J Oral Maxillofac Surg

66:1245-1252, 2008

Accuracy of Miniscrew Implant

Placement With a 3-Dimensional
Surgical Guide
Eduardo Yugo Suzuki, DDS, PhD,* and
Boonsiva Suzuki, DDS, PhD†

Purpose: Deviation in the trajectory during drilling or tapping of miniscrew implants increases the
risks of root injury. The purposes of this study were to assess the accuracy of miniscrew placement into
the dentoalveolar bone, aided by a 3-dimensional (3D) surgical guide, and to compare the results with
those from conventional procedures.
Materials and Methods: A total of 220 miniscrews implanted, aided by a 3D surgical guide (n ⫽
180), a conventional wire guide (n ⫽ 20), or no surgical guide (n ⫽ 20), were retrospectively
examined in relation to the accuracy of placement. Coordinates, distances, and angles of the
superimposed images of the planned and the correspondent implants were assessed and analyzed by
1-way analysis of variance.
Results: The results demonstrate that using the 3D surgical guide produced a significantly smaller
variation between the planned and actual implant positions at the miniscrew head and tail (0.6 ⫾ 0.5 mm
[mean ⫾ standard deviation] and 2.0 ⫾ 0.4 mm) compared with the wire guide (1.0 ⫾ 0.4 mm and 5.3 ⫾
1.1 mm) and no guide (3.6 ⫾ 1.7 mm and 10.5 ⫾ 3.5 mm). The accuracy of placement was significantly
improved with the 3D surgical guide (1.8 ⫾ 0.9°) compared with the wire guide (16.9 ⫾ 2.6°) and no
guide (21.2 ⫾ 2.9°).
Conclusions: The 3D surgical guide provides a precise method for miniscrew placement into the
dentoalveolar bone. The accurate insertion of miniscrews using the 3D surgical guide allows orthodon-
tists to precisely transfer the radiographic information from preoperative planning to the surgical site,
thus minimizing the risks of root injury.
© 2008 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 66:1245-1252, 2008

The use of skeletal anchorage for aiding orthodontic
treatment is a common procedure with sufficient flex-
ibility to allow the orthodontist to address a wide
range of problems.1-10 Because this procedure uses
the bone as anchorage, it has become broadly ac-
cepted as a viable alternative to the use of extraoral
devices in patients who either have insufficient dental
support suitable for anchorage or are not compliant in
wearing prescribed extraoral devices.11-15
Received from the Department of Orthodontics, Faculty of Den-
tistry, Chiang Mai University, Chiang Mai, Thailand.
*Lecturer.
†Lecturer.
Address correspondence and reprint requests to Dr Suzuki:
Department of Orthodontics, Faculty of Dentistry, Chiang Mai Uni-
versity, Suthep Road, Amphur Muang, Chiang Mai 50200, Thailand;
e-mail: yugo@chiangmai.ac.th
© 2008 American Association of Oral and Maxillofacial Surgeons
0278-2391/08/6606-0022$34.00/0
doi:10.1016/j.joms.2007.08.047
The skeletal anchorage technique was originally
applied using conventional prosthetic osseointe-
grated implants in the midsagittal area of the palate1-3
and in the retromolar area of the mandible.4,5 In
recent years, the technique has been applied success-
fully to the dentoalveolar area as well, by means of
miniscrew implants.6-37 These orthodontic implants’
small diameter allows their insertion into several areas
of the maxilla and mandible that were previously
unavailable for implant insertion, such as the alveolar
bone between the roots of adjacent teeth. Nonethe-
less, the placement of miniscrew implants poses a
challenge to the orthodontist because of the limited
space available for implant placement and the poten-
tial risk of root damage during implant placement
procedures.9-33
Several methods have been proposed for transfer-
ring the 2-dimensional (2D) information in the radio-
graphs used for surgical planning to the 3D surgical
site to minimize the risks of root damage. For exam-
ple, inserting a radiopaque marker, such as brass 9,10

