Miniscrew Anchorage Research Articles

Miniscrew anchorage versus Class II elastics for maxillary arch distalization using clear aligners.

To identify whether intramaxillary miniscrew anchorage could achieve a better maxillary arch distalization effect in clear aligner treatment compared to Class II elastics. Thirty adult patients with Class II dentition who were treated with whole maxillary arch distalization using clear aligners were collected. Either intramaxillary miniscrew anchorage (miniscrew group, n = 17) or intermaxillary Class II elastics (Class II elastic group, n = 13) were used to support maxillary arch distalization. Three-dimensional predicted and achieved displacements, and angular changes of maxillary posterior teeth and anterior teeth, were measured and compared. The achieved distalization efficiency was 36.2%-43.9% in the posterior teeth and the retraction efficiency was 36.9%-49.4% in the anterior teeth. No statistically significant differences were found in maxillary arch distalization efficiency between the groups. The miniscrew group achieved less incisor extrusion and posterior tooth distal tipping than the Class II elastic group. Both groups achieved comparable arch expansion, posterior tooth buccal inclination, and anterior tooth lingual inclination. Intramaxillary miniscrew anchorage and intermaxillary Class II elastics achieved comparable efficiency in maxillary arch distalization. However, the miniscrew anchorage showed better vertical control in anterior teeth and mesiodistal tipping control in posterior teeth.

Comparative Evaluation of Molar Distalization Between Pendulum Appliance and Miniscrew Anchorage System: A Clinical Study

Introduction: Molar distalization is one of the treatment protocols in cases with mild to moderate arch discrepancy and class II molar relationship associated with a normal mandible. It is achieved by using pendulum appliance and temporary anchorage devices such as miniscrew anchorage system. Aims and Objectives: To evaluate and compare the dentoalveolar and skeletal changes between pendulum appliance and miniscrew anchorage system. Materials and Methods: The patients were divided into 2 groups of 10 each: group I (using the pendulum appliance) and group II (using miniscrew anchorage system). Lateral cephalogram was taken for each subject and various skeletal such as SNA, SNB, ANB, and PTV-A dentoalveolar (U1-PTV, U6-PTV, U5-FH, and U6-FH) measurements were taken. The data obtained were statistically analyzed using Statistical Package for Social Sciences (SPSS) software. Intragroup analysis between pendulum and implant group was done using Wilcoxon Matched pairs test and the intergroup analysis between pendulum and implant group was done using Mann–Whitney test. Results: The results showed that there was nonsignificant difference in both the groups ( p > .05) with the less tipping in group II (1.2) than group I (2.7) .The molar extrusion was more with the pendulum group (2.1 mm) than the miniscrew anchorage distalization group (1.3 mm). Conclusion: The molar distalization using the miniscrew anchorage system showed more bodily movement than the pendulum appliance which showed more tipping movement. Moreover, the pendulum appliance showed significant amount of anchor loss than the miniscrew anchorage system.

The treatment of severe class II division 2 patients with deep overbites and gummy smiles using lingual appliances: a case series

Abstract The treatment of Class II division 2 patients with palatally inclined upper incisors using lingual appliances is generally challenging due to difficulties in achieving upper incisor torque control. The present case series aims to describe a simple method combining lingual appliances and mini-screws for the non-surgical management of two severe Class II division 2 patients presenting with deep overbites and gummy smiles. The treatment plans involved initial bite opening and upper incisor torque recovery, followed by distalisation of the entire upper arch using mini-screw anchorage. In one case, additional anterior labial mini-screws were necessary to assist incisor intrusion and complete upper arch levelling. Favourable treatment results suggest that lingual appliances, when combined with mini-screws and pre-torqued arch wires, may offer an effective approach for the non-surgical management of severe Class II division 2 patients with deep overbites and gummy smiles.

Biomechanical analysis of miniscrew-assisted molar distalization with clear aligners: a three-dimensional finite element study.

