Journal of the World Federation of Orthodontists 11 (2022) 68–73

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Journal of the World Federation of Orthodontists

journal homepage: www.ejwf.org

Research Article

The association between thread pitch and cortical bone thickness

influences the primary stability of orthodontic miniscrew implants:
a study in human cadaver palates
Chalermporn Budsabong a, Vorapat Trachoo b, Pisha Pittayapat c, Pintu-on Chantarawaratit d,∗
a
Post-graduate student in rescidency program, Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
b
Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
c
Assistant Professor, Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
d
Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand

a r t i c l e i n f o a b s t r a c t

Article history: Objective: The purpose of this study was to mathematically evaluate the influence of variations in thread
Received 13 October 2021 pitch and cortical bone thickness on the maximum insertion torque (MIT) and implant stability (IS) of
Revised 27 November 2021
miniscrew implants (MIs).
Accepted 14 December 2021
Methods: Sixty custom made MIs with a 0.4-, 0.6-, 0.8-, 1.0-, or 1.2-mm thread pitch,12 for each pitch,
Available online 6 January 2022
were randomly placed into the palates of 10 embalmed human maxillae. The MIT was measured with a
Keywords: hand-operated digital torque reader screwdriver with a holding guide, and the IS test was performed using
Miniscrew implants Anycheck. Conebeam computerized tomography was used to measure the cortical bone thickness(CBT) at
Primary stability each MI site. One-way ANOVA, Tukey post hoc test, Pearson’s correlation,and multiple linear regression
thread pitch models were performed using the SPSS program.
Cortical bone thickness Results: The MIT and IS tests demonstrated a pitch-dependent decrease. The pitch had a strong negative
Human study
correlation with MIT and IS, while the CBT had a strong positive correlation with those outcomes. The
association between pitch and CBT significantly influenced MI primary stability. Moreover, a strong corre-
lation was found between MIT and IS.
Conclusions: The MI primary stability, MIT, and IS are strongly influenced by theassociation between MI
thread pitch and CBT.
© 2021 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.

1. Introduction
Miniscrew implants (MIs) are widely used for anchorage during
orthodontic treatment because of their advantages, such as a sim-
ple insertion method, short operation time, low cost, and patients’
acceptance. When used as absolute anchorage, an MI extends the
amount and direction of tooth movement possible, reinforces the
anchorage, and facilitates the mechanics of orthodontic treatment.
However, clinical MI failures, such as displacement and mobility,
Funding: The authors have not declared a specific grant for this research from
any funding agency in the public, commercial or not-for-profit sectors.
Competing interest: Authors have completed and submitted the ICMJE Form for
Disclosure of potential conflicts of interest. None declared.
Provenance and peer review: Not commissioned; Externally peer reviewed.
∗
Corresponding author: Department of Orthodontics, Faculty of Dentistry, Chula-
longkorn University, Bangkok 10330, Thailand.
E-mail address: pintuon@gmail.com (P.-o. Chantarawaratit).
can occur shortly after MI insertion [1]. Therefore, many studies
have investigated how to predict MI stability.
The maximum insertion torque (MIT) and implant stability (IS)
are typically measured to evaluate MI primary stability. These mea-
surements provide important information for predicting the suc-
cess rate of MIs. The optimum MIT relates to the MI retention.
However, excessive MIT is a major cause of bone microdamage and
necrosis leading to MI failure [2]. The IS test, a noninvasive tech-
nique, is usually performed for dental implants and MI stability.
The IS value reflects the mobility of the implant, which is directly
related to its likelihood of failure [3].
MIs are typically loaded immediately. Therefore, the primary
stability of an MI is not a consequence of the process of bone heal-
ing or osseointegration [4]. To resist orthodontic forces, the pri-
mary stability depends on the MI holding power [4,5]. Among bone
characteristics, cortical bone thickness (CBT) is one of the most cru-
cial anatomic factors affecting MI holding power [6–8]. CBT varies
depending on the jaw, bone site, age, and sex of the patient [6,7].