1245
1246 THREE-DIMENSIONAL SURGICAL GUIDE FOR MINISCREW IMPLANT PLACEMENT
or stainless steel wire,15 into the interproximal space
of the selected implant site has been suggested as a
practical method to help guide the drill between the
dental roots. But these techniques do not avoid devi-
ation in the trajectory of the drill while creating a pilot
hole during miniscrew implant placement and may
result in significant errors in the final implant posi-
tion. They also do not eliminate the risk of root injury.
Recently, the use of custom-made surgical guides34
and templates35-37 has been proposed for transferring
radiographic preoperative planning information to the
surgical site and outlining the ideal implant axis, to
promote safe miniscrew implant placement into the
dentoalveolar bone. But in the methods reported to
date, fabricating the individualized surgical guide is
time-consuming and requires extensive advance prep-
aration in the laboratory, thus limiting their clinical
applications. The need for a simpler and more accu-
rate technique for miniscrew implant placement into
dentoalveolar bone has led us to develop a user-
friendly version of the 3D surgical guide to aid both
surgical planning and placement procedures.38
In this article, we describe the development of an
innovative surgical guide device that permits the 3D
placement of miniscrew implants in the dentoalveolar
area, avoiding root damage, and also compare the
accuracy of this technique with that of the conven-
tional surgical guide technique.
Materials and Methods
SAMPLE
The sample consisted of 220 miniscrew implants
that were systematically implanted into the dentoal-
veolar bone, rigorously following the MIG protocol
for safe miniscrew implant placement (Miniscrew Im-
plant Group, Department of Orthodontics, Faculty of
Dentistry, Chiang Mai University). Miniscrew implants
were retrospectively examined in relation to the ac-
curacy of placement. In the present study, planning
and miniscrew placement into the dentoalveolar bone
were performed by the same orthodontist (E.Y.S.),
aided by a 3D surgical guide (n ⫽ 180), a convention-
al surgical wire guide (n ⫽ 20), or no surgical guide
(n ⫽ 20).
THE 3D SURGICAL GUIDE
The newly developed 3D surgical guide used in this
study (Y&B Products LP, Chiang Mai, Thailand) is the
product of refinements to the previous version of this
totally adjustable surgical guide,38 with a size reduc-
tion to allow more versatility for orthodontists (Fig 1).
The simple design of this new version allows quick
and easy connection to any desired position along the
archwire of the orthodontic appliance. A manual
FIGURE 1. A, Intraoral picture of the 3D surgical guide in position.
B, The user-friendly 3D surgical guide allows easy and quick connec-
tion to any desired position along the archwire of the orthodontic
appliance.
Suzuki and Suzuki. Three-Dimensional Surgical Guide for Mini-
screw Implant Placement. J Oral Maxillofac Surg 2008.
screwdriver is used to accurately adjustment the trac-
tion hook along the archwire either inside or outside
the patient’s mouth. These modifications reduce pro-
duction costs and improve user-friendliness.
The 3D surgical guide consists of a 5-, 7-, or 9-mm-
long vertical arm connected at one end to the main
orthodontic wire to provide rigid, stable anchorage
by means of Gurin locks. At the opposite end of the
adjustable arm is the surgical guide, a stainless steel
tube 5 mm long and 3 mm in diameter. The surgical
guide tube is used to map the optimum implant site
during the radiographic diagnostic procedures, orient
the drilling of the pilot hole, and, subsequently, place
the implant (Figs 2A,B).
The 3D surgical guide is positioned as accurately as
possible at the preselected miniscrew implant site. A
radiograph is obtained to determine whether the ra-
diopaque tube is in the correct location. If it is not,
then the device is adjusted and successive radio-
graphs are made until the tube is positioned correctly.
The tube position guides the drilling of the pilot hole
and subsequent implant placement (Figs 2C-F). Mi-
nor adjustments in the position of the 3D surgical
guide allow for variations in the recommended mi-
niscrew implant angulations to the long axes of the
teeth. Changes in these angulations produce in-
creased surface contact between the implant and
bone.9,10,38
In this study, the conventional surgical wire guide
