Original Article

Insertion Torque of Orthodontic Miniscrews According to Changes in

Shape, Diameter and Length
Seon-A Lima; Jung-Yul Chab; Chung-Ju Hwangc

ABSTRACT
Objective: To determine the variation in the insertion torque of orthodontic miniscrews according
to the screw length, diameter, and shape.
Materials and Methods: The maximum insertion torque (MIT) was measured using a torque
tester at a constant speed of 3 rotations per minute. Cylindrical and taper type of miniscrews
(Biomaterials Korea Inc, Seoul, Korea) with different lengths, diameters, and pitches were tested.
Results: The results showed that the insertion torque significantly increased with increasing screw
length (P ⬍ .01). In particular, there was a significant increase in torque with increasing screw
length and diameter (P ⬍ .01). An analysis of the serial insertion torque of miniscrews revealed
the cylindrical type screw to have much higher insertion torque at the incomplete screw thread,
while the taper type screw showed a much higher insertion torque at the final inclination part of
the screw thread. The insertion torque was affected by the outer diameter, length, and shape in
that order.
Conclusions: An increase in screw diameter can efficiently reinforce the initial stability of the
miniscrew, but the proximity of the root at the implanted site should be considered.
KEY WORDS: Miniscrew; Insertion torque; Diameter; Length

INTRODUCTION type implant is useful because it is easy to insert and

remove, and can be used for various purposes be-
Securing appropriate anchorage is one of the im-
cause it can be inserted in a wide range of areas.
portant factors in achieving the objectives of orthodon-
However, miniscrews have occasionally been re-
tic treatment. Therefore, many osseointegrated im-
moved due their mobility before or during orthodontic
plants have been used with relative success as stable
treatment. It was reported that miniscrews have a low-
orthodontic anchorages.1–6 However, there are some
er success rate (80%–85% lower) than osseointegrat-
limitations with an osseointegrated implant. It is ex-
ed implants.11–14 Therefore, there is a need to improve
pensive, it requires extensive surgery, it needs consid-
the stability of miniscrews in order to achieve repro-
erable time for osseointegration, and there is limited
ducible treatment results.
area for insertion due to the size of the implant.
The initial stability of a miniscrew is important be-
Many studies on the possibility of using miniscrews
cause most incidences of orthodontic miniscrew failure
as orthodontic anchorage have been carried out with
some success.7–11 It was reported that a miniscrew occur at the early stage.15 The displacement of a
screw can occur due to inflammation as a result of a
poor bone-screw interface,12 but screw factors such as
a
Private Clinic, Seoul 120-752, Korea. the screw diameter, length, pilot hole diameter, and
b
Full-time lecturer, Department of Orthodontics, College of
screw thread form are also believed to be important
Dentistry, Yonsei University, Seoul, Korea.
c
Professor, Department of Orthodontics, College of Dentistry, for their initial stability.16–18
Yonsei University, Seoul, Korea. One of the methods used to predict the initial sta-
Corresponding author: Chung-Ju Hwang, DDS, PhD, Profes- bility of a miniscrew is to measure the insertion torque.
sor, Department of Orthodontics, College of Dentistry, Yonsei The insertion torque is commonly used to evaluate the
University, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752,
Korea mechanical stability of implants including mini-
(e-mail: [email protected]) screws.19–24 Previous studies have shown that a cer-
Accepted: May 2007. Submitted: December 2006.
tain level of insertion torque is necessary in order to
 2008 by The EH Angle Education and Research Foundation, achieve the initial anchorage at the screw and the
Inc. bone interface, and that the insertion torque of mini-

Angle Orthodontist, Vol 78, No 2, 2008 234 DOI: 10.2319/121206-507.1

INSERTION TORQUE OF ORTHODONTIC MINISCREWS 235

length, outer diameter, and shape of the screw, were

examined.

