Insights to Extraradicular Bone Screw Applications for Challenging Malocclusions

Anchorage management is essential for orthodontic success, and temporary anchorage devices play an important role. Mandibular buccal shelf (MBS) miniscrews have proven very effective for the conservative management of skeletal malocclusion. The MBS is an area between the buccal frenum and anterior border of the masseter muscle. The boundaries of the buccal shelf are: alveolar ridge crest medially, the retromolar pad distally, buccal frenum mesially, external oblique ridge laterally. Infrazygomatic crest bone screws are a promising new approach for extra-radicular anchorage in the posterior maxilla. Bone screws are placed in the lateral aspect of the posterior alveolar process, on the buccal surface of the maxillary first and second molar roots. From a biomechanics perspective, the anterior border of the mandibular ramus is an ideal location for an anchorage screw.