technique was performed using brass wires as mark-
ers (Fig 3).
IMPLANT PROCEDURE
Preoperative bitewing radiographs of the selected
implant site were made using the vertical bitewing
technique (VBT) aided by a film holder (Rinn XCP film
holding system; Dentsply, York, PA) to ensure precise
mapping of the optimum implant site (Fig 4A). For the
SUZUKI AND SUZUKI
FIGURE 2. Surgical procedure with the 3D surgical guide. A, The 3D
surgical guide in position. B, Preoperative radiographic assessment of the
optimum position. The radiographic markers orient both the ideal mini-
screw implant placement position projected onto the recipient bone and
the implant position relative to the surrounding structures. C, A pilot hole is
drilled with aid of the 3D surgical guide in position. D, The miniscrew
implant is inserted through the surgical tube. E, Final miniscrew position.
F, Postoperative radiographic image of the miniscrew implant in position.
Suzuki and Suzuki. Three-Dimensional Surgical Guide for Mini-
screw Implant Placement. J Oral Maxillofac Surg 2008.
3D surgical guide and conventional surgical guide
techniques, radiographs were obtained with the sur-
gical guide in position to show the relationship of the
guide to surrounding structures and available bone.
The patient’s bite registration was performed on
the plastic tab of the film holder to ensure precise
positioning of the film at the chosen implant site. Bite
registration was performed using conventional elasto-
meric impression material. The purpose of this cus-
tom-made film holder was to obtain a standardized
series of radiographs of the implant site throughout
the implant placement procedures. It also ensured the
alignment of the film and prevented cone cutting. The
long-cone technique reduced distortion and the stan-
dardized film–x-ray tube distance (Fig 4B). Radio-
graphs were developed using standard techniques. All
radiographs were taken using the long-cone tech-
nique.
1247
Additional radiographs were taken until a definitive
implant placement position that would not violate
any surrounding structures was determined. The ra-
diographic image of the surgical guides projected
onto the recipient bone allowed orientation of the
ideal miniscrew implant placement position relative
to the surrounding structures. Once the optimum
implant position was determined, a pilot hole was
drilled using a manual drill with normal saline irriga-
tion to avoid excessive heat generation and remove
the bone debris produced by the drilling.
In the conventional surgical guide methods, the
miniscrew implants were inserted directly into the
pilot hole using a manual screwdriver. In the 3D
surgical guide method, the miniscrew implants were
inserted into the pilot hole through the surgical guide
tube with a manual screwdriver, to reduce the risk of
implant deviation during implant insertion and to
ensure precise 3D implant placement in the preoper-
atively planned position.
Once the miniscrew implant was inserted, an addi-
tional periapical radiograph of the implant site was
made using the custom-made film holder to confirm
proper implant positioning.
MEASUREMENT METHODS
The accuracy of miniscrew implant placement was
assessed using a custom software application (Smart’n
Ceph version 10; Y & B Products) that was developed
to “virtually plan” the optimum implant placement
before initiation of the actual implant placement pro-
cedure.38 This software automatically generates a
virtual bisecting line in the following manner. Using
the cementoenamel junction as a reference, a tan-
gent is drawn to the point of greatest convexity on
the proximal root surface of adjacent teeth at the
implant site. These lines are extended coronally to
form an angle, which is then bisected. The virtual
bisecting line thus formed is used as a reference for
the optimum planned implant position. The equi-
distant position between the roots of the adjacent
teeth is considered the safest site for mini-screw
FIGURE 3. A, Intraoral picture of the conventional surgical wire guide
technique. B, The radiographic image of the surgical wire orients the ideal
miniscrew implant placement position projected onto the recipient bone.
Suzuki and Suzuki. Three-Dimensional Surgical Guide for Mini-
screw Implant Placement. J Oral Maxillofac Surg 2008.
1248 THREE-DIMENSIONAL SURGICAL GUIDE FOR MINISCREW IMPLANT PLACEMENT