2212-4438/$ – see front matter © 2021 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.ejwf.2021.12.002

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 C. Budsabong et al / Journal of the World Federation of Orthodontists 11 (2022) 68–73
Fig. 1. Specimen preparation. (A) Custom-made 1.5 × 8 mm miniscrew implant with 5 different pitches—from left to right: 0.4-, 0.6-, 0.8-, 1.0-, and 1.2-mm thread pitch. (B)
Half of a cadaver maxilla. (C) Cone beam computerized tomography was used to analyze the cortical bone thickness, using the One Volume Viewer program (Morita, Osaka,
Japan).
Greater CBT was associated with higher MI success rates [9]. In-
creased CBT results in an increased MI–bone interface, resulting in
better stress distribution under orthodontic load [10].
Thread pitch, the distance between 2 threads, controls the linear
advancement distance of the MI after one turn. Variations in pitch
can increase or decrease the bone-to-implant surface area [5,11].
Consequently, thread pitch directly affects the primary stability of
the MI. However, the effect of thread pitch on the primary stability
of MIs remains unclear. Previous studies found that an MI with a
smaller pitch had a higher primary stability compared with a larger
pitch MI [5,12]. In contrast, Cunha et al. [13] and Radwan et al.[14]
reported that MIs with smaller pitches had lower primary stabil-
ity compared with those with larger pitches [13,14]. To date, few
reports are available on the pure effect of thread pitch on MI pri-
mary stability performed with a completely controlled geometric
design.
We hypothesized that the combination of thread pitch and CBT
would influence the primary stability of orthodontic MIs. Thus,
we formulated mathematical models to estimate the weight co-
efficients of these candidate predictors of MI primary stability. In
the present study, MIs were custom-made with 5 different thread
pitches, to isolate the effect of thread pitch variation from that of
other geometric designs on the MIT and IS. The experiments were
performed with MIs 1.5 mm in diameter x 8 mm in length, in em-
balmed human maxillae.
2. Materials and methods
2.1. Miniscrew implant design
MIs were specifically designed (Solid Work program, Dassault
Systèmes, Waltham, MA) and manufactured by a Computer Nu-
merical Control machine (C.C. Autopart, Chachoengsao, Thailand).
MIs with a 0.4-mm, 0.6-mm, 0.8-mm, 1.0-mm, or 1.2-mm pitch
were manufactured, keeping the length, diameter, and thread de-
sign constant (Fig. 1A). The MIs were made of 316 medical-grade
stainless steel (SS); they were 8 mm long, with a major and minor
diameter of 1.5 and 1 mm, respectively. The thread design, a but-
tress reverse thread shape, had 45° leading and 90° trailing angles,
with tapered, sharp-end points.
2.2. Human cadavers
The study protocol was approved by the Human Research Ethics
Committee of the Faculty of Dentistry, Chulalongkorn University,
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69
Thailand (HREC-DCU 2021-012). Ten maxillae were retrieved from
embalmed human cadavers of subjects who donated their bodies
to the Department of Anatomy, Faculty of Dentistry, Chulalongkorn
University, Bangkok, Thailand. The inclusion criteria, modified from
Bourassa et al. [15], were that the whole maxilla specimen was in-
tact and complete, and no palatal torus or any bony pathology was
present. The sex and age of the specimens were not specific re-
quirements due to the limited number of specimens available. The
donors were 5 male and 5 female cadavers with ages ranging from
38 to 92 years at the time of death (average age ± standard devia-
tion: 69.6 ± 15.3 years).
The maxilla was surgically separated from the skull. To facilitate
the accessibility of the IS measuring device, Anycheck (Neobiotech,
Seoul, Korea), to every MI head, the palates were split along the
median palatine suture, and the specimen was separated into left
and right halves. The soft tissue covering the palate was removed
to eliminate variations in soft-tissue thickness. The crowns of the
teeth with a metal restoration or crown were removed, eliminat-
ing any metal that could generate artifacts in the computerized to-
mography imaging. The nasal part of the specimens was partially
embedded in epoxy resin blocks to be stabilized by the specimen
holder, leaving 1 cm clearance from the nasal floor to allow MI
penetration. The palatal surface was placed superiorly for MI place-
ment [15] (Fig. 1B).
The palates of the specimens were measured for their cortical
bone thickness (CBT) using cone beam computerized tomography
(CBCT), using high solution, 90 kV, and 5 mA. The CBT was an-
alyzed by One Volume Viewer (Morita, Osaka, Japan; Fig. 1C). The
MI sites were marked at least 3 mm from the split suture and from
each other.
2.3. MIT, IS, and CBT measurement
Twelve MIs of each thread pitch group—0.4, 0.6, 0.8, 1.0, and
1.2 mm—were randomly inserted at the marked sites (2–5 MIs per
palate specimen). The MIs were self-drilling and were manually in-
serted by one researcher. To replicate the average palatal soft-tissue
thickness, a 1-mm silicone spacer was inserted under each MI head
before insertion [15].
The MIT, IS, and CBT were evaluated on each sample. The MIT
was measured with a hand-operated digital torque reader screw-
driver (MXITA, Zhejiang, China) at a constant speed of 60 rpm and
reported in newton-centimeters (N.cm) at a precision of 0.1 N.cm.
To ensure the perpendicular orientation and reproducibility, the
70 C. Budsabong et al / Journal of the World Federation of Orthodontists 11 (2022) 68–73