To compare the biomechanical characteristics of maxillary molar distalization with clear aligners in conjunction with three types of miniscrew anchorage. Three-dimensional (3D) finite element models of maxillary molar distalization with clear aligners and three types of miniscrew anchorage were established, including (A) control group, (B) direct buccal miniscrew anchorage group, (C) direct palatal miniscrew anchorage group, and (D) indirect buccal miniscrew anchorage group. The 3D displacement of maxillary teeth and the principal stress (maximum tensile and compressive stress) on the root and periodontal ligament (PDL) during molar distalization were recorded. The tooth displacement pattern during maxillary molar distalization in the four groups showed similarities, including labial tipping of anterior teeth, mesial and buccal tipping of premolars, and distal and buccal tipping of molars, but with varying magnitudes. Group C exhibited the greatest molar distalization, with the first molar achieving 0.1334 mm of crown distalization. Group D demonstrated a notable buccal crown movement (0.0682 mm) and intrusion (0.0316 mm) of the first premolar. Compared to Groups A and B, Groups C and D showed less labial crown tipping of the central incisor. Group B showed the greatest amount of maxillary incisor intrusion (central incisor: 0.0145 mm, lateral incisor: 0.0094 mm). Moreover, Groups C and D displayed significantly lower levels of compressive and tensile stress in the roots and PDL of the maxillary central and lateral incisors. Molar distalization is a dynamic process involving sequential tooth movement stages; however, our research primarily examined the tooth movement patterns in the initial aligner. The use of miniscrew anchorage, especially direct palatal miniscrew anchorage, may enhance the treatment efficacy of maxillary molar distalization with clear aligners, leading to increased molar distalization, reduced mesial movement of premolars, and minimized labial tipping of anterior teeth.

Effectiveness of Miniscrew-Supported Molar Intrusion: A Clinical Study.

Mini-screws, also known as temporary anchorage devices (TADs), offer enhanced control and versatility in orthodontic treatment by providing stable anchorage points. This clinical study aims to evaluate the effectiveness of mini-screw-supported molar intrusion in orthodontic practice. For this clinical study, a cohort of 40 orthodontic patients with various malocclusions requiring molar intrusion as part of their treatment plan was recruited. The age range of the participants spanned from 14 to 35 years, representing a diverse patient population. The intervention involved the implementation of mini-screw-supported molar intrusion on one side of the maxillary arch in each patient. To achieve this, temporary mini-screws were strategically placed, and a combination of orthodontic forces and mini-screw anchorage was employed to intrude the molars. The primary outcome measure for this study was the amount of molar intrusion achieved, which was quantified in millimeters from the initial evaluation to the final visit. Additionally, the duration of treatment required to achieve the desired molar intrusion was recorded in months. The results of this clinical study demonstrated that mini-screw-supported molar intrusion was an effective and safe orthodontic technique. On average, a significant mean molar intrusion amount of 4.8 mm (standard deviation [SD] ± 0.6) was achieved with the mini-screw-supported approach. Furthermore, the treatment duration required to attain the desired molar intrusion was relatively short, with a mean of 6.2 months (SD ± 1.1). In conclusion, this clinical study provides evidence that mini-screw-supported molar intrusion is an effective and safe approach in orthodontic practice. It offers orthodontists the advantage of enhanced control and predictability in molar intrusion procedures.

Unilateral intrusion of extruded upper molar with use of transpalatal arch – A case report

Loss of tooth in either arch result in over eruption of antagonist tooth which eliminates the vertical space needed for tooth substitution or placement of a prosthesis. Conventional methods with miniscrew anchorage (TADs) demonstrated excellent results Although, they rely on patient compliance for success due to oral hygiene and bone quality. In this case, to overcome it, a modified transpalatal (TPA) has easily intruded maxillary molars during orthodontic treatment. After gaining the vertical spaces, natural tooth substitution is a better option than conventional prosthesis in terms of alveolar bone support and oral hygiene.

Management of an adult patient with severe crowding using lingual appliances and mini-screw anchorage: A case report

At present, more adult patients seek orthodontic treatment so orthodontists are more likely to face periodontal patients and esthetic appliance demand increases. This case report presents the management of an adult patient with mild periodontitis and severe crowding using lingual appliances and mini-screw anchorage. Interproximal stripping was performed to create space and correct the triangular tooth shape and gingival black triangles. Four mini-screws were implanted in the palatal alveolar bone and mandibular buccal shelf to distalize the entire upper and lower arch. According to the case report, interproximal stripping in combination with mini-screw-assisted entire arch distalization and lingual appliances may be an effective space-creation approach in patients treated with non-extraction way.