FIGURE 4. A, Preoperative periapical radiographs of the selected implant site were made using VBT with the aid of a film holder to ensure precise
mapping of the optimum implant site. B, Radiographs were taken using the long-cone technique.
Suzuki and Suzuki. Three-Dimensional Surgical Guide for Miniscrew Implant Placement. J Oral Maxillofac Surg 2008.

placement and thus serves as the “gold standard”
for miniscrew implant placement in all 3 methods
used in this study (Figs 5, 6).
A best-fit superimposition of the preoperative and
postoperative radiographic images of the interradicu-
lar bone at the implant site was performed using the
alveolar bone crest and the adjacent roots as refer-
ences. For each miniscrew implant, the distance be-
tween the center of the implant head and the virtual
bisecting line was calculated. The center of the im-
plant head was defined as the point of maximum
convexity on the radiographic image of the surface of
the head. This calculation was repeated for the tail.
These measurements were recorded twice by the
same examiner, and results were averaged. In addi-
tion, the angles formed between the virtual bisecting
lines and the long axes of the corresponding implants
were calculated (Fig 7).
ERRORS OF THE METHOD
The errors associated with the method were com-
puted using all periapical radiographs to evaluate
measurement reliability. Four randomly selected ra-
diographs were remeasured and redigitized after a
3-week interval. The mean differences between dupli-
cate measurements were analyzed using paired t tests
to show the systematic errors (P ⬍ .05). Dahlberg’s
method20 was used to determine the error between
the duplicate determinations. The coefficient of reli-
ability also was calculated.21
STATISTICAL ANALYSIS
The statistical analyses were performed using the
SPSS program (SPSS Inc, Chicago, IL) on a personal
computer. A paired t test statistical analysis was used
to assess the significance of the amount of 2D dis-
placement demonstrated by the preoperative plan-
ning and the actual implant positions. Descriptive
statistics (reported here as mean ⫾ standard devia-
tion) were calculated for all measurement differences
between the preoperative and postoperative data sets
and analyzed by 1-way analysis of variance. Statistical
significance was established at the 0.5% level.

FIGURE 5. A, For each miniscrew implant, 2 points were located, 1 on the long axis at the center of the head of the miniscrew implant and the
other at the tail of the screw. B, Coordinates of preoperative planning sites were compared with their actual position coordinates as identified on
the radiographic image using custom-made software.
Suzuki and Suzuki. Three-Dimensional Surgical Guide for Miniscrew Implant Placement. J Oral Maxillofac Surg 2008.
SUZUKI AND SUZUKI 1249

were 2.0 ⫾ 0.4 mm for the 3D surgical guide, 5.3 ⫾

1.1 mm for the conventional surgical wire, and 10.5 ⫾
3.5 mm for the no guide method (Fig 8). These dif-
ferences are statistically significant (P ⬍ .001). The
mean angles formed between the long axes of the
miniscrew implant and the virtual bisecting line were
1.8 ⫾ 0.9° for the 3D surgical guide, 16.9 ⫾ 2.6° for
the conventional surgical wire, and 21.2 ⫾ 2.9° for
the no guide method (Fig 9). These differences are
statistically significant (P ⬍ .001).

Discussion
These results indicate that the 3D surgical guide
technique produced significantly less variation be-
tween the planned and actual implant placement po-
sitions at both the miniscrew head and tail compared
with both the conventional surgical wire guide and
no guide methods. The esthetic and social concerns
related to wearing headgear for molar distalization

FIGURE 6. Diagram of the anatomic references and constructed lines

used for the measurements. The virtual bisecting line formed by the
tangent lines to the mesial (a) and distal (c) roots of the adjacent teeth
passing through the cementoenamel junction was used as a reference
for the construction of a virtual bisecting line (b).
Suzuki and Suzuki. Three-Dimensional Surgical Guide for Mini-
screw Implant Placement. J Oral Maxillofac Surg 2008.

