Clinical analysis of successful insertion of orthodontic mini-implants in infrazygomatic crest

Background: The insertion positions of mini-implant in infrazygomatic crest has been reported, but due to the anatomical variation, the precise location of this site is not clear yet. This study used cone-beam computed tomography (CBCT) to analyze the position and angle of mini-implants successfully inserted in the infrazygomatic crest, with the goal of providing reference data for clinical practice.

Methods: CBCT was used to image 40 mini-implants and their surrounding tissues in adult orthodontic patients who successfully underwent mini-implant insertion in the infrazygomatic crest. The insertion positions and angles of mini-implants were measured, and the thicknesses of buccal and palatal bone adjacent to the mini-implants were also recorded. Then, we proposed the position and implantation angle for infrazygomatic crest insertion. According to the position and angle, the cortical bone thickness and distance to the root of another 54 randomly selected infrazygomatic crests were recorded to verify its feasibility.

Results: In the coordinate system, the implantation position of the 40 successful mini-implants was (-0.4 ± 2, 8.2 ± 2.5) and the implantation angle between the long axis of the mini-implant and horizontal reference plane was 56.4° ± 7.7°. The bone thicknesses on buccal and palatal sides of infrazygomatic crest adjacent to mini-implants were 4.1 ± 2.5 mm and 7.2 ± 3.2 mm, respectively, and the cortical bone thickness was 2.4 ± 0.6 mm. Among 54 infrazygomatic crests, 75.9% of them met the safety and stability requirements. When the implantation height was increased by 1, 2, and 3 mm, the proportions of implants that met requirements for success were 81.5%, 90.7%, and 94.4%, respectively. But, the proportions of eligible implants were limited at implantation angle increases of 5° and 10°.

Conclusions: Using the long axis of the maxillary first permanent molar (U6) as the vertical reference line, mini-implants could be safely inserted in the infrazygomatic crest at a distal distance of 0.4 mm and height of 8.2 mm from the central cementum-enamel junction of U6, with an implantation angle of 56.4°. The success rate increased when the implant height increased, but the proportion of eligible implantation was limited with the increase of implantation angle.