Assessment of Miniscrew Stability and Bone Response Using Titanium-Zirconium Hybrid Alloys with Nanostructured Surfaces, a Systematic Review and Meta-Analysis Perspective

Rania A.  Sharif; Amna Mehwish  Ikram; Ghazala  Suleman; Amna Batool  Ehsan

doi:10.51253/pafmj.v76iSUPPL-10.14122

Authors

Rania A. Sharif Department of Dental, College of Dentistry, King Khalid University, Abha, KSA
Amna Mehwish Ikram Department of Dental, School of Dental Sciences, University Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
Ghazala Suleman Department of Dental, College of Dentistry, King Khalid University, Abha, KSA
Amna Batool Ehsan Department of Dental, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-10.14122

Keywords:

Biomechanical Phenomena, Orthodontic Anchorage Procedures, Orthodontic Appliance Design, Titanium, Zirconium.

Abstract

Objective: The purpose of this systematic review and meta-analysis was to determine the effects of titanium-zirconium hybrid alloy miniscrew surface modifications on clinical failure and removal torque, as well as their impact on orthodontic patient stability and bone response.

Data Sources: PubMed, Scopus, Web of Sources, and Google Scholar were searched in November 2025.

Study Selection: Eligible studies were clinical and experimental studies which involve randomized controlled trials, cohort studies, and animal models that evaluated miniscrew surface-treated and untreated implants or other treated implants and reported clinical failure or removal torque.

Data Extraction: Two reviewers extracted data separately on the study design, sample size, implant material/surface treatment, location of insertion, loading protocol, primary outcomes, and duration of follow-up. The Cochrane RoB-2, NOS, or SYRCLE tools were used to assess the risk of bias according to the suitable tool, and the certainty of evidence was determined with the help of GRADE.

Data Synthesis: A total of 12 studies were used. Meta-analysis indicated no statistically significant difference in clinical failure between surface-treated and untreated miniscrews (pooled OR= 0.54, 95% CI: 0.11-2.67), but surface-treated miniscrews presented a significantly higher removal torque (pooled SMD= 1.16, 95% CI: 0.70-1.63). The heterogeneity was strong in terms of outcomes, and sensitivity analyses helped in defending the strength of the results.

Conclusion: Surface modification of miniscrews improves mechanical stability, which is measured in removal torque; however, failure rates are multifactorial. To optimize design, location, and clinical procedures, standardized, longitudinal studies are needed.

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References

1. Hsin-Chung Cheng J, De-Shing Chen D, Tan Y, Hu H-T. Factors associated with usage frequency and pricing of temporary anchorage devices among orthodontists. J Dent Sci 2024; 19(1): 404–410. https://doi.org/10.1016/j.jds.2023.07.033

2. Patel KS, Parmar I, Digumarthi UK, Parmar J, Quraishi A, Patel K, et al. Temporary Anchorage Device: A Narrative Review. Cureus 2025; 17(4): e81617.

https://doi.org/10.7759/cureus.81617

3. Figueiredo AL, Travassos R, Nunes C, Ribeiro MP, Santos M, Iaculli F, et al. Surface Treatment of Dental Mini-Sized Implants and Screws: A Systematic Review with Meta-Analysis. J Funct Biomater 2024; 15(3): 68. https://doi.org/10.3390/jfb15030068

4. Gogheri MS, Kasiri-asgarani M, Bakhsheshi-rad HR, Ghayour H, Rafiei M. Mechanical properties, corrosion behavior and biocompatibility of orthopedic pure titanium−magnesium alloy screw prepared by friction welding. Trans Nonferrous Met Soc China 2020; 30(11): 2952–2966.

https://doi.org/10.1016/S1003-6326(20)65434-6

5. AlRafee A, Saleh Alanazi Y, Hayfa KB, Saif Saad Alqahtani A, Alwadie NS. Dental implants: modern materials and methods of their surface modification: narrative review. J Int Crisis Risk Commun Res 2024; 7(S4): 149.

https://doi.org/10.63278/jicrcr.vi.2529

6. Sotova C, Yanushevich O, Kriheli N, Grigoriev S, Evdokimov V, Kramar O, et al. Dental implants: modern materials and methods of their surface modification. Materials 2023; 16(23): 7383. https://doi.org/10.3390/ma16237383

7. Shukla J, Sharma N, Chitlangia K, Ansari S, Patel D, Hamid S. Effect of acid etching and sandblasting on the osseointegration potential of implants. Bioinformation 2025; 21(4): 862–865.

https://doi.org/10.6026/973206300210862

8. Akbulut Y, Ozdemir S. Optimizing Miniscrew Stability: A Finite Element Study of Titanium Screw Insertion Angles. Biomimetics 2025; 10(10): 650.

