by Jack C. Fisher, DMD, and Anne Marie Ross

Taking out orthodontic mini-implants is the simplest part of using them

Jack C. Fisher, DMD, and Anne Marie Ross

Much has been written about the placement and use of orthodontic mini implants (OMIs). However, the subject of removing OMIs is not often covered.

In this article, we will discuss the removal of OMIs from the four main areas of placement:

  1. Incisal areas in both keratinized and non-keratinized tissue;

  2. buccal and lingual areas in both keratinized and non-keratinized tissue;

  3. the infrazygomatic crest, where the tissue is almost always non-keratinized; and

  4. the palatal approach, where OMIs are placed using a lingual approach in the alveolus of the maxilla. This tissue is keratinized.

The Incisal, Buccal, and Lingual Aspects

Figure 1a: OMIs that have been placed in the lingual area.

Figure 1b: The same area after the removal of the OMIs.

The protocol for the removal of OMIs from the incisal as well as buccal and lingual aspects are the same. OMIs that are placed in keratinized tissue on the incisal area (the facial aspect of anterior teeth) and the buccal aspect of the posterior teeth, including on the lower lingual aspect, rarely will have tissue overgrowth of the OMI (Figure 1).

In these instances, local injectable anesthesia is rarely indicated for the removal of the mini-implant. If needed, FDA-cleared topical anesthesia can be used in these instances prior to the removal of the implant. For removal, we recommend using a driver that the manufacturer of your OMI system provides with the kit. Once the driver has been securely placed on the head of the implant, the clinician simply detorques the implant in a counterclockwise rotation. The only exception to this would be an implant that has reverse threads. These OMIs are rare, but they are available and used when the mechanics being used could place a detorquing force on a right-handed thread type.

We have found that once the driver is securely placed, the process of removal should be expedited; this seems to be less traumatic for the patient. Once the detorquing of the OMI is complete, take care to avoid dropping it in the oral cavity, where it could be aspirated or swallowed.

Little, if any, hemorrhage will occur in this area of placement when removing the OMI from keratinized tissue. If needed, a dampened cotton roll can be placed over the area after removal.

When removing OMIs from the facial and buccal aspect where the implant was placed in non-keratinized tissue, the tissue will frequently overgrow the mini-implant. In these instances, you have to remove the tissue covering the implant prior to removing the OMI. The simplest way to accomplish this is with the use of a dermal-tissue punch. These devices are available in many different diameters; the 3-mm tissue punch is adequate. After the anesthesia has taken effect, simply locate the OMI with a forefinger, place the cutting edge of the tissue punch over the OMI, and twist. Then remove the tissue punch and use a mathieu plier to remove the small plug of tissue. You can use a cotton roll to blot the area of hemorrhage.

The driver can now be securely positioned on the OMI and twisted counter-clockwise as discussed above.

The Infrazygomatic Crest

Figure 2: An OMI placed in the infrazygomatic crest has undergone complete tissue overgrowth. A tissue punch can be used to expose the OMI.

The use of OMIs in the infrazygomatic crest is expanding at a rapid pace. Since this area of placement almost always has non-keratinized tissue, the tissue will frequently overgrow the implant (Figure 2). You might assume that it would be necessary to remove the tissue prior to removing the OMI. This is not always the case.

After administering local anesthesia, the clinician can often simply massage the area immediately covering the OMI. The implant often will cut its way out and become visible. You can then place the driver on the OMI and remove it as usual. In these instances, there is surprisingly little, if any, hemorrhage.

When this simple technique of massaging the OMI is not successful, the tissue directly covering the OMI should be removed using a dermal tissue punch. After a liberal amount of tissue has been removed, the massage technique can be used to fully expose the OMI and allow you to complete the removal process.

The Palatal Approach

The last area of removal of OMIs to be discussed is the palatal approach (Figure 3). The tissue in this area is keratinized tissue. Topical anesthesia has not been found to be very effective in this area. Thus, the best course of action is to simply place the driver securely on the head of the OMI and remove it. You should take particular care, in this location, to secure the OMI when removing it from the oral cavity, guarding against dropping it.

Figure 3a: Two palatal approach OMIs prior to removal

Figure 3b: The same area after removal of the OMIs.

When the tissue overgrows the OMI in this area, the tissue is often very healthy. This can make it difficult to locate the OMI. In this instance, you will need to administer local, injectable anesthesia. Either employ local infiltration or a greater palatine block, which is often the best choice because it seems to be less traumatic to the patient.

The clinician can then take either a periodontal probe or an explorer and locate the head of the OMI. Mark the point with the probe/explorer. The OMI can then be exposed, either with a diode laser or by using a 3-mm dermal tissue punch. Using the laser is more time consuming but produces less hemorrhage. After the head of the OMI has been exposed, place the driver securely over it and remove the OMI.

In conclusion, the removal of OMIs is a very benign and quick procedure, easily the simplest part of the overall process of learning the proper placement and mechanics of mini-implants.

OMI Education

As the insertion and use of OMIs by orthodontists continues to rise, the education must continue to improve. Most courses that are offered are used by companies to market their own products. As is often the case with this type of course, the shortcomings and complications are rarely presented. Most new techniques, such as self-ligating brackets, new wire metallurgy, and the use of CBCT radiographs, have a relatively short and not-so-steep learning curve. This is not the case with OMI placement and mechanics.

In our profession, new techniques can often be delegated to expanded-duty staff members. Placing and using OMIs, however, requires the orthodontist to learn procedures that cannot be delegated. The insertion of a OMI is a more invasive procedure than a “traditional” orthodontist is used to. The orthodontist must mentally prepare himself or herself by learning these techniques. This requires a long-term commitment to these techniques by the orthodontist and the staff, particularly in a busy practice.

Jack C. Fisher, DMD, has maintained a practice limited to orthodontics since 1982. He can be reached at

Anne Marie Ross is a senior dental student at the University of Louisville School of Dentistry. She is pursuing a residency in orthodontics. She can be reached at