Primary Stability of Orthodontic Titanium Miniscrews due to Cortical Bone Density and Re-Insertion

The increasing demand for orthodontic treatment over recent years has led to a growing need for the retrieval and reuse of titanium-based miniscrews to reduce the cost of treatment, especially in patients with early treatment failure due to insufficient primary stability. This in vitro study aimed to evaluate differences in the primary stability between initially inserted and re-inserted miniscrews within different cortical bone densities. Artificial bone was used to simulate cortical bone of different densities, namely 20, 30, 40, and 50 pound per cubic foot (pcf), where primary stability was evaluated based on maximum insertion torque (MIT), maximum removal torque (MRT), horizontal resistance, and micromotion. Scanning electron microscopy was used to evaluate morphological changes in the retrieved miniscrews. The MIT, MRT, horizontal resistance, and micromotion was better in samples with higher cortical bone density, thereby indicating better primary stability (P < 0.05). Furthermore, a significant reduction of MIT, MRT, and horizontal resistance was observed during re-insertion compared with the initial insertion, especially in the higher density cortical bone groups. However, there was no significant change in micromotion. While higher cortical bone density led to better primary stability, it also caused more abrasion to the miniscrews, thereby decreasing the primary stability during re-insertion.