Table Of ContentAnd we know that in all things, God works for
the good of those who love him, who have been
called according to his purpose
(Romans 8:28)
Commissioning Editor: Alison Taylor
Development Editor: Barbara Simmons
Copy Editor: Lotika Singha
Project Manager: Frances Affleck
Designer: Stewart Larking
Illustration Manager: Bruce Hogarth
Illustrator: Bong-Kyu Chang
Dgi]dYdci^X
iniscrew
M
>beaVcih
8A > C > 8 6 A 6 E E A > 8 6 I > D C H
8]Zda"=dEV^`99HE]9;689
Dgi]dYdci^hi!Eg^kViZegVXi^XZ!HZdja!@dgZV
>c"@ldcEVg`99HBH9E]9
Dgi]dYdci^hi!Eg^kViZegVXi^XZ!HZdja!@dgZV
Ndjc\_dd?jY^ZLdd99H
Dgi]dYdci^hi!Eg^kViZegVXi^XZ!HZdja!@dgZV
IVZ"Ldd@^b99HBH9E]9
8]V^gbVcVcYEgd[Zhhdg!
9ZeVgibZcid[Dgi]dYdci^Xh!HX]ddad[9Zci^hign!
HZdjaCVi^dcVaJc^kZgh^in!@dgZV
8dchjaiVci:Y^idg
C^\Za=VggVY^cZ79H;9HG8H:Y^cBDgi]G8H:c\BHXB77H
8dchjaiVciDgi]dYdci^hi!
7g^hida9ZciVa=dhe^iVaVcYHX]dda!
7g^hida!
An imprint of Elsevier Limited
©2009, Elsevier Limited. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by
any means, electronic or mechanical, including photocopying, recording, or any
information storage and retrieval system, without permission in writing from the
publisher. Permissions may be sought directly from Elsevier’s Rights Department:
phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865
853333; e-mail:
Preface
The idea of writing of this book began when we implant anchorage might have helped complete the
made a presentation at a meeting of the Southern treatment without the need for orthognathic surgery.
Californian Component of the Edward H Angle Society
of Orthodontists, of which two of the authors, Cheol- Skeletal Class II malocclusions with vertical excess
Ho Paik and In-Kwon Park, are members. Immediately are common in the Caucasian population, and such
after the meeting, we were offered an opportunity patients are often treated with orthognathic surgery
to publish a textbook on the orthodontic miniscrew involving maxillary impaction and autorotation of
implant. We would like to thank Dr Richard P the mandible. However, this aggressive procedure may
McLaughlin and Dr John C Bennett for encouraging us be substituted by intrusion of the maxillary dentition
in writing this textbook. using midpalatal miniscrew implant anchorage. This is
one of the reasons we have written this book in English.
Orthodontic movements that are considered difficult to Our work will be worthwhile if even a few patients are
accomplish with traditional methods can be achieved spared unnecessary orthognathic surgery with the help
with minimal patient cooperation by using miniscrew of the orthodontists who read this book.
implants. This book brings together our knowledge and
experience of using miniscrew implants in orthodontic In Asian populations, Class III malocclusions are more
practice. As practicing orthodontists, we have mainly common. However, many of these patients have mild
focused on the clinical applications of the miniscrew to moderate Class III malocclusion and orthognathic
implant, illustrated with cases treated at our clinic. surgery is not always an acceptable treatment option.
Details of basic research have been kept to a minimum, In such patients, miniscrew implants can be used very
as the book is designed to be an easy to read guide, effectively to retract the entire mandibular dentition. In
aimed at the orthodontist wishing to adopt miniscrew South Korea, most of the orthodontists use miniscrew
implant anchorage in their everyday practice. We have implants in daily clinical practice. This phenomenon
attempted to demonstrate how miniscrew implants can is unique, and it may have been triggered by the
be used to simplify orthodontic treatment. publication in 2001 of a textbook on the microscrew
implant in Korean by Dr Hyo-Sang Park.