Fig. 2. Testing apparatus used for inserting the miniscrew implant (MI) in the cadaver maxillae. (A) Testing apparatus used for MI insertion. (B) Measuring implant stability
of the MI in a cadaver with the Anycheck (Neobiotech, Seoul, Korea) device.

Table 1
The means, standard deviations (SDs), and coefficient of variation (CoV) values of maximum insertion torque (MIT), implant stability (IS), and cortical bone
thickness (CBT) in palatal bones of embalmed human maxillae (n = 12)

Pitch(mm) MIT (N.cm) IS (IST) CBT (mm)

Mean, n SD, n CoV, % Mean, IST SD, IST CoV, % Mean, mm SD, mm CoV, %

0.4 16.1∗ 1.8 11.0 75.47∗ 4.26 5.64 1.34∗ 0.33 24.60
0.6 14.2∗ 2.8 19.6 71.23∗ ,† 3.10 4.35 1.30∗ ,† 0.34 26.14
0.8 13.9∗ 2.6 18.8 74.25∗ 4.80 6.46 1.30∗ ,† 0.24 18.54
1.0 10.0† 2.1 20.8 69.31† 3.48 5.02 1.08∗ ,† 0.24 22.15
1.2 9.1† 2.0 22.1 68.22† 3.29 4.82 0.99† 0.20 20.44

IST, implant stability test value.

∗ ,†
Different symbols indicate a significant difference between groups (P < 0.05).

MIT was measured using a holding guide, designed with 2 parts— Table 2
The correlation coefficients between independent and dependent variables
a specimen holder and a digital torque-reader screwdriver holder
(Fig. 2A). The palate was placed and locked firmly by the holder Variables Pitch MIT IS CBT
to prevent displacement and verify the accuracy of the placement Pitch Pearson Correlation –0.745 –0.504 –0.437
procedure. The screwdriver holder was a roller with a lock that al- Sig. (2-tailed) 0.000 0.000 0.000
lowed free rotation and precise horizontal alignment. The insertion MIT Pearson Correlation –0.745 0.674 0.606
torque was measured along the MI until the entire thread was in- Sig. (2-tailed) 0.000 0.000 0.000
IS Pearson Correlation –0.504 0.674 0.765
serted and the maximum torque was recorded.
Sig. (2-tailed) 0.000 0.000 0.000
To evaluate the micromotion, the IS of each MI was measured 3 CBT Pearson Correlation –0.437 0.606 0.765
times, using an Anycheck device after MI placement (Fig. 2B). The Sig. (2-tailed) 0.000 0.000 0.000
device measured physical mobility of the MIs and converted into Non-zero values are Pearson correlation, significant at the 0.01 level. Zero values
the implant stability test (IST) values. The palate was also fixed by are significance (2-tailed).
a holding guide to minimize its movement. The device tip was po- CBT, cortical bone thickness; IS, implant stability; MIT, maximum insertion
sitioned perpendicular to the long axis of the MI. torque.

