Orthodontic Mini-Screws | Anchorage Clermont-Ferrand

At the OrthoClermont practice in Clermont-Ferrand, Dr François Normand uses orthodontic mini-screws — also known as temporary anchorage devices (TADs) — for certain treatments requiring absolute anchorage. These small biocompatible titanium screws, inserted into the alveolar bone of the jaw, serve as a fixed anchor point for achieving tooth movements that would be difficult or even impossible with conventional methods. They have transformed orthodontic practice over the past twenty years by opening up therapeutic possibilities that were previously reserved for surgery.

The anchorage problem in orthodontics

In physics, every force implies an equal and opposite reaction. In orthodontics, this means that when a tooth is pulled to move it, the teeth serving as the anchor also experience a force and risk moving in the opposite direction — this is known as anchorage loss. This fundamental law has long limited treatment possibilities, sometimes forcing clinicians to accept compromises or resort to surgery.

Mini-screws solve this problem by providing a perfectly immobile anchor point, embedded in bone and not connected to the teeth. The orthodontist can apply forces to teeth without worrying about unwanted movements on adjacent teeth. This is absolute anchorage — and it fundamentally changes what treatment can achieve.

How mini-screws work

A mini-screw is a titanium screw 6 to 12 millimetres long and approximately 1.5 millimetres in diameter. It is inserted into the bone between tooth roots, under local anaesthesia, in just a few minutes. Placement is quick, minimally invasive and painless. Once in place, the mini-screw is connected to the orthodontic appliance (brackets and wire) by a spring, elastic or metal wire that applies the force needed for the desired movement.

Unlike dental implants, mini-screws do not osseointegrate: they are held in place by mechanical retention in the cortical bone. This is what makes them very easy to remove at the end of treatment — in a few seconds, without anaesthesia, and without leaving any lasting effect.

Clinical indications

Mini-screws are used in numerous clinical situations where conventional anchorage is insufficient:

• Intrusion of over-erupted teeth: When a tooth has grown too far out (for example after the loss of the opposing tooth), the mini-screw enables it to be pushed back into the bone — a movement that is virtually impossible without skeletal anchorage.
• Closing extraction spaces: After premolar extractions, mini-screws allow the incisor-canine block to be retracted without the molars migrating forward.
• Correction of anterior open bites: Posterior mini-screws enable molar intrusion to close an open bite (lack of contact between upper and lower front teeth).
• Uprighting tilted molars: When a molar has tipped into the space of a tooth extracted long ago, the mini-screw provides the anchorage needed to upright it.
• Distalisation of molars: Mini-screws allow molars to be moved backward along the arch, creating space without extraction.
• Traction of impacted teeth: Certain teeth (most commonly canines) remain trapped in the bone and fail to erupt. The mini-screw can serve as anchorage to pull them into the arch.
• Alternative to orthognathic surgery: In some borderline cases, mini-screws enable sufficient corrections to avoid surgical intervention.

Placement procedure at the practice

Before placement, Dr François Normand takes a radiograph (sometimes a cone beam 3D scan) to precisely identify the insertion site, ensuring there is adequate space between the roots of adjacent teeth and that the bone quality is sufficient.

Placement itself takes just a few minutes. After local anaesthesia of the site (identical to that used for a standard dental procedure), the mini-screw is manually threaded through the gum directly into the cortical bone. Most patients describe a sensation of pressure without pain. No incision or suture is necessary.

The mini-screw is immediately functional: the orthodontist can attach an elastic or spring at the same appointment. In the following days, slight tenderness on touch is possible, which resolves spontaneously. An antiseptic mouthwash is prescribed for a few days, and gentle brushing around the screw is recommended.

Advantages of orthodontic mini-screws

• Absolute anchorage: no unwanted movement of adjacent teeth
• Enables tooth movements previously impossible without surgery
• Simple, quick and painless placement under local anaesthesia
• No major surgery, no sutures, no time off work
• Removal in seconds, without anaesthesia, at the end of treatment
• Complete and rapid bone healing after removal
• Can reduce overall orthodontic treatment duration by enabling more direct movements
• In some cases, avoids the need for orthognathic surgery

Risks and side effects

Complications related to mini-screws are rare and minor. The main risk is loosening (loss of stability), which occurs in approximately 10 to 15 per cent of cases according to the scientific literature. When this happens, the screw is simply removed and repositioned elsewhere, with no consequence for the treatment. Accidental contact with a tooth root is exceptional thanks to prior radiographic planning, and does not cause permanent damage to the tooth.

Maintaining the area around the mini-screw is important: regular, gentle brushing around the screw head prevents gingival inflammation, which is the primary cause of early loosening.

Who is it for?

Mini-screws are mainly used in teenagers (after the growth spurt, when the cortical bone is sufficiently dense) and adults. They are a supplementary tool used alongside the main orthodontic appliance — they are not a treatment in themselves, but an auxiliary that considerably broadens therapeutic possibilities.

They are particularly valuable in complex cases: re-treatment after a previous inadequate treatment, orthodontic compensation of moderate skeletal discrepancies, or treatment of patients who refuse surgery and for whom a purely orthodontic alternative, while limited, can be offered.

Frequently asked questions about mini-screws

Does placement hurt?

No. Local anaesthesia eliminates all pain during placement. Afterwards, some tenderness may persist for one to two days, easily managed with a standard painkiller. The majority of patients describe the experience as less unpleasant than a routine dental procedure.

Can I feel the mini-screw in my mouth?

During the first few days, the tongue or cheek may be aware of the screw head. This sensation fades quickly — after a week, most patients forget the mini-screw is there.

How long does it stay in place?

The duration depends on the movement required: from a few months to approximately one year on average. The screw is removed as soon as it is no longer needed, in seconds, usually without anaesthesia. The bone heals completely within a few weeks and retains no trace of the screw.

Duration and integration into the treatment plan

Mini-screws are integrated into a comprehensive orthodontic treatment plan. They do not alter the total duration of treatment — they may even shorten it by enabling more direct and efficient movements. Dr François Normand determines at the initial assessment whether mini-screws are necessary and schedules their placement at the optimal point in treatment, in coordination with the other stages of orthodontic care at the OrthoClermont practice in Clermont-Ferrand.