MATERIALS AND METHODS

Experimental Materials
The Ti-6Al-4V ELI miniscrews (Biomaterials) were
used, and the samples were divided into cylindrical
and taper types. The cylindrical type was composed
of a parallel thread along the whole length of tread part
showing different inner and outer diameters and pitch
for each subgroup. The taper type had different ranges
of increasing inner and outer diameter at the end of
the thread part. The prescription of the subgroups was
measured using hyperscope (MF-A1010H; Mitutoyo
Corp, Japan) from 10 samples, and the error range
during the manufacturing procedure was determined
to be within 25 ␮m (Figure 1, Table 1).
Figure 1. Drawing of 1508C and 1508T miniscrews.
In this study, an experimental artificial bone block
(Sawbones; Pacific Research Laboratories Inc, Wash)
was fabricated and used to measure the insertion
torque, as reported by Song et al.27 The E-Glass–filled
screws is an important factor in determining the ap-
epoxy sheets were cut into 1 mm, 1.5 mm, and 2 mm
propriate initial stability of a screw.22,25 Furthermore, it
sizes using a milling machine (NSM-A; Nam Sun Ma-
was suggested that excessive insertion torque, heat at
chine Tools Co Ltd, Seoul, Korea), and attached to
the border between the screw and bone, and mechan-
solid rigid polyurethane foam using an acrylate bond
ical injury can cause degeneration of the bone at the
(Automix; 3M, St Paul, Minn). The dimensions of the
implant-tissue interface.26
blocks (L ⫻ W ⫻ H) were 110 ⫻ 10 ⫻ 10 mm.
Orthodontic miniscrews are used generally to se-
cure anchorage in contemporary orthodontic treat-
Insertion Torque Test
ments. Therefore, there is a need for an objective
method for examining the influences of the morpho- After setting the miniscrew tip to contact the artificial
logic characteristics of miniscrews on the screw sta- bone sample perpendicularly, the rotational axis of the
bility. In this study, a driving torque tester (Biomaterials torque tester was rotated clockwise at a speed of 3
Korea Inc, Seoul, Korea), which provides a constant rotations per minute, and the torque values were re-
rotational speed and vertical force to increase the re- corded every 0.1 second using a computer program
producibility of the experiment, was used to measure (QuickDataAcq, SDK Developer, London, UK) (Figure
the serial torque from the initial phase of implantation 2). To allow sufficient vertical force for the miniscrew
to the end phase. The changes of maximum insertion to perforate the cortical bone, a weight of 470 g was
torque (MIT) for different screw design factor, ie, the attached to the rotational axis of the torque tester, and

Table 1. The Prescription of Screws Tested in This Study (unit: mm)

Measurements
External Internal Total Taper
Type Subgroup Diameter (d1) Diameter (d) Length (l1) Pitch (P) Length (l2)
Cylindrical 1208C 1.15 0.80 8.0 0.50 —
1507C 1.45 1.00 7.0 0.70 —
1508C 1.45 1.00 8.0 0.70 —
1509C 1.45 1.00 9.0 0.70 —
1808C 1.75 1.20 8.0 0.75 —
2008C 2.00 1.20 8.0 0.80 —
2508C 2.50 1.65 8.0 1.00 —
Taper 1506T 1.45 1.00 6.0 0.70 1.51
1507T 1.45 1.00 7.0 0.70 1.94
1508T 1.45 1.00 8.0 0.70 1.94

Angle Orthodontist, Vol 78, No 2, 2008

236 LIM, CHA, HWANG

Figure 2. Graph with diagram of torque tester of 1508C screw on the 1.5 mm cortical bone. Photos show the amount of screw insertion at
each time point.