2.4. Statistical analysis

The sample size was calculated based on a previous study [16].
One-way analysis of variance (ANOVA) and Tukey post-hoc tests
were used to compare the MIT and IS among the different thread
pitches. Pearson’s correlation values were calculated for the pre-
dictor and the outcome variables. Univariate and multivariate lin-
ear regression models were generated to assess the impact of both
the thread pitch and CBT individually on the MIT and IS. Statisti-
cal analysis was performed using SPSS for Mac statistical software
(version 22.0, IBM, Chicago, IL). The level of significance was set at
0.05.
3. Results
The means, standard deviations (SD), and coefficients of varia-
tion for the MIT and IS are shown in Table 1. The mean MIT ranged
from 9.1 ± 2.0 N.cm (1.2-mm pitch) to 16.1 ± 1.8 N.cm (0.4-mm
pitch). The MIT results demonstrated a pitch-dependent decrease.
The 0.4-, 0.6-, and 8.0-mm groups had a significantly higher MIT,
compared with the 1.0- and 1.2-mm groups.
IS showed a pitch-dependent decrease, except for that in the
0.6-mm group, which was slightly lower than that in the 0.8-mm
group. The highest and lowest IS, 75.47 ± 4.26 and 68.22 ± 3.29
IST, were also found in the 0.4- and 1.2-mm pitches, respectively.
The 0.4- and 0.8-mm pitch groups had a significantly higher IS,
compared with those in the 1.0- and 1.2-mm groups. However, no
significant difference in IS was detected between the 0.6-mm group
and the other groups.
The mean CBT ranged from 0.99 ± 0.2 mm (1.2-mm pitch) to
1.34 ± 0.33 mm (0.4-mm pitch). A significant difference in the
mean CBT was found between only the 0.4- and 1.2-mm pitch
groups.
We determined the correlation coefficients between the inde-
pendent and dependent variables (Table 2). Strong negative corre-
lations, –0.745 and –0.504, were detected between the thread pitch
and the dependent variables, MIT and IS, respectively (P = 0.0 0 0).

