How To Write Your Medical Research course (Dr. Khames T.

AL Zahrani)

Knowledge and Awareness of Orthodontic

Mini Screws among Dental Students in
Saudi Arabia: a cross sectional study
Name of authors: Huda A.Alnami, Wedad S.Alburaidi, Amjad M.Alasmari,
Wejdan S.Alshamrani, Roba I.Alshahrani , Abdulmalik A.Alqazlan, Sundus
S.Alqarni, Wasan A.Alhussain, Khames T.ALzahrani.

Abstract

TADs have become increasingly popular in the orthodontic sector latest years as
they reduce patient compliance requirements while increasing the number of
treatment alternatives to better meet esthetic and occlusal treatment goals. Mini-
implants obtain anchorage from jawbone, which increases control over orthodontic
tooth movement and helps minimize side effects when treating misaligned teeth.
There is little research on micro-screws, and the majority of them indicate that
dental students are unaware of them. Aim: The aim of this study was to measure
the level of knowledge about orthodontic mini screws among dental students in
Saudi Arabia. Materials and Methods: This study uses a structured questionnaire
that the authors created as part of a cross-sectional study. The population of this
study consists of Saudi dental students (male and female) from all six years of
study and seventh year of internship in all dental colleges in Saudi Arabia. The
Qualtrics calculator was used for estimating the sample size. The survey was used
to gather information from students via Google Form and was then sent around
various dental student groups. Those who answered the questionnaire at the end of
the months of 2023 AD were selected as participants in our study.

Keywords: Mini Implants, Orthodontic Anchorage, Temporary anchorage

devices.

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 How To Write Your Medical Research course (Dr. Khames T. AL Zahrani)

Introduction:

Through the use of force and the conversion of mechanical stimulation into a
biologic reaction, teeth can be moved during orthodontic therapy, It takes either
inter-arch or intra-arch anchoring to produce differential tooth movement. In
orthodontics, anchorage is crucial, and its management is required for the greatest
outcomes [1]. To manage anchoring, orthodontists have employed teeth, intraoral,
and extraoral appliances. However, before the emergence of mini-orthodontic
implants, the field of orthodontics was somewhat unable to resolve this issue [2].

The concept of anchorage refers to stopping unintentional tooth movement. Mini-

implants obtain anchorage from jawbone, which increases control over orthodontic
tooth movement and helps to minimize side effects when malocclusions are
managed [3]. Unlike prosthetic implants, the stability of MIs is primarily derived
from mechanical retention with partial osseointegration, whereas prosthetic
implants indicate full osseointegration [4].

Mini-screws are also known as TADs (Temporary Anchorage Devices), Micro-

implants, or Ortho-implants. With the introduction of TADS, the area of clinical
orthodontics faced a huge change [5]. TADs have been increasingly popular in the
orthodontic sector due to their potential to decrease the requirement for patient
compliance while increasing the number of treatment alternatives to better fit
esthetic and occlusal treatment goals [6].Before the development of mini-implants:
Active distalization, increased anchoring, etc. were performed via extra-oral
traction, and that need significant for patient compliance. Now regardless of the
patient's compliance, a single, continuous force of a mild to moderate size is
produced [7].

Gainsforth and Higley gave the first record idea of skeletal anchorage at (1945)
[8]. first clinical trial was done for correction of severe deep bite by intrusion of
upper incisors using the TAD in the anterior nasal spine, this clinical trial was
given by Creekmore and Eklund (1983) [9]. The approach did not immediately
become popular since it was too soon to try it in a clinical setting without enough
knowledge about reliability or pathophysiology. With the mandibular incisors
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 How To Write Your Medical Research course (Dr. Khames T. AL Zahrani)

protruding 6 mm and a mini-screw (1.2 mm in diameter; 6 mm in length), Kanomi

reported the first successful case in (1997) [10]. Nowadays, orthodontic mini-
implants are used commonly due to their many advantages and variety of treatment
possibilities [11].

In 2020, K. Thirumagal et al. carried out a survey regarding the familiarity and
understanding of orthodontic mini implants among dental undergraduates at
Saveetha University. The findings indicated that 62% of participants were
acquainted with morse taper in implants, while the remaining 38% lacked
awareness of this concept. However, the study had certain constraints, including a
relatively small sample size and a specific focus on morse implant design [12].

