European Journal of Orthodontics, 2016, 154–162

doi:10.1093/ejo/cjv017
Advance Access publication 23 April 2015

Original article

Laser-treated stainless steel mini-screw

implants: 3D surface roughness, bone-implant
contact, and fracture resistance analysis
He-Kyong Kang*,**, Tien-Min Chu***, Paul Dechow****,

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Kelton Stewart*****, Hee-Moon Kyung****** and Sean Shih-Yao Liu***** 
*Department of Orthodontics, University of Detroit Mercy School of Dentistry, MI, **Department of Orthodontics
and Oral Facial Genetics, ***Department of Restorative Dentistry, Division of Dental Biomaterials, Indiana University
School of Dentistry, Indiana University-Purdue University, Indianapolis, IN, ****Department of Biomedical Sciences,
Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, TX, *****Department of Orthodontics and
Oral Facial Genetics, Indiana University School of Dentistry, Indiana University-Purdue University, Indianapolis, IN,
USA, and ******Department of Orthodontics, School of Dentistry, Kyung-Pook National University, Daegu, Korea.

Correspondence to: Sean Shih-Yao Liu, Department of Orthodontics and Oral Facial Genetics, Indiana University School of
Dentistry, Indiana University-Purdue University, Indianapolis, IN, USA. E-mail: [email protected]

Summary
Background/Objectives:  This study investigated the biomechanical properties and bone-implant
intersurface response of machined and laser surface-treated stainless steel (SS) mini-screw
implants (MSIs).
Material and Methods:  Forty-eight 1.3 mm in diameter and 6 mm long SS MSIs were divided into
two groups. The control (machined surface) group received no surface treatment; the laser-treated
group received Nd-YAG laser surface treatment. Half in each group was used for examining surface
roughness (Sa and Sq), surface texture, and facture resistance. The remaining MSIs were placed in
the maxilla of six skeletally mature male beagle dogs in a randomized split-mouth design. A pair
with the same surface treatment was placed on the same side and immediately loaded with 200 g
nickel–titanium coil springs for 8 weeks. After killing, the bone-implant contact (BIC) for each MSI
was calculated using micro computed tomography. Analysis of variance model and two-sample t
test were used for statistical analysis with a significance level of P <0.05.
Results:  The mean values of Sa and Sq were significantly higher in the laser-treated group
compared with the machined group (P <0.05). There were no significant differences in fracture
resistance and BIC between the two groups.
Limitation:  animal study
Conclusions/Implications:  Laser treatment increased surface roughness without compromising
fracture resistance. Despite increasing surface roughness, laser treatment did not improve BIC.
Overall, it appears that medical grade SS has the potential to be substituted for titanium alloy MSIs.

Introduction was reported in 1945 (1). Later, Linkow presented a different

approach for anchorage reinforcement with an endosseous blade
The achievement of ‘absolute’ anchorage has always been a chal-
implant (2). Skeletal anchorage, however, did not become widely
lenge in orthodontics. The earliest attempt to use a screw or
accepted until the first successful case report in 1983 of a surgical
implant as skeletal anchorage to facilitate orthodontic treatment

© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved.
154
For permissions, please email: [email protected]
H.-K. Kang et al. 155