https://doi.org/10.3390/biomimetics10100650

9. Romasco T, De Bortoli Jr N, Paulo De Bortoli J, Jorge Jayme S, Piattelli A, Di Pietro N. Primary stability evaluation of different morse cone implants in low-density artificial bone blocks: A comparison between high-and low-speed drilling. Heliyon 2024; 10(15): e35225.

https://doi.org/10.1016/j.heliyon.2024.e35225

10. Rosso C del, Poli PP, Ghizzoni M, Caprioglio A. Clinical Management of Orthodontic Miniscrew Complications: A Scoping Review. Dent J 2025; 13(12): 582.

https://doi.org/10.3390/dj13120582

11. Varut RM, Trasca D-M, Stoica GA, Sirbulet C, Arsenie CC, Popescu C. Animal Models as Foundational Tools in Preclinical Orthopedic Implant Research. Biomedicines 2025; 13(10): 2468.

https://doi.org/10.3390/biomedicines13102468

12. Domínguez-Oliva A, Hernández-Ávalos I, Martínez-Burnes J, Olmos-Hernández A, Verduzco-Mendoza A, Mota-Rojas D, et al. The Importance of Animal Models in Biomedical Research: Current Insights and Applications. Animals 2023; 13(7): 1223.

https://doi.org/10.3390/ani13071223

13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol 2021; 74(9): 790–799.

https://doi.org/10.1016/j.rec.2021.07.010

14. Cochrane Bias Methods Group. RoB 2: A revised Cochrane risk-of-bias tool for randomized trials. [Internet]. Available at:

https://methods.cochrane.org/bias/resources/rob-2-revised-cochrane-risk-bias-tool-randomized-trials. [Accessed on October 23, 2025]

15. Meta-Analysis Online. Meta-Analysis Online statistical tool. [Internet]. Available at:

https://metaanalysisonline.com/. [Accessed on October 19, 2025]

16. Park H-J, Choi S-H, Choi YJ, Park Y-B, Kim K-M, Yu H-S. A prospective, split-mouth, clinical study of orthodontic titanium miniscrews with machined and acid-etched surfaces. Angle Orthod 2019; 89(3): 411–47.

https://doi.org/10.2319/031618-211.1

17. Ravi J, Duraisamy S, Rajaram K, Kannan R, Arumugam E. Survival rate and stability of surface-treated and non-surface-treated orthodontic mini-implants: a randomized clinical trial. Dent Press J Orthod Dental Press Int 2023; 28(2): e2321345.

https://doi.org/10.1590/2177-6709.28.2.e2321345.oar

18. Topouzelis N, Tsaousoglou P. Clinical factors correlated with the success rate of miniscrews in orthodontic treatment. Int J Oral Sci 2012; 4(1): 38–44. https://doi.org/10.1038/ijos.2012.1

19. Manni A, Cozzani M, Tamborrino F, De Rinaldis S, Menini A. Factors influencing the stability of miniscrews. A retrospective study on 300 miniscrews. Eur J Orthod 2011; 33(4): 388–395.

https://doi.org/10.1093/ejo/cjq090

20. Sousa-Santos P, Sousa-Santos S, Oliveira AC, Queirós C, Mendes J, Aroso C, et al. Evaluation of Orthodontic Mini-Implants’ Stability Based on Insertion and Removal Torques: An Experimental Study. Bioengineering 2025; 12(5): 549.

https://doi.org/10.3390/bioengineering12050549

21. Palone M, Darsiè A, Maino GB, Siciliani G, Spedicato GA, Lombardo L. Analysis of biological and structural factors implicated in the clinical success of orthodontic miniscrews at posterior maxillary interradicular sites. Clin Oral Investig 2022; 26(4): 3523–3532.

https://doi.org/10.1007/s00784-021-04321-9

22. Suzuki EY, Suzuki B. Placement and removal torque values of orthodontic miniscrew implants. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2011; 139(5): 669–678.

https://doi.org/10.1016/j.ajodo.2010.11.017

23. Kim HJ. Influence of late removal after treatment on the removal torque of microimplants. Korean J Orthod 2022; 52(3): 201–209.

https://doi.org/10.4041/kjod21.217

24. Moghaddam SF, Mohammadi A, Behroozian A. The effect of sandblasting and acid etching on survival rate of orthodontic miniscrews: a split-mouth randomized controlled trial. Prog Orthod 2021; 22(1): 2.

https://doi.org/10.1186/s40510-020-00347-z

25. Romanec CL, Panaite T, Zetu IN. Dimensions Define Stability: Insertion Torque of Orthodontic Mini-Implants: A Comparative In Vitro Study. J Clin Med 2025; 14(5): 1752.

