Orthodontic bone screws: A quick update and its promising future

Orthodontic bone screws (OBSs) provide intraoral anchorage by penetrating oral mucosa and seating firmly in basilar bone (BB). Retromolar (prosthetic-type) implants introduced the extra-alveolar (E-A) concept for BB anchorage to move teeth throughout the alveolar process, but the clinical procedures were complex and expensive. Titanium alloy (Ti) miniscrews placed in inter-radicular (I-R) alveolar bone are more convenient and provide some tooth movement potential, but multiple screws are usually required and the devices often interfere with the path of tooth movement. The advantages of BB anchorage and the convenience of miniscrew are combined into the E-A OBS system. These miniscrews are relatively large in diameter (2 mm), and strong (stainless steel), which are placed intraorally in the BB of the infra-zygomatic crest (IZC) and mandibular buccal shelf (MBS). E-A OBSs provide osseous anchorage to retract the dentition and/or rotate either arch. Recovery of impactions is effectively managed with lever arm springs anchored with IZC or MBS bone screws. An emerging frontier is BB anchorage for correcting severe malocclusions with clear aligners. Since the osseous-anchored mechanics are complementary, fixed appliances and clear aligners can be used individually or in tandem to resolve a broad variety of malocclusions. This report summarizes current concepts for conservatively managing complex malocclusions such as severe crowding, skeletal discrepancies, asymmetries and impactions with the OBS system.