a dial indicator depth gauge with 1/100 mm of accu- miniscrews were implanted into the artificial bone for
racy was used for precise insertion depth of the mini- each screw design, making a total of 115 miniscrews.
screw. Among the serial values of the insertion torque, A Kruskal-Wallis significance test using SPSS for
the maximum value was recognized as the MIT. Windows (version 12.0) was performed at ␣ ⫽ .05 lev-
To test the two types of miniscrews, miniscrews with el of significance to determine the changes in MIT ac-
an identical width of 1.5 mm (1507C, 1508C, 1509C, cording to the length and width of the miniscrew.
1506T, 1507T, 1508T) were used to measure the MIT
according to the length. The MIT according to the out- RESULTS
er diameter was measured by testing cylindrical type
The Measurement of MIT According to Length of
screws with a length of 8 mm (1208C, 1508C, 1808C,
the Screw
2008C, 2508C). A multiple regression equation on the
MIT was acquired from the variables of shape, exter- In the 1.5-mm thick cortical bone, the MIT value in-
nal diameter, internal diameter, length, taper length, creased with increasing screw length for both the cy-
and pitch. The MIT according to the cortical bone lindrical and taper type screws (Table 2). The serial
thickness was measured while implanting cylindrical insertion torque graph was acquired and matched with
type screws (1508C, 2008C, 2508C) and taper type the expected screw position at the artificial bone using
screws (1506T, 1507T, 1508T) into a cortical bone real time video capture during the installation of the
block, 1.0 mm, 1.5 mm, and 2.0 mm in thickness. Five miniscrew (Figure 3). Part A shows where the screw

Angle Orthodontist, Vol 78, No 2, 2008

INSERTION TORQUE OF ORTHODONTIC MINISCREWS 237

Table 2. Maximum Insertion Torque Depending on Screw Length Table 3. Maximum Insertion Torque Depending on the External Di-
on the 1.5 mm Cortical Bonea ameter of Screws
Max. Insertion Torque (Ncm) Max. Insertion Torque (Ncm)
Length Length
Subgroup (mm) Mean SD P-value Subgroup (mm) Mean SD P-value
1507C 7.0 19.5 0.4 1208C 1.2 16.5 0.4
1508C 8.0 20.9 0.7 0.021* 1508C 1.5 20.9 0.7
1509C 9.0 23.0 0.8 1808C 1.8 31.3 0.2 0.001*
2008C 2.0 51.1 0.3
1506T 6.0 32.6 0.6
2508C 2.5 80.6 1.1
1507T 7.0 35.6 0.9 NS
1508T 8.0 37.3 0.9 a
Sample number ⫽ 5; SD, Standard deviation; Significance de-
termined by Kruskal-Walis test.
a
Sample number ⫽ 5; SD, Standard deviation; Significance de-
* P ⬍ .01.
termined by Kruskal-Walis test.
* P ⬍ .01.

Figure 4. The change of torque depending on the external diameter

of cylindrical type screw on the 1.5 mm cortical bone.

Figure 5. Maximum insertion torque depending on the thickness of

cortical bone.
Figure 3. The change of torque depending on the length of screw
type on the 1.5 mm cortical bone. (A) Cylindrical type screw. (B) dient of the continuous graph increased suddenly as
Taper type screw.
the outer diameter was increased. The changes in MIT
according to the outer diameter were statistically sig-
was drilled into cortical bone in the initial phase. Part nificant (P ⬍ .001).
B shows where the middle cylindrical part of the screw
was implanted. Part C indicates the results of a sud- Multiple Regression Analysis
denly changing inclination where the tapered part of
Multiple regression analysis showed that among all
the screw was implanted (Figure 3). The changes in
torque according to length were significant in the cy- the variables, external diameter, length, and shape
lindrical type (P ⬍ .01). had a significant influence on the MIT (Table 4).

The Measurement of MIT According to Outer The Measurement of MIT According to Cortical
Diameter of the Screw Bone Thickness
The MIT increased with increasing diameter as With all the screws, the MIT increased with increas-
shown on Table 3 and Figure 4. In addition, the gra- ing cortical bone thickness (Table 5, Figure 5). How-

Angle Orthodontist, Vol 78, No 2, 2008

238 LIM, CHA, HWANG

Table 4. Multiple Regression Analysis Between Insertion Torque and Shape, Length, and Diameter of Screws
Unstandardized Standardized
Coefficients Coefficients
Beta SE Beta t P-value
Shape 16.58 13.17 0.41 1.26 0.04*
External diameter 70.26 8.98 1.38 7.83 0.00***
Internal diameter 19.79 16.64 0.24 1.19 0.24
Length 3.21 1.18 0.13 2.73 0.01**
Taper length 1.70 6.97 0.08 0.24 0.81
Pitch ⫺97.01 21.00 ⫺0.61 ⫺4.62 0.09
SE indicates standard error.
* P ⬍ .05; ** P ⬍ .01; *** P ⬍ .001.

