ORIGINAL ARTICLE

Class II malocclusion treated with miniscrew

anchorage: Comparison with traditional
orthodontic mechanics outcomes
Shingo Kuroda,a Kazuyo Yamada,b Toru Deguchi,c Hee-Moon Kyung,d and Teruko Takano-Yamamotoe
Tokushima, Okayama, Sendai, Japan, and Daegu, Korea

Introduction: Anchorage control in patients with severe skeletal Class II malocclusion is a difficult problem
in orthodontic treatment. In adults, treatment often requires premolar extractions and maximum anchorage.
Recently, incisor retraction with miniscrew anchorage has become a new strategy for treating skeletal Class
II patients. Methods: In this study, we compared treatment outcomes of patients with severe skeletal Class
II malocclusion treated using miniscrew anchorage (n 11) or traditional orthodontic mechanics of headgear
and transpalatal arch (n 11). Pretreatment and posttreatment lateral cephalograms were analyzed.
Results: Both treatment methods, miniscrew anchorage or headgear, achieved acceptable results as
indicated by the reduction of overjet and the improvement of facial profile. However, incisor retraction with
miniscrew anchorage did not require patient cooperation to reinforce the anchorage and provided more
significant improvement of the facial profile than traditional anchorage mechanics (headgear combined with
transpalatal arch). Conclusions: Orthodontic treatment with miniscrew anchorage is simpler and more useful
than that with traditional anchorage mechanics for patients with Class II malocclusion. (Am J Orthod
Dentofacial Orthop 2009;135:302-9)

A
nchorage control in severe skeletal Class II
patients is a difficult problem in orthodontic
treatment. In adults, treatment of severe skele-
tal Class II malocclusion often requires premolar ex-
tractions and maximum anchorage. To reinforce an-
chorage, various auxiliaries can be used, including
headgear, lingual arch, transpalatal arch, holding arch,
and intermaxillary elastics.1 These auxiliaries help to
achieve acceptable results regarding the interincisal
relationships and to reduce overjet with good patient
cooperation. However, improvement can be minimal,
because it is difficult to establish absolute anchorage for
incisor retraction with traditional orthodontic mechan-
a
Associate professor, Department of Orthodontics and Dentofacial Orthope-
dics, The University of Tokushima Graduate School of Oral Sciences, To-
kushima, Japan.
b
Postgraduate student, Department of Orthodontics and Dentofacial Orthope-
dics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,
Okayama University, Okayama, Japan.
c
Assistant professor, Division of Orthodontics and Dentofacial Orthopedics,
Graduate School of Dentistry, Tohoku University, Sendai, Japan.
d
Professor, Department of Orthodontics, School of Dentistry, Kyungpook
National University, Daegu, Korea.
e
Professor and chair, Division of Orthodontics and Dentofacial Orthopedics,
Graduate School of Dentistry, Tohoku University, Sendai, Japan.
Reprint requests to: Teruko Takano-Yamamoto, Division of Orthodontics and
Dentofacial Orthopedics, Graduate School of Dentistry, Tohoku University,
4-1 Seiryo-machi, Aoba-ku, Sendai, Japan, 980-8574; e-mail, t-yamamo@
mail.tains.tohoku.ac.jp.
Submitted, November 2006; revised and accepted, March 2007.
0889-5406/$36.00
Copyright 2009 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2007.03.038
302
ics such as multi-brackets combined with intraoral or
extraoral anchorage.
Recently, dental implants,2-4 screws,5-10 and mini-
plates11-16 have been used for skeletal anchorage. Even
without patient cooperation, these devices can provide
stationary anchorage for various tooth movements.
Titanium screws are currently in vogue because they
are useful for various orthodontic tooth movements
with minimal anatomic limitations on placement, lower
medical costs, and simpler placement with less trau-
matic surgery.17 There have been several case reports
about skeletal Class II patients treated with incisor
retraction with miniscrews after premolar extractions.18-20
Incisor retraction with miniscrew anchorage is a new
strategy for treating skeletal Class II patients. However, no
report has analyzed in detail the treatment results of Class
II patients with implant anchorage. It is unknown which
method is better for treating skeletal Class II malocclu-
sions: retraction of incisors with miniscrew anchorage or
traditional orthodontic mechanics.
Our findings demonstrate the advantages of treat-
ment with miniscrew anchorage for incisal retraction in
skeletal Class II patients compared with traditional
orthodontic mechanics.
MATERIAL AND METHODS
Our subjects were 22 nongrowing female patients
(ages, 13-39 years; mean, 20.1 years; SD, 6.2 years),
American Journal of Orthodontics and Dentofacial Orthopedics Kuroda et al 303
Volume 135, Number 3

