Miniscrews

as Orthodontic Anchorage
Sahar Shafi
02/13/06

Anchorage
Extraoral

Head and Neck Gear

Patient

non-compliance

Patient

discomfort

Limited

range of movement

Intraoral Anchorage
Intraarch
-assumes more teeth offer greater anchorage than fewer
teeth and that tipping is easier than translation

Interarch
-move teeth in one direction in ie. the upper jaw and in the
opposite direction in the lower jaw

Extradental
-transfer of reactive forces to the interface between metallic
anchorages and bone

Intraoral Extradental Anchorage

Use

alveolar bone for anchorage

Minimizes or completely neutralizes
undesired reactive forces during
tooth movements
Especially indicated when lack quality
or quantity of dental anchorage units
ie. periodontally involved teeth or
partial edentualism

Intraoral Extradental Anchorage Systems

Osseointegrated Implants
-Sx trauma upon insertion/removal
-Limited available sites
-Wait time for osseointegration before loading
-High Cost

Onplants
-Same as above but considerably easier to remove

Zygomatic Wires
-Limited available sites but immediate load possible for the
first time, leading to the discovery of miniscrews using the
same principles.

Miniscrews

Direct anchorage
Can be attached with elastics
or NiTi superelastic coils to
fixed appliances
Reduced cost compared to
implants
Titanium or Stainless steel
miniscrews 6-12mm in length
and 1.5-2mm in diameter
penetrating bone 5-8mm
depending on location
Cap placed over top of
miniscrew and secured with
light cured composite to avoid
contamination

Introductory Kit

A screw driver
Burs for drilling bony hole
Miniscrews 6,8,10, & 12mm in length
and 1.5-2mm in diameter
2 different screw head designs

Maxillary Locations

Inferior surface of anterior nasal spine

-Proclination of incisors

Midpalatal suture
-Dense crista nasalis bone for intrusion and retraction of
flared and over-erupted incisors

Infrazygomatic crest
-Retraction and intrusion of anterior teeth or intrusion of
molars

Mandibular Locations

Retromolar position
-Mesal movement of molars w/o retraction of anterior teeth
Edentulous areas of alveolar process
-Move single tooth w/o interfering with remaining dentition
Laterally in molar/premolar region
-Vertical and/or transverse movement of molars and premolars
Anterior Mandible
-Intrusion and proclination of incisors

Advantages

Ease of insertion and removal

Orthodontist can perform- no need for referral

Immediate loading- shortening tx time

Limited local irritation vs. other transmucosal

types of anchorage
If present, local applicaton of chlorhexidine
controlled it
Small enough to be placed between roots of
adjacent teeth in alveolar bone without
mucoperiosteal flap

Disadvantages
Local

irritation
Risk of infection specific in relation to
different locations (associated with
all transmucosal anchorages)
Perforation of maxillary sinus when
screw placed in infrazygomatic crest
(no associated problems)
Potential risk of contacting roots or
nerves (leading to complicatons
depending on location)

Most Notable Complication:

Loosening of Miniscrews
In the preliminary report in 1998 by Costa
et al., 2 out of 16 clinical trial miniscrews
were lost before tx was completed
In a 2004 study done by Fortini et al., 3/19
miniscrews were lost due to incorrect
positioning of 1 in the maxilla and the use
of 2 short (8mm) miniscrews in the
mandible, which were easily replaced with
12mm screws without changing the
location

2004 Publication: Arturo et al

Sx Procedure

10/19 inserted under LA via 2mm mucosal

incision
-periosteum reflected from underlying bone
-drill hole w/ twist drill into bone under continuous irrigation
-miniscrew inserted manually w/ screwdriver

2/19 inserted with mucosa punch

-allows creation of transmucosal access to bone w/o flap
-miniscrew inserted manually w/ screwdriver

7/19 inserted directly through mucosa w/o

any flap dissection
-used slow speed twist drill to drill into bone under irrigation
-used slow speed handpiece for screwing the screws into bone

Mucosal Incision

Mucosa Punch

Creates direct transmucosal access to

bone

Insertion Directly Through Mucosa

Side Notes

In situations where flap

was raised, waited 8-10
days before loading screws
to allow soft tissue healing
and maintainance of good
OH
Loading accomplished by
superelastic NiTi coil
springs, power chains, or
elastic modules attached
to head of miniscrew
SS over titanium because
ease of handling

Clinical Examples

Intrusion and Retrusion of anterior teeth with

superelastic NiTi coil springs and elastics,
respectively

Maxillary Right First Molar Intrusion

Pretreatment

Maxillary Right First Molar Intrusion:

Loading

Maxillary Right First Molar Intrusion:

PostTreatment

Extrusion of Impacted Maxillary Right Canine

Premolar Distalization

Protraction of Lower Right 2nd and 3rd Molars

Pretreatment

Protraction of Lower Right 2nd and 3rd Molars

Loading

Protraction of Lower Right 2nd and 3rd Molars

Post-Treatment

Discussion

Miniscrews proved efficient in maintaining the

type of extradental anchorage required in several
different clinical situations
Apart from slight local irritation, neither
discomfort nor allergic rxns were reported by
patients

All miniscrews were well accepted and tolerated

throughout tx

Loosening of 3/19 screws occurred that could

have been avoided with appropriate planning

References
Costa

et al. Miniscrews as
orthodontic anchorage: A preliminary
report. Int. J. Adult Orthodontics and
Orthognathic Sx. 1998;13(2):201-9

Fortini

et al. Clinical Application and

Efficacy of Miniscrews for Extradental
Anchorage. Orthodontics. 2004;
1(2).

Questions?