Vitallium bone screw used to intrude maxillary central incisors Nd-YAG laser (wave length 1064 nm) was commonly used for
(3). Fourteen years later, Kanomi (4) reported that titanium mini- changing surface texture of titanium implants (11, 23–27) due to
implants (1.2 mm in diameter and 6 mm long) can be used to con- its higher absorption on metallic surface compared to other types
trol vertical and horizontal tooth movement without undesired of lasers (35). It has been shown that Nd-YAG laser irradiation can
side effects. Since then, numerous clinical reports and experimen- modify the metallic surfaces and cause extensive melting on titanium
tal studies have been published showing that mini-screw implants disc even at the lowest energy setting (36). This laser roughening
(MSIs) have become a crucial tool in contemporary orthodontic process can enhance bone-implant surface interaction of SS MSIs.
mechanics (5). However, whether laser treatment can affect the strength of SS MSIs
Most modern MSIs are fabricated from medical type IV or V tita- and bone reaction around them has not been fully evaluated. The
nium alloy with a thread diameter ranging from 1.2 to 2.0 mm and aims of this study were to 1. investigate surface roughness, surface
a length from 4.0 to 12.0 mm (6). Their applications were limited texture, and fracture resistance of SS MSIs with machined surface
because of the anatomic structures of the jaws. Since most MSIs are and Nd-YAG laser-treated surface, 2. explore whether SS MSIs can
inserted into inter-radicular areas, the risk of damage to roots, nerves, be suitable substitutes of titanium alloy MSIs for orthodontic load-
blood vessels, nasal, and maxillary sinuses, bone, etc. still exists (7). ing, and 3.  determine whether or not the surface modification by
The inter-radicular distances were reported as 1.60–3.46 mm in the Nd-YAG laser improves the bone response around immediate loaded
maxilla and 1.99–4.25 mm in the mandible with increasing widths SS MSIs.

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from the CEJ to the apex (8). To avoid damaging structures, MSI
diameters should be reduced as much as possible. Based on a volu-
metric tomographic image study, an ideal titanium MSI placed in the Materials and methods
inter-radicular spaces is recommended to be a conic-shaped implant, A total of 48 MSIs (316 SS, 1.2–1.3 mm in diameter, 6 mm long)
with a cutting thread of 6–8 mm in length, and a maximum diam- were customized from medical grade 316 SS (Dentos, Daegu, Korea)
eter of 1.2–1.5 mm (9). A study showed that the optimal length of and randomly assigned to two surface texture groups (Figure 1). One
MSIs with a diameter of 1.3 mm is 5 mm in the maxilla and 6 mm in group received no surface treatment (machined surface); the other
the mandible (10). However, the decrease in MSI diameter reduces was treated with Nd-YAG/passively Q-switched laser (laser-treated
its strength and can possibly result in fracture during insertion (11) surface) according to the manufacturer protocol. Half of the samples
and removal (9, 12). When fractured, it is sometimes difficult to (12 machined and 12 laser-treated) were used for surface roughness
remove small MSI tips from bone (13). To avoid fracture, the MSI’s and strength evaluation and the other half was used in a prospective
material should have adequate strength to resist insertion torque. in vivo experiment to compare BIC.
Alternatively, instead of Ti, 316 stainless steel (SS) can be considered Surface roughness was measured directly with a non-contact
for its low cost, high yield strength, corrosion resistance, and easy scanning white light interferometer, ZeGage (Zygo Corporation,
processing (6, 14). Middlefield, Connecticut, USA). Samples were placed directly on the
Stainless steel is one of the most widely used biomaterials and has stage for measurements on the valley and inclined at approximately
been used for fixation of bone segments for decades (6). Although 60 degrees on a V-block for measurements on the flank (Figure 1).
the stability of MSIs is expected from the mechanical interlock and
osseointegration between screw and bone (15), the formation of a
fibrous tissue capsule around SS MSIs may interrupt proper bone-
implant contact (BIC) (16). Current evidence suggests that a high
percentage of BIC is not desirable for temporary anchorage because
MSIs must be easily removed at the end of treatment (13). In addi-
tion, some mobility is acceptable with unidirectional light force (12).
Deguchi et al. (17) speculated that low BIC could successfully toler-
ate 200–300 g of orthodontic force. However, a certain amount of
osseointegration around SS MSIs may still be required for successful
anchorage (18).
Many articles proposed a strong correlation between surface
roughness and BIC (19–22). Among additive and subtractive meth-
ods used for surface texturing, laser treatment is a new approach
(22). Several studies have noted that the removal torque of laser-
treated titanium was significantly higher when compared with
machined groups (11, 23–26). A tendency for more bone formation
on laser-treated surface was also observed (27). Laser roughening
enhances hardness, roughness, corrosion resistance, and the degree
of purity on modified surfaces (28, 29). Besides, laser ablation cre-
ates microporosity in a strictly regular pattern by melting superficial
layer of metal surfaces (24, 29, 30). Several studies showed that cells
involved in osseointegration had preferable reactions with highly
ordered and uniform surface roughness than with random roughness
(31, 32). The pattern of surface microstructure can easily be con-
trolled by manipulating the parameters of laser machines including:
pulse frequency, output energy, scanning speed, and pulse intervals
(33, 34). Figure 1.  MSIs with machined surface (left) and laser-treated surface (right).
156 European Journal of Orthodontics, 2016, Vol. 38, No. 2

