USE OF ORTHODONTIC MINISCREWS AS TEMPORARY SKELETAL ANCHORAGE IN THE TREATMENT OF SKELETAL CLASS III MALOCCLUSION: A NARRATIVE REVIEW

Authors

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6501

Keywords:

Skeletal Class III Malocclusion, Orthodontic Miniscrews, Temporary Anchorage Devices, Skeletal Anchorage, Maxillary Protraction, MARPE

Abstract

Skeletal Class III malocclusion presents substantial therapeutic challenges because of its heterogeneous skeletal and dentoalveolar components and the limitations of conventional orthodontic and orthopedic approaches. This narrative review aimed to critically summarize the available evidence on the use of orthodontic microimplants as temporary skeletal anchorage in the treatment of skeletal Class III malocclusion. A literature search was conducted in PubMed, Scopus, and Google Scholar for English-language publications from 2015 to 2026 using terms related to skeletal Class III malocclusion, microimplants, skeletal anchorage, MARPE, and maxillary protraction; additional studies were identified through reference screening. The reviewed evidence indicates that microimplant-assisted protocols can improve anchorage control, reduce unwanted dentoalveolar compensation, and facilitate maxillary protraction, hybrid expansion, intermaxillary elastic therapy, and mandibular distalization. The greatest clinical benefit appears to occur in growing patients with maxillary deficiency, whereas in nongrowing patients microimplants mainly support orthodontic camouflage. Outcomes depend on skeletal maturity, appliance design, implant location and stability, force direction, anatomical conditions, and patient cooperation. Although short-term skeletal, dental, and soft-tissue effects are generally favorable, microimplants do not predictably restrict mandibular growth and cannot replace orthognathic surgery in severe skeletal discrepancies. Current evidence remains limited by heterogeneous protocols, small samples, and insufficient long-term follow-up. Microimplants should therefore be regarded as an adjunctive anchorage method within individualized biomechanical treatment planning.

References

Adel, S. M., Abbas, B. A., Marzouk, W. W., & Zaher, A. R. (2023). Airway dimensional changes following bone-anchored maxillary protraction: A systematic review. BMC Oral Health, 23(1), Article 260. https://doi.org/10.1186/s12903-023-02940-0

Alhammadi, M. S., Almashraqi, A. A., Khadhi, A. H., Arishi, K. A., Alamir, A. A., Beleges, E. M., & Halboub, E. (2022). Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in borderline Class III malocclusion: A systematic review. Clinical Oral Investigations, 26(11), 6443–6455. https://doi.org/10.1007/s00784-022-04685-6

Alhammadi, M. S., Halboub, E., Fayed, M. S., Labib, A., & El-Saaidi, C. (2018). Global distribution of malocclusion traits: A systematic review. Dental Press Journal of Orthodontics, 23(6), 40.e1–40.e10. https://doi.org/10.1590/2177-6709.23.6.40.e1-10.onl

Aslan, B. I., & Küçükkaraca, E. (2019). Nonextraction treatment of a Class III malocclusion case using mini-screw-assisted lower molar distalization. Turkish Journal of Orthodontics, 32(2), 119–124. https://doi.org/10.5152/TurkJOrthod.2018.18026

Azamian, Z., & Shirban, F. (2016). Treatment options for Class III malocclusion in growing patients with emphasis on maxillary protraction. Scientifica, 2016, Article 8105163. https://doi.org/10.1155/2016/8105163

Baik, J.-C., Choi, Y.-K., Jeon, H. H., Kim, S.-H., Kim, S.-S., Park, S.-B., & Kim, Y.-I. (2023). Skeletal and dentoalveolar effects of maxillary protraction using tooth- and miniscrew-anchored devices in patients with Class III malocclusion with maxillary deficiency: A retrospective follow-up study. Applied Sciences, 13(18), Article 10530. https://doi.org/10.3390/app131810530

Casaña-Ruiz, M. D., Bellot-Arcís, C., Paredes-Gallardo, V., García-Sanz, V., Almerich-Silla, J. M., & Montiel-Company, J. M. (2020). Risk factors for orthodontic mini-implants in skeletal anchorage biological stability: A systematic literature review and meta-analysis. Scientific Reports, 10(1), Article 5848. https://doi.org/10.1038/s41598-020-62838-7

de Souza, R. A., Rino Neto, J., & de Paiva, J. B. (2019). Maxillary protraction with rapid maxillary expansion and facemask versus skeletal anchorage with mini-implants in Class III patients: A non-randomized clinical trial. Progress in Orthodontics, 20(1), Article 35. https://doi.org/10.1186/s40510-019-0288-7

Eissa, O., ElShennawy, M., Gaballah, S., ElMehy, G., & El-Bialy, T. (2018). Treatment of Class III malocclusion using miniscrew-anchored inverted Forsus FRD: Controlled clinical trial. The Angle Orthodontist, 88(6), 692–701. https://doi.org/10.2319/110717-760.1