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Table 3
Linear regression models presenting the influence of thread pitch and cortical bone thickness (CBT) on maximum insertion torque (MIT) and implant stability
(IS)
Variables Univariable model
R2 β ± SE
MIT Pitch 0.554 –9.029
(1.063)
CBT 0.368 6.973
(1.200)
IS Pitch 0.254 –8.213
(1.849)
CBT 0.586 11.828
(1.306)
SE, standard error; Std Co, standardized coefficient.
In contrast, the CBT demonstrated strong positive correlations with
MIT and IS, of 0.606 and 0.765, respectively (P = 0.0 0 0). Significant
positive correlations were also found between the MIT and the IS
(0.674; P = 0.0 0 0).
Univariable linear regression analysis was used to determine
correlation coefficients (R2 ; P < 0.0 0 0; Table 3). Thread pitch and
CBT were identified as significant predictors for the MIT and IS.
High correlations between predictors (thread pitch: X1 ; and CBT:
X2 ), and outcomes (MIT: Y1 ; IS: Y2 ) were found, with the following
equations:
Y1 = 19.885 + (–9.029) X1 ;
Y1 = 4.304 + (6.973) X2 ;
Y2 = 78.266 + (–8.213) X1 ; and
Y2 = 57.519 + (11.828) X2.
Moreover, the multivariate linear regression analysis revealed
that the MIT and IS values were significantly influenced by the
association between thread pitch and CBT (Table 3). The relative
weight coefficients of pitch and CBT on MIT were –0.593 and 0.347,
respectively. Accordingly, for IS, the relative weight coefficients of
pitch and CBT were –0.209 and 0.674. The equations used to cal-
culate the MIT and IS values with the contribution of thread pitch
and CBT are as follows:
Y1 = 13.626 + (–7.188) X1 + (3.993) X2 ; and
Y2 = 61.940 + (–3.409) X1 + (10.414) X2.
4. Discussion
MI design (e.g., diameter, length, shaft design, flute, surface
treatment, tip, and thread) is essential for its primary stability.
The design of MIs in our study was based on findings in previ-
ous studies [17–20]. The outer diameter and length were 1.5 × 8
mm, respectively, because this size is commonly used for anchor-
age reinforcement in multiple areas, such as the interradicular area,
tuberosity, and palate. The recommended ratio of the outer and in-
ner diameters is 1:0.68; therefore, a 1.0-mm inner diameter was
chosen in this study [20]. The thread was designed with a but-
tress reverse thread shape that provides the greatest pull-out force
[19]. Moreover, the MI tips were designed with a sharp and ta-
pered point that can be inserted by both self-drilling and pre-
drilling techniques. In the present study, all the MIs were success-
fully placed by self-drilling with a hand-operated screwdriver.
Currently, orthodontic MIs are made of 2 types of metal—
stainless steel and titanium alloy (Ti). MIs of these 2 materials
provide the same primary stability, biological response, and micro-
damage, therefore, both materials are suitable for immediate load-
ing in clinical orthodontic treatment [21]. The success rates of each
of these 2 materials are also similar [21,22]. In addition, stainless
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71
Multivariable model
Std Co P R2 β ± SE Std Co P
–0.745 0.000 0.652 –7.188 –0.593 0.000
(1.054)
0.606 0.000 3.993 0.347 0.000
(0.999)
–0.504 0.000 0.621 –3.409 –0.209 0.025
(1.478)
0.765 0.000 10.414 0.674 0.000
(1.401)
steel costs less than titanium alloy [22]. Thus, stainless steel was
chosen as the material for the MI prototypes in the present study.
The influence of thread pitch variation on MI primary stabil-
ity has been evaluated in previous studies [4,5,12,13]. Theoreti-
cally, an MI with a smaller pitch has more bone-to-implant contact
area, and therefore should have a higher primary stability com-
pared with a larger pitch MI [4]. Although some studies have sup-
ported this hypothesis [5,12], others have reported the opposite re-
sults [13,14]. Cunha et al. reported that MIs with a 0.6-mm pitch
had a lower MIT, compared with those with an 0.8-mm pitch [13].
Accordingly, Radwan et al. noted that MIs with a larger pitch had
a higher pull-out force [14].
Two important factors, the MI design and the bone model, were
not completely controlled in most previous studies [11,13,14]. Most
of these used MIs from different manufacturers [11,13]. In addi-
tion to pitch variation, other design features varied considerably.
Therefore, the differences between the MI geometric designs would
impact the primary stability. Brinley et al. custom-made titanium
MIs with 3 different pitches and evaluated the effect of pitch and
flute on their primary stability [5]. Comparing the 0.75-, 1.0-, and
1.25-mm pitches, no significant difference in MIT was detected in
their cadaver study. In contrast, in the present study, the MIs with
5 different thread pitches were custom made, with the other pa-
rameters kept constant. Our results revealed that MIs with smaller
pitches (0.4, 0.6, and 0.8 mm) presented a significantly higher MIT
than those with larger pitches (1.0 and 1.2 mm). This difference
in findings may be a result of the variation in thread pitch in the
previous study being insufficient to demonstrate a significant dif-
ference between pitches [5].
The palatal area is an attractive site for an MI because of its
surgical accessibility, attached mucosa, and adequate bone quality
[15]. In patients with thin buccal cortical bone or sinus pneuma-
tization, the palatal area becomes the first option for an MI site.
Palatal MIs have been used for various purposes, such as maxi-
mum anchorage, distalization of the maxillary dentition, protrac-
tion of posterior teeth, molar intrusion, and miniscrew-assisted
rapid palatal expansion (MARPE) [23]. Palatal MIs can be used to
reinforce many appliances, such as a transpalatal bar, a rapid ex-
pander, or a Pendulum [23]. In addition, a study reported that
palatal MIs have a significantly higher success rate than buccal MIs
[24].
The CBT of the palate can vary from less than 1 mm to 1
cm, depending on the jaw, bone site, and biological factors of the
bone [6,7,15]. The MI sites in the present study were chosen to