Surface roughness was measured on a standardized area of approxi- Animal Care and Use Committee. Using a randomized split-mouth
mately 200 × 200 μm on the valley and 160 × 160 μm on the flank design, two MSIs with the same surface texture were placed on one
(Figure  2). The Sa (arithmetical mean height, mean surface rough- side of the maxilla and immediately loaded with 200 g of force.
ness) and Sq (root mean square height, standard deviation of the Similarly, a pair of MSIs with the other type of surface was placed
height distribution) measurements were repeated three times on each and loaded on the other side of the maxilla. Inter-radicular areas
MSI. All images were acquired and analysed with the integrated of the third premolars and the first molars were appropriate place-
ZeMaps software in micrometers. ment locations according to diagnostic periapical radiographs.
For evaluation of surface characteristics, two SS MSIs from each A  surgical stent was fabricated with two pieces of SS rectangular
group were examined under a scanning electron microscope (SEM). wires and light-curing temporary filling material (Spident, Incheon,
Each MSI was set on aluminium SEM specimen mounts by using Korea). Each wire was marked every 3 mm as a gauge (Figure 4). All
double stick carbon tape (Electron Microscopy Sciences, Hatfield, MSIs were placed perpendicular to the buccal alveolar bone with an
Pennsylvania, USA). SEM images were captured digitally on an implant motor at 15 rpm following initial insertion by a hand driver.
Amray 1910 Field Emission scanning electron microscope with Periapical radiographs were taken during placement to verify the
SEMTech Solutions X-Stream Imaging software (SEMTech solu- clearance with the roots.
tions, North Billerica, Massachusetts, USA). The surface features The 200 g tension loads were applied with nickel–titanium (NiTi)
were examined on the valley between third and fourth threads with coil springs (Dentsply GAC International, Bohemia, New York,

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low (500×) and high magnification (5000×). USA) with activation >3 mm (Figure 4). The length was measured at
Following the topographic measurements and SEM, fracture the first day and final day of experiment to confirm that the 200 g of
resistance was assessed as the maximum torque at the time of frac- force was maintained. The appliances were inspected and irrigated
ture. Each MSI was inserted into a pilot hole (1.0 mm diameter, 3 mm with 0.2 per cent chlorhexidine every week. Stabilities were evalu-
deep) in homogenous acrylic blocks 1 × 1 × 1.8 cm. The MSIs were ated at insertion and at week 8, and the survival rate was calculated
hand driven half the length of the threads into the acrylic (Figure 3). (Figure 5A). Any MSI that showed mobility greater than 1 mm when
Once the MSIs were firmly seated in the pilot holes, each sample tested with cotton pliers, or that had pulled out by the spring, was
block was connected to an engine driver attached to a digital torque deemed a failure.
gauge (Mark-10, Copiague, New York, USA).The block with MSI Eight weeks after placement, the animals were euthanized and
was secured on the stage and rotated 2 degrees per second until the each maxilla was resected en bloc (Figure 5B) and stored in 70 per
MSI was fractured. The peak torque value at MSI fracture was indi- cent ethanol followed by methylmethacrylate (MMA) embedding
cated as fracture resistance at accuracy of 0.5 Ncm (Figure 3). prior to sectioning for scanning. Each bone-MSI sample was trimmed
Six skeletally mature female beagle dogs (ages 10–15  months; parallel to the long axis of the MSI (Figure 5C) and placed into a
weight, about 9 kg) were selected and approved by Institutional specimen carrier for scanning (Figure  5D and 5F). Each specimen

