Clinical applications of miniscrews that broaden the scope of nonsurgical orthodontic treatment.

Previously, in the case of malocclusion owing to skeletal discrepancy in adults, the amount of tooth movement was limited since there was no reliable skeletal anchorage device. The only way to treat this case was by repositioning the maxilla and mandible via orthognathic surgery, but most patients are reluctant to undergo surgery owing to the risk and expenses incurred. However, with the current introduction and use of miniscrews as temporary anchorage devices, the entire dental arch can be relocated to a target position without surgery, thus broadening the scope of nonsurgical orthodontic treatment compared to the past. For a nonsurgical approach to improve skeletal discrepancy, anteroposterior, vertical, and transverse displacements of the dental arch is necessary. In this case, the localization of the center of resistance of the whole arch must precede the appliance design with an appropriate biomechanical design. Especially, in the transverse dimension, the envelope of discrepancy is reportedly narrow, and the tooth movement must accompany the orthopedic correction involving the midpalatal suture expansion. Recently, in adults with transverse maxillomandibular discrepancy, miniscrew-assisted rapid palatal expansion (MARPE) can be performed. Moreover, compared to surgically-assisted rapid palatal expansion, MARPE reduces the cost to the patient and achieves clinically acceptable stable maxillary expansion. In this article, we will discuss the role of total arch movement and MARPE in widening the scope of nonsurgical orthodontic treatment, despite the inherent limitations of miniscrews' mechanical aspects. This article is protected by copyright. All rights reserved.