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Accuracy of torque-limiting devices for mini-implant removal: an in vitro study

Genauigkeit drehmomentlimitierender Instrumente bei Entfernung von Mini-Implantaten – Eine In-vitro-Studie

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Introduction

Mini-implants, due to their potential for osseointegration, are exposed to torque levels that may cause them to fracture during removal. Thus, it is advisable to control the torque levels applied during mini-implant removal.

Materials and methods

A torque sensor with strain gauges was used to analyze torque-limiting devices for their accuracy in reverse (counterclockwise) operation. Eight devices were tested in this manner, including a group of hand-operated drivers (n=3), a group of battery-operated drivers (n=4), and a mains-operated surgical unit (n=1). Each device was analyzed eight times at each of the various torque levels. Shapiro–Wilk, Kruskal–Wallis H-, and Mann–Whitney U-tests were used to analyze the results.

Results

Most of the various devices revealed significant differences upon comparison. The accuracy of torque control offered by the three hand drivers was clinically acceptable. As two of the four battery-operated drivers did not feature torque limitation in reverse mode, they did not prevent high torque levels from occurring. Likewise, some of the maximum torque levels observed in conjunction with the other two battery-operated drivers and the mains-operated surgical unit exceeded considerably the clinically recommended range of 10–25 Ncm.

Conclusion

Although miniscrews can be removed successfully with hand-operated drivers while limiting torque, we advise against the use of battery-operated drivers or mains-operated surgical units not offering torque limitation in reverse mode.

Zusammenfassung

Einleitung

Aufgrund des Osseointegrationspotenzials von Mini-Implantaten werden diese bei der Entfernung Drehmomenten ausgesetzt, die zur Fraktur des Mini-Implantates führen können. Eine Entfernung der Mini-Implantate unter Kontrolle des applizierten Drehmomentes erscheint sinnvoll.

Material und Methode

Acht Instrumente mit Drehmomentbegrenzung wurden mittels eines Drehmomentsensors mit Dehnungsmessstreifen auf die Genauigkeit der Drehmomentkontrolle im Linkslauf überprüft. Drei Geräte wiesen einen manuellen, vier einen elektrischen Antrieb auf, bei einem Gerät handelte es sich um eine chirurgische Einheit. Die Messungen wurden auf den unterschiedlichen Stufen je Instrument und Stufe acht Mal durchgeführt. Die Auswertung der Ergebnisse erfolgte mittels Shapiro-Wilk-, Kruskal-Wallis-H- sowie Mann-Whitney-U-Tests.

Ergebnisse

Zwischen den einzelnen Instrumenten bestehen zum Großteil signifikante Unterschiede. Die drei Geräte mit manuellem Antrieb wiesen eine klinisch ausreichende Genauigkeit der Drehmomentkontrolle auf. Von den vier elektrischen Geräten verfügten zwei herstellerseitig über keine Drehmomentbegrenzung im Linkslauf und ließen somit hohe Drehmomente zu. Auch die maximal zugelassenen Drehmomente der übrigen elektrischen Geräte sowie der chirurgischen Einheit lagen zum Teil deutlich oberhalb des klinisch zu empfehlenden Bereichs zwischen 10 und 25 Ncm.

Schlussfolgerung

Eine Entfernung von Mini-Schrauben unter Kontrolle des Drehmomentes ist mit manuellen Instrumenten möglich. Elektrische Instrumente oder chirurgische Einheiten ohne Drehmomentbegrenzung im Linkslauf können nicht zur Entfernung von Mini-Implantaten empfohlen werden.

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Acknowledgment

We wish to thank Mr. Kump for fabricating the coupling appliance which was interposed between the torque sensor and contra-angled handpiece in the tests performed. We are also indebted to Günter Witt GmbH, NSK, Promedia, PSM and W&H for kindly providing the screwdrivers used in this study.

Danksagung

Wir danken Herrn Kump für die Herstellung der Kopplungsvorrichtung zwischen Drehmomentsensor und Winkelstückansatz sowie den Firmen Günter Witt GmbH, NSK, promedia, psm und W&H für die freundliche Überlassung der in dieser Studie verwendeten Schrauber.

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Authors and Affiliations

  1. Policlinic of Orthodontics, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

    A. Pauls,  M. Nienkemper & D. Drescher

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  1. A. Pauls
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  2. M. Nienkemper
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  3. D. Drescher
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Correspondence to M. Nienkemper.

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Pauls, A., Nienkemper, M. & Drescher, D. Accuracy of torque-limiting devices for mini-implant removal: an in vitro study. J Orofac Orthop 74, 205–216 (2013). https://doi.org/10.1007/s00056-013-0141-4

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  • DOI: https://doi.org/10.1007/s00056-013-0141-4

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