A similar study conducted by Abu Al-Melh et al. at Kuwait University revealed

that the survey indicated 65.3% of dental students were educated about orthodontic
Temporary Anchorage Devices (TADs) as part of their undergraduate orthodontic
curriculum. Furthermore, 11.1% of dental students acquired knowledge about
orthodontic TADs through alternative channels like social media and promotional
campaigns. However, this study was limited by the distribution of participants, as
all participants were from one university [13].

A closely related study was undertaken within the Saudi Arabian population.
Published in 2023 by Alotaibi et al. , this study revealed that 61% of the
participants expressed their inadequacy in identifying cases that could benefit from
orthodontic Temporary Anchorage Devices (TADs). Notably, a considerable
proportion of dental students across various academic years advocated for the
incorporation of TADs into the fifth-year curriculum. It is worth mentioning,
however, that certain participants in this study were unable to provide detailed
information about their undergraduate dental curriculum as mentioned by the
author [14].

In Saudi Arabia, the topic of mini implants limited attention, particularly among
students, with previous research predominantly focusing on orthodontists rather
than addressing the students' perspective. Furthermore, existing studies have used

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 How To Write Your Medical Research course (Dr. Khames T. AL Zahrani)

varying sample sizes, resulting in divergent outcomes, while incomplete

questionnaires have hindered a comprehensive understanding of students'
awareness and knowledge. Addressing these limitations through further research
encompassing a broader range of dental students and employing more
comprehensive surveys is essential to gain valuable insights into the topic's
significance and impact within the student community.
Objectives:
The main objective of this study was to measure the knowledge level among
general dental students about orthodontics mini screws in Saudi Arabia.

Materials and Methods:

Study design:
This study will used a structured questionnaire that the authors had created as part
of an across-sectional study questionnaire survey.

Study setting: Participants, recruitment, and sampling procedure:

The population of this study will consist of Saudi undergraduate dental students
(both male and female) from all six years of study and the seventh-year internship
at all dental colleges in Saudi Arabia. Participants will be selected among those
who respond to the questionnaire in September 2023.

Inclusion and Exclusion criteria:

Adult males and females dental students from level 3 to level 14 were included. all
graduated dental students who completed the seventh internship was excluded.

Sample size:
The required sample size was determined to be 384 individuals based on
calculations performed by (Raosoft, Inc., Seattle, WA, USA). This calculation
involved using the provided formula and incorporating means and standard
deviation. The selection of a 95% confidence interval along with a standard
deviation of 1.96 and a maximum acceptable marginal error of 0.05 contributed to

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 How To Write Your Medical Research course (Dr. Khames T. AL Zahrani)

this determination. Thus, the study necessitates a minimum sample size of n=

(1.96)^2 X 0.50 X 0.50 / (0.50)^2, resulting in 384 participants.

Method for data collection and instrument (Data collection

Technique and tools):
The tools used were self evaluation questionnaires developed by Google Forms first to
measure the knowledge and awareness levels of mini implants among dental students in
KSA.

Data collection was done in the form of participants' responses to the questions. the
questionnaire included demographic features such as age, gender level of dental student.

Theparticipants were asked about knowledge of temporary anchorage devices'

advantages, disadvantages, use, and side effects.

Scoring system of knowledge & awareness :

There were nineteen questions in this part and the students were asked regarding
their knowledge and awareness level toward the orthodontic mini-screws in
dentistry. Thirteen questions have two options. A correct answer was given ( 1
score), whereas a ( 0 score) was given for the wrong answer, Four questions have
more than 2 options, but all the answers are wrong it’s carry a (score 0) and only
one is correct and carries a (score 1), just One question has more than one correct
choice and the correct answers of it have (1 score) were as the wrong answer has (0
score). one question had 4 scores ( 0 score) for No knowledge at all,(1 score) for
Poor,(2 score) for Fair, and (3 score) for Well. Total knowledge scores were
categorized into 3 levels based on Bloom’s cut 80 %-100% ( high level),60%-79%
(moderate level ) and ≤ 59% (low level), The scores for knowledge varied from 1
to 22 points, and were classified into three levels as follows: High level ( 18 points
or more.),Moderate level ( 14-17 points), Low level (13 points or less ).