be within the recommended areas located in the anterior part of
the hard palate [15], staying 3 mm away from the median pala-
tine suture. In our study, the average CBT in the MI sites was 1.20
± 0.30 mm, which was thinner than those reported in a previous
study [15].
72 C. Budsabong et al / Journal of the World Federation of Orthodontists 11 (2022) 68–73
CBT is critical for MI stability [6–8]. The high density of corti-
cal bone results in greater contact with the MI thread [11]. Greater
bone-to-implant surface area results in greater primary stability.
Miyawaki et al. found that thin CBT was associated with MI mo-
bility [8]. A high MI failure rate was reported when the CBT was
< 1 mm; therefore, a CBT > 1 mm was required for adequate pri-
mary stability [9]. In addition, a strong correlation between CBT
and insertion torque and IS has been reported [25,26]. The higher
the CBT, the higher the MIT and IS that were found [11]. Similarly,
strong positive correlations were found between CBT and MIT and
IS in the present study.
Insufficient MIT affects the retention, whereas excessive MIT
causes microdamage to the bone, followed by bone necrosis and
eventual MI failure [2]. Motoyoshi et al. recommended that the in-
sertion torque be at least 5 N.cm for an MI with a 1.6-mm diameter
[19]. However, an insertion torque above 23.0 N.cm might result in
MI fracture [26]. A smaller pitch increases the bone-to-implant sur-
face area. Therefore, a smaller pitch should increase the MIT [5]. To
achieve sufficient insertion torque and avoid MI fracture, the op-
timum thread pitch is crucial. In our study, a significantly higher
MIT was found in the 0.4-, 0.6-, and 0.8-mm pitch groups, com-
pared with the1.0- and 1.2-mm pitch groups. However, the MIT in
every thread pitch group was in the optimum range.
IS analysis measuring the primary stability of dental implants
and using MI, by quantifying the bone–implant interface stiffness,
are currently the best methods for clinically assessing IS [3,27,28].
High and low IS values are interpreted as high and low stability
of the implant, respectively [25]. Two reliable analysis systems are
commonly used for IS measurement: resonance frequency analy-
sis (RFA) and damping capacity analysis (DCA) [29]. An RFA device
transmits an electromagnetic frequency to the bone-implant inter-
face and interprets the vibration frequency and converts the results
into an Implant Stability Quotient (ISQ), while a DCA system mea-
sures the contact time between the device tip and the implant and
converts the time into the IST values [29]. Recently, a new DCA
device, Anycheck, was introduced. [29]. Unlike an Osstell, an RFA
device used in many previous studies [3,28–30],Anycheck does not
need a connector between the device and MI. In addition to being
practical to use, Anycheck was reported to be an accurate and re-
liable device for IS testing of dental implants [29]. However, in MI
stability testing, little is known about the correlation of this new
device to the primary stability or the factors affecting the IS val-
ues.
In the present study, mathematical models to estimate the
weight coefficients of thread pitch, and CBT for predicting the MI
primary stability were formulated. Multivariate linear regression
analysis was used to determine the weight coefficients of the 2
predictors, possibly influencing the outcomes. The results indicated
that the contributions of pitch and CBT have a great impact on MIT
and IS. Between the 2 predictors, thread pitch has a larger influ-
ence on MIT than does CBT. The coefficients of thread pitch and
CBT were –7.188 ± 1.054 and 3.993 ± 0.999, respectively. In con-
trast, CBT impacted IS more than thread pitch. The coefficient of
CBT was 10.414 ± 1.401, whereas that of the thread pitch was –
3.409 ± 1.478. To obtain the greatest stability and success rate, the
IS should be as high as possible, and the MIT should be in the op-
timal range. Altogether, we should place an MI in a bone area with
thick CBT. Moreover, based on our results, the appropriate thread
pitch that provides the optimal MIT and high IS for a 1.5-mm di-
ameter x 8-mm long MI is 1.0 mm.
The present study has some limitations. Studies in cadavers
have inherent limitations, such as alteration in bone properties af-
ter preservation, and factors related to the cause of death [15].
In addition, because of the limited number of specimens, the sex
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and age at death cannot be controlled. Almost all donors of ca-
davers in every study are senile, and some are middle-aged peo-
ple, who are not the best representation of orthodontic patients
[15,30]. These unavoidable factors might affect the primary stability
and CBT. Moreover, using embalmed human maxillae in the present
study did not completely represent bone biologically or histologi-
cally. Further studies focusing on how the contribution of thread
pitch and CBT impacts the MI primary stability in living animals or
in a clinical study, such as a split-mouth model, are required.
5. Conclusions
In this study, the thread pitch of an MI and CBT were found to
be strong predictors of MI primary stability.
• The association between pitch and CBT significantly influenced
the MIT and IS.
• Pitch had a high negative correlation with the MI primary sta-
bility. Smaller pitch exhibited higher MI primary stability.
• CBT had a high positive correlation with the MI primary stabil-
ity. Higher MI primary stability was found with thicker CBT.
• The MIT and IS tests demonstrated a pitch-dependent decrease.
• A strong correlation between MIT and IS was detected.
Acknowledgements
We express our appreciation to Professor Martin Tyas, Dr. Kevin
Tompkins, and Assist. Prof. Soranun Chantarangsu for their valu-
able suggestions. This work was supported by the Faculty of Den-
tistry, Chulalongkorn University, Bangkok, Thailand (Lecturer Fund-
ing; DRF 62024).
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