Table 5. Maximum Insertion Torque (Mean  SD in Ncm) Depending on the Thickness of Cortical Bone
Cortical Bone Thickness, mm
Subgroup 1.0 1.5 2.0 P valuea
1508C 20.50 ⫾ 0.65 20.91 ⫾ 0.74 22.14 ⫾ 0.76 .088
2008C 42.56 ⫾ 2.60 51.10 ⫾ 0.27 52.41 ⫾ 1.86 .054
2508C 70.47 ⫾ 0.56 80.56 ⫾ 1.11 81.38 ⫾ 0.50 .049*
1506T 29.05 ⫾ 1.71 31.90 ⫾ 0.37 32.55 ⫾ 0.61 .044*
1507T 29.78 ⫾ 1.11 35.64 ⫾ 0.88 37.43 ⫾ 0.50 .027*
1508T 30.68 ⫾ 03.7 37.27 ⫾ 0.92 39.38 ⫾ 1.99 .039*
a
Significance determined by Kruskal-Wallis test.
* P ⬍ .05.

ever, with the exception of 1508C, there were some ing the sample from human cadavers. This challenge
differences between the cortical bone thickness of 1.0 occurs because of the variations in thickness and den-
mm and 1.5 mm, but not between the cortical bone sity of the cortical bone from the site of extraction.
thickness of 1.5 mm and 2.0 mm. Hence, the amount of torque cannot be compared.
There were significant differences in torque between The cortical bone sample used in this study had a
the 2508C and taper type screw according to the density of 1.7 g/cL and 0.64 for cancellous bone.
changes in the cortical bone thickness. As cortical Based on the research by Misch et al,28 the density of
bone thickened, the MIT also increased. In particular, the mandible ranges from 0.85⬃1.53 g/cL, with an av-
there were larger differences in the MIT between 1.0 erage of 1.14 g/cL, which is similar to the density of
mm and 1.5 mm than between 1.5 mm and 2.0 mm. the bone samples used in this study.
Various lengths of cylindrical and taper screw im-
DISCUSSION plants were tested in a 1.5-mm block of bone with var-
The experimental method applied in this study was ious levels of MIT. The results showed that the MIT of
based on the ASTM (American Standard Specification the implant increased with increasing screw length
and Test Methods) F543-02 regulation. The ASTM (Figure 3). In particular, in the cylindrical type, there
F543-02 is a general evaluation of the metallic medical was a significant difference in MIT according to the
bone screw. Therefore, a stretch needs to be applied change in length.
in evaluating the characteristics of the miniscrew in the The cylindrical type required a longer period of time
field of orthodontics. For a more relevant orthodontic to penetrate the bone than the tapered type screw
standard for the miniscrew, this evaluation was carried (Figure 3). This is particularly true when penetrating
out using a 470-g weight connected to the rotational the cortical bone. Although the number of screw
axis, which was fixed with a rotational speed of 3 ro- threads and the shape of the tips were the same in
tations per minute. both types, the reason for the difference might be due
Biomechanical test blocks, which are E-Glass–filled to the morphologic characteristics of the screw that are
epoxy sheets, a mixture of short E-Glass fibers and related to the driver generating a change in torque in
epoxy resin, were used as artificial bone, and solid the same side. However, more research will be need-
polyurethane foam was used as a substitute for hu- ed.
man cancellous bone. It is difficult to test the torque in The graph shows that the torque of the screw im-
vivo, and it was problematic when it comes to extract- plant increased rapidly in the last part of the incom-

