Clinical and radiographic assessment of the association between orthodontic mini-screws and periodontal health

Abstract

Objectives

Proper anchorage control is crucial for predictable tooth movement and preventing inadequate torque during orthodontic treatment. Through clinical and radiographic parameters; this study assesses the association between mini-screws and periodontal health.

Materials and methods

A prospective observational study included 16 systemically healthy non-smoking individuals requiring mini-screws. Mini-screws with a rough, titanium oxide-coated surface were placed. Periodontal assessments (Plaque index, gingival index, probing pocket depth, gingival recession, bleeding on probing, mucosal discomfort, mucosal redness, keratinized tissue width, supracrestal tissue height, and transmucosal soft tissue thickness) were performed at 2nd week and 3 months post-placement. Radiographic evaluations measured distances between mini-screws and adjacent teeth using Image J software.

Results

The study included 13 females and 3 males (mean age 21.9 ± 1.8 years) with 24 mini-screws. Early mini-screw loss was not observed. Significant reductions in site-level Gingival Index and bleeding on probing (p < 0.05) and full-mouth bleeding on probing (p < 0.05) were noted over time. Absence of significant differences was found in mucosal discomfort and redness, keratinized tissue width, or transmucosal soft tissue thickness, but supracrestal tissue height decreased significantly (p < 0.05). Radiographically, significant bone reduction around mini-screws was observed at 3 months, with torque gauge values significantly decreased as well (p < 0.05).

Conclusions

Orthodontic mini-screws can be effectively utilized in orthodontic treatment with proper planning and monitoring. While improvements in gingival health were observed with targeted oral care, the study underscores the need for careful consideration of potential risks to periodontal tissues, such as reductions in supracrestal tissue height and bone levels. A balanced approach that integrates preventive strategies with precise screw placement is essential to maximize the benefits of mini-screws while minimizing potential periodontal complications.

Clinical relevance

While proper oral hygiene can help control inflammation around mini-screw sites, clinicians must also be mindful of potential risks, such as reductions in bone levels and tissue height. Careful patient selection, precise placement, and regular follow-up are crucial to ensure the stability of mini-screws’ stability and to prevent complications, ultimately contributing to better treatment outcomes in orthodontic care.

Trial registration

This study was registered on ClinicalTrials.gov with the registration number NCT06491849 on June 28, 2024.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-024-05136-2.

Introduction

Predictable tooth movement can be achieved with proper anchorage application, while inadequate torque movements can also be prevented [1]. Anchorage control during orthodontic treatment is one of the most crucial factor determining treatment outcomes [1, 2]. Traditionally, anchorage is derived from adjacent teeth and various appliances; however, the utilization of these methods often yields suboptimal responses due to the condition of neighbouring teeth and the patient’s compliance [2]. In recent years, orthodontic screw systems have been developed to attain complete orthodontic anchorage [3]. In contemporary orthodontic treatments, mini-screws have been used to achieve the desired anchorage [2, 4, 5]. These innovations such as mini-screws for anchorage, new materials for braces, or improved treatment planning using digital tools, have led to reduced patient discomfort and accelerated treatment outcomes by minimizing the physical and psychological burden associated with orthodontic treatments on patients.

A recent study indicate that the use of mini-screws in orthodontic therapy has become increasingly common, with estimates suggesting that mini-screws are used in approximately 80–90% of complex orthodontic cases [6]. Orthodontic mini-screws are commonly placed in areas with sufficient bone density, typically in the posterior maxilla and mandible. The buccal interradicular spaces, particularly between the second premolar and first molar, are frequently selected sites due to their ease of accessibility and improved bone quality. The palatal region of the maxilla is also a preferred site when additional stability is required. Site selection is crucial to avoid root damage and ensure the mini-screws’ stability, particularly in areas with thicker cortical bone [7]. This high adoption rate is due to their numerous advantages such as ease of application, cost-effectiveness, biocompatibility, minimally invasive insertion and removal procedures, and independence from patient compliance [8]. Despite these advantages, many patients experience complications, including early mini-screw loss, infections, pain, and swelling, as well as reported disadvantages associated with the risk of periodontal inflammation and development of periodontal disease in the regions where mini-screws are placed, potentially causing harm to adjacent root surfaces [9–11]. Inflammation around mini-screws can also jeopardize the success of orthodontic treatment [2]. Significant increases in bleeding scores and plaque accumulation around mini-screw sites have also been reported [12]. Alharbi et al. have reported that approximately 17.5% of patients experience soft tissue inflammation around mini-screws [8]. Additionally, a higher failure rate in mini-screws placed in areas lacking keratinized tissue, with failure rates reaching up to 30%, has been reported [13]. Moreover, root damage and periodontal ligament issues were observed in 10–15% of cases following mini-screw placement [14].

