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| Title |
Miniplates Demonstrate Lower Failure Rates and Superior Anchorage Control Compared to Miniscrews for Molar Intrusion in Anterior Open Bite Patients |
| Clinical Question |
In orthodontic patients with anterior open bite, does miniplates, compared to miniscrews, result in lower failure rate and better anchorage control during molar intrusion? |
| Clinical Bottom Line |
In orthodontic patients with anterior open bite requiring temporary anchorage devices (TADs) for molar intrusion, miniplates demonstrate a generally lower failure rate and better stability compared to miniscrews. However, miniplates involve more invasive surgical placement, increased patient discomfort, and higher costs. Miniscrews, while easier to place and less invasive, are associated with higher failure rates and less anchorage reliability. Therefore, the choice between miniplates and miniscrews should be guided based on individual patient factors such as bone quality, anatomical considerations, treatment goals, cost, and patient preference. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 38584993 | Omidkhoda/2023 | Orthodontic patients receiving TADs in 14 included studies for meta-analysis | Meta-Analysis | | Key results | Miniplates achieved an average maxillary molar intrusion (3.29 mm) compared to miniscrews (2.25 mm; (p = 0.03), indicating superior effectiveness. The overall average intrusion using TADs was 2.89 mm. Clinically, TADs increased overbite by 4.81 mm and decreased overjet by 2.06 mm, showing notable improvements in dental relationships. However, overbite improvements did not differ significantly between miniplates and miniscrews (p=0.40), or between force levels. Also, although there were no significant changes in the vertical position of the maxillary and mandibular incisors, retroclination of these teeth was observed. Skeletal changes included a significant reduction in lower anterior facial height (LAFH) and mandibular plane angle, with a forward rotation of the mandible and soft tissue profile improvements. | | #2) 19793320 | Schätzle/2009 | Orthodontic patients receiving TADs in 27 included studies for meta-analysis | Meta-Analysis | | Key results | The failure rate for miniplates was 7.3% (95% CI: 5.4%–9.9%) compared to 16.4% (95% CI: 13.4%–20.1%) for miniscrews. When used bilaterally, the probability of at least one failure was 14.1% for miniplates versus 29.4% for miniscrews. Moreover, miniplates had a statistically significant 1.9-fold lower clinical failure rate than miniscrews (95% CI: 1.1–2.8, p = 0.005). This article concluded that miniplates yielded the most favorable results in the mandible, while palatal implants were more favorable in the maxilla. | | #3) 20877162 | Takaki/2008 | 904 TADs in 455 orthodontic patients | Retrospective Clinical Study | | Key results | Miniplates (n = 444) had a 6% failure rate comparable to self-drilling miniscrews (n=225) (6%). The study revealed that miniplates placed in the maxillary zygomatic buttress had a particularly high success rate (98%), highlighting their utility in high-load movements like molar intrusion. While miniplates showed favorable stability, they were associated with a higher rate of soft tissue inflammation (7.6%) compared to miniscrews (1.3%). | |
| Evidence Search |
((miniscrews) AND (miniplates)) AND ((TAD) OR (anchorage)) in PubMed |
Comments on
The Evidence |
The study by Omidkhoda et al. is a systematic review and meta-analysis conducted under PRISMA guidelines, representing a high level of evidence. The risk of bias in the included articles was evaluated using validated tools (RoB 2 for RCTs and ROBINS-I for observational studies), and the overall certainty of evidence for each outcome was rated as low to moderate using the GRADE system. Strengths of this review include clear inclusion criteria, subgroup analyses, and clinically relevant outcomes. However, variability in study design, patient populations, and intervention protocols introduced clinical heterogeneity. Despite this, the review maintains high validity due to its comprehensive methodology and robust synthesis of the literature.
Schätzle et al. conducted a systematic review with meta-analysis, providing high level evidence through descriptive statistics of failure rates and survival outcomes for temporary anchorage devices (TADs). With a large cumulative sample size, it offers useful failure probabilities for unilateral and bilateral placements, aiding clinical decisions. However, the included studies were mostly retrospective.
The clinical study by Takaki et al., a large retrospective cohort involving 455 patients over 9 years, offers valuable real-world data on TAD performance, failure rates, and complications. While limited by its retrospective design and potential biases, it supports the findings from the higher-level reviews. Collectively, these studies form a robust evidence base favoring miniplates in anterior open bite treatment. |
| Applicability |
This critical appraisal included a wide age range of patients (8 to 68 years) with various dental conditions such as skeletal anterior open bite, malocclusion, jaw deformities, impacted teeth, and cleft lip and palate. Most participants were medically healthy and undergoing comprehensive orthodontic treatment, enhancing the generalizability of the findings.
Miniplates require invasive flap surgery with screw fixation, usually needing an oral surgeon. This leads to more postoperative discomfort, swelling, longer recovery, higher costs, and a greater rate of soft tissue inflammation compared to miniscrews. Miniplates may also be unsuitable for patients with poor bone quality, bleeding disorders, bisphosphonate use, or those unable to undergo surgery.
Miniplates are ideal in challenging cases like anterior open bite, where high-force and multidirectional tooth movement, like molar intrusion, is required. Their superior stability and low failure rates also make them ideal for providing bilateral anchorage and vertical control.
In summary, miniplates are recommended for healthy adolescents or adults needing moderate to significant molar intrusion, while miniscrews remain a practical alternative when surgical intervention is limited by clinical or patient-related factors. |
| Specialty/Discipline |
(Oral Surgery) (Orthodontics) |
| Keywords |
Anterior Open Bite, Miniplates, Miniscrews, Molar Intrusion
|
| ID# |
3582 |
| Date of submission: |
06/24/2025 |
| E-mail |
J.delacruz3792@gmail.com |
| Author |
Jewelyn dela Cruz |
| Co-author(s) |
Madison Haager |
| Co-author(s) e-mail |
maddieferris14@gmail.com |
| Faculty mentor/Co-author |
Kelly Lemke, DDS, MS |
| Faculty mentor/Co-author e-mail |
lemkek@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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