Consecutive use of mini-implants in the palate to treat skeletal maxillary constriction and Class II malocclusion in an adult case

This report describes the successful use of two multifunctional mini-implants that were inserted into the palate in the treatment of an 18-year-old woman in whom the maxilla was skeletally narrowed and the molars have migrated mesially on both sides. Three different appliances were used in sequence in the course of treatment: first, an appliance supported by bone and teeth (hybrid hyrax) for surgically-assisted rapid maxillary expansion (SARME); second, a distalization device supported by mini-implants to achieve molar distalization; and third, a transpalatal arch (TPA) stabilized by mini-implants to allow indirect anchorage during retraction of the incisors. The mini-implants in the palate led to a reduction in the adverse effects of the SARME procedure and made treatment with cervical headgear unnecessary. TPA stabilized by the mini-implant was also used to retract the anterior teeth en masse, with no need for alterations in the treatment mechanism and using routine orthodontic methods.