Analyzes and entry method:

software program for Windows (2016). Then, in order to perform a statistical
analysis, the data was transferred to the SPSS application, version 20 (IBM SPSS
Statistics for Windows, Version 20.0 Armonk, NY: IBM Corp.). Data was input
using the Microsoft Excel application for Windows (2016) after being collected.

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The Statistical-Package of Social-Science Software (SPSS) application, version 20,

was then used to import the data. being assessed statistically

References:
1. Journal, MeProfessional T, Dical. Factors affecting success and failure of
orthodontic mini-implants : A retrospective. 2023;30(02):285–91.
2. Daokar S, Shahu C, Shikshan M, Daokar SG, Shahu C, Shikshan M.
Implants in Orthodontics. 2016;(April 2015).
3. Kharadi L. Applications of mini-implants in orthodontics. Int J Appl Dent
Sci. 2021;7(2):558–60.
4. Dasor APDM. Orthodontic Mini Implant: Malaysian perspective. 2022 Jul;
5. Johns G. Orthodontics mini implants – A brief review. Int Dent J Student’s
Res. 2022;9(4):176–80.
6. Ferrillo M, Nucci L, Gallo V, Bruni A. Temporary anchorage devices in
orthodontics : a bibliometric analysis of the 50 most-cited articles from 2012
to 2022 Temporary anchorage devices in orthodontics : a bibliometric
analysis of the 50 most-cited articles from 2012 to 2022. 2023;(May).
7. Swapna D, Ramasamy N. KAP Survey on the Knowledge and the Use of
Temporary Anchorage Devices among Orthodontists. Int J Innov Stud Med
Sci [Internet]. 2019;(October 2020). Available from: www.ijisms.com
8. Ra, Uribe, FlaviNanda R, Yadav S. Temporary Anchorage Devices in
Orthodontics. Tempor Anchorage Devices Orthod. 2020;5:1–330.
9. Jaradat M, Al Omari S. Orthodontic Mini Implants, an Update. EC Dent Sci.
2021;20(10):107–16.
10. Bhattacharjee R, Khan R, Baruah N, Roy BK. Orthodontic mini-implant
success–Analysis and review. IP Indian J Orthod Dentofac Res. 2022 May
28;8(2):79–82.
11. Leo M, Cerroni L, Pasquantonio G, Condò SG, Condò R. Temporary
anchorage devices (TADs) in orthodontics: Review of the factors that
influence the clinical success rate of the mini-implants. Vol. 167, Clinica
Terapeutica. Societa Editrice Universo; 2016. p. 70–7.
12. Thirumagal K, Duraisamy R, Ganapathy D, Maiti S, Thirumagal K,

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Duraisamy R, et al. Awareness About Dental Mini Implants Among

Undergraduate Dental Students. 2022;13(6):454–63.
13. Abu Al-Melh MM, Al-Anzi AN. Knowledge of undergraduate dental students
toward orthodontic skeletal temporary anchorage devices at Kuwait
University. BMC Med Educ. 2020;20(1):1–10.
14. Alotaibi S, Albatil A, Almalki A, Shyagali TR. Knowledge and Perception
Toward Orthodontic Skeletal Temporary Anchorage Devices Among
Undergraduate Dental Students in Saudi Arabia. 2023;310–7.

Appendix 1: Informed consent

Knowledge And Awareness Of Orthodontic Mini Screws

Among Dental Students In Saudi Arabia: A Cross Sectional
Study

Dear participant:

We are a group of academic researchers from several dental schools in

Saudi Arabia. We would like to conduct a study which aims to assess the
level of "Knowledge And Awareness Of Orthodontic Mini Implants
(Screws) among Dental Students in Saudi Arabia".

You are invited to take part in a survey that is run using Google Forms.
filling out the questionnaire will take only a few minutes.

Please be informed that your identity will be completely anonymous and

your participation is voluntary. By completing this questionnaire, you
consent to participate in this study and all information revealed by you
will be kept strictly confidential and will be used only for publication
and scientific purposes.