Faria-Teixeira, M. C., Tordera, C., Salvado e Silva, F., Vaz-Carneiro, A., & Iglesias-Linares, A. (2024). Craniofacial syndromes and Class III phenotype: Common genotype fingerprints? A scoping review and meta-analysis. Pediatric Research, 95(6), 1455–1475. https://doi.org/10.1038/s41390-023-02907-5

Fleseriu, M., Langlois, F., Lim, D. S. T., Varlamov, E. V., & Melmed, S. (2022). Acromegaly: Pathogenesis, diagnosis, and management. The Lancet Diabetes & Endocrinology, 10(11), 804–826. https://doi.org/10.1016/S2213-8587(22)00244-3

Garib, D., Miranda, F., Palomo, J. M., Pugliese, F., Bastos, J. C. da C., dos Santos, A. M., & Janson, G. (2021). Orthopedic outcomes of hybrid and conventional Hyrax expanders: Secondary data analysis from a randomized clinical trial. The Angle Orthodontist, 91(2), 178–186. https://doi.org/10.2319/060820-527.1

Jaramillo-Bedoya, D., Villegas-Giraldo, G., Agudelo-Suárez, A. A., & Ramírez-Ossa, D. M. (2022). A scoping review about the characteristics and success-failure rates of temporary anchorage devices in orthodontics. Dentistry Journal, 10(5), Article 78. https://doi.org/10.3390/dj10050078

Kamel, A. M., Tarraf, N. E., Fouda, A. M., Hafez, A. M., El-Bialy, A., & Wilmes, B. (2023). Dentofacial effects of miniscrew-anchored maxillary protraction on prepubertal children with maxillary deficiency: A randomized controlled trial. Progress in Orthodontics, 24(1), Article 22. https://doi.org/10.1186/s40510-023-00473-4

Lo Giudice, A., Rustico, L., Longo, M., Oteri, G., Papadopoulos, M. A., & Nucera, R. (2021). Complications reported with the use of orthodontic miniscrews: A systematic review. The Korean Journal of Orthodontics, 51(3), 199–216. https://doi.org/10.4041/kjod.2021.51.3.199

Maino, G. B., Cremonini, F., Maino, G., Paoletto, E., De Maio, M., Spedicato, G. A., Palone, M., & Lombardo, L. (2022). Long-term skeletal and dentoalveolar effects of hybrid rapid maxillary expansion and facemask treatment in growing skeletal Class III patients: A retrospective follow-up study. Progress in Orthodontics, 23(1), Article 44. https://doi.org/10.1186/s40510-022-00429-0

Mandall, N., Cousley, R., DiBiase, A., Dyer, F., Littlewood, S., Mattick, R., Nute, S. J., Doherty, B., Stivaros, N., McDowall, R., Shargill, I., & Worthington, H. V. (2016). Early Class III protraction facemask treatment reduces the need for orthognathic surgery: A multi-centre, two-arm parallel randomized, controlled trial. Journal of Orthodontics, 43(3), 164–175. https://doi.org/10.1080/14653125.2016.1201302

Meyns, J., Thanatchaporn, J., Shujaat, S., Politis, C., & Jacobs, R. (2025). Long-term three-dimensional skeletal effects of hybrid Hyrax with facemask versus mentoplate in growing Class III patients: A randomized controlled trial. Progress in Orthodontics, 26(1), Article 14. https://doi.org/10.1186/s40510-025-00561-7

Miranda, F., Parra, L. D., Bastos, J. C. da C., dos Santos, A. M., Silva, I. de S., Quevedo, B., Aliaga-Del Castillo, A., & Garib, D. (2023). Pain and discomfort perception during miniscrew-anchored maxillary protraction: Secondary data analysis of a randomized clinical trial. The Angle Orthodontist, 93(3), 313–319. https://doi.org/10.2319/092022-655.1

Mohammed, H., Wafaie, K., Rizk, M. Z., Almuzian, M., Sosly, R., & Bearn, D. R. (2018). Role of anatomical sites and correlated risk factors on the survival of orthodontic miniscrew implants: A systematic review and meta-analysis. Progress in Orthodontics, 19(1), Article 36. https://doi.org/10.1186/s40510-018-0225-1

Moon, W., Wu, K. W., MacGinnis, M., Sung, J., Chu, H., Youssef, G., & Machado, A. (2015). The efficacy of maxillary protraction protocols with the micro-implant-assisted rapid palatal expander (MARPE) and the novel N2 mini-implant—A finite element study. Progress in Orthodontics, 16(1), Article 16. https://doi.org/10.1186/s40510-015-0083-z

Nucera, R., Ciancio, E., Maino, G., Barbera, S., Imbesi, E., & Bellocchio, A. M. (2022). Evaluation of bone depth, cortical bone, and mucosa thickness of palatal posterior supra-alveolar insertion site for miniscrew placement. Progress in Orthodontics, 23(1), Article 18. https://doi.org/10.1186/s40510-022-00412-9