Angle Orthodontist, Vol 78, No 2, 2008

INSERTION TORQUE OF ORTHODONTIC MINISCREWS 239

plete thread region of the cylindrical type and the excessive insertion torque results in screw breakage
sloped region for the tapered type. The reason for this or instability caused by bone necrosis at the bone-im-
is that the outside diameter remains constant in the plant interface. However, the high MIT value in this
cylindrical type, while the upper portion of the incom- study was related to the type of screw insertion (non-
plete part (0.5–1 pitch) of the thread widens. The drilling type) and the physical characteristics of the ar-
structure of the tapered type, which consists of a dual tificial bone, which is different from fresh bone.
core diameter, an inside and outside diameter, grad- The removal torque can be used to evaluate the
ually increases, and consists of a sloped portion that miniscrew stability and insertion torque. Chen32 re-
continues to the soft tissue. ported removal torques ⬎0.89 kg cm (8.7 Ncm). The
The changes in diameter were applied only to ex- removal torque was significantly higher in the mandi-
amine the cylindrical type screw. This is because in ble than in the maxilla. In addition, the insertion and
the case of the taper type, the outside diameter, which removal torque was found to be strongly associated
contacts the soft tissue, runs parallel and coexists with with the implant used.33 In this study, the insertion
the region that gradually increases in size. Therefore, torque was used as a factor to evaluate the screw sta-
it is difficult to control both outside factors simulta- bility because the initial stability plays an important role
neously. in the clinical application of a miniscrew.
The change in the outer diameter had the most sig- These results showed that an increase in screw di-
nificant effect on the torque. From this result, it can be ameter can efficiently reinforce the initial stability of the
concluded that the outer diameter of the screw is the miniscrew, but the proximity of the root at the implant-
most influential factor in determining the torque. This ed site should be considered. In addition, the compar-
corresponds to the results from finite element analysis ison of MIT with fresh bone is necessary for the vali-
of the difference in a bone’s stress and distribution ac- dation of experimental design using artificial bone
cording to the screw design. Previous studies reported block, and the clinical trial of long-term stability for dif-
that among the various miniscrew designs, the change ferent screw design, as well as the histological anal-
in diameter caused the greatest change in stress.28–30 ysis from bone-implant interface, are essential for fur-
All the screws showed that the amount of maximum ther research, which make it possible to select a more
implant torque increased with increasing cortical bone suitable screw for clinical use.
thickness.
With the exception of 1508C, there was a larger dif- CONCLUSIONS
ference in the amount of maximum insertion torque
when the cortical bone thickness was changed from • In both types of screws, the maximum implant torque
1.0 mm to 1.5 mm, than when the thickness was increased with increasing screw length.
changed from 1.5 mm to 2.0 mm. This is due to the • The maximum implant torque increased with in-
incomplete thread region of the cylindrical type and the creasing outer diameter.
sloped region of the tapered screw being ⬍1.8 mm. • As the thickness of cortical bone increased the max-
The depressing effect of the tapered part increased imum insertion torque increased. A significant in-
with increasing cortical bone thickness from 1.0 mm to crease of MIT was observed mainly in the taper type
1.5 mm, which is in contrast to the one partially con- miniscrew.
tacting the cancellous bone, showing a rapid increase • These results show that the maximum insertion
in insertion torque. However, when the thickness was torque increased with increasing diameter and
increased from 1.5 mm to 2.0 mm, the contact be- length of the orthodontic miniscrews as well as in-
tween the taper part and the cortical bone did not in- creasing cortical bone thickness.
crease as dramatically, rather the contact area of the • An increase in screw diameter can efficiently rein-
parallel part increased. force the initial stability of miniscrews, but the prox-
Clinically, the MIT increases when the tapered part imity of the root at the implanted site should be con-
of the screw is long and the cortical bone is thick. How- sidered.
ever, there is increased risk of fracture of the cortical
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