If there are any dental terms you don't understand, ask the researcher to
define them.

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Your participation is appreciated, thank you for your cooperation.

Appendix 2. Questionnaire

Scoring System of knowledge and awareness level:

- There were 19 questions in our survey except for demographic questions.
- All correct answers will receive score of 1 and all (incorrect or I don't know)
answers will receive score of 0.
- The participants will be divided into three groups based on their scores:

High level ( = 80% or more) : 18 points or more.

Moderate level ( = 60% to 80%) : 14-17 points
Low level ( = 59% or less ) : 13 points or less.

1- Do you agree to join us and answer these questions??

Demographic-pieces of information:

2- age
3- gender
4-Residential area
5-level
6- Have you ever undergone orthodontic treatment?
Yes No
7-Have you ever assisted an orthodontist in the clinic?
Yes No

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Knowledge and awareness:

7- Are you aware of a mini-implant?

Yes – 1 score.
No-0 score

8-During your orthodontic undergraduate education, did anyone give you any
information about orthodontic micro implants?

Yes – 1 score.
No - 0 score
9-How much do you know about micro implants (screws) for orthodontics?
Well – 3 scores.
Fair – 2 scores.
Poor– 1 score.
No knowledge at all – 0 score.
10- What are orthodontic Temporary Anchorage Devices(mini screws)?
Implants for orthodontic treatment – 1 score.
Implants for orthognathic surgeries – 0 score.
I do not know – 0 score.
11-What are the main advantages of using orthodontic micro implants
(screws)?
Tooth replacement – 0 score.
Skeletal anchorage – 1 score.
Soft Tissue anchorage – 0 score
No additional advantage – 0 score.
I do not know – 0 score.
12-Which material is most often used to make orthodontic micro implants
(screws)?
Pure titanium – 1 score.
Titanium and chrome – 0 score.
Titanium and copper – 0 score.
I do not know – 0 score.
13-What potential issues might arise with mini-implants (screws)?
Loosening of the screw – 1 score.
Trauma to the roots and the PDL – 1 score.
Carcinogenicity - 0 score.
Creates gray to black gingival pigmintation – 0 score.
I do not know – 0 score.
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14- Do you think the mini-implants need complete osseointegration?

Yes – 0 score.
No – 1 score.

15- Do you think that mini implants can be used in cases of insufficient
posterior teeth for retracting anterior teeth?
Yes – 1 score.

No – 0 score.
16-Can developing patients with mixed dentition use orthodontic mini-
implants (screws)?
Yes – 0 score.
No – 1 score.
17-Do you think that small implants (screws) cost a lot of money compared to
traditional anchorage devices?
Yes – 0 score.
No – 1 score.
18- In what all situations orthodontic implants are placed?
Closure of extraction spaces, Molar intrusion, Molar mesialization, intrusion of
Incisors – 0 score.
Correction of canted occlusal plane, Molar intrusion, Molar mesialization,

Molar distalization, and Intrusion of incisors – 1 score.

Correction of canted occlusal plane, molar intrusion,molar distalization, intrusion

of
Incisors. – 0 score.

19-Are you learning that mini implants often have a diameter of less than
3mm?
Yes – 1 score.
No – 0 score.
20-does mini-screws (Temporary Anchorage Devices) use as an alternative
to traditional anchorage systems in heavy smoker patients?
Yes – 0 score.
No – 1 score.

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21- does mini-screws (Temporary Anchorage Devices) use as an alternative

to traditional anchorage systems in osteoporosis patients?
Yes – 0 score.
No – 1 score.
22- is there a relationship between insulin-dependent diabetes and failure of
orthodontic mini-implants?

Yes – 1 score.
No – 0 score.
23- Did you consider whether micro-implants, mini-implants, and the mini
screw anchorage system had any disadvantages?
No – 0 score.
yes(reason) – 1 score.
24- From your perspective, which one would you recommend as a source of
anchorage in patients’doubtful cooperation?
Orthodontic implant – 1 score.
Extra oral anchorage – 0 score.
25- One advantage of using a micro-implant is that doctors can apply it in a
patient's mouth without worrying about infection control?
True – 0 score.
False – 1 score.

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