Results
Using the t test for paired data, no significant dif-
ferences were found between the means of the mea-
surements taken on 2 occasions. As a general rule, the
linear measurements were less reproducible than the
angular measurements.
The positions of miniscrew implants placed using
the different surgical guide methods were compared
with their corresponding preoperatively planned po-
sitions (virtual bisecting line), and the accuracy of
placement was analyzed. The mean distances be-
tween the planned and actual implant placement po-
sitions measured at the miniscrew heads were 0.6 ⫾
0.4 mm for the 3D surgical guide method, 1.0 ⫾ 0.4 FIGURE 7. Distances between the virtual bisecting line (b) and the
center of the implant head (h) and tail (t) on the long axis of the implant
mm for the conventional surgical wire method, and (s), along with the angle formed between the virtual bisecting line (b)
3.6 ⫾ 1.4 mm for the no guide method. The mean and the long axis of the corresponding implant.
distances between the planned and actual implant Suzuki and Suzuki. Three-Dimensional Surgical Guide for Mini-
placement positions, measured at the miniscrew tail, screw Implant Placement. J Oral Maxillofac Surg 2008.
1250 THREE-DIMENSIONAL SURGICAL GUIDE FOR MINISCREW IMPLANT PLACEMENT
FIGURE 8. Mean distance between the planning and actual implant placement positions measured at the miniscrew head and tail.
Suzuki and Suzuki. Three-Dimensional Surgical Guide for Miniscrew Implant Placement. J Oral Maxillofac Surg 2008.
and control of anchorage loss with the use of intraoral
molar mechanics has stimulated many investigators to
evaluate the possibility of using miniscrew implants as
anchorage devices.6-38
One benefit of miniscrew implants is that they
reduce the problem of patient compliance, permit-
ting total control over the orthodontic treatment and,
consequently, allowing the orthodontist to address a
wide range of problems.6-38 Moreover, compared
with traditional anchorage methods, miniscrew im-
plants permit absolute anchorage while allowing the
use of relatively simple force delivery systems involv-
ing either elastomeric chains or nickel-titanium
closed-coil springs activated between the heads of the
miniscrew implants and the orthodontic appli-
ance.6-33
Despite these advantages, however, the placement
of miniscrew implants in the septal bone between the
roots of adjacent teeth poses a challenge to orthodon-
tists because of the limited space for implant place-
ment and the potential risk of root damage. To avoid
these problems, surgical guides and templates have
been developed to help transfer the preoperative
planning information to the surgical site and promote
safe miniscrew implant placement into the dentoalve-
olar bone.9,10,15,34-36 However, most of the surgical
guide methods proposed to date do not avoid devia-
tion in the trajectory of the drill during creation of a
pilot hole during miniscrew implant placement pro-
cedures, which can result in significant error in the
final implant position. They also do not eliminate the
potential risk of root injury.
Three-dimensional surgical guides and templates
for visualizing the restorative plan during implant
surgery and precisely aligning the implant axis are
used routinely in dental implantology.39,40 Several
studies have demonstrated the value of this technique
in the diagnosis, planning, and placement of dental
implants.39-43 Nonetheless, the clinical application of
a 3D surgical guide that allows for more accurate and
safe placement of orthodontic miniscrew implants in
the interproximal spaces of the dentoalveolar area
remains rarely reported in the literature.
In a previous report, we described the clinical use
of a totally adjustable surgical guide device that allows
3D control during miniscrew implant placement pro-
cedures.38 Although we obtained excellent results,
the bulky size of that device limited its clinical appli-
cation. In contrast, the present study used an im-
proved version of this guide—the 3D surgical
guide—to aid miniscrew placement. This device in-
corporates all of the best features of the earlier ver-
