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Straight Talk Sebastian Baumgaertel, DMD, MSD, FRCD(C)

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by Sebastian Baumgaertel, DMD, MSD, FRCD(C)

A recent survey conducted by Hyde and colleagues¹ reported that the prominent complication of mini-screw use in orthodontic private practice appears to be loosening of the anchorage device. This is a confirmation of reported findings of a previously published survey² and shows that, unfortunately, not much has changed in the time period from 2008 to 2010. Despite the fact that the body of evidence relating to orthodontic mini-screws is constantly growing, it is clear that success rates in practices are still lower than they should be. This can easily lead to frustration and might have even lead some adopters of the technique to dismiss mini-screws altogether, even though no doubt exists about the potential benefits of these small bone-borne helpers… if only we could make them remain stable!

Perhaps part of the problem can be explained by the way mini-screws are marketed and taught: there is a general tendency to oversimplify the insertion process leading to the assumption that there is actually not a big difference between miniscrew insertion on live patients and wood-working in your garage. Aside from the fact that both use a screwdriver and screws they have very few things in common.

Another reason that success rates don't seem to improve might be psychological in nature. It's a welcome excuse that mini-screws have relatively high failure rates and that there is not much you can do about it – and since failures usually don't cause any major orthodontic problems it's easy to accept that fact. Some sources even advise users to set the expectations purposely low to avoid disappointment, taking away any motivation to excel and improve.

Perhaps the major factor for our current situation is that the clarity of evidence does not tell the best practice in regard to mini-screws. There is much conflicting information in our journals, which only confuses unless studies are dissected diligently and interpreted cautiously. Future publications will validate some findings and refute others; so in a few years I anticipate that best practices will be crystal clear.

Even today's reality can look surprisingly different and high failure rates do not have to be accepted. Even with our current knowledge, mini-screw stability should not be a matter of luck but can already be predictably achieved if certain fundamental (published) principles are adhered to. By relying on common sense, mini-screws are implementable by even us simplicity-loving orthodontists. That does mean that we will need to put a little more effort into planning and preparation than most of us typically do; an effort well worth undertaking as we will be rewarded with higher success rates, greater confidence with our insertions, and the good feeling that we've taken a lot of the guess work out of the equation and are in control of our treatment outcomes, once again.

In this sense I have prepared an article explaining the five "TAD axioms" that I find important to increase your experience with mini-screws and keep you out of trouble. Look for it in the July/August issue of Orthotown Magazine. I hope this will point you in the right direction and motivate you to explore this topic a little further.

References
  1. Hyde JD, King GJ, Greenlee GM, Spiekerman C, Huang GJ. Survey of Orthodontists' attitudes and experiences regarding miniscrew implants. J.Clin. Orthod. 2010; 44(8):481-6.
  2. Buschang PH, Carillo R, Ozenbaugh B, Rossouw PE. 2008 survey of AAO members on miniscrew usage. J. Clin. Orthod. 2008; 42(9):513-8.
Author’s Bio
Sebastian Baumgaertel, DMD, MSD, FRCD(C), received his orthodontic education at Case Western Reserve University where he now holds the position of assistant clinical professor and is co-director of the sub-specialty clinic for skeletal anchorage. In addition, Dr. Baumgaertel maintains an active private practice in the Cleveland area. He is a diplomate of the American Board of Orthodontics, a fellow of the Royal College of Dentists of Canada and a certified orthodontic specialist in Germany.
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October 2025
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