Current research indicates risks associated with mini-screws for orthodontic anchorage, emphasizing the importance of bone quality, periodontal health, and screw specifications like diameter and length for their stability. The inflammatory process triggering bone resorption around the screw can result in early mini-screw loss both in animal and human clinical studies, occurring in the early stages and before completion of the treatment phases [15, 16]. Therefore, in cases of localized periodontal inflammation and poor oral hygiene, risks related to periodontal disease can arise through the mediation of inflammatory cells during the orthodontic treatment. Furthermore, elevated mediators associated with periodontal inflammation can lead to early loss of mini-screws similar to dental implants. A recent systematic review indicates that complications related to the gingiva, periodontal tissue, and mucous membranes occurred in approximately 20–30% of orthodontic cases involving mini-screws. The rates could range from mild gingival inflammation to more severe periodontal problems, such as periodontitis and mucosal discomfort. In particular, the proximity of the mini-screw to the tooth root significantly impacts the success rate, with incorrect placement leading to a decrease in stability and a higher incidence of periodontal complications [7]. Maintaining optimal periodontal health throughout the mini-implant anchorage phase during orthodontic treatment is important in light of all these factors,.

Despite the presence of studies investigating orthodontic treatment and periodontal health, the evidence on the relationship between mini-screws and periodontal health is scarce [17]. Therefore, the present study aims to assess the relationship between mini-screws and periodontal health through clinical and radiographic parameters.

Materials and methods

Study population and protocol

This prospective observational clinical study included individuals who applied to the Department of Orthodontics, Faculty of Dentistry, Altınbaş University, between 2021 and 2023 (Ethical Committee Approval Number: 2021/49). The inclusion criteria for patients were as follows:

1. Systemically healthy,

2. Non-users of any medication or tobacco products,

3. Those requiring mini-screw placement,

4. Periodontally healthy,

5. Absence of a history of radiotherapy,

6. Currently undergoing orthodontic treatment.

Prior to the study, individuals meeting the inclusion criteria provided their informed consent. All participants underwent professional dental surface cleaning and polishing, followed by oral hygiene education to ensure optimal periodontal conditions. Mini-screw placement was performed two weeks after these procedures to minimize the risk of pre-existing inflammation. Each participant’s periodontal status was carefully evaluated during the placement session, and mini-screws were only applied if no signs of inflammation were observed. As a result, patients were considered periodontally healthy at the time of screw insertion. The first periodontal measurements were collected two weeks post-placement to specifically assess any inflammatory response induced by the mini-screws.

All mini-screw surgeries were performed by an experienced orthodontist. For proper anaesthesia, 2% lidocaine with 1:100,000 epinephrine was administered to the intended insertion site of the screw. Mini-screws with a rough surface, coated with titanium oxide, and with a diameter of 1.6 mm and a length of 7 mm were used (DEWIMED, Germany). The screws were made from a biocompatible titanium alloy and featured a roughened surface through the titanium oxide coating. They also included a self-tapping and self-drilling design, which allowed for placement without pre-drilling. All mini-screws were placed using a freehand approach. Standard control panoramic radiographs were obtained at 2nd weeks post-placement and before mini-screw removal at the 3rd month. Furthermore, at the 2-week and 3-month follow-up sessions, the stability of the mini-screws was measured using a torque gauge (TG). All mini-screws included in the study were removed within 3.5 to 4 months following their placement.

Examined parameters

Comprehensive clinical measurements and evaluations were conducted for all participants at both the 2nd week (T0) and 3rd month follow-up (T1) sessions. These included Plaque Index (PI) [18], Gingival Index (GI) [18], Probing Pocket Depth (PPD), Gingival Recession (GR), Bleeding on Probing (BOP), Mucosal Discomfort (MD), Mucosal Redness (MR), Keratinized Tissue Width (KTW), Supracrestal Tissue Height (STH), and Transmucosal Soft Tissue Thickness (TST). Periodontal clinical measurements of PI, GI, PPD, GR, and BOP were performed both at the full mouth and site-levels. Site-level measurement values were obtained by averaging the clinical parameter values of the two adjacent teeth neighbouring the area where the mini-screw was placed and then dividing the sum by two. GI/PI and PPD/GR scores were calculated by averaging measurements taken from four and six regions of each tooth, respectively, using a UNC 15 periodontal probe. MD assessed using a patient-reported scale, where patients rate their discomfort, categorizing the presence or absence. This subjective measurement was essential for capturing the patient’s experience of pain or irritation around the mini-screw sites. MR was measured clinically by visual inspection of the tissue around the mini-screws. The assessment of the redness is judged by the clinician using a binary approach as presence or absence. STH was measured using a UNC-15 periodontal probe. The measurements were taken by gently inserting the probe into the sulcus or pocket at the site of the mini-screw placement, ensuring consistent angulation and pressure to avoid variability. For STH, the distance from the bone to the gingival margin was recorded as millimeters, while for TST, the thickness of the soft tissue covering the mini-screw was assessed as thick or thin.