Fig 1. Miniscrew used as orthodontic anchorage.

who had skeletal Class II jaw-based relationships with Fig 2. Angle measurements: 1, ANB; 2, SNA; 3, SNB; 4,
ANB angle of more than 5.0 (mean 5.6; SD, 2.1) or Frankfort horizontal (FH) to mandibular plane (MP); 5,
U1 to FH plane; 6, L1 to MP; 7, interincisal angle (II); 8,
excessive overjet of more than 5.0 mm (mean, 6.2 mm;
occlusal plane (OP) angle.
SD, 3.0 mm). We received informed consent from all
patients, and they agreed to Class II camouflage treat-
ment with premolar extractions.
Eleven patients (mean age, 18.5 years; SD, 3.3
years) were treated orthodontically by using miniscrew
anchorage (implant group). The mean overjet at pre-
treatment (T1) was 7.0 mm (SD, 3.8 mm), and the ANB
angle was 5.7 (SD, 1.8). The maxillary first (9
patients) or second (2 patients) premolars were ex-
tracted to provide the retraction spaces for the anterior
teeth, and the mandibular first (7 patients) or second (2
patients) premolars were also extracted, except in 2
patients. Miniscrews (AbsoAnchor, Dentos, Daegu,
Korea; diameter, 1.3 mm; length 8 mm) were placed
between the maxillary second premolar and the first
molar without a mucoperiosteal incision or flap by an
orthodontist (S.K.).17 The orthodontic load was applied
by using nickel-titanium closed-coil spring (Sentalloy,
Tomy, Tokyo, Japan), estimated at 100 g (Fig 1). Fig 3. Linear measurements: 1, anterior cranial base
The other 11 patients (mean age, 21.8 years; SD, (S-N); 2, anterior facial height (N-Me); 3, upper incisal
7.9 years) were treated with maximum anchorage by edge to palatal plane (PP) (U1/PP); 4, upper molar cusp
using headgear and transpalatal arch (headgear group). to PP (U6/PP); 5, lower incisal edge to MP (L1/MP); 6,
Mean overjet at T1 was 6.2 mm (SD, 2.6 mm), and the lower molar cusp to MP (L6/MP); 7, upper incisal edge
ANB angle was 5.4 (SD, 2.1). The maxillary first to pterigoid vertical line (PTV) (U1/PTV); 8, upper molar
premolars were extracted in all patients, and the man- cusp to PTV (U6/PTV); 9, lower incisal edge to PTV
dibular first (7 patients) or second (2 patients) premo- (L1/PTV); 10, lower molar cusp to PTV (L6/PTV).
lars were also extracted, except in 2 patients. Closing
loop mechanics were used to retract the 4 incisors after
independent retraction of the canines, and headgear was were used for cephalometric analysis. Eight angular
used until the extraction spaces were closed. We and 12 linear measurements were made to evaluate the
selected the type of headgear according to the mandib- skeletal and dental changes after orthodontic treatment
ular plane angle. Combination headgear was used in 5 (Figs 2 and 3).21 Four angular and 4 linear measure-
patients, high-pull in 4, and cervical in 2. ments were also made to evaluate the soft-tissue profile
Lateral cephalograms at T1 and after treatment (T2) changes between T1 and T2 (Fig 4).22,23
304 Kuroda et al
Gn
FH-Plane
E-line
3 group and 6.3 mm in the headgear group). The maxillary
Sn
1
7
5 the headgear group).
6 8
2 tween T1 and T2 showed that the soft-tissue profile was
Pog Pog
Pog
4 group was more retracted than that in the headgear
Fig 4. Evaluation of soft-tissue profile: 1, nasolabial
angle; 2, inferior labial sulcus angle; 3, Z-angle (chin/lip
line to FH plane); 4, facial convexity (Gn=-Sn-Pog=); 5,
upper lip (UL) protrusion (SnP-UL); 6, lower lip (LL)
protrusion (SnP-LL); 7, E-line to UL (E-UL); 8, E-line to
LL (E-LL).
Statistical analysis
The Mann-Whitney U test was used to examine the
difference between the T1 and T2 cephalometric anal-
yses in each group. The Wilcoxon signed rank test was
used to compare the pretreatment and posttreatment
cephalometric measurements between the implant and
