Clinical applications of the Miniscrew Anchorage System.

dontic tooth movement and orthopedic jaw movement?” With this question in 1983, Creekmore and Eklund were the first orthodontists to suggest in print that a small metal screw could withstand a constant force of sufficient magnitude and duration to reposition an entire anterior maxillary dentition without becoming loose, painful, infected, or pathologic.1 Their case opened an entirely new area for managing orthodontic anchorage, but may have been too progressive and too invasive for its time. Toward the end of the 1980s, a number of clinicians focused on the use of standard dental implants as temporary anchorage for orthodontic tooth movement and then as permanent abutments for tooth replacement.2-5 The major advantage of these implants is that they make it possible to move multiple teeth without loss of anchorage. They can be placed in areas where natural anchorage or conventional orthodontic appliances are impractical, including the edentulous spaces in the alveolus of either arch, the palate, the zygomatic process, the retromolar regions, and the ramus. Disadvantages of dental implants are the need for an invasive surgical procedure, the limitations on placement sites imposed by the implants’ 10mm length, the time required for osseointegration prior to force application, and cost. In addition, they are not recommended for female patients younger than 16 or males younger than 18. More recently, new onplants, miniplates, and palatal implants have been developed specifically for use in orthodontics.6-8 The miniplates have been advocated as anchorage for molar intrusion7,9-11; palatal implants have been used for space closure, and most effectively for distalization of maxillary molars.5,7 Because these new devices still have many of the same limitations as standard dental implants, however, most orthodontists have now turned to miniscrews.12-17 Repeating the experience of Creekmore, they have found that small screws, like those used for rigid fixation in maxillofacial surgery, work well for orthodontic anchorage.14,15 The size of the screws has been reduced even further in the last few years.16,17 The material generally used for miniscrews is medical grade 4 or 5 titanium, although stain-