ASSESSMENT OF MANDIBULAR BUCCAL SHELF CHARACTERISTICS AS AN OPTIMAL SITE FOR MINI-SCREW INSERTION
DOI:
https://doi.org/10.71000/6qfy5234Keywords:
orthodontics, Cone-Beam Computed Tomography, , Dental Implantation, Mandible, Orthodontic Anchorage Procedures, Skeletal Pattern, South Asian Population.'Abstract
Background: Orthodontic mini-screw implants have revolutionized anchorage strategies, offering enhanced control during complex tooth movements. The mandibular buccal shelf (MBS) is frequently favored for extra-alveolar mini-screw insertion due to its dense cortical bone and anatomical accessibility. However, most available anatomical data stem from non-South Asian populations, limiting direct application in the Pakistani context. Region-specific CBCT-based evidence is essential to ensure safe and effective mini-screw placement aligned with local anatomical patterns.
Objective: To evaluate mandibular buccal shelf bone thickness and apicoronal depth at clinically relevant points across different vertical skeletal patterns in a Pakistani orthodontic cohort using three-dimensional CBCT imaging.
Methods: This cross-sectional study was conducted at the Department of Orthodontics, Islamic International Dental College, Islamabad, from October 2024 to April 2025. A total of 78 orthodontic patients aged 13–30 years were included. High-resolution CBCT scans were analyzed to measure MBS bone depth at 4 mm and 6 mm apical to the cementoenamel junction (CEJ), and bone thickness at 6 mm and 11 mm below the CEJ, bilaterally. Vertical skeletal pattern was determined via mandibular-maxillary angle (MMA), categorized as low (<21°), normal (21–29°), or high (>29°). Data were statistically analyzed using ANOVA and independent t-tests.
Results: The sample had a mean age of 22.67 ± 4.47 years and a mean BMI of 25.04 ± 1.02 kg/m²; 51.3% were male. At 4 mm from the CEJ, bone depth averaged 17.70 ± 1.95 mm (low angle), 17.42 ± 1.99 mm (normal), and 17.60 ± 1.89 mm (high). At 6 mm, depths were 12.30 ± 1.71 mm, 12.38 ± 1.94 mm, and 12.55 ± 1.79 mm, respectively. Bone thickness at 6 mm was approximately 4.67 ± 1.30 mm across groups, increasing to 5.55 ± 1.07 mm at 11 mm. No statistically significant differences were noted by skeletal pattern, gender, or hemiarch (p > 0.05).
Conclusion: The MBS demonstrates consistent bone morphology suitable for mini-screw anchorage in Pakistani patients, regardless of vertical growth pattern or gender. CBCT remains essential for individualized treatment planning and minimizing complications.
References
Gao H, Luo L, Liu J. Three-dimensional finite element analysis of maxillary molar distalization treated with clear aligners combined with different traction methods. Prog Orthod. 2024;25(1):47.
Arqub SA, Gandhi V, Mehta S, Palo L, Upadhyay M, Yadav S. Survival estimates and risk factors for failure of palatal and buccal mini-implants. Angle Orthod. 2021;91(6):756-63.
Vieira CA, Pires F, Hattori WT, de Araújo CA, Garcia-Junior MA, Zanetta-Barbosa D. Structural resistance of orthodontic mini-screws inserted for extra-alveolar anchorage. Acta Odontol Latinoam. 2021;34(1):27-34.
Alhammadi MS, Qasem AAA, Yamani AMS, Duhduh RDA, Alshahrani RT, Halboub E, et al. Skeletal and dentoalveolar effects of class II malocclusion treatment using bi-maxillary skeletal anchorage: a systematic review. BMC Oral Health. 2022;22(1):339.
Chang CH, Lin LY, Roberts WE. Orthodontic bone screws: A quick update and its promising future. Orthod Craniofac Res. 2021;24 Suppl 1:75-82.
Miranda F, Garib D, Silva I, Bastos J, Aliaga-Del Castillo A, Yatabe M, et al. Maxillary protraction anchored on miniplates versus miniscrews: three-dimensional dentoskeletal comparison. Eur J Orthod. 2024;47(1).
Vargas EOA, Lopes de Lima R, Nojima LI. Mandibular buccal shelf and infrazygomatic crest thicknesses in patients with different vertical facial heights. Am J Orthod Dentofacial Orthop. 2020;158(3):349-56.