the headgear groups. Probability of 0.05 was consid-
ered insignificant. The analyses were carried out with
statistical software (StatView, SPSS, Chicago, Ill).
RESULTS
There was no significant difference in any variable
between the implant and headgear groups at T1 (Table
I). Comparison of the pretreatment and posttreatment
cephalometric evaluations in the implant group showed
that overjet was significantly improved as a result of
en-masse retraction with miniscrew anchorage (Fig 5,
Table II). The mesiodistal position of the maxillary
molars showed a small change (1 mm). The mandib-
ular plane angle and the anterior facial height were
slightly increased. Comparison of pretreatment and
posttreatment evaluations in the headgear group
showed that the incisors were retracted, and acceptable
overjet was achieved; however, the maxillary molars
were significantly moved mesially (Table II). Neither
the mandibular plane angle nor the anterior facial
height was increased.
There was no significant difference in reduction of
overjet between the implant and the headgear groups.
They were both effective in treating excessive overjet,
with approximately a 3 to 4 mm decrease (Fig 5, Table
American Journal of Orthodontics and Dentofacial Orthopedics
March 2009
III). However, the results of dental measurements were
significantly different. The maxillary incisors in the im-
plant group were more retracted than those of the head-
gear group (changes of U1/PTV: 9.3 mm in the implant
molars in the headgear group were moved more mesi-
ally than those in the implant group (changes of
U6/PTV: 0.7 mm in the implant group and 3.0 mm in
Comparison of the soft-tissue measurements be-
significantly improved in both groups (Table III).
However, the sagittal upper lip position in the implant
group.
DISCUSSION
The skeletal and dental characteristics of the sub-
jects were similar between the implant and headgear
groups at T1. No skeletal or dental variables showed a
significant difference between the 2 groups. Subjects
having any syndrome, systemic disease, or abnormal
skeletal characteristics were excluded from this study.
Most patients at T1 had a tendency of mandibular
deficiency, but they did not complain about their facial
characteristics. Japanese people generally prefer a fa-
cial profile with slight mandibular retrusion rather than
a straight profile or mandibular protrusion.22,24,25 We
received informed consent from all patients, who
agreed to Class II camouflage treatment with premolar
extractions.
After treatment with premolar extractions, the max-
illary incisors were significantly retracted, and both
groups had proper overjet. These results suggested that
both methods were useful to improve maxillary dental
protrusion and interincisal relationships, but the move-
ments of the molars and the incisors were significantly
different in the groups.
In the implant group, as a result of reinforced
anchorage with miniscrews, the incisors were suffi-
ciently retracted without significant mesial movement
of the maxillary molars compared with the headgear
group. Minimum mesial movement of the maxillary
molars would have occurred during leveling and align-
ment, because we usually implanted the screws after
the leveling phase. In addition, miniscrews do not
require the patients cooperation to obtain anchorage.
In the treatment of premolar extraction patients with
traditional mechanics, the maxillary molars were usu-
ally mesialized approximately 30% into the extraction
space with excellent cooperation for maximum anchor-
age.26,27 In this study, the maxillary molars were
mesialized 3.0 mm in the headgear group. The amount
American Journal of Orthodontics and Dentofacial Orthopedics Kuroda et al 305
Volume 135, Number 3