The interactions between mini-screws and the bone were assessed using standardized radiographic analysis. Radiographs were standardized by matching specific landmarks, such as screw lengths, on paired panoramic X-rays using the scaling tool in ImageJ software (National Institutes of Health, Bethesda, MD, USA). This allowed for accurate measurements of the distances between the mini-screws and neighboring teeth, as well as the distances from the mesial and distal endpoints of the screws to the crestal bone level, which was used as a constant and reproducible reference point (Fig. 1). The mean values of the mesial and distal measurements were calculated for assessments of crestal bone level. The values closest to the root were used for the tooth-screw distance measurements to better assess the potential impact on adjacent periodontal structures. In light of this information, the primary outcome of our study is to evaluate the impact of periodontal health on the stability of orthodontic mini-screws, with a specific focus on the parameter of gingival inflammation.

Fig. 1.

Radiographic measurements around orthodontic mini-screws. (a)Initial calibration. (b) Initial screw-crest mesial measurement. (c) Initial screw-crest distal measurement. (d) Initial screw-tooth mesial measurement. (e) Initial screw-tooth distal measurement. (f) Follow up calibration. (g) Follow up screw-crest mesial measurement. (h) Follow up screw-crest distal measurement. (i) Follow up screw-tooth mesial measurement. (j) Follow up screw-tooth distal measurement

Intraexaminer calibration and statistical analysis

All measurements in this study were conducted by a single investigator (MSY). To ensure researcher calibration, periodontal clinical measurements and radiographic assessments of 4 orthodontic patients who were not included in the study and had mini-screw placements were repeated at 24-hour intervals. The calibration pertains specifically to the periodontal clinical parameters (PI, GI, PPD, GR, and BOP) as well as the radiographic measurements (distances between the mini-screws and adjacent teeth; and bone level). To ensure reliability, intra-class correlation coefficients (ICC = 0.9) were calculated; with 95% confidence intervals.

Based on previous studies indicating a significant effect of gingival inflammation on mini-screw stability [9–11], the effect size was set as ‘Large’ for our sample size calculation. Using G*Power software (Version 3.1, Heinrich-Heine-Universität Düsseldorf, Germany), with an alpha error probability of 0.05 and a desired power of 0.95, the calculation determined that a minimum of 23 mini-screws would be required to detect a significant effect. To account for potential dropout or variability, a total of 24 mini-screws were included in the study.

All statistical evaluations were performed using IBM SPSS Statistics version 23.0. For the statistical assessment, the normal distribution of the data set was determined using histograms, coefficient of variation, kurtosis/skewness values, detrended q-values, and Shapiro-Wilk tests. The data did not exhibit a normal distribution; Wilcoxon Sign-Rank and Spearman correlation tests were subsequently conducted to identify changes at each time point and correlations of variables. Values with p < 0.05 were considered statistically significant.

Results

A total of sixteen individuals were included in this study. Of these individuals, 13 were female, and 3 were male, with an average age of 21.9 ± 1.8 years. A total of 24 mini-screws were applied to orthodontically treated individuals. Out of the 16 patients, mini-screws were applied unilaterally in 9 patients and bilaterally in 7 patients. A total of 18 mini-screws were placed in the maxilla and 6 in the mandible. Specifically, 8 mini-screws were inserted between the 15th and 16th teeth, 8 between the 25th and 26th teeth, 2 in the 35–36 region, and 1 mini-screw each in the 34–35, 44–45, 45–46, and 46–47 regions. All patients successfully completed their orthodontic treatments without any complications. Throughout this process, no instances of early mini-screw loss were observed.

