The clinical success of infra-zygomatic crest (IZC) bone screw in non-extraction treatment of Class II malocclusion: a Case Report

Vina Andriani, Zenith Paskalin, Avi Laviana, Ida Ayu Evangelina, Endah Mardiati, Elih Sayuti

Abstract


Introduction: Temporary Anchorage Devices (TADs), absolute anchorage systems with minimal side effects on orthodontic mechanical movements, can be alternatives to wider non-surgical, non-extraction, and non-compliance treatments. The placement of extra-radicular mini-screws at the infra zygomatic crest (IZC) is one of the most commonly used approaches for skeletal anchorage. Maxillary arch distalization with IZC can be effectively performed in Class II malocclusion patients with large overjet using non-extraction treatment, especially due to increasing patient demands to avoid extractions. The aim of this case report is to demonstrate the effectiveness of infrazygomatic crest (IZC) extra-radicular TADs for maxillary distalization in a Class II malocclusion cases treated without extractions. Case report: A 16-year-old female patient came to the Orthodontic Clinic with the complaint of forward upper teeth, Class II Angle malocclusion and Class I skeletal with a convex facial profile, deep overbite, overjet 6 mm, posterior scissor bite, diastema between teeth 32-33, and deep curve of Spee. The patient was treated with non-extraction fixed orthodontics using a self-ligating system prescription, utilizing extra radicular Temporary Anchorage Devices (TADs) at the infra zygomatic crest measuring 2 x 12 mm for maxillary retraction. Following the maxillary retraction treatment, successful outcomes were achieved as the overjet decreased from 6 mm to 3 mm; Class I molar and canine relationships were established; and the distance from I to NA was reduced from 11 mm to 5 mm. Conclusion: The clinical use of infra-zygomatic crest (IZC) bone screw in non-extraction treatment of Class II malocclusion case was successfully conducted with non-extraction fixed orthodontic treatment.

Keywords


Class II malocclusion, infra zygomatic crest, non-extraction treatment, temporary anchorage

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References


Lombardo G, Vena F, Negri P, Pagano S, Barilotti C, Paglia L, et al. Worldwide prevalence of malocclusion in the different stages of dentition: A systematic review and meta-analysis. Eur J Paediatr Dent . 2020 ;21(2):115–22. https://doi.org/10.23804/ejpd.2020.21.02.05

Goenka YS, Toshniwal NG, Manerikar R, Mani SA, Rathi P. Correcting a skeletal ClassII malocclusion with full maxillary dental arch distalisation using Infra-zygomatic crest (IZC) bone screw: A case report. Journal of Contemporary Orthodontics. 2024 Aug 28;8(3):374–9. https://doi.org/10.18231/j.jco.2024.056

Lone IM, Zohud O, Midlej K, Proff P, Watted N, Iraqi FA. Skeletal Class II Malocclusion: From Clinical Treatment Strategies to the Roadmap in Identifying the Genetic Bases of Development in Humans with the Support of the Collaborative Cross Mouse Population. J Clin Med. 2023 Aug 6;12(15):5148. https://doi.org/10.3390/jcm12155148

Rastogi S, Gohilot A, Singh G. Nonsurgical management of class II division 1 malocclusion in an adult patient using fixed functional appliance: A case report. IP Indian Journal of Orthodontics and Dentofacial Research. 2022 Oct 28;8(3):209–13. https://doi.org/10.18231/j.ijodr.2022.035

Agarwal L, Singh K, Tandon R. Figure 1: Pre-treatment intra-oral and extra-oral photographs Figure 2: Pre-treatment lateral cephalogram and OPG Treatment of Class II Div 2 Malocclusion using PowerScope: A Case Report. Vol. 8, Orthodontic Journal of Nepal. 2018. https://doi.org/10.3126/ojn.v8i1.21352

Chandrasekaran A, Naga Deepti HP, Kidiyoor H. Understanding Orthodontic Bone Screws. In India: IntechOpen; 2022. p. 1–16. https://doi.org/10.5772/intechopen.100276

Sharma P, Mohan S, Raghav P. Management of a non-growing skeletal class II patient: A case report 23 publications 107 citations see profile. 2020. Available from: https://www.researchgate.net/publication/348323661

Shaikh AA, G. AK, GC R, Chinthan G. En-Masse Distalization of Class I Bimaxillary Protrusion Treated with Damon System Using Infrazygomatic and Buccal Shelf Bone Screw: A Case Report. Journal of Indian Orthodontic Society. 2022 Jul 15;56(3):267–73.https://doi.org/10.1177/03015742211029625

Shah RR, Choksi S, Mahadevia S, Trivedi B. Driving the maxillary molar distally with infra-zygomatic crest implant: A case report. IP Indian Journal of Orthodontics and Dentofacial Research. 2023 Jun 28;9(2):137–42. https://doi.org/10.18231/j.ijodr.2023.025

Nandan H, Reddy SG, Chug A, Dixit A, Jha P. Failure rate of infra-zygomatic crest (IZC) bone screws in orthodontics: A Systematic review. Journal of Contemporary Orthodontics. 2024 May 28;8(2):114–24. https://doi.org/10.18231/j.jco.2024.019

Shukur DrI. ⁠Biomechanical Considerations in the Use of Temporary Anchorage Devices (TADs) in Complex Orthodontic Cases. OTS Canadian Journal. 2025 Jun 11;4(6):119–29. https://doi.org/10.58840/zbv8y569

Chang CH, Lin JS, Roberts WE. Temporary skeletal anchorage devices to correct challenging malocclusions with clear aligners. AJO-DO Clinical Companion. 2021 Aug;1(2):102–12. https://doi.org/10.1016/j.xaor.2021.05.002

