Application of orthodontic mini-implants and ligation for absolute skeletal anchorage to the intraoral labiolingual appliance: midface distraction osteogenesis cases treated with the RED System.

Patients with cleft and several craniofacial syndromes usually show skeletal class III malocclusion with midface hypoplasia. Although the Rigid External Distraction (RED) System (KLS Martin, LP, Jacksonville, FL) has been used widely, bowing of the external traction hooks (ETHs) and tooth-borne anchorage for the intraoral labiolingual appliance (ILA) can result in inappropriate change of force application level and vector control, eventually improper rotation of the osteotomized bony segment and unwanted dentoalveolar effect. Instead of the ETH and ILA, direct fixation of the skeletal plate on the maxilla can be another option. However, it also has some disadvantages including inflammation, fixation failure, and the need for a second surgery to remove the plates. These phenomena could be minimized by the addition of rigidity to the ETHs and fortification of absolute skeletal anchorage to the ILA. Therefore, the purpose of this article was to introduce application orthodontic mini-implants on the buccal attached gingiva and palate areas and ligation for absolute skeletal anchorage to the ILA in midface distraction osteogenesis cases treated with the RED System. In cases that need a large amount of advancement and bodily translation or clockwise rotation of the midface and that have oligodontia or anchorage problem for the ILA, application of the orthodontic mini-implants and ligation for absolute skeletal anchorage to the ILA can be a highly effective fixation approach to obtain more accurate vector control.