Figure 2.  3D scanning images of surface roughness. (A) Valley of machined surface. (B) Flank of machined surface. (C) Valley of laser-treated surface. (D) Flank
of laser-treated surface.
H.-K. Kang et al. 157

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Figure 3.  (A) MSI placement in an acrylic block prior to measuring the peak fracture torque. (B) The head being twisted by an engine driver attached to a torque
gauge. (C) The MSI was fractured.

was scanned by µCT 35 (Scanco Medical, Basserdorf, Switzerland). compare the mean values of Sa and Sq on the flank and the valley
The resolution was set at 1 slice every 6 µm and a X-ray energy level in the same group. For comparison of peak fracture torque, ANOVA
of 70 kVp, 114 µA, and 8W was used. The three-dimensional (3D) model was used. Two sample t-test was used to evaluate the effects of
BIC was calculated as the ratio of bone volume to total volume (BV/ surface treatment (machined, laser-treated) on 3D and 2D BIC. The
TV) in the zone of 18–36  µm from the MSI surface. The zone of overall significance level was set at 5 per cent.
0–18 µm from the MSI surface was excluded to minimize metallic
artifacts of the voxel adjacent to the MSI.
After scanning, all bone-MSI samples were ground along the Results
axis of the MSIs to slices of 150–170 µm thick with an Exakt sys- Three SS MSIs demonstrated mobility of less than 1 mm. They were
tem (EXAKT Technologies, Oklahoma City, Oklahoma, USA) and all machined type, located at the first molars, but firm enough for
stained with Toluidine blue. Images of each MSI were captured clinical use. Thus, consistent with the above defined criteria, there
under 4× magnification using Nikon microscopy and merged using were no failures. The three coil springs associated with the mobile
Image Composite Editor (Microsoft Research, Mountain View, MSIs became shorter, but they remained stretched more than 3 mm
California, USA) software (Figure 5E and 5G). The two-dimensional at week 8, meaning that all MSI loads were maintained at 200 g of
(2D) BIC was evaluated as the length of bone in direct contact with force throughout the experiment. Most MSIs at the third premolar
the thread of the MSI divided by the total length of the MSI thread demonstrated bicortical anchorage with the perforation of the max-
multiplied by 100. illary sinus wall (Figure 5).
The mean values of Sa and Sq were significant higher in the laser-
Statistical methods treated group (Sa: 0.36 ± 0.076  μm; Sq: 0.54 ± 0.199  μm) than the
Surface roughness, peak fracture torque, and 3D and 2D BIC of each machined group (Sa: 0.10 ± 0.051 μm; Sq: 0.17 ± 0.149 μm). Laser
group were summarized as mean and standard deviation. ANOVA treatment increased surface roughness more than 3-fold (Table  1).
model with repeated measurements was used to test the effect of The mean values of Sa and Sq on the valley (Sa: 0.13 ± 0.02 μm; Sq:
groups (control and treated) for each outcome (Sa and Sq separately 0.21 ± 0.03 μm) were significantly higher than on the flank in the con-
for the flank and the valley. The same statistics was performed to trol group, but not in the laser-treated group (valley: 0.38 ± 0.03 μm;
158 European Journal of Orthodontics, 2016, Vol. 38, No. 2

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Figure  4.  MSI placement. (A) Positioning stent. (B) Radiographic image indicating the furcation areas of the third premolar and the first molar. (C) MSI in
placement. (D) Radiographic image confirming the proper placement of MSI in the inter-radicular areas. (E) Immediate loading with a NiTi coil of 200 g. (F)
Radiographic image showing inter-radicular placement of MSIs with attachment of a NiTi coil.