Lovely, Pradeep Raghav, Reddy CM. Clinical applicability of IZC’s in orthodontics - A review. Journal of Contemporary Orthodontics. 2023 Jan 28;6(4):172–7. https://doi.org/10.18231/j.jco.2022.033

Shetty S, Parveen K. An overview of extra alveolar bone screws-izc/bs screws. Biomedicine (India). 2020 Apr 1;40(2):108–10. http://dx.doi.org/10.51248/.v40i2.49

Sharan J, Bajoria A, Jena AK, Sinha P, Shivakumar A, Kamal VK, et al. Assessment of Bone Thickness at the Infra Zygomatic Crest Region for Various Orthodontic Miniscrew Implant (OMSI) Insertion Angles: A Cone-Beam Computed Tomographic Study. Turk J Orthod. 2024 Jun 1;37(2):104–11. https://doi.org/10.4274/TurkJOrthod.2023.2023.14

Ghosh A. Infra-Zygomatic Crest and Buccal Shelf - Orthodontic Bone Screws: A Leap Ahead of Micro-Implants – Clinical Perspectives. Journal of Indian Orthodontic Society. 2018 Dec 1;52(4_suppl2):127–41.https://doi.org/10.1177/0974909820180609S

Lu et al. Orthodontic incisor retraction caused changes in the soft tissue chin area: a retrospective study. BMC Oral Health (2020) 20:108 https://doi.org/10.1186/s12903-020-01099-2

Gorucu-Coskuner H, Atik E, Taner T. The effectiveness of Hawley and vacuum-formed retainer usage protocols on the stability of fixed orthodontic treatment results. Australasian Orthodontic Journal. 2021 Jan 1;37(1):69–78. https://doi.org/10.21307/aoj-2021-007

Shetty S, Ramesh A, Maniyankod SB, Parveen K, Selvakumar SG, Mubeen M, et al. Comparing the Efficiency of Infrazygomatic Crest (IZC) Screws and Conventional Method for Anterior Retraction in Patients Undergoing Fixed Orthodontic Treatment for Class 2 Malocclusion: A Prospective Clinical Study. Cureus. 2024 Feb 21; https://doi.org/10.7759/cureus.54599

Liu C, Du S, Wang Z, Guo S, Cui M, Zhai Q, et al. Impact of orthodontic-induced facial morphology changes on aesthetic evaluation: a retrospective study. BMC Oral Health. 2024 Jan 5;24(1):24. https://doi.org/10.1186/s12903-023-03776-4

Kouskoura T, Ochsner T, Verna C, Pandis N, Kanavakis G. The effect of orthodontic treatment on facial attractiveness: a systematic review and meta-analysis. Eur J Orthod. 2022 Dec 1;44(6):636–49. https://doi.org/10.1093/ejo/cjac034

Oğuz F, Özden S, Cicek O. Distalization Methods for Maxillary Molars Utilizing Temporary Anchorage Devices (TADs): A Narrative Review. Applied Sciences. 2024 Dec 5;14(23):11333. https://doi.org/10.3390/app142311333

Ravelo V, Olate G, Brito L, Sacco R, Olate S. Tooth movement with dental anchorage vs. skeletal anchorage: A systematic review of clinical trials. J Orthod Sci. 2024 May;13(1). https://doi.org/10.4103/jos.jos_4_23

Soheilifar S, Mohebi S, Ameli N. Maxillary molar distalization using conventional versus skeletal anchorage devices: A systematic review and meta-analysis. Int Orthod. 2019 Sep 1;17(3):415–24. https://doi.org/10.1016/j.ortho.2019.06.002

Rosa WGN, de Almeida-Pedrin RR, Oltramari PVP, de Castro Conti ACF, Poleti TMFF, Shroff B, et al. Total arch maxillary distalization using infrazygomatic crest miniscrews in the treatment of Class II malocclusion: a prospective study. Angle Orthod. 2023 Jan 1;93(1):41–8. https://doi.org/10.2319/050122-326.1

Thulukanam P, Gopalakrishnan U, Rayshika G, Baghya C. A Simple Implant Guide for Infrazygomatic Bone Screw Placement with High Precision—A Clinical Innovation. Journal of Indian Orthodontic Society. 2025 Jan 30;59(1):89–91. https://doi.org/10.1177/03015742231210630

Hedayati Z, Shomali M. Maxillary anterior en masse retraction using different antero-posterior position of mini screw: a 3D finite element study. Prog Orthod. 2016 Dec 3;17(1):31. https://doi.org/10.1186/s40510-016-0143-z

He et al. Clinical analysis of successful insertion of orthodontic mini-implants in infrazygomatic crest. BMC Oral Health. 2023; 23: 348 https://doi.org/10.1186/s12903-023-03081-0

Pan, Yingdan, Lijun Wei, Zhanglong Zheng, Wei Bi. An evaluation of bone depth at different three-dimensional paths in infrazygomatic crest region for miniscrew insertion: A cone beam computed tomography study. Heliyon. 2024 Feb 3;10(3):e25827. https://doi.org/10.1016/j.heliyon.2024.e25827

Sharan J, Bajoria A, Jena AK, Sinha P, Shivakumar A, Kamal VK, Marya A. Assessment of Bone Thickness at the Infra Zygomatic Crest Region for Various Orthodontic Miniscrew Implant (OMSI) Insertion Angles: A Cone-Beam Computed Tomographic Study. Turk J Orthod. 2024; 37(2): 104-111




DOI: https://doi.org/10.24198/pjd.vol37no3.62842

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