Roberts WE, Chang CH, Chen J, Brezniak N, Yadav S. Integrating skeletal anchorage into fixed and aligner biomechanics. J World Fed Orthod. 2022;11(4):95-106.
Sarul M, Lis J, Park HS, Rumin K. Evidence-based selection of orthodontic miniscrews, increasing their success rate in the mandibular buccal shelf. A randomized, prospective clinical trial. BMC Oral Health. 2022;22(1):414.
Tian H, Xie C, Lin M, Yang H, Ren A. Effectiveness of orthodontic temporary anchorage devices in canine retraction and anchorage preservation during the two-step technique: a systematic review and meta-analysis. BMC Oral Health. 2020;20(1):278.
Peng J, Lei Y, Liu Y, Zhang B, Chen J. Effectiveness of micro-implant in vertical control during orthodontic extraction treatment in class II adults and adolescents after pubertal growth peak: a systematic review and meta-analysis. Clin Oral Investig. 2023;27(5):2149-62.
de Almeida MR. Current status of the biomechanics of extra-alveolar miniscrews. J World Fed Orthod. 2024;13(1):25-37.
Choi SH, Jeon JY, Lee KJ, Hwang CJ. Clinical applications of miniscrews that broaden the scope of non-surgical orthodontic treatment. Orthod Craniofac Res. 2021;24 Suppl 1:48-58.
Sreenivasagan S, Sivakumar A. CBCT comparison of buccal shelf bone thickness in adult Dravidian population at various sites, depths and angulation - A retrospective study. Int Orthod. 2021;19(3):471-9.
Wang S, Zhao Z, Zhang Q, Liu C. Biomechanical and histomorphometric evaluation of biodegradable mini-implants for orthodontic anchorage in the mandible of beagle dogs. BMC Oral Health. 2025;25(1):516.
Aleluia RB, Duplat CB, Crusoé-Rebello I, Neves FS. Assessment of the mandibular buccal shelf for orthodontic anchorage: Influence of side, gender and skeletal patterns. Orthod Craniofac Res. 2021;24 Suppl 1:83-91.
Sreenivasagan S, Subramanian AK, Nivethigaa B. Assessment of Insertion Torque of Mini-implant and Its Correlation with Primary Stability and Pain Levels in Orthodontic Patients. J Contemp Dent Pract. 2021;22(1):84-8.
Arango E, Plaza-Ruíz SP, Barrero I, Villegas C. Age differences in relation to bone thickness and length of the zygomatic process of the maxilla, infrazygomatic crest, and buccal shelf area. Am J Orthod Dentofacial Orthop. 2022;161(4):510-8.e1.
Chastanet S, Louisy A, Bonnin F, Kulker D, Laure B. Abalakov: Posterior mandibular anchorage technique for orthodontic treatment. J Stomatol Oral Maxillofac Surg. 2020;121(5):575-8.
Patla M, Kumari V, Subrahmanya R, Soans CR, Achalli S. Assessment of mandibular buccal shelf for an ideal miniscrew implantation site using cone-beam computed tomography. Gulhane Med J. 2021;63(1):13-20.
Escobar-Correa N, Ramírez-Bustamante MA, Sánchez-Uribe LA, Upegui-Zea JC, Vergara-Villarreal P, Ramírez-Ossa DM. Evaluation of mandibular buccal shelf characteristics in the Colombian population: A cone-beam computed tomography study. Korean J Orthod. 2021;51(1):23-32.
García-Gonzales LA, Ruiz-García de Chacón VE. Tomographic evaluation of mandibular buccal shelf in patients with different vertical growth pattern. Odovtos-Int J Dent Sc. 2023;25(1):196-208.
Sarul M, Lis J, Park H-S, Rumin K. Evidence-based selection of orthodontic miniscrews, increasing their success rate in the mandibular buccal shelf. BMC Oral Health. 2022;22(1):414.
Yazid ASA, Sukri AAM, Abdullah SM, Alias A. High Angle Cases in Different Types of Skeletal Pattern among Malay Orthodontic Patients. JIDMR. 2022.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Rida Iqbal, Ulfat Bashir Raja, Kanwal Zulfikar, Obaid Ullah (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