sion in a smaller device, providing more versatility for
orthodontists.
The 3D surgical guide was designed to permit easy
connection to the main wire of the orthodontic ap-
pliance using the available interbracket spaces. Minor
adjustments of the Gurin locks allow connection to
any position of the maxillary or mandibular dental
arch with excellent stability. Through the vertical arm
of the surgical guide, modifications may be performed
FIGURE 9. Measurement of the angle formed between the planned
and actual miniscrew implant positions.
Suzuki and Suzuki. Three-Dimensional Surgical Guide for Mini-
screw Implant Placement. J Oral Maxillofac Surg 2008.
SUZUKI AND SUZUKI
to select an angle between the implant and the bone
surface that produces increased surface contact be-
tween the implant and bone.9,10 These modifications
allow for total adjustment in all spatial planes to im-
prove the control and versatility of the surgical guide.
A statistically significant improvement was found in
all linear measurements when the 3D surgical guide
was used. Accuracy of placement of both the head
and the tail of the miniscrew implant was significantly
improved when the center of the surgical tube of the
3D surgical guide was positioned at the center of the
insertion site. Only a minor deviation in the tapering
trajectory of the miniscrew implant occurred
throughout the placement. This minor deviation was
confirmed by the small difference in the angle formed
between the planned virtual line bisecting the angles
between the proximal root surfaces of adjacent teeth
at the implant site and the long axes of the corre-
sponding implants. These angles were significantly
reduced with use of the 3D surgical guide. Accord-
ingly, use of the 3D surgical guide resulted in more
precise miniscrew implant placement compared with
both the conventional wire guide and no guide meth-
ods. The clinical significance of these results may be
relevant when applied to such situations as reduced
space between the roots, where accuracy is critical.
More importantly, no case of root damage was ob-
served during miniscrew implantation using the 3D
surgical guide method.
The use of a conventional wire guide improved the
accuracy of placement at the center of the insertion
site compared with the use of no surgical guide.
However, use of the conventional wire guide did not
eliminate deviation of the trajectory of the miniscrew
implant during placement. This finding was con-
firmed by the significant difference in the angles be-
tween the long axes of the preoperative and the
actual miniscrew positions. Although no case of root
damage was observed during miniscrew implant
placement procedures with the conventional wire
guide, the actual miniscrew position was not predict-
able with this technique.
The use of no surgical guide was the least accurate
method of placing both the head and the tail of the
miniscrew implants. This assessment was confirmed
by the significant difference in the angles formed
between the long axes of the preoperative and the
actual miniscrew positions.
The main advantage of implant placement using the
3D surgical guide is the ability to transfer preopera-
tive radiographic information to the surgical site. Con-
sequently, the pilot hole can be drilled safely, avoid-
ing important anatomic structures, such as the dental
roots. Moreover, the ability to directly insert the mi-
niscrew implant through the surgical guide reduces
the risk of implant deviation and ensures precise, 3D
1251
implant placement into the preoperatively planned
position.
The 3D surgical guide can be used only when
connected to an orthodontic appliance, and stability
of the guide can be achieved only when natural teeth
are present. But the 3D surgical guide is not needed in
a large edentulous area, where conventional implant
placement methods, such as the conventional surgical
wire guide, or even the use of no surgical guide may
provide sufficient accuracy of implant placement
without compromising important anatomic struc-
tures.
Radiographic diagnosis is important for detecting
anatomic limitations and identifying potential implant
sites. Precise preoperative positions may be identified