Management of moderate crowding by two-arch distalization using passive self-ligating lingual brackets, in-house digital indirect bonding, and mini-screw anchorage: A case report

This case report presents the management of an adult patient with moderate crowding in both arches and anterior crossbite with passive self-ligating lingual brackets. The orthodontic setup and bracket positioning was done digitally with an in-house approach. Virtual setup and bracket placement was performed on Autolign software (Diorco, Gyeonggi-do, Korea). The indirect bonding trays were vacuum-formed on printed malocclusion models with resin brackets. Two palatal and two buccal shelf miniscrews were used for two-arch distalization to correct proclined incisors and anterior open bite after leveling and alignment stage. After 12-month treatment, normal overbite,overjet and well-aligned dentition were achieved without premolar extraction. The incisors were uprighted slightly and the protrusive lower lip was retracted with improvement of facial harmony. One-year retention records confirmed that the outcome was stable. In-house digital setup and bracket placement could be a cost-effective approach for indirect lingual bracket bonding. Two-arch distalization with miniscrew anchorage may have the possibility of managing moderate crowding cases without premolar extraction or interproximal stripping.

Orthodontic treatment with miniscrew anchorage: Analysis of quality of information on YouTube

The evaluation of the quality of information (QOI) and clarity of information (COI) among oral health-related videos on the video-streaming Web site YouTube is scarce. This study evaluated QOI and COI regarding temporary anchorage devices contained within videos uploaded by dental professionals (DPs) on YouTube. YouTube videos were systematically acquired with 4 search terms. The top 50 videos per search term by the number of views were stored in a YouTube account. A set of inclusion/exclusion criteria were applied, videos were assessed for viewing characteristics, a 4-point scoring system (0-3) was applied to evaluate QOI in 10 predetermined domains, and a 3-point scoring system (0-2) was applied to evaluate COI. Descriptive statistical analyses and intrarater and interrater reliability tests were performed. Strong intrarater and interrater reliability scores were observed. Sixty-three videos from the top 58 most-viewed DPs were viewed 1,395,471 times (range, 414-124,939). Most DPs originated from the United States (20%), and orthodontists (62%) uploaded most of the videos. The mean number of reported domains was 2.03 ± 2.40 (out of 10). The mean overall QOI score per domain was 0.36 ± 0.79 (out of 3). The "Placement of miniscrews" domain scored highest (1.23 ± 0.75). The "Cost of miniscrews placement" domain scored the lowest (0.03 ± 0.25). The mean overall QOI score per DP was 3.59 ± 5.64 (out of 30). The COI in 32 videos was immeasurable, and only 2 avoided using technical words. The QOI related to temporary anchorage devices contained within videos provided by DPs through the YouTube Web site is deficient, particularly in the cost of placement. Orthodontists should be aware of the importance of YouTube as an information resource and ensure that videos related to temporary anchorage devices contain comprehensive and evidence-based information.

Effect of uncertain quantities on the stability analysis of a miniscrew anchorage system

ABSTRACT Purpose To determine how the uncertainties related to both the material properties and failure threshold value affect the failure prediction of a miniscrew using the FE analysis. Materials and Methods Three-dimensional surface models for molar, and premolar, segments of the mandibular bone surrounding these two teeth were generated using patient-specific CT data. The 3D model was exported to a finite element Ansys/Workbench to conduct a static analysis with the traction load of 2 N exerted on the miniscrew. The probabilistic analysis was carried out to determine the failure of the miniscrew, in which Kriging was selected as the metamodeling method. Results The uncertainties related to material properties significantly affect the failure probability of the miniscrew, especially for the values with a higher percentage of variability. The analyses in which a constant threshold value is considered indicate no failure, whereas the probabilistic analysis in which the random effect of the threshold value is considered yields a failure probability for the miniscrew. Conclusion To accurately evaluate the stability of a miniscrew from an FE analysis, the computation of the failure probability of the miniscrew should take into account the uncertainty regarding the threshold value.

Correction of Skeletal Class II Open Bite Treated by Miniscrew Anchorage: A Case Report

A case report of a Class II malocclusion with an anterior open bite and vertical maxillary excess was presented. A 14-year-old female patient had a tongue thrusting habit, mouth breathing and centric occlusion (CO)-maximal intercuspal position (MIP) discrepancy with condylar anterior displacement. Mini-implants were used to intrude and retract the maxillary molars. Myofunctional therapy was actively instructed to the patient after obtaining positive overbite. After 34-month of overall treatment, open bite was improved with condylar repositioning and minimal CO-MIP discrepancy. To minimize the relapse, especially during the first year after treatment, interradicular mini-implants were remained and the patient was instructed to actively use retainers.

