The introduction of skeletal anchorage devices has revolutionized the treatment options for challenging malocclusions that were previously unresponsive to conventional orthodontics. Research indicates that a majority of orthodontists have embraced this modality in their practice. However, the failure rates of these devices, ranging from 28.1% to 6.3%, are attributed to various factors, with inaccurate placement being a significant concern. The relatively inexperienced practioners specifically can find it challenging to accurately place these imlants. While literature extensively covers the anatomy and placement guidelines, individual variations in skeletal malocclusions do occur. These necessitate an evaluation of bone quality, thickness, and other parameters to achieve optimal primary stability and enhance success rates while safeguarding adjacent structures. This presentation aims to highlight clinical scenarios where complications arose from direct placement of intraosseous cortical (IZC) bone screws and proposes a simple method for creating CAD/CAM surgical guides to ensure precise placement. By employing CAD/CAM templates, orthodontists can achieve greater precision and predictability even when dealing with relatively inexperienced practitioners. This not only reduces the risk of injuries to surrounding anatomical structures but also enhances patient comfort. In light of the evolving imaging technologies for accurate diagnosis and treatment simulation, orthodontists must be proficient in the digital workflow to harness the full potential of these advancements.


Learning Objectives
After this lecture, you will be able to identify challenging scenarios for the placement of extra alveolar bone screws.
After this lecture, you will be able to create a customized surgical guide using CAD-CAM technology within your office for precise bone screw placement.
After this lecture, you will be able to enhance the efficiency and predictability of inserting extra alveolar bone screws in your office.