for implants using radiographs; however, these posi-
tions may need to be modified during the surgery,
especially with regard to clinical access to the implant
sites and the difficulty in achieving a perpendicular
angle between the pilot hole drill and the bone sur-
face in the posterior maxillary area. Small deviations
during drilling of the pilot hole may cause damage to
dental roots. The use of a 3D surgical guide may
significantly reduce this problem, thus facilitating the
surgical procedure.
The use of custom-made film holders proved to be
extremely important in acquiring a standardized se-
ries of radiographs of the implant site throughout the
implant placement procedures. It also ensured cor-
rect alignment of the film and prevented cone-cutting.
In the clinical setting, selection of the optimum
implant sites is determined by the treatment plan,9
mechanics,10 quality and quantity of interseptal bone
between the roots of 2 adjacent teeth, and proximity
to important anatomic structures.30,33 In this study,
however, only the proximity to the important ana-
tomic structures was taken into account when assess-
ing the accuracy of miniscrew implant placement and
comparing the 3D surgical guide method with con-
ventional methods, because proximity was the only
factor that could be objectively measured.
In this study, a customized software program was
especially developed to “virtually plan” optimum mi-
niscrew implant placement into the dentoalveolar
bone before the actual implant placement was under-
taken. To the best of our knowledge, this is the first
attempt at assessing the accuracy of insertion of mi-
niscrew implants into the dentoalveolar bone using a
customized software program.
Within the limits of this retrospective clinical study,
it can be concluded that the 3D surgical guide allows
for improved implant placement with significantly
reduced risk of root damage. Further studies are
needed to evaluate the accuracy of the placement of
miniscrew implants under controlled experimental
conditions.
1252 THREE-DIMENSIONAL SURGICAL GUIDE FOR MINISCREW IMPLANT PLACEMENT
Acknowledgments
The authors thank Dr M. Kevin O Carroll, Professor Emeritus,
University of Mississippi School of Dentistry and Faculty Consul-
tant, Chiang Mai University Faculty of Dentistry, for helping to
prepare the manuscript. They also thank Y & B Products LP for
providing the surgical guide used in this study and other materials
and software necessary to this project.
References
1. Wehrbein H, Merz BR, Diedrich P: Palatal bone support for
bone orthodontic implant anchorage: A clinical and radiologi-
cal study. Eur J Orthod 21:65, 1999
2. Mannchen R: A new supraconstruction for palatal orthodontic
implants. J Clin Orthod 7:373, 1999
3. Janssens F, Swennen G, Dujardin T, et al: Use of onplant as
orthodontic anchorage. Am J Orthod Dentofac Orthop 122:
566, 2002
4. Roberts WE, Helm FR, Marshall KJ, et al: Rigid endosseous
implants for orthodontic and orthopedic anchorage. Angle
Orthod 59:247, 1989
5. Roberts WE, Marshall KJ, Mozsary PG: Rigid endosseous im-
plant utilized as anchorage to protract molars and close an
atrophic extraction site. Angle Orthod 60:135, 1990
6. Kanomi R: Miniscrew implant for orthodontic anchorage. J Clin
Orthod 11:763, 1997
7. Freudenthaler JW, Haas R, Bantleon HP: Bicortical titanium
screws for critical orthodontic anchorage in the mandible: A
preliminary report on clinical applications. Clin Oral Implants
Res 12:358, 2001
8. Park HS, Bae SM, Kyung HM, et al: Micro-implant anchorage for
treatment of skeletal class I bialveolar protrusion. J Clin Orthod
35:417, 2001
9. Kyung HM, Park HS, Bae SM, et al: Development of orthodontic
miniscrew implants for intraoral anchorage. J Clin Orthod
6:321, 2003.
10. Kyung SH, Choi JH, Park YC: Miniscrew anchorage used to
protract lower second molars into first molar extraction sites.
J Clin Orthod 37:575, 2003
11. Lin JC, Liou EJ: A new bone screw for orthodontic anchorage.
J Clin Orthod 12:676, 2003
12. Park HS, Bae SM, Kyung HM, et al: Simultaneous incisor retrac-
tion and distal molar movement with microimplant anchorage.
World J Orthod 5:164, 2004