flank: 0.36 ± 0.08 μm) (Table1). Under SEM, laser-modified surface usually ‘cut’ from a metal rod. The relatively smooth surface on the
texture was characterized with spherical elevations and extensive flank area is due to the machining process when cutting the metal
melting (Figure 6). There was no significant difference in the mean rod (41). Our results suggest that laser surface treatment increases
values of peak torque at fracture between machined (13.42 ± 0.63 surface roughness on both valley and flank areas of the MSI thread.
Ncm) and laser-modified (13.08 ± 0.85 Ncm) MSIs (Table 2). No sig- Consistent with surface roughness measurement, SEM images
nificant differences were found for the mean values of 3D and 2D also show that surface texture was modified to become rougher
BIC between two groups (Table 3). by laser treatment. In previous studies, a ring structure with cen-
tral holes and melting pearls was identified on laser-roughened CP
Ti implant (23, 24, 30). The 200  µm pores created on the surface
Discussion of Ti6Al4 V implants by laser texturing was suggested as the opti-
Several parameters can be used for measuring surface roughness, but mal size for new bone formation (33, 34). Compared to machined
Sa is most commonly used for 3D studies (37, 38). In addition, Sq, surface (Figure 6A and 6B), the roughness was obviously increased
another 3D parameter of surface roughness, was used for roughness on laser-treated surface (Figure 6C and 6D). Round projections and
measurement because Sq is more sensitive to extreme values and sta- extensive melting were observed (Figure 6D), but a regular pattern
tistically more powerful than Sa (39, 40). Laser treatment increased of laser work usually seen on laser-treated titanium implants was not
Sa and Sq more than 3-fold (Table 1). This indicates that Nd-YAG prominent in this study. This is probably because the periodic stria-
laser treatment improved surface roughness by increasing both aver- tion pattern is attenuated by extensive melting due to lower melt-
aged surface peak heights and deviations of the surface peak heights ing temperature of SS (42). Although linear scratches and surf-like
with a uniform surface texture on the surface of the thread. In the pattern crossing over the scratches were apparent on the machined
machined surface control group, Sa and Sq were higher on the valley surface (Figure  6A), the machined surface looked smooth even at
than on the flank areas (Table 1). In the fabricating process, a MSI is high magnification (Figure 6B).
H.-K. Kang et al. 159

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Figure 5.  3D and 2D images of MSIs. (A) Picture taken at week 8 showing the head of SS MSIs covered by connective tissue. (B) Bone-MSI sample showing
bicortical anchorage obtained at third premolar. (C) Each bone-MSI sample was trimmed parallel to the long axis of the MSI. (D) 3D reconstructed image of
SS MSI placed at furcation of left third premolar. (E) Histological image of SS MSI placed at furcation of left third premolar with bicortical anchorage. (F) 3D
reconstructed image of MSI at furcation of left first molar. (G) Histological image of SS MSI placed at furcation of left first molar.

Table 1.  Comparison of surface roughness of valley and flank and overall roughness.

Sa Overall Sa Sq Overall Sq

Group Area N Mean SD P value Mean SD P value Mean SD P value Mean SD P value

Machined type Valley 12 0.13 0.02 0.0003* 0.10 0.051 <0.0001* 0.21 0.03 <0.0001* 0.17 0.149 <0.0001*
Flank 12 0.10 0.05 0.17 0.15
Laser-treated type Valley 12 0.38 0.03 0.5189 0.36 0.076 0.53 0.08 0.5104 0.54 0.199
Flank 12 0.36 0.08 0.54 0.20

SD indicates standard deviation.

*Indicates statistically significant differences between the measurements on the valley and flank surfaces within the same surface texture group and between
machined-surface and laser-treated mini-screw implants (P < 0.05), determined by ANOVA model with repeated measurements.