Comparison of Bone Thickness in Infrazygomatic Crest Area at Various Miniscrew Insertion Angles: A Cone-beam Computed Tomographic Study

Introduction: The infrazygomatic crest (IZC) is an alternative site for miniscrew anchorage. It is important to analyze the anatomy of the region during preoperative planning to minimize the risk of unwanted tooth movement and injury to the vital structures. The literatures on the clinical application of miniscrew in IZC is scarce. Objective: To determine bone thickness, height and angle of insertion of miniscrew in the IZC region. Materials and methods: This cross-sectional observational comparative study included 44 patients above18 years. IZC bone thickness and height of miniscrew insertion were measured on cone-beam computed tomographic (CBCT) records. Student t-test was done to compare the bone thickness and insertion height between gender and between sides. Results: Infrazygomatic crest bone thickness when measured at an angle of 40° to 75° and 11 to 17 mm above the occlusal plane of the maxillary first molar was 3 to 9 mm. There was no significant gender and side variation in bone thickness of IZC and insertion height. Conclusion: Infrazygomatic crest thickness increases with the increase in insertion angle and the decrease in height. The optimal site for miniscrew placement in IZC in an adult is at the angle of 70°and 13 mm from the occlusal plane in the Nepali sample.

Three-dimensional evaluation of maxillary tooth movement in extraction patients with three different miniscrew anchorage systems: a randomized controlled trial

ObjectiveTo compare the three-dimensional (3-D) movement of maxillary teeth in response to three common miniscrew anchorage systems in extraction patients with maxillary dentoalveolar protrusion.Materials and methodsThe study employed a randomized controlled single-blinded design with three arms. Thirty extraction patients who required maximum anchorage to retract maxillary anterior teeth were included and randomly allocated into three treatment groups: space closure with direct miniscrew anchorage and low crimpable hooks (DL group), indirect miniscrew anchorage and low crimpable hooks (IL group), and direct miniscrew anchorage and high crimpable hooks (DH group). Cone beam computed tomography (CBCT) images of all included patients were obtained immediately before (T0) and after (T1) space closure. The outcomes were 3-D positional changes of maxillary central incisor, lateral incisor, canine, second premolar, and first molar. The repeated measures analysis of variance with post hoc LSD test was used to evaluate differences among groups.ResultsA significant intrusion (− 1.34 mm; 95% CI, − 1.60 mm, 1.08 mm) and buccal (− 6.92°; 95% CI, − 8.67°, − 5.13°) and distal (4.90°; 95% CI, 3.75°, 6.04°) inclination of the maxillary first molars were observed in the DL group, compared to the other two groups. The mesial movement (− 0.40 mm; 95% CI, − 0.83 mm, − 0.03 mm) of the maxillary first molars was found in the IL group, while the DL (0.44 mm; 95% CI, 0.15 mm, 0.73 mm) and IL (0.62 mm; 95% CI, 0.28 mm, 0.96 mm) groups exhibited distal movement. In the DH group, the lingual inclination changes of maxillary central incisor (5.04°; 95% CI, 2.82°, 7.26°) were significantly lower, which is indicative of good lingual root torque control of the maxillary anterior teeth.ConclusionThree miniscrew anchorage systems produced significantly different 3-D maxillary tooth movement. The maxillary first molars were significantly buccally and distally inclined and intruded in patients using direct miniscrew anchorages with low crimpable hooks. Direct miniscrew anchorages with high crimpable hooks could help to achieve better lingual root torque control of the maxillary incisors.Trial registration The trial was registered at www.chictr.org.cn (ChiCTR1900026960). Registered 27 October 2019.

