Korean J Orthod.  2025 Jan;55(1):26-36. 10.4041/kjod24.136.

Combined anterior and posterior miniscrews increase apical root resorption of maxillary incisors in protrusion and premolar extraction cases

• Wang Z
• Mei L
• Tang Z
• Wu D
• Zhou Y
• Abdulghani EA
• Li Y
• Zheng W
• Li Y

• KMID: 2565026
• DOI: http://doi.org/10.4041/kjod24.136

Abstract

Objective
Miniscrews are commonly utilized as temporary anchorage devices (TADs) in cases of maxillary protrusion and premolar extraction. This study aimed to investigate the effects and potential side effects of two conventional miniscrew configurations on the maxillary incisors.
Methods
Eighty-two adult patients with maxillary dentoalveolar protrusion who had undergone bilateral first premolar extraction were retrospectively divided into three groups: non-TAD, two posterior miniscrews only (P-TADs), and two anterior and two posterior miniscrews combined (AP-TADs). Cone-beam computed tomography was used to evaluate the maxillary central incisors (U1).
Results
The APTADs group had significantly greater U1 intrusion (1.99 ± 2.37 mm, n = 50) and less retroclination (1.70° ± 8.80°) compared to the P-TADs (–0.07 ± 1.65 mm and 9.45° ± 10.68°, n = 60) and non-TAD group (0.30 ± 1.61 mm and 1.91° ± 9.39°, n = 54). However, the AP-TADs group suffered from significantly greater apical root resorption (ARR) of U1 (2.69 ± 1.38 mm) than the P-TADs (1.63 ± 1.46 mm) and non-TAD group (0.89 ± 0.97 mm). Notably, the incidence of grade IV ARR was 16.6% in the AP-TADs group, significantly higher than the rates observed in the P-TADs (6.7%) and non-TAD (1.9%) groups. Multiple regression analysis revealed that after excluding tooth movement factors, the AP-TADs configuration resulted in an additional 0.5 mm of ARR compared with the P-TADs group.
Conclusions
In cases of maxillary protrusion and premolar extraction, the use of combined anterior and posterior miniscrews enhances incisor intrusion and minimizes torque loss of the maxillary incisors. However, this approach results in more severe ARR, likely due to the increased apical movement and composite force exerted.

Keyword

Temporary anchorage device; Apical root resorption; Incisor; Orthodontic extraction

Figure

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  Figure 1 Mechanical set-up for A, non-TAD; B, P-TADs; C, AP-TADs. TAD, temporary anchorage device; P-TADs, two posterior miniscrews only; AP-TADs, two anterior and two posterior miniscrews combined.

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  Figure 2 A, Construction of FH plane, PP and MSP. B, Linear and angular measurements are projected onto the MSP. FH, Frankfurt Horizontal; MSP, mid-sagittal plane; PP, palatal plane.

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  Figure 3 Measurements of dehiscence and pulp chamber. A, The size of a dehiscence was defined as the linear distance from alveolar crest to cementoenamel junction. B, Middle sagittal slice of U1 was located, where cross-sectional area was obtained in C.

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  Figure 4 Root resorption in modified Malmgren’s grade. Means not sharing superscripts differ significantly at α = 0.05 level as indicated by Bonferroni post-hoc comparison after Fisher’s exact test. TAD, temporary anchorage device; P-TADs, two posterior miniscrews only; AP-TADs, two anterior and two posterior miniscrews combined.

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  Figure 5 Decision tree for managing maxillary incisors requiring retraction and intrusion based on pre-treatment root length. IPO, incisor position objective; CBCT, cone-beam computed tomography; ARR, apical root resorption.

Reference

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