The average peak torque at fracture was not statistically differ- strengths of these 1.3 mm in diameter × 6 mm long MSIs are not
ent between machined and laser-treated groups (Table 2), indicating higher than machined titanium alloy MSIs in identical shape and
that laser treatment did not alter the strength of the MSIs. Based size. It seems to be in conflict with the current knowledge that SS
on the data released from the manufacturer, the average torque has higher Young modulus compared with titanium (43). However,
160 European Journal of Orthodontics, 2016, Vol. 38, No. 2

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Figure 6.  SEM images of SS MSIs. (A) Machined surface at 500× magnification. (B) Machined surface at 5000× magnification. (C) Laser-treated surface at 500×
magnification. (D) Laser-treated surface at 5000× magnification.

Table 2.  Comparison of the mean values of peak fracture torque. Table  3. Comparison of the mean values of three-dimensional
bone-implant contact (BIC), indicated by bone volume/total vol-
Peak Fracture Torque (Ncm) ume (BV/TV) and two-dimensional BIC.

Group N Mean SD Minimum Maximum P value 3D BIC 2D BIC

Machined type 12 13.42 0.63 12.50 14.50 0.2873 Group N Mean (%) SD P value N Mean (%) SD P value
Laser-treated type 12 13.08 0.85 12.00 14.50
Machined 12 46.2 7.2 0.95 12 6.3 4.9 0.42
SD indicates standard deviation. type
Laser-treated 12 46.0 8.8 11 8.2 6.1
type
the superiority of mechanical strength between SS and Ti MSIs can-
not be simply concluded due to fracture torques measurements per- SD indicates standard deviation.

formed by different operating settings. Carano et  al. (44) showed

that SS MSIs started bending at lower level of forces regardless treatment significantly increased roughness, it did not improve 3D
of the values of failure load twice higher than Ti MSIs. The origi- BIC. Albrektsson and Wennerberg suggested that the optimal bone
nal properties of SS probably were altered by heat and pressure response can be induced by the moderate roughness (Sa of 1–2 μm)
created during cutting process. The screw geometry and materi- of the majority of commercial dental implants (37, 38). However,
als compositions can also change the screw’s mechanical strength in this study, even the laser-treated surface would be considered as
(44). Therefore, further studies regarding how the screw design and a smooth surface (Sa less than 0.5  μm) (37), which explains why
manufacturing process affects MSI mechanical properties are still laser-treatment did not increase BIC compared with the relatively
needed. smoother machined surface.
Ure et  al. (15) demonstrated that primary and secondary sta- In this study, the ratio of BV/TV, the relative amount of bone
bility affected clinical stability of MSIs. Maximal primary stabil- per unit of volume, was used to represent BIC in the 3D analysis.
ity was obtained immediately by mechanical retention mainly Because of the radiographic scatter induced by the metal implant
from cortical bone and gradually reduced while bone remodelling thread (45), it is impossible to assess BV/TV immediately adja-
occurred around MSIs. Secondary stability formed by osseointegra- cent to the surface of MSIs. The zone of 18–36  μm from the
tion increased over time and compensated the loss of primary sta- implant surface has been recommended as the best estimate for
bility starting at week 3 for maintaining clinical stability of MSIs. BV/TV (46). Ikeda et al reported that 3D BIC (BV/TV) ratios of
Secondary stability is usually indicated by BIC. Although laser medullary bone ranged from 15 to 36 per cent in the zone of
H.-K. Kang et al. 161

2. Despite significantly increased roughness of laser treated MSIs,

compared with machined ones, laser treatment does not increase
peak torque at fracture. Therefore, improvement of strength of
MSI is not the indication for laser treatment of MSIs
3. For secondary stability of SS MSIs, there was no significant dif-
ference between machined and laser-treated MSIs. Despite the
mild mobility of some machined SS MSIs, all SS MSIs survived
for 8 weeks under constant force (200 g) application. The BV/
TV of 3D analysis can be considered a useful measurement to
determine the bone-implant attachment of MSIs.

Acknowledgements
The authors are grateful to Carol Bain from the Mineralized Tissue and
Histology Research Laboratory of Indiana University School of Dentistry for
histology and image analyses and Dorothy Sorenson from Biomedical Research

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Core Facilities of University of Michigan Medical School for SEM analysis.

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