Table I. Comparison of pretreatment measurements between groups

Japanese norm Headgear Implant

Variable Norm SD Mean SD Mean SD P value

Cephalometric values*
Angle ()
ANB 2.7 2.2 5.4 2.11 5.7 1.81 0.818
SNA 80.8 3.6 80.9 3.23 80.7 5.07 0.844
SNB 78 4.4 75.5 2.87 74.9 4.84 0.670
MP-FH 29.4 3.5 29.8 7.17 29.1 5.12 0.694
U1-FH 113.7 8.2 119.0 8.39 120.8 5.22 0.670
L1-MP 93.3 6.1 100.8 7.49 101.5 7.01 0.793
IIA 123.3 11.2 109.9 7.08 107.7 7.91 0.622
OP 17.1 4.2 10.6 5.16 9.0 2.77 0.325
Linear (mm)
S-N 67.4 3.7 69.5 3.54 70.3 2.37 0.948
N-Me 124.1 5.4 126.1 7.53 128.4 4.32 0.393
U1/NF 30.6 2.7 30.4 4.43 31.7 1.57 0.9999
U6/NF 24 2.4 24.9 3.11 26.1 1.69 0.470
L1/MP 43.3 2.9 46.0 3.27 47.5 3.55 0.555
L6/MP 32.1 2.6 36.5 2.53 37.2 3.17 0.793
U1/PTV 63.2 2.64 64.7 3.52 0.577
U6/PTV 27.5 2.39 28.4 4.53 0.768
L1/PTV 56.7 3.43 57.5 5.65 0.974
L6/PTV 28.8 2.66 29.4 5.13 0.896
Overjet 3.1 0.8 6.2 2.59 7.0 3.75 0.922
Overbitte 3.1 1.7 1.8 1.21 2.7 2.02 0.555
Soft tissue values
Angle ()
Nasolabial angle 99.8 8.5 99.0 9.14 96.8 11.98 0.818
Inferior labial sulcus angle 140.5 13.5 127.9 18.18 120.0 18.25 0.309
Z-angle 66.6 7.1 55.6 7.96 55.7 8.92 0.974
Facial convexity 13.2 4.9 14.2 4.99 15.2 4.43 0.793
Linear (mm)
SnP-UL 6.5 1.5 8.5 1.90 8.6 1.85 0.870
SnP-LL 6.4 1.9 8.9 2.30 8.7 1.99 0.431
E-UL 2.5 1.9 2.6 2.02 2.8 2.55 0.793
E-LL 0.9 1.9 5.1 2.38 5.1 2.24 0.577

Japanese norms reported by *Wada et al,21 Ioi et al,22 and Miyajima et al.23

A B
Fig 5. Mean profilograms in the implant and headgear groups: solid lines, mean profilograms at T1;
dotted lines, mean profilograms at T2. A, Implant group; B, headgear group.
306 Kuroda et al American Journal of Orthodontics and Dentofacial Orthopedics
March 2009