Gingival index (GI) was chosen as the primary outcome for this study, as gingival inflammation plays a critical role in the stability and success of mini-screws. At the site level, a significant reduction in the GI was observed between T0 and T1 (p < 0.05). This indicates a decrease in gingival inflammation overtime at the sites adjacent to the mini-screws, suggesting that with proper oral hygiene, inflammation can be controlled despite the placement of orthodontic mini-screws. At the full-mouth level, while there was a reduction in the GI from T0 to T1, this decrease did not reach statistical significance (p > 0.05). This may reflect localized improvements in gingival health, specifically around the mini-screw sites, highlighting the importance of targeted oral hygiene in these areas, as presented in Table 1.

Table 1.

Comparison of periodontal clinical parameter measurements over time

Variables	Mean ± Std.Dev.	Median (Min-Max)	P *
PI-SL T0	1.1 ± 0.4	1.2 (0.1-2)	0.512
PI-SL T1	1.2 ± 0.4	1.1 (0.1–2.5)
PPD-SL T0	1.9 ± 0.3	1.9 (1.3–2.6)	0.211
PPD-SL T1	2.2 ± 0.7	2 (1.3–3.9)
GI-SL T0	1.4 ± 0.4	1.4 (0.5-2)	0.016
GI-SL T1	1.1 ± 0.5	1.1 (0-1.9)
GR-SL T0	0 ± 0	0 (0–0)	0.317
GR-SL T1	0.4 ± 0.2	0 (0–1)
BOP-SL T0	55.7 ± 30.4	62.5 (0-100)	0.000
BOP-SL T1	29.7 ± 32.3	12.5 (0-87.5)
PI-FM T0	1.1 ± 0.5	1.1 (0.4–2.8)	0.954
PI-FM T1	1.1 ± 0.4	1.0 (0.2–1.8)
PPD-FM T0	1.7 ± 0.2	1.7 (1.3–2.2)	0.188
PPD-FM T1	1.9 ± 0.4	1.8 (1.3–2.6)
GI-FM T0	1.2 ± 0.4	1.3 (0.6–1.8)	0.092
GI-FM T1	1.1 ± 0.5	1.2 (0.1–1.6)
GR-FM T0	0.0 ± 0.1	0 (0-0.2)	0.673
GR-FM T1	0.1 ± 0.4	0 (0-1.3)
BOP-FM T0	38.7 ± 21.6	38.5 (1.9–66.7)	0.003
BOP-FM T1	29.6 ± 19.4	25.96 (3.9–58.3)

*Wilcoxon Sign Rank Test was used for analysis, and values with p < 0.05 were considered statistically significant

T0: 2nd week after screw placement, T1: 3rd month control, PI: Plaque Index, PPD: Probing Pocket Depth, GI: Gingival Index, GR: Gingival Recession, BOP: Bleeding on Probing Percentages, SL: Site-level, FM: Full-mouth

Other parameters were analyzed as secondary outcomes. BOP showed a significant reduction at both the site level and full-mouth level (p < 0.05), further indicating improvements in periodontal health following mini-screws placement. However, no significant differences were observed in PI, PPD, or GR between T0 and T1 (p > 0.05), (Table 1).

Regarding soft tissue parameters, no statistically significant differences were found in the MD, MR, KTW, and TST parameters (p > 0.05). However, a statistically significant decrease over time was observed in the STH around the mini-screw (Table 2). Regarding the radiographic analysis results, a significant bone reduction around the mini-screw was observed at the 3rd month follow up (p < 0.05). Nonetheless, there was no significant difference in the distance change between the screw and root surface (p > 0.05). Additionally, the TG values exhibited a significant decrease at the 3rd month follow-up (p < 0.05), (Table 3).

Table 2.

Comparison of soft tissue variables around the mini-screw over time

Variables	Mean ± Std.Dev.	Median (Min-Max)	P *
MD T0	0.3 ± 0.5	0.0 (0–1)	0.317
MD T1	0.2 ± 0.4	0.0 (0–1)
MR T0	0.5 ± 0.5	0.0 (0–1)	0.180
MR T1	0.6 ± 0.5	0.0 (0–1)
KTW T0	2.4 ± 1.0	3.0 (0.5–4.5)	0.463
KTW T1	2.5 ± 0.9	2.9 (1–4)
STH T0	2.0 ± 1.0	1.5 (0.5–4.5)	0.038
STH T1	1.5 ± 0.7	1.0 (0.5-3)
TST T0	1.2 ± 0.4	1.0 (1–2)	0.655
TST T1	1.2 ± 0.4	1.0 (1–2)

* Wilcoxon Sign Rank Test was used for analysis, and values with p < 0.05 were considered statistically significant

T0: 2nd week after screw placement, T1: 3rd month control, MD: Mukozal discomfort, MR: Mukozal redness, KTW: Keratinized tissue width, STH: Supracrestal tissue height, TST: Transmucosal soft tissue thickness

Table 3.