We remember an impressive case presented by an
orthodontic resident more than 10 years ago. The We specially thank Dr Youn Sic Chun, Dr Jong-Suk Lee
patient, who presented with the complaint of mild and Dr Jong-Wan Kim, who shared their data with us,
crowding of his front teeth, had undergone bimaxillary and we appreciate the passion and commitment of Dr
surgery following a reassessment of his malocclusion Sungmin Kang, which helped complete the writing of
midway through his orthodontic treatment. This was this book in a short time.
required because with the orthodontic leveling of
the teeth his underlying mild vertical skeletal excess Cheol-Ho Paik
led to the development of an anterior open bite with
In-Kwon Park
asymmetry. If orthodontic miniscrew implants had
been available back then, a small amount of intrusion Youngjoo Woo
and retraction of the dentition using miniscrew Tae-Woo Kim
Korean norms and
cephalometric
abbreviations
9:CI6A6C9;68>6A8:E=6ADB:IG>8 @dgZVccdgb
B:6HJG:B:CIH/@DG:6CCDGBH
m Korean norms and cephalometric abbreviations
9:CI6A6C9;68>6A8:E=6ADB:IG>8
B:6HJG:B:CIH/677G:K>6I>DCH
JH:9>CI=>H
8=6EI:G &
C h a p t e r
&
Introduction
8VhZZmVbeaZ (
6Wdjii]^hWdd` *
GZ[ZgZcXZh +
' ORTHODONTIC MINISCREW IMPLANT
1
When Brånemark invented the first successful as the cost, need for extensive surgery, time required for
osseointegrated implant, he certainly would not have osseointegration, and limited availability of sufficient
envisaged how it would transform the practice of bone to act as an implant site. More recently, titanium
dentistry in the years to come. Such implants have miniplates have been shown to successfully intrude
5
significantly enhanced the scope and quality of dental posterior teeth in patients with skeletal open bite, but
treatment and to a lesser extent, this has included flap surgery for placement and removal is unavoidable.
orthodontic treatment. In spite of these disadvantages, osseointegrated
implants are proving to be an extremely useful adjunct
For a long time, orthodontists have struggled to achieve to conventional orthodontic treatment in a minority of
efficient control of anchorage. However, their efforts cases.
have only had partial success owing to Newton’s third
law of motion, which states that for each action there The miniscrew, which was originally designed to fix
is an equal and opposite reaction. A variety of extraoral bony segments, has shown great promise as a simpler
appliances have been designed to overcome this and more versatile solution for obtaining absolute
limitation, but these have their own problems, such as anchorage. Many authors have reported successful use
inadequate patient compliance. of miniscrews in a wide range of orthodontic tooth
6–8
movements. Miniscrews are used as temporary
Dissatisfaction with conventional methods of fixtures in bone and their greatest advantage lies in
anchorage led some pioneer orthodontists to explore their small size, which permits rapid and atraumatic
the use of implants as a source of absolute anchorage. placement in almost all sites within the mouth. In the
In 1990, a temporary retromolar implant was shown to past decade, there have been rapid advances in the
2
work as an absolute anchor to move molars mesially. development of miniscrews and they are increasingly
In 1995, the midpalatal onplant was proposed as used in orthodontics. It is the authors’ goal, and the
another means of providing absolute anchorage aim of this book, to popularize the use of the miniscrew
3
for tooth movement, and this has since become an implant among orthodontists and to reduce the need
4
accepted form of treatment mechanics. From the for orthognathic surgery in patients with mild or
orthodontic viewpoint these conventional endosseous moderate skeletal discrepancy.
implants and onplants have many disadvantages, such
8=6EI:G &
>cigdYjXi^dc (
86H::M6BEA: molars can be intruded to reduce face height, thus
avoiding costly and extensive orthognathic surgery.
A 30-year-old full-time career woman attended the
One of the best examples of the ability of miniscrew
authors' clinic with the complaint of severe open bite
implants to open whole new possibilities in
and difficulty biting. On examination she had skeletal
orthodontics is in the treatment of anterior open bite
vertical excess with incompetent lips (Figs 1.1–1.5).
with vertical skeletal excess. With these implants,
;^\#&#& ;^\#&#'
;^\#&#( ;^\#&#) ;^\#&#*
) ORTHODONTIC MINISCREW IMPLANT
If this patient had presented in the era before the dental relapse and no realistic possibility of intruding
introduction of the miniscrew implant, the treatment the molars and therefore reducing the face height.
options would have been either the extensive and However, this patient was fortunate that her
invasive procedure of bimaxillary anterior subapical orthodontist offered non-surgical treatment using
osteotomy with simultaneous impaction of the miniscrew implants. The improvement in esthetics and
maxilla, or conventional orthodontic treatment with function following this treatment has remained stable
the probability of some degree of post-treatment for 3 years (Figs 1.6–1.10).
;^\#&#+ ;^\#&#,
;^\#&#- ;^\#&#. ;^\#&#&%