Table II. Comparison of pretreatment (T1) and posttreatment (T2) measurements

Headgear group

Japanese norm T1 T2 T2-T1

Variable Norm SD Mean SD Mean SD Mean SD P value

Cephalometric values*
Angle ()
ANB 2.7 2.2 5.4 2.11 5.6 2.48 0.1 0.74 0.541
SNA 80.8 3.6 80.9 3.23 80.4 3.58 0.5 0.92 0.019
SNB 78 4.4 75.5 2.87 74.8 3.11 0.6 1.18 0.126
MP-FH 29.4 3.5 29.8 7.17 29.6 7.15 0.2 1.55 0.213
U1-FH 113.7 8.2 119.0 8.39 105.0 7.26 14.0 7.62 0.003
L1-MP 93.3 6.1 100.8 7.49 98.7 7.05 2.0 3.54 0.155
IIA 123.3 11.2 109.9 7.08 126.2 6.90 16.3 8.13 0.003
OP 17.1 4.2 10.6 5.16 13.8 4.43 3.2 2.27 0.006
Linear (mm)
S-N 67.4 3.7 69.5 3.54 69.5 3.52 0.0 0.17 0.463
N-Me 124.1 5.4 126.1 7.53 127.0 7.07 0.8 1.77 0.155
U1/PP 30.6 2.7 30.4 4.43 31.7 3.44 1.3 1.96 0.100
U6/PP 24 2.4 24.9 3.11 25.6 2.87 0.6 0.71 0.018
L1/MP 43.3 2.9 46.0 3.27 43.5 3.28 2.5 1.56 0.004
L6/MP 32.1 2.6 36.5 2.53 37.5 2.52 1.1 0.92 0.010
U1/PTV 63.2 2.64 56.9 3.17 6.3 1.44 0.003
U6/PTV 27.5 2.39 30.5 2.00 3.0 0.76 0.003
L1/PTV 56.7 3.43 53.6 2.96 3.1 1.57 0.004
L6/PTV 28.8 2.66 32.1 3.30 3.3 2.03 0.004
Overjet 3.1 0.8 6.2 2.59 3.1 0.83 3.1 2.52 0.008
Overbite 3.1 1.7 1.8 1.21 1.3 0.46 0.5 1.32 0.173
Soft tissue values
Angle ()
Nasolabial angle 99.8 8.5 99.0 9.14 109.1 9.90 10.1 6.35 0.003
Inferior labial sulcus angle 140.5 13.5 127.9 18.18 130.4 14.44 2.5 19.99 0.9999
Z-angle 66.6 7.1 55.6 7.96 62.2 8.40 6.5 5.49 0.008
Facial convexity 13.2 4.9 14.2 4.99 14.6 5.21 0.5 3.15 0.689
Linear (mm)
SnP-UL 6.5 1.5 8.5 1.90 6.5 2.74 2.0 1.28 0.005
SnP-LL 6.4 1.9 8.9 2.30 6.1 2.55 2.8 1.29 0.003
E-UL 2.5 1.9 2.6 2.02 0.6 2.46 2.0 1.58 0.010
E-LL 0.9 1.9 5.1 2.38 2.4 2.40 2.7 1.46 0.003

*Wada et al,21 Ioi et al,22 and Miyajima et al.23 P 0.01; P 0.05; Wilcoxon signed rank test.

of overjet reduction was not statistically different be-
tween the groups, although the maxillary incisors were
more retracted in the implant group. However, there
was greater esthetic improvement in the implant group,
since the mandibular incisors were also significantly
retracted backward. In other words, the treatment re-
sults in the headgear group showed more bimaxillary
protruded profiles than those in the implant group.
Therefore, from an esthetic viewpoint, treatment with
traditional mechanics might be a compromise com-
pared with implant anchorage. We concluded that
orthodontic treatment with miniscrew anchorage is
simpler and more useful than traditional anchorage
mechanics for patients with skeletal Class II malocclu-
sion.
In this study, the upper lips were retracted 2.0 mm
as a result of the 6.3-mm retraction of the maxillary
incisors in the headgear group. A recent report showed
similar treatment results in Class II Division 1 patients
with traditional maximum anchorage: incisor retraction
of 5.3 mm and upper lip retraction of 2.0 mm.28
However, our soft-tissue analysis showed that lip posi-
tion in the implant group was more retracted than that
in the headgear group. As a result of sufficient retrac-
tion of incisors, the upper lip in the implant group was
significantly retracted, and the facial profile was im-
proved. Japanese people generally prefer a facial profile
with slightly retruded lips, even though the Japanese
soft-tissue cephalometric norm indicates a more convex
facial profile than in white people.22,23,29 Therefore, we
American Journal of Orthodontics and Dentofacial Orthopedics Kuroda et al 307
Volume 135, Number 3