Comparison of radiographic measurement and Torque Gauge data over time

Variables	Mean ± Std.Dev.	Median (Min-Max)	P *
TG T0	103.3 ± 23.6	115 (62–140)	0.000
TG T1	63.3 ± 29.0	80 (10–105)
ST T0	3.2 ± 1.7	3.08 (0.6–6.8)	0.501
ST T1	3.1 ± 1.3	3.95 (1.0-4.3)
SC T0	2.2 ± 1.2	2.04 (0.7–4.7)	0.008
SC T1	3.1 ± 1.5	3.26 (0.9–5.3)

* Wilcoxon Sign Rank Test was used for analysis, and values with p < 0.05 were considered statistically significant

T0: 2nd week after screw placement, T1: 3rd month control, TG: Torque gauge, ST: Screw tooth distance, SC: Screw alveolar crest distance

Correlations among demographic, clinical, and radiographic data were evaluated. With increasing age, both PI and GI values increased around the mini-screw as well as full-mouth (r: 0.4). As the location of the mini-screw placement progressed toward the posterior region, the gingival phenotype thickened while STH decreased (r: -0.4), and as the distance between the implant and the tooth root decreased, MD increased (r: -0.6). A strong correlation (r: -0.6) was observed between the increase in MR and the decrease in TG values over time. A moderate correlation was observed between increase in KTW, and the decrease in BOP (site/full mouth level), and the decrease in GR (r: -0.5). The initial placement torque of the mini-screw was found to enhance screw stability (r: 0.6), and as screw torque increased, MD and MR decreased (r: -0.5). Additionally, a reduction in the distance between the screw and root surfaces was associated with a site-level increase in PI (r: -0.5).

Discussion

Present study revealed that the use of orthodontic mini-screws has a significant impact on periodontal health, particularly concerning gingival inflammation and alveolar bone integrity. We observed that with proper oral hygiene protocols and regular follow-ups, the health of periodontal tissues can be maintained, thereby enhancing the stability and success of mini-screws throughout orthodontic treatment. These findings align with, and contribute to, existing research, which has highlighted the importance of periodontal health in ensuring the effectiveness of mini-screw anchorage. However, our study further underscores the critical need for pre-treatment periodontal assessments, which have not been sufficiently emphasized in the current literature. By addressing this gap, our research provides new insights into optimizing orthodontic outcomes and minimizing complications associated with mini-screws.

One of the most significant considerations in the application of mini-screws is their impact on periodontal tissues. Moeini et al. demonstrated that orthodontic mini-screws do not significantly alter periodontal indices in teeth adjacent to the mini-screw compared to control teeth, suggesting minimal adverse effects on periodontal health [17]. This aligns with our observations, which underscore the potential of mini-screws as a reliable anchorage method without posing significant risks to periodontal tissues. Also, no research has been conducted that the radiographic assessment conducted in our study could be compared to.

Mini-screws’ success as anchorage devices depends on various factors, including their design, placement, and the patient’s bone quality. Park et al. highlighted that screw implant success rates were influenced significantly by mobility, jaw placement, and inflammation [19]. This resonates with our findings, where we note that inflammation around mini-screws can jeopardize orthodontic treatment success and potentially induce early mini-screw loss.

Guidelines for optimal placement and design of mini-screws are crucial for enhancing their success rate. The literature provides valuable insights into these aspects. For instance, recommendations for allowing a healing period before loading mini-screws and considering placement torque to ensure stability are particularly relevant [3]. This is in line with Wilmes et al., who emphasized the role of implant site preparation and compact bone thickness in achieving primary stability of mini-implants [16]. The mini-screws placed in this study were positioned per the literature mentioned above.

Motoyoshi et al. shed light on the long-term stability of mini-implants, underscoring the significance of factors such as placement torque, age, and cortical bone thickness [15]. Their study concluded that a torque of 4 N cm is indicative of sufficient anchorage capability. This finding is vital for orthodontists in calibrating the force applied during mini-screw placement, thereby minimizing the risk of periodontal damage.