https://doi.org/10.3390/jcm14051752

26. Bayani S, Masoomi F, Aghaabbasi S, Farsinejad A. Evaluation of the Effect of Platelet-Released Growth Factor and Immediate Orthodontic Loading on the Removal Torque of Miniscrews. Int J Oral Maxillofac Implants 2016; 31(2): 471–477.

https://doi.org/10.11607/jomi.4288

27. Choi S-H, Jang S-H, Cha J-Y, Hwang C-J. Evaluation of the surface characteristics of anodic oxidized miniscrews and their impact on biomechanical stability: An experimental study in beagle dogs. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod 2016; 149(1): 31–38.

https://doi.org/10.1016/j.ajodo.2015.06.020

28. Bungau TC, Marin RC, Țenț A, Ciavoi G, Bungau TC, Marin RC, et al. Temporary Anchorage Devices in Orthodontics: A Narrative Review of Biomechanical Foundations, Clinical Protocols, and Technological Advances Appl Sci 2025; 15(24): 13035. https://doi.org/10.3390/app152413035

29. Li S, Ni J, Liu X, Zhang X, Yin S, Rong M, et al. Surface characteristics and biocompatibility of sandblasted and acid‐etched titanium surface modified by ultraviolet irradiation: An in vitro study. J Biomed Mater Res B Appl Biomater 2012; 100(6): 1587–1598. https://doi.org/10.1002/jbm.b.32727

30. Łosiewicz B, Osak P, Nowińska D, Maszybrocka J, Łosiewicz B, Osak P, et al. Developments in Dental Implant Surface Modification. Coatings. 2025; 15(1).

https://doi.org/10.3390/coatings15010109

31. Bauer CAJ, Karl PAM, Mielke JM-K, Roser CJ, Lux CJ, Scheurer M, et al. Development and in vitro testing of an orthodontic miniscrew for use in the mandible. J Orofac Orthop Fortschritte Kieferorthopädie 2025; 86(Suppl 1): 100–10.

https://doi.org/10.1007/s00056-024-00560-z

32. Asgharzadeh Shirazi H, Ayatollahi MR, Asnafi A. To reduce the maximum stress and the stress shielding effect around a dental implant–bone interface using radial functionally graded biomaterials. Comput Methods Biomech Biomed Eng 2017; 20(7): 750–759. https://doi.org/10.1080/10255842.2017.1299142

33. Stefano DAD, Arosio P, Capparè P, Barbon S, Gherlone EF, Stefano DAD, et al. Stability of Dental Implants and Thickness of Cortical Bone: Clinical Research and Future Perspectives. A Systematic Review. Materials 2021; 14(23): 7183.

https://doi.org/10.3390/ma14237183

34. Gao X, Fraulob M, Haïat G. Biomechanical behaviours of the bone–implant interface: a review. J R Soc Interface 2019; 16(156): 20190259. https://doi.org/10.1098/rsif.2019.0259

35. Yilanci H, Gezer P. Effects of Common Surface Modifications on the Mechanical Properties of Miniscrews: A Systematic Review. Appl Sci 2024; 14(3): 1314.

https://doi.org/10.3390/app14031314

36. Issa NS, Othman TA, Sleman BM. A comparative radiographic study of bone density changes around titanium implants in the posterior mandible, preoperative, and postoperative. Ann Med Surg 2024; 86(6): 3216–3221. https://doi.org/10.1097/MS9.0000000000002142

37. Aikin M, Shalomeev V, Kukhar V, Kostryzhev A, Kuziev I, Kulynych V, et al. Recent advances in biodegradable magnesium alloys for medical implants: evolution, innovations, and clinical translation. Crystals 2025; 15(8): 671.

https://doi.org/10.3390/cryst15080671

38. Shujaat S, Bornstein MM, Price JB, Jacobs R. Integration of imaging modalities in digital dental workflows: possibilities, limitations, and potential future developments. Dentomaxillofac Radiol 2021; 50(4): 20210268. https://doi.org/10.1259/dmfr.20210268

39. Mezio M, Putrino A, Barbato E, Pandolfi S, Cassetta M, et al. Application of CAD CAM 3D technology in designing a molar distalization device with skeletal anchorage: a case report. Dent J 2024; 12(12): 417.

https://doi.org/10.3390/dj12120417

40. Lafuente Ibáñez de Mendoza I, Marichalar Mendia X, Setién Olarra A, García de la Fuente AM, Martínez Conde Llamosas R, Aguirre Urizar JM. Genetic polymorphisms of inflammatory and bone metabolism related proteins in a population with dental implants of the Basque Country: a case control study. BMC Oral Health 2024; 24(1): 659.

https://doi.org/10.1186/s12903 024 04319 1