Table II. Continued

Implant group

T1 T2 T2-T1

Mean SD Mean SD Mean SD P value

5.7 1.81 6.0 2.0 0.3 0.99 0.286

80.7 5.07 80.3 5.1 0.4 0.67 0.066
74.9 4.84 74.1 4.9 0.8 0.48 0.003
29.1 5.12 30.4 5.4 1.4 1.04 0.008
120.8 5.22 100.6 6.2 20.3 6.79 0.003
101.5 7.01 96.0 6.1 5.5 9.81 0.110
107.7 7.91 132.0 5.9 24.3 9.40 0.003
9.0 2.77 13.7 3.6 4.6 2.66 0.003

70.3 2.37 70.4 2.5 0.0 0.29 0.767

128.4 4.32 129.7 4.6 1.3 1.20 0.010
31.7 1.57 32.5 1.6 0.9 1.83 0.139
26.1 1.69 26.4 1.6 0.4 1.12 0.169
47.5 3.55 45.4 3.3 2.1 1.55 0.008
37.2 3.17 39.0 2.9 1.8 0.91 0.003
64.7 3.52 55.4 3.9 9.3 2.03 0.003
28.4 4.53 29.1 4.1 0.7 0.64 0.008
57.5 5.65 52.7 4.0 4.8 2.96 0.004
29.4 5.13 30.8 4.5 1.4 1.65 0.033
7.0 3.75 2.7 0.8 4.4 3.70 0.003
2.7 2.02 2.1 0.6 0.6 1.88 0.359

96.8 11.98 110.4 10.14 13.6 5.12 0.003

120.0 18.25 126.6 12.57 6.7 9.99 0.051
55.7 8.92 64.3 8.33 8.6 5.94 0.006
15.2 4.43 15.9 3.91 0.7 1.61 0.169

8.6 1.85 5.2 1.72 3.4 0.59 0.003

8.7 1.99 5.4 2.07 3.3 1.93 0.005
2.8 2.55 1.0 2.44 3.7 1.25 0.003
5.1 2.24 1.5 2.52 3.6 2.03 0.004

believe that treatment for severe skeletal Class II
patients using miniscrew anchorage achieves superior
morphologic improvement with respect to patients
desires than traditional orthodontic mechanics. How-
ever, it is important to diagnose the proper positions of
both incisors and lips if implant anchorages are used,
because excessive incisor retraction might cause a
dished-in face.
The mandibular molars were slightly extruded in both
groups, but the mandibular plane angle did not increase in
the headgear groups. These results suggested that the
wedge effect caused by mesial movements of the maxil-
lary and mandibular molars after space closure canceled
the mandibular clockwise rotation. In contrast, mesial
movements of the molars in both jaws were small as a
result of minimum anchorage loss of the maxillary molars
in the implant group. Thus, a slight clockwise rotation of
the mandible might be observed in the implant group not
to produce the wedge effect. Most subjects in this study
had an average mandibular plane angle with normal
overbite and few problems in the vertical dimension.
However, mandibular clockwise rotation should be
avoided when a patient has a long-face tendency or a high
mandibular plane angle with reduced overbite. In such
Class II cases, the molar intrusion mechanics should be
combined with incisor retraction. We could treat Class II
patients with anterior open bite using titanium screw
anchorage.10,30 Significant counterclockwise rotation of
the mandible was observed as a result of molar intrusion
by using implant anchorage, and it provided desirable
308 Kuroda et al American Journal of Orthodontics and Dentofacial Orthopedics
March 2009

Table III. Comparison of pretreatment and posttreatment changes (T2-T1) between groups
Headgear Implant

