Answering the Questions about Miniscrews

Over the last few years, JCO has published a number of articles dealing with skeletal anchorage, including the comprehensive treatment by Drs. Carano, Velo, Leone, and Siciliani in this issue. Most of these papers have been submitted from Asia, particularly South Korea; others have come out of Italy, Germany, and Scandinavia. Although the United States led the world in orthodontic innovations throughout the 20th century, it now seems that we have fallen behind other countries in adopting a new technology. Despite my initial reluctance to embrace this procedure, I think I will finally have to admit that the time has come for the acceptance of skeletal anchorage as a mainline clinical technique.

One stumbling block to the acceptance of miniscrews in this country has been the issue of who should place the implants. Dr. Carano and his colleagues advocate direct placement by the orthodontist and offer a number of valid points in favor of that position. A little over a year ago, the same question was addressed at a joint meeting I attended of the AAO Council on Orthodontic Education and the analogous council from the American Association of Oral and Maxillofacial Surgeons, held in conjunction with the annual session of the American Dental Education Association. The surgeons, as might be expected, maintained that since screw placement was indeed a surgical procedure, miniscrews should be placed by oral surgeons. I was somewhat surprised that with only minor dissension, the orthodontists in the room concurred. No one seemed to believe that orthodontists lack the necessary skills to place miniscrews, but the prevailing attitude was that orthodontists are busy enough with orthodontic procedures and would prefer to leave anything surgical to the surgeons. Since that time, I have spoken to a number of American orthodontists who are now using miniscrews, and most have agreed that the implantation should be done by oral surgeons or periodontists. I have concluded that while Asian and European orthodontists seem to prefer placing their own miniscrews, American orthodontists would rather not. If surgeons are going to be performing these procedures, though, orthodontists have to take responsibility for keeping them up to date on the current literature and for carefully monitoring the screw selection and placement for each individual patient. As many authors have illustrated, the location and angle of implantation are critical to the success of a case.