Impact of micro-osteoperforations on root resorption and alveolar bone in en-masse retraction in young adults: A CBCT randomized controlled clinical trial

Micro-osteoperforations (MOPs) as a surgical technique is increasingly being used as a method to enhance orthodontic tooth movement. However, its iatrogenic effects on root and alveolar bone morphology have been less studied. This parallel-groups single-centered trial aimed to assess the impact of micro-osteoperforations (MOPs) on orthodontically induced inflammatory root resorption (OIIRR) and alveolar bone during en-masse retraction stage of maxillary and mandibular anterior teeth. Fifty-two patients (mean age 21.35±2.2 years) with Class I bi-dentoalveolar protrusion, requiring all 1st premolar extractions and miniscrews for anchorage, were randomly distributed into two groups (n=26 each): MOP group treated using single application of MOP's and control group treated with routine sliding mechanics, for en-masse retraction. The primary outcomes were assessed using CBCT-based measurements. Anterior teeth in MOP group showed increased mean OIIRR than control group, though the difference was statistically non-significant [maxillary anteriors, MOP group-OIIRR=0.78±0.29mm and control group OIIRR=0.73±0.36mm; mandibular anteriors, MOP group-OIIRR=0.733±0.20mm and control group OIIRR=0.70±0.24mm]. Levander and Malmgren's Index for objective scoring of OIIRR revealed only mild resorption with most teeth in both the groups (47% and 51%, respectively). Lateral incisors showed highest OIIRR followed by central incisors and canines in both groups. Lingual side bone thickness and height decreased significantly, however, the differences between the two groups were non-significant (P>0.05). Within the settings of the current RCT, en-masse retraction when combined with single application of micro-osteoperforations did not pose an increased risk of root resorption or alveolar bone changes compared to routine sliding mechanics.

A quantitative analysis of macrophage-colony-stimulating factor in peri-miniscrew implant crevicular fluid before and after orthodontic loading.

To analyze macrophage-colony-stimulating factor (M-CSF), a bone remodeling biomarker in the peri-miniscrew implant crevicular fluid (PMICF) after insertion and orthodontic loading. This prospective study included 40 miniscrew implant (MSI) sites in 10 subjects undergoing fixed orthodontic mechanotherapy utilizing miniscrew anchorage. After dental alignment, miniscrews were inserted between the second premolar and first molar roots. After 21 days of insertion, MSIs were direct loaded with closed-coil springs (200 g force) for en masse retraction of anterior teeth. PMICF was collected with Periopaper™ strips from the gingival crevice around MSIs at six time points (T1-T6: 1 hour, 1 day, 21 days postinsertion, and 7, 21, and 42 days postloading). PMICF was quantified for M-CSF by enzyme-linked immunosorbent assay. Paired comparison of mean M-CSF concentrations before and after loading stages (T1-T6) was made using the Wilcoxon signed-rank test. The mean M-CSF concentration showed a significant peak at T3 (21 days postinsertion; 12.646 pg/mL; T1 vs T3: P < .0001). After orthodontic loading of miniscrews, M-CSF levels increased to 13.570 pg/mL at T4 (7 days after loading; T1 vs T4: P < .001) and maintained at a plateau to T5 (21 days postloading; 11.994 pg/mL). However, the difference between preloading and postloading was not statistically significant (T3 vs T4). The maximum M-CSF activity around MSIs was observed at around 3 weeks of miniscrew insertion, suggesting underlying bone remodeling after surgical injury. However, orthodontic force on MSIs did not cause any significant surge in M-CSF levels postloading.

Miniscrews for orthodontic anchorage: analysis of risk factors correlated with the progressive susceptibility to failure

The phenomenon of orthodontic anchorage miniscrews loosening after being implanted several times happens in daily clinical practice, and the reasons need to be traced. This study aimed to investigate the underlying risk factors influencing the progressive susceptibility of orthodontic miniscrews to failure. Overall, 889 miniscrews were successively inserted into 347 patients because some loosened or fell off once, twice, or more before achieving their purposes. The number of miniscrew failures (ie, once, twice, or more) was defined as progressive susceptibility to failure. The clinical indicators were assessed via univariate analysis, multicollinearity diagnosis, and Poisson log-linear regression model with stepwise calculation to screen out. The progressive susceptibility of miniscrews to failure was proved to be affected by the age of patients, the onset of force application, site of placement, and appliance type. Age and onset of force application presented a negative relationship with susceptibility. Miniscrews inserted in the palatal region appeared to be more stable than the forepart of the arch. In contrast, the retromaxillary and retromandibular areas obtained the lowest stability. The patients with fixed appliances were more unlikely to suffer progressive failure than removable appliances. In addition, the larger number of screws inserted in each patient, the greater probability of failure. Younger people with removable appliances that miniscrews inserted in the retromaxillary or retromandibular regions and earlier onsets of loading had a higher progressive susceptibility to loosening. Meanwhile, the failure rate was elevated with the increasing number of screws per patient received.

