Considerations for Optimizing the Use of Miniscrew Implants in Orthodontic Practice

Miniscrew implants (MSIs) have redefined how orthodontics is practiced. Not only do they provide absolute anchorage, but they also greatly enhance the possibilities of dentofacial orthopedics. It has been reported that approximately 13.5–16.4 % of the miniscrews placed fail. Such rates are excessive and deter many orthodontists, preventing them from, preventing them from taking advantage of these devices. To ameliorate failure rates, MSIs could be optimized by changing their characteristics and individualized depending on the sites where they are to be placed and how they are loaded. For example, increases in MSI length and width, decreases in pitch, and the addition of flutes provide ways to enhance both primary and secondary stability. Increasing the surface area of the screws also increases secondary stability. Excessive cortical bone thickness and density, which enhance primary stability, could be detrimental to secondary stability. Pilot holes can also be problematic and should only be used with thicker and denser bone. Orthodontists must also be meticulous about their placement techniques. They must carefully plan where the MSIs will be placed, they must take care to maintain the screw’s position and orientation throughout the insertion phase, they must evaluate MSI stability after insertion and take corrective action when necessary, and they must ensure proper post-op hygiene. Placement techniques may well turn out to be as important, or even more important, for stability than the screw’s physical characteristics or the characteristics of the placement sites.