Palatal-implant anchorage in an adult class II patient.

ment can be particularly challenging in adult patients. Although many appliances have been proposed for maxillary molar distalization in such cases,1,2 they generally require some degree of patient compliance, and their de sign causes anchorage loss due to the incorporation of occlusal rests or bands on the premolars. The introduction of skeletal anchorage has radically changed orthodontists’ approach to Class II treatment.3,4 Still, there are a few cases in which buccal miniscrews cannot be inserted because of a lack of interradicular space or an extended maxillary sinus.5 At first, only available edentulous spaces could be used for implant insertion,6 but the midpalate was subsequently confirmed as a po tential site for skeletal orthodontic anchorage in the maxilla.7-16 This article shows the use of a modified Hilgers Pendulum17 appliance, supported by an osseointegrated palatal mini-implant, to gain space in the maxillary arch of an adult patient. Diagnosis and Treatment Plan