Reliability and safety of miniscrew insertion planning with the use of lateral cephalograms assessed on corresponding cone-beam computer tomography images

Recently, lateral cephalograms have been proposed for guided miniscrew insertion planning. Therefore, the aim was to assess the reliability and safety of such planning on corresponding cone-beam computer tomography (CBCT) images.

Intraoral scans, lateral cephalograms, and CBCT images of 52 subjects (even sexes distribution), aged 15.1 ± 2.5 years, were included. Miniscrew (n = 104) insertion planning was performed using lateral cephalograms superimposed on the maxillary intraoral scans, while the assessment of their bicortical placement, length in bone, contact with adjacent teeth, incisive canal, and nasal floor perforation was done on corresponding superimposed CBCT images. Moreover, maxillary incisor inclination, crowding, and the maxillary intercanine width were measured.

The overall miniscrew length in bone was 7.2 ± 1.3mm. Bicortical placement was seen in 58.7% of the sample (38.5% of subjects). Incisive canal and nasal floor perforation was seen in 25% and 21.2% of subjects, respectively. No contact of the miniscrew with adjacent teeth was recorded. A negative significant interaction was seen between the miniscrew length in bone, the percentage of total miniscrew length and maxillary anterior teeth crowding (β, -0.10, P = .047 and β, -0.90, P = .006, respectively). Moreover, a positive significant interaction was seen between the incisive canal perforation and maxillary anterior teeth crowding (OR = 1.32, P = .021).

Exclusion of subjects with impacted teeth.

Miniscrew insertion planning using lateral cephalograms, despite being safe in preventing contact with adjacent teeth, is limited in achieving bicortical placement and insufficient in completely avoiding incisive canal and nasal floor perforation.