Treatment Effects of Splint-Supported Forsus Fatigue Resistant Device with and without miniscrew anchorage in skeletal Class II growing patients, A Randomized Controlled Trial

Treatment Effects of Splint-Supported Forsus Fatigue Resistant Device with and without miniscrew anchorage in skeletal Class II growing patients, A Randomized Controlled Trial

Evaluation of anchorage loss following anterior segment Evaluation of anchorage loss following anterior segment retraction using friction versus frictionless mechanics: a retraction using friction versus frictionless mechanics: a randomized clinical trial

Objective: Evaluation of anchorage loss following anterior segment retraction (ASR) using friction versus frictionless mechanics when mini-screws are directly and indirectly loaded using Cone beam computed tomography (CBCT). Material and methods: Thirty females with bimaxillary protrusion were randomly allocated into two groups, friction and frictionless. In friction group, a hook was crimped on 0.017- by 0.025-inch stainless steel wire distal to the lateral incisor and elastomeric chain rendering 160 g/side extending between the hook and mini-screw implant to complete the ASR. In the frictionless group, canines were ligated to the mini-screws for indirect anchorage then ASR was done using closing T-loops fabricated from 0.017- by 0.025-inch titanium molybdenum alloy (TMA) wire rendering comparable retraction force. Analysis of first molar anchorage loss in terms of bodily and angular movement were assessed using cone beam computed tomographic (CBCT) images. Results: The use of mini-screws prevented significant anchorage loss in both groups and ASR was accomplished successfully. Anchorage loss in the form of angular tipping was of no statistical significance between friction and frictionless group. Conclusion: No advantage of either mechanics over the other regarding anchorage loading on the first permanent molars. Mini-screws are efficient devices to control the anchorage. Both direct and indirect mini-screw anchorage prevented first permanent molar mesial tipping and can be use alternatively.

Maxillary Skeletal Expansion with Monocortical and Bicortical Miniscrew Anchorage: A 3D Finite Element Study

The aim of the present study is to use a 3D finite element analysis to investigate and compare the transverse displacement and stress distribution between stainless steel miniscrews and titanium alloy miniscrews used for monocortical and bicortical anchorage during miniscrew-assisted rapid maxillary expansions. Skull models were constructed to depict expansion after and before midpalatal suture opening at varying miniscrew insertion depths in four clinical scenarios: monocortical, monocortical deepening, bicortical, and bicortical deepening. Finite element analyses of miniscrew properties, including transverse displacement and von Mises stress distribution, were performed for each clinical scenario. Peri-implant stress was lesser in both bicortical anchorage models compared to both monocortical models. Transverse displacement in the coronal and axial planes was also greater and more parallel in both bicortical models compared to both monocortical models. Transverse displacement and peri-implant stress did not significantly differ between monocortical and monocortical deepening models or between bicortical and bicortical deepening models. From a biomechanical perspective, the bicortical deepening miniscrew anchorage is preferable to monocortical and monocortical deepening anchorage, because bicortical anchorage induces less stress on the peri-implant bone. Consequently, bicortical deepening anchorage should be considered the preferred option in challenging clinical scenarios in which strong anchorage is required for maxillary skeletal expansion.

Management of Severe Proclination and Crowding Using Mini-Screw Anchorage: An IBO Case Report

This case report was presented at the Indian Board of Orthodontics examination under category I in September 2021. It demonstrates fixed orthodontic treatment of a 13-year-old female presenting with Angle’s Class I malocclusion on Class I skeletal base with an average growth pattern. This was complicated by a 7 mm overjet with proclination and crowding of the upper and lower labial segments. She also presented a reduced overbite and a centerline discrepancy of 1.5 mm. Lips were protruded and incompetent at rest with decreased nasolabial angle. Treatment involved extraction of all first premolars followed by fixed orthodontic mechanotherapy with preadjusted edgewise appliance (0.022 × 0.028” slot with MBT–McLaughlin Bennett and Trevisi prescription). Anchorage reinforcement in the upper arch was provided with mini-screw implants.