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Trends ORTHO TRIBUNE | JUNE & JUly 20104 of anchorage/blocking (e.g., a liga- ture) must then be used. In this case, the presence of the primary molars represented a con- traindication for insertion on the vestibular side of the premolar region. The paramedian insertion of two miniscrews has several advantag- es. Firstly, the miniscrews provide a very solid basis for anchorage of the distalization appliance. Secondly, they will never impede the movement of the lateral teeth. Even after successful molar distal- ization, they can be used to stabi- lize the situation achieved for the remainder of the treatment. Thirdly, there is no risk of dam- aging other teeth because of an unfavorable spatial situation and/or incorrect insertion. One disadvantage of the cou- pling necessary between the Walde Frog Appliance used (FORESTA- DENT) and the miniscrews (see Figs. 1a–c) is that cleaning becomes difficult. As large areas of the mucous membrane are covered, there is the risk of the development of peri-mucositis. If this develops further into peri-implantitis, pre- mature loss of the miniscrews could result. A possible future alternative could be the use of “laboratory abut- ments” (Figs. 2a–d), which contain no plastics and can be used to couple the appliance with the miniscrews hygienically. Mesialization One of the most problematic areas of orthodontic therapy is the correction of the anterior dis- placement of teeth and particularly of jaw segments. It might seem that the availability of miniscrews means that conventional appliances no longer need to be used at all. However, depending on the baseline situation and the nature of the required correction, the use of a combination of devices and appliances is recommended. This is often advisable and may even be necessary for biomechanical reasons, such as in a Class III situ- ation. In the case shown in figures 3a–c, forced transverse expansion of the palatine suture was used in combination with mesial traction, applied by means of a Delaire facial mask. The support provided by two miniscrews inserted in the parame- dian region redirected the forces of sagittal and transverse movements almost entirely onto the bones. Dental side effects were markedly reduced. Figs. 1b, 1c: Walde Frog Appliance (FORESTADENT) anchored to two miniscrews (b). Distalization by approximately 6 mm after three months’ treatment, providing sufficient space for the correct repositioning of the canines (c). Figs. 2a–d: Distalization of the upper laterals. Miniscrews were inserted in the paramedian region (OrthoEasy, FORESTADENT) (a). OrthoEasy with attached laboratory abutments (b). The Frog Appliance was lashed to the laboratory abutments (c). Lateral X-ray showing the ideal positioning of miniscrews, laboratory abutments and Frog Appliance (d). f OT page 1 Figs. 4a–c: Space closure in the region of the upper anterior teeth. Diagram showing the anchorage principle (a). Baseline situation: The central frontal teeth were held in place using a steel arch (19 x 25) fixed to a miniscrew with additional frontal dental torque (b). After nine months, the anchorage is stable (c). Figs. 3a–c: Mesialization of the upper molars. Miniscrews inserted in the paramedian region with laboratory abutments (FORESTADENT) and transverse screw with hook for a Delaire facial mask (a). Status after transverse expansion and formation of a median diastema (b). Extra-oral view of the appliance with a Delaire mask (c). 1b 1c 2a 2c 3a 4a 3b 4b 3c 4c 2b 2d