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Mini-implant system is a novel orthodontic anchorage approach applied recently in the chinic, with good effects^[1-3]. It has been widely used, but the implantation position and angle of interradicular alveolar bone are difficult to identify due to limited operation visual field or little bone mass at the implant site^[4], which increases difficulties of accurate mini-implant implantation. In addition, the operation may damage dental root, maxillary sinus, and nervus alveolaris mandibularis, which increase risks for operation failure in patients with crowding of teeth, torsion of teeth, surrounding important tissue variation or bone density abnormity^[5]. Multislice spiral computed tomography (MSCT) can accurately evaluate bone mass in the implant region preoperatively^[6-8] to help formulate implant strategy. The present study utilized MSCT imaging information to design radiographic and tunnel-type surgical templates assisting implant anchorage surgery and evaluate the clinical accuracy, so as to unify preoperative design and accurate operation and search effective clinical operations for improving success rate of mini-implant anchorage surgery.

Recently developed mini-implant anchorage system has raised exciting questions due to stability and high efficiency. However, the failure rate of miniscrews is high^[10-11], which leads to mental and economic loss and affects miniscrews application. The major factors that influence the success of mini-implant is the bone mass of implant site^[12-13], such as thin cortical bone, short interradicular distance, and degenerative surrounding important tissues (maxillary sinus, nervus alveolaris mandibularis). Accurate preoperative evaluation, precise treatment design and accurate operations can resolve these problems. MSCT imaging can accurately measure bone mass in the implant region, allowing for identification of implant location and design of implantation direction^[14-15], which displays advantages compared with 2-D imaging examinations^[16]. However, miniscrews have been clinically used in implant region with limited operation visual fields, such as cheek and palate in molar region, or place with little bone mass, such as anterior teeth region of inferior occlusion^[4], which is difficult for physicians in clinical operation because they cannot identify the implantation position and angle of alveolar bone among tooth root. Moreover, the MSCT imaging information is not completely used for preoperative design. Therefore, the accurate implantation of miniscrews is difficult, in particular for patients with severe teeth crowding, teeth torsion, or abnormal bone density. Template has been frequently used as information vector to facilitate effective use of accurate image information in implantation^[17-18]. Template includes radiographic template and surgical template. The present study designed transparent radiographic template, which confirmed the location on alveolar bone and helped CT imaging to correctly detect bone appearance and bone mass at implant regions and to design appropriate implantation angle. In the past clinical practice, three-dimensional localization indicator has been used to guide operation based on CT information^[19]. However, limited by buccinators, indicator in some patients was not easy to fix, thereby affecting accuracy. The present study utilized three- dimensional localization indicator containing angle design to transfer information to the plaster model, followed by three-dimensional tunnel-type surgical template, which ensured accuracy and stability of miniscrew implantation. Statistical results showed that tunnel-type surgical template effectively and accurately assist implant anchorage, unify preoperative design and accurate operations and improve success rate of mini-implant. Tunnel-type surgical template exhibits helpful guidance. The diameter of tunnel is 0.2 mm thicker than the pioneer drill, which guarantees accuracy and prevents damage of the drill. In addition, the present study utilized self-developed metal cylinder as inner wall of the tunnel. The assembled indicator and metal cylinder provided by miniscrew factory can simplify preparation of surgical template and reduce influences of powder on implantation.

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