The significance of precise screw placement in orthodontics is important. For instance, Motoyoshi et al. emphasize the necessity of considering bone quality and anatomy for optimal placement [15]. Wilmes supports this by highlighting the need for careful pre-operative planning and skilful execution [16]. These studies indicate the idea that success in using mini-screws largely depends on the practitioner’s expertise and a tailored approach to each patient’s unique anatomical characteristics. The expertise of the surgeon plays a significant role in ensuring proper placement, minimizing risks such as root damage, and reducing the likelihood of complications such as inflammation or early mini-screw loss. Studies have shown that improper placement, often due to inexperience, can significantly increase the risk of adverse effects, including screw failure and damage to adjacent structures [7]. To address the challenges identified in previous studies, this research employs an experienced orthodontist for mini-screw application, aligning with the literature.

Studies have demonstrated that digitally planned insertion guides offer superior accuracy compared to traditional freehand methods. For example, research has shown that the use of CAD/CAM-designed guides significantly reduces angular deviations and insertion depth errors, which are critical factors in ensuring the stability and effectiveness of mini-screws. This reduction in errors not only improves clinical outcomes but also minimizes the potential for patient discomfort and complications [20, 21]. However, in our study, prior to placement, periapical radiographic analysis was conducted to meticulously evaluate the bone structure and anatomical features, aiming to replicate the success rates documented in the literature. Additionally, the mini-screws in our study were placed in the buccal region. With the knowledge that the buccal region typically provides sufficient visibility and accessibility for accurate placement, especially when performed by a skilled practitioner.

The changes observed in gingival tissue and bone levels, despite improved oral hygiene highlight, the localized effects of mini-screw placement. Given that all participants were periodontally healthy at the onset of the study and received thorough oral hygiene instructions, the observed changes are likely a response to the presence of the mini-screws rather than pre-existing conditions. This emphasizes the need for careful monitoring of periodontal health following mini-screw insertion, even in patients with good oral hygiene practices. These findings should be interpreted with caution, considering the study’s design and the absence of baseline measurements prior to the two-week post-placement mark.

While our study demonstrates that mini-screws can be effective in maintaining periodontal stability in the short term, it is important to consider potential long-term effects. Previous studies have suggested that the prolonged use of mini-screws may lead to changes in bone levels due to continuous mechanical stress and bone remodelling [22]. Additionally, the long-term stability of mini-screws may be influenced by factors such as insertion depth and the quality of the surrounding bone [15]. These findings suggest that although initial improvements in periodontal parameters are promising, further research with extended follow-up periods is necessary to fully understand the potential risks and benefits of mini-screw use over time.

This study has several limitations that must be considered. The potential influence of the Hawthorne effect, where participants might have improved their oral hygiene simply because they knew they were being observed, could have led to an overestimation of the treatment’s effectiveness. The use of panoramic radiographs for linear measurements may have introduced distortion due to inherent projection errors, which may affecting the accuracy of certain measurements. Additionally, the relatively small sample size may limit the generalizability of the findings. Finally, the lack of long-term follow-up restricts our ability to assess the durability of the observed improvements in periodontal health, indicating a need for further research to confirm these results over a more extended period.

In conjunction with the reviewed literature, our study suggests that while mini-screws are a promising orthodontic anchorage tool, their success hinges on careful consideration of various factors, including placement technique, patient-specific variables, and meticulous management of periodontal health. Future research should aim to refine these techniques and explore new methodologies to mitigate risks, enhance patient comfort, and improve treatment outcomes.

Conclusions

This study highlights the significant impact of orthodontic mini-screws on periodontal health, particularly with regard to gingival inflammation and alveolar bone integrity. Our findings demonstrate that with proper oral hygiene and consistent follow-up, the health of periodontal tissues can be maintained, enhancing the stability and success of mini-screws during orthodontic treatment. Gingival inflammation, as measured by the gingival index, showed a marked reduction over time, indicating the effectiveness of targeted oral care. However, the observed reduction in supracrestal tissue height and bone levels around the mini-screws underscores the importance of careful planning, correct placement, and ongoing monitoring to prevent complications. While the study provides valuable insights, further research, particularly with larger samples and longer follow-up periods, is essential to understand to the long-term effects of mini-screws on periodontal tissues fully and to optimize their use in clinical practice.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

MSY, PAU, IO have been involved in data collection and data analysis. MSY and AA have been involved in data interpretation, drafting the manuscript and revising it critically and have given final approval of the version to be published.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethical approval

This study was approved by Altınbas University Ethics Committee of Clinical Research (Dated 04/03/2021, Acceptance number: 2021/49) with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants who took part in the study.

Competing interests

The authors declare no competing interests.