13. Park HS, Kwon OW, Sung JH: Micro-screw implant anchorage
sliding mechanics. World J Orthod 6:265, 2005
14. Yun SW, Lim WH, Chun YS: Molar control using indirect
miniscrew anchorage. J Clin Orthod 39:661, 2005
15. Bae SM, Park HS, Kyung HM, et al: Clinical application of
micro-implant anchorage. J Clin Orthod 36:298, 2002
16. Jeon YJ, Kim YH, Son WS, et al: Correction of a canted occlusal
plane with miniscrews in a patient with facial asymmetry. Am J
Orthod Dentofac Orthop 130:244, 2006
17. Jeon JM, Yu HS, Baik HS, et al: En-masse distalization with
miniscrew anchorage in class II nonextraction treatment. J Clin
Orthod 40:472, 2006
18. Park HS, Jang BK, Kyung HM: Maxillary molar intrusion with
micro-implant anchorage (MIA). Aust Orthod J 21:129, 2005
19. Park HS, Kwon TG, Sung JH: Nonextraction treatment with
micro-screw implants. Angle Orthod 74:539, 2004
20. Park HS, Kwon OW, Sung JH: Uprighting second molars with
micro-implant anchorage. J Clin Orthod 38:100, 2004
21. Park HS, Kwon TG, Kwon OW: Treatment of open bite with
micro-screw implant anchorage. Am J Orthod Dentofac Orthop
126:627, 2004
22. Lee JS, Park HS, Kyung HM: Micro-implant anchorage for lin-
gual treatment of a skeletal class II malocclusion. J Clin Orthod
35:643, 2001
23. Fritz U, Ehmer A, Diedrich P: Clinical suitability of titanium
micro-screws for orthodontic anchorage: Preliminary experi-
ences. J Orofac Orthop 65:410, 2004
24. Carano A, Velo S, Incorvati C, et al: Clinical applications of the
Mini-Screw Anchorage System (MAS) in the maxillary alveolar
bone. Prog Orthod 5:212, 2004
25. Carano A, Velo S, Leone P, et al: Clinical applications of the
Miniscrew Anchorage System. J Clin Orthod 39:9, 2005
26. Maino BG, Bednar J, Pagin P, et al: The spider screw for skeletal
anchorage. J Clin Orthod 37:90, 2003
27. Maino BG, Maino G, Mura P: Spider screw: A skeletal anchor-
age system. Prog Orthod 6:70, 2005
28. Maino BG, Mura P, Bednar J: Miniscrew implants: The spider
screw anchorage system. Semin Orthod 11:40, 2005
29. Herman R, Cope JB: Miniscrew implants: IMTEC Mini Ortho
implants. Semin Orthod 11:32, 2005
30. Poggio PM, Incorvati C, Velo S, et al: “Safe zones”: A guide for
miniscrew positioning in the maxillary and mandibular arch.
Angle Orthod 76:191, 2006
31. Deguchi T, Nasu M, Murakami K, et al: Quantitative evaluation
of cortical bone thickness with computed tomographic scan-
ning for orthodontic implants. Am J Orthod Dentofac Orthop
129:721, 2006
32. Ishii T, Nojima K, Nishii Y, et al: Evaluation of the implantation
position of mini-screws for orthodontic treatment in the max-
illary molar area by a micro CT. Bull Tokyo Dent Coll 45:165,
2004
33. Schnelle MA, Beck FM, Jaynes RM, et al: A radiographic evalu-
ation of the availability of bone for placement of miniscrews.
Angle Orthod 74:832, 2004
34. Kitai N, Yasuda Y, Takada K: A stent fabricated on a selectively
colored stereolithographic model for placement of orthodontic
mini-implants. Int J Adult Orthod Orthognath Surg 17:264,
2002
35. Morea C, Dominguez GC, Wuo Ado V, et al: Surgical guide for
optimal positioning of mini-implants. J Clin Orthod 39:317,
2005
36. Cousley RR, Parberry DJ: Surgical stents for accurate miniscrew
insertion. J Clin Orthod 40:412, 2006
37. Martin W, Heffernan M, Ruskin J: Template fabrication for a
midpalatal orthodontic implant: Technical note. Int J Oral Max-
illofac Implants 17:720, 2002
38. Suzuki EY, Buranastidporn B: An adjustable surgical guide for
miniscrew placement. J Clin Orthod 39:588, 2005
39. Tosun T, Keles A, Erverdi N: Method for the placement of
palatal implants. Int J Oral Maxillofac Implants 17:95, 2002
40. Weinberg LA, Kruger B: Three-dimensional guidance system
for implant insertion: Part I. Implant Dent 2:81, 1998
41. Higginbottom FL, Wilson TG: Three-dimensional templates for
placement of root-form dental implants: A technical note. Int
J Oral Maxilofac Implants 11:787, 1996
42. Cehreli MC, Calis AC, Sahin S: A dual-purpose guide for opti-
mum placement of dental implants. J Prosthet Dent 88:640,
2002
43. Almog DM, Torrado E, Meitner SW: Fabrication of imaging and
surgical guides for dental implants. J Prosthet Dent 85:504,
2001