and
self-drilling groups was not significantly different, they
were combined (n ⫽ 32) for analyzing the miniscrew
displacement patterns and the Pearson linear correlation
analysis. The miniscrew displacement patterns were
12.5% (4 of 32) with no displacement, 43.8% (14 of 32)
with extrusion and controlled tipping, 28.1% (9 of 32)
with extrusion and bodily movement, and 15.6% (5 of
32) with extrusion and uncontrolled tipping (Table III,
Fig 5). Horizontal displacement was significantly cor-
related to the loading period but not to the magnitude of
the loading force and the force direction (Table IV).
DISCUSSION
Both the predrilled and the self-drilling miniscrews
in this study were not absolutely stationary under
orthodontic loading, although they all remained stable
without clinically detectable mobility or loosening. The
miniscrews were displaced in accordance with the force
direction no matter whether they were predrilled or
42 Wang and Liou American Journal of Orthodontics and Dentofacial Orthopedics
January 2008

Fig 5. Miniscrew displacement patterns (n ⫽ 32, predrilled and self-drilling) under orthodontic
loading F, Force.

Table IV. Pearson correlation coefficients (r) of mini- a continuous process throughout the entire loading
screw displacement from T1 to T2 (n ⫽ 32, predrilled period. It was reported in an experimental study in
and self-drilling) to loading force, force direction, and rabbits that 1 of the 16 endosseous implants (4.0 mm in
loading period diameter) was displaced for 0.5 mm in the first 8 weeks
Loading force Force direction Loading period under 150 g of orthodontic force.16 In this study, the
observed loading period for all the miniscrews was at
Screw tail least 5 months. We were able to determine only the
Horizontal 0.09 0.12 0.36*
cumulative amount of miniscrew displacement after,
Vertical 0.16 0.17 ⫺0.29
Screw body but not before, the fifth month. However, horizontal
Horizontal 0.29 0.25 0.47† miniscrew displacement was significantly correlated to
Vertical 0.22 0.15 ⫺0.26 loading period. The longer the loading period, the more
Screw head miniscrew displacement. This implied that miniscrew
Horizontal 0.19 0.32 0.48†
Vertical 0.16 0.21 ⫺0.24
displacement under orthodontic loading could be a
progressive process throughout the entire loading pe-
*P ⬍.05; †P ⬍.01. riod rather than just a temporary process.
In the maxilla, the most frequent miniscrew place-
ment site is the interdental area,3,4,17,18 although the
self-drilling. The displacement patterns included extru-
sion and controlled tipping, extrusion and bodily move- infrazygomatic crest of the maxilla,1,6,19,20 the area
ment, and extrusion and uncontrolled tipping. How- below the anterior nasal spine,2,21 and the hard palate22
ever, these displacement patterns represented the have been reported. Including this study, the infrazy-
average rather than individual displacement of the right gomatic crest of the maxilla is the only site that has
and left miniscrews. The displacement pattern and been studied for miniscrew displacement under orth-
amount between the left and right miniscrews might not odontic loading.9 The other placement sites have not
be the same in a patient. been studied. Bone density in the interdental areas of
As shown in this study, the predrilled or the the maxilla is less than that in the infrazygomatic crest
self-drilling miniscrew was not a determining factor of of the maxilla.23,24 If bone density is a factor affecting
miniscrew displacement. Neither were the magnitude loading stability, a miniscrew in the interdental area
and the direction of the loading force determining would be subject to displacement under orthodontic
factors. However, without investigating loading forces loading, and its displacement would be even greater
beyond 200 to 425 g, placement sites other than the than the displacement of a miniscrew in the infrazygo-
infrazygomatic crest of the maxilla, and other minis- matic crest of the maxilla.
crew lengths and diameters, it is too early to conclude The displacement of a miniscrew in the infrazygo-
that they have no influence on miniscrew loading matic crest of the maxilla might be not a problem,
behavior. whereas it would be a serious issue if a miniscrew in the
Miniscrew displacement could happen temporarily interdental area is displaced under orthodontic loading
in the earlier or later stage during loading, or it could be and touches adjacent dental roots. Although the dis-
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 133, Number 1
placement of a miniscrew in the interdental area has not
been reported before, this does not mean that it could
not happen. A miniscrew in the interdental area is
usually placed perpendicular to the attached gingiva6 or
30° to 40° to the long axis of the teeth.3,4 With this
angle, any miniscrew displacement in the interdental
area would be hard to see on a lateral or a posteroan-
terior cephalometric radiograph.
If the displacement of a miniscrew under orthodon-
tic loading is a common phenomenon and threatens
adjacent dental roots or vital organs no matter what the
size of the miniscrew, the loading force, and the fixture
design, this would be a serious yet overlooked possi-
bility. For placing a miniscrew in the interdental area, it
was recommended to keep a safety clearance of 2.0 mm
between the miniscrew and the tooth root.9 We make
the same recommendation, according to the findings of
this study that the displacement was ⫺1.5 to 1.6 mm.
CONCLUSIONS
The loading behavior of predrilled and self-drilling
miniscrews was similar in the infrazygomatic crest of
the maxilla. Both types were subject to displacement
under orthodontic loading, and the amount of displace-
ment was correlated to the length of the loading period,
although the miniscrews remained stable without de-
tectable mobility or loosening.
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