Orthodontic Miniscrew Placement in Interradicular Regions using a Chairside Digital CAD-CAM Surgical Guide

Summary

The goal of this protocol is to present a chairside digital workflow that integrates CBCT and CEREC CAD/CAM technology to design and fabricate in-office, biocompatible surgical guides for orthodontic miniscrew placement, enhancing accuracy while eliminating external software and laboratory-dependent procedures.

Abstract

This study aims to introduce a novel chairside digital technique for creating surgical guides to assist in the placement of orthodontic miniscrews. In this clinical validation study, 12 orthodontic miniscrews were placed in six patients using a chairside economical restoration of esthetic ceramics (CEREC) system combined with cone-beam computed tomography (CBCT). A three-dimensional image was generated by integrating CBCT scans with digital dental models acquired via the chairside digital system. The optimal insertion angle and position for orthodontic miniscrews were planned using this image. A surgical guide was then designed in the computer-aided design (CAD) software and manufactured using the computer-aided manufacturing (CAM) system. Preoperative and postoperative CBCT scans obtained from patients were superimposed to compare the angular deviation, entry-point deviation, and endpoint deviation between the planned and actual miniscrew positions. The mean entry-point and endpoint deviations were 2.4 ± 0.7 mm (range: 1.2–3.4 mm) and 2.4 ± 0.6 mm (range: 1.3–3.4 mm), respectively. The mean angular deviation was 3.8° ± 2.3° (range: 0.4°–7.2°). No miniscrew failures were observed during the 6-month follow-up period. This study successfully developed a chairside CAD/CAM-based miniscrew surgical guide method, and its accuracy and stability were preliminarily validated in patients.

Introduction

Orthodontic miniscrews have gained widespread popularity due to their simplicity, rapid insertion, minimal invasiveness, and cost-effectiveness^1,2,3. Despite these advantages, clinical success is often limited by anatomical constraints, variability in operator skill, and the lack of standardized auxiliary tools. One of the most critical challenges remains the precise positioning of miniscrews, as improper placement may result in root damage or compromise bone integrity³.

Surgical guide systems have been widely recognized as ....

Protocol

This study was approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University (KY2022-041-01), and was conducted in accordance with the Declaration of Helsinki and institutional human research guidelines. Written informed consent was obtained from all patients prior to participation and initiation of clinical procedures. Six patients treated between April 2022 and June 2023 at the Department of Orthodontics, Beijing Tiantan Hospital, underwent orthodontic miniscrew placement.

1. Obtaining digital data of the targeted area

1. Acquire intraoral digital models.
   1. Perf....

Results

A total of 12 orthodontic miniscrews were successfully placed in 6 patients in either the buccal or palatal interradicular regions of the posterior maxilla using the digitally fabricated chairside surgical guide. All surgical guides demonstrated stable intraoral seating during the procedure, and no guide fractures or intraoperative complications were observed. Representative clinical images of guide positioning and guided miniscrew insertion are shown in Figure 2A–C.

Discussion

Orthodontic miniscrew implants have gained widespread clinical acceptance because of their minimal invasiveness, ease of insertion, and effectiveness as temporary anchorage devices. Nevertheless, accurate placement remains technically challenging, particularly in interradicular regions where limited bone availability and close proximity to adjacent roots increase the risk of root damage and miniscrew instability⁷. Previous studies have demonstrated that computer-guided surgical approaches can impr.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
CEREC Guide Bloc maxi	Dentsply Sirona	REF 6447093	Resin block used to fabricate surgical guide
CEREC Omnicam	Dentsply Sirona	REF 6390327	Intraoral scanner
CEREC SW 4.4	Dentsply Sirona	REF 6731637	Software used to design miniscrew surgical guide
GALILEOS Implant software v 1.9	Dentsply Sirona	REF 6369503	Software used to superimpose digital dental models and CBCT data
GuideMia V5.0	GuideMia Inc.	https://ai.guidemia.com/downloads/	Software used to acess the accuracy of implant placement
Implant motor	W&H SI-923	REF 00900100	Machine used to place miniscrew
Miniscrew	Ormco	REF 601-0021	Orthodontic anchorage device
Orthophos XG 3D	Dentsply Sirona	REF 6303452	CBCT machine