Otel, A., Montiel-Company, J. M., & Zubizarreta-Macho, Á. (2025). Comparative analysis of early Class III malocclusion treatments: A systematic review and meta-analysis. Children, 12(2), Article 177. https://doi.org/10.3390/children12020177

Raghupathy, Y., Ananthanarayanan, V., Kailasam, V., & Padmanabhan, S. (2023). Posttreatment stability following facemask therapy in patients with skeletal Class III malocclusion: A systematic review. International Journal of Clinical Pediatric Dentistry, 16(6), 897–907. https://doi.org/10.5005/jp-journals-10005-2686

Rai, P., Garg, D., Tripathi, T., Kanase, A., & Ganesh, G. (2021). Biomechanical effects of skeletally anchored Class III elastics on the maxillofacial complex: A 3D finite element analysis. Progress in Orthodontics, 22(1), Article 36. https://doi.org/10.1186/s40510-021-00375-3

Ritchie, C., McGregor, S., & Bearn, D. R. (2023). Temporary anchorage devices and the forces and effects on the dentition and surrounding structures during orthodontic treatment: A scoping review. European Journal of Orthodontics, 45(3), 324–337. https://doi.org/10.1093/ejo/cjac072

Sarangal, H., Namdev, R., Garg, S., Saini, N., & Singhal, P. (2020). Treatment modalities for early management of Class III skeletal malocclusion: A case series. Contemporary Clinical Dentistry, 11(1), 91–96. https://doi.org/10.4103/ccd.ccd_393_19

Seo, W.-G., & Han, S.-J. (2017). Comparison of the effects on the pharyngeal airway space of maxillary protraction appliances according to the methods of anchorage. Maxillofacial Plastic and Reconstructive Surgery, 39(1), Article 3. https://doi.org/10.1186/s40902-017-0101-9

Silva, I. de S., Miranda, F., Bastos, J. C. da C., & Garib, D. (2024). Comparison of alveolar bone morphology after expansion with hybrid and conventional Hyrax expanders. The Angle Orthodontist, 94(4), 414–420. https://doi.org/10.2319/092623-650.1

Srinidhee, M. K., Shetty, S., Umar, D., & Koya, S. (2024). Class III malocclusion: Insights and current perspectives. International Journal of Preventive and Clinical Dental Research, 11(1), 20–23. https://doi.org/10.4103/ijpcdr.ijpcdr_9_24

Sugawara, Y., Ishihara, Y., Takano-Yamamoto, T., Yamashiro, T., & Kamioka, H. (2016). Orthodontic treatment of a patient with unilateral orofacial muscle dysfunction: The efficacy of myofunctional therapy on the treatment outcome. American Journal of Orthodontics and Dentofacial Orthopedics, 150(1), 167–180. https://doi.org/10.1016/j.ajodo.2015.08.021

Suresh, A., Velath, A. V., Sarika, K., Prabha, R. D., & Varma, N. K. S. (2024). Effect of different mini implant assisted rapid palatal expansion (MARPE) designs on maxillary protraction in skeletal Class III malocclusion: An FEM study. Contemporary Clinical Dentistry, 15(1), 27–34. https://doi.org/10.4103/ccd.ccd_428_23

Wang, J., Yang, Y., Wang, Y., Zhang, L., Ji, W., Hong, Z., & Zhang, L. (2022). Clinical effectiveness of different types of bone-anchored maxillary protraction devices for skeletal Class III malocclusion: Systematic review and network meta-analysis. The Korean Journal of Orthodontics, 52(5), 313–323. https://doi.org/10.4041/kjod21.264

Zere, E., Chaudhari, P. K., Sharan, J., Dhingra, K., & Tiwari, N. (2018). Developing Class III malocclusions: Challenges and solutions. Clinical, Cosmetic and Investigational Dentistry, 10, 99–116. https://doi.org/10.2147/CCIDE.S134303

Zhou, X., Chen, S., Zhou, C., Jin, Z., He, H., Bai, Y., Li, W., Wang, J., Hu, M., Cao, Y., Liu, Y., Yan, B., Shi, J., Guo, J., Li, Z., Ma, W., Liu, Y., Li, H., Lu, Y., … Chen, L. (2025). Expert consensus on early orthodontic treatment of Class III malocclusion. International Journal of Oral Science, 17(1), Article 20. https://doi.org/10.1038/s41368-025-00357-9

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Published

2026-09-21

How to Cite

Grzegorczyk, J., Opala, K., & Krowiński, J. (2026). USE OF ORTHODONTIC MINISCREWS AS TEMPORARY SKELETAL ANCHORAGE IN THE TREATMENT OF SKELETAL CLASS III MALOCCLUSION: A NARRATIVE REVIEW. International Journal of Innovative Technologies in Social Science, 4(3(51). https://doi.org/10.31435/ijitss.3(51).2026.6501