Variable Mean SD Mean SD P value

Cephalometric values
Angle ()
ANB 0.1 0.74 0.3 0.99 0.168
SNA 0.5 0.92 0.4 0.67 0.793
SNB 0.6 1.18 0.8 0.48 0.555
MP-FH 0.2 1.55 1.4 1.04 0.006
U1-FH 14.0 7.62 20.3 6.79 0.057
L1-MP 2.0 3.54 5.5 9.81 0.131
IIA 16.3 8.13 24.3 9.40 0.045*
OP 3.2 2.27 4.6 2.66 0.251
Linear (mm)
S-N 0.0 0.17 0.0 0.29 0.670
N-Me 0.8 1.77 1.3 1.20 0.224
U1/PP 1.3 1.96 0.9 1.83 0.694
U6/PP 0.6 0.71 0.4 1.12 0.818
L1/MP 2.5 1.56 2.1 1.55 0.511
L6/MP 1.1 0.92 1.8 0.91 0.107
U1/PTV 6.3 1.44 9.3 2.03 0.003
U6/PTV 3.0 0.76 0.7 0.64 0.000
L1/PTV 3.1 1.57 4.8 2.96 0.158
L6/PTV 3.3 2.03 1.4 1.65 0.042*
Overjet 3.1 2.52 4.4 3.70 0.341
Overbite 0.5 1.32 0.6 1.88 0.818
Soft-tissue values
Angle ()
Nasolabial angle 10.1 6.35 13.6 5.12 0.123
Inferior labial sulcus angle 2.5 19.99 6.7 9.99 0.309
Z-angle 6.5 5.49 8.6 5.94 0.279
Facial convexity 0.5 3.15 0.7 1.61 0.818
Linear (mm)
SnP-UL 2.0 1.28 3.4 0.59 0.009
SnP-LL 2.8 1.29 3.3 1.93 0.393
E-UL 2.0 1.58 3.7 1.25 0.028*
E-LL 2.7 1.46 3.6 2.03 0.212

P 0.01; *P 0.05; Wilcoxon signed rank test.

skeletal improvement in severe open-bite patients.10,30
Therefore, we do not consider treatment with miniscrew
anchorage inferior to that with headgear as a solution for
vertical skeletal problems. We suggest that orthodontic
treatment using miniscrew anchorage might be useful in
Class II patients with vertical problems.
Orthodontic treatment with miniscrew anchorage is
more comfortable for the patient than traditional rein-
forced anchorage such as multi-brackets combined with
intraoral or extraoral anchorage, because there is no
requirement for the patients cooperation. Nevertheless,
the success rate was approximately 80% to 95%, and
minimum invasion for placement surgery was necessary;
the patients complained of little pain and discomfort after
placement of the miniscrews.17,31-33 In addition, orth-
odontists can make a more correct diagnosis and treatment
plan, because the possible tooth movement does not
depend on the patients cooperation. However, the long-
term stability after treatment for skeletal Class II maloc-
clusion with implant anchorage is unknown. More relapse
might be possible in implant-treated patients during the
retention phase, because greater tooth movement was
achieved compared with traditional mechanics. However,
the profile of the implant-treated Class II patient after
long-term retention might be better than the traditional
treatment result even with greater relapse, since sufficient
distal movement of the maxillary teeth was achieved
during active treatment. This is a topic for future study in
implant orthodontics.T2a
CONCLUSIONS
Orthodontic treatment combined with either minis-
crew anchorage or headgear can achieve acceptable
results with reduction of overjet and improvement of
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 135, Number 3
facial profile in patients with skeletal Class II maloc-
clusion. However, incisor retraction with miniscrew
anchorage did not require the patients cooperation to
reinforce the anchorage and provided more significant
improvement of facial profile than that with traditional
anchorage mechanics such as headgear combined with
a transpalatal arch. Therefore, we conclude that orth-
odontic treatment with miniscrew anchorage is simpler
and more useful than traditional anchorage mechanics
in treating patients with Class II malocclusion.
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