Hijazi Muwaquet Kais, Muwaquet Rodriguez Susana, Ferrer Molina Marcela, Hijazi Alsadi Tawfiq
Department of Dentistry, Universidad Católica de Valencia, 46001 Valencia, Spain.
Department of Restorative Dentistry and Endodontics, Faculty of Medicine and Health Science, Catholic University of Valencia (UCV), C/Quevedo, 2, 46001 Valencia, Spain.
J Clin Med. 2025 Jun 5;14(11):4005. doi: 10.3390/jcm14114005.
Infrazygomatic crest (IZC) miniscrews are widely used for skeletal anchorage in orthodontics. Despite their growing popularity, the optimal insertion parameters-such as height, angulation, and anatomical position-remain controversial, with existing studies offering inconsistent and fragmented data. To determine the optimal insertion position, height, and angulation of infrazygomatic miniscrews to maximize bone insertion using cone-beam computed tomography (CBCT) analysis and to investigate the influence of facial skeletal patterns on IZC bone morphology. This review was conducted according to the PRISMA 2020 guidelines. A comprehensive electronic search was performed across six databases: PubMed, Scopus, Web of Science, Cochrane, EBSCO, and Google Scholar. Studies reporting CBCT-based IZC bone thickness were included. A meta-analysis was conducted using a random-effects model, and meta-regression was applied to assess the relationship between insertion height, angulation, and bone thickness. The STROBE checklist was used to assess the quality of the included observational studies. Seventeen studies comprising a total of 1840 CBCT-based measurements were included. The meta-regression revealed a significant inverse relationship between insertion height and bone thickness (β = -0.53; < 0.001) and a positive correlation with angulation (β = 0.09; < 0.001). The U67 region refers to the anatomical area between the maxillary first and second molars, adjacent to the infrazygomatic crest and zygomatic buttress, which with an insertion height of 9.9 mm and 80° angulation, demonstrated the highest mean cortical bone thickness (3.52 mm). There was no evidence of a significant association between facial pattern and bone thickness ( = 0.878). This review presents the first predictive model for IZC miniscrew placement based on meta-regression. The findings support the U67 site at 9.9 mm height and 80° angulation as the optimal insertion protocol. These data-driven guidelines provide clinicians with practical, evidence-based direction for improving miniscrew stability and minimizing complications.
颧下嵴（IZC）微型螺钉在正畸治疗中广泛用于骨骼锚固。尽管其应用越来越广泛，但最佳植入参数，如高度、角度和解剖位置，仍存在争议，现有研究提供的数据不一致且不完整。为了使用锥形束计算机断层扫描（CBCT）分析确定颧下微型螺钉的最佳植入位置、高度和角度，以最大化骨植入，并研究面部骨骼模式对IZC骨形态的影响。本综述按照PRISMA 2020指南进行。在六个数据库中进行了全面的电子检索：PubMed、Scopus、Web of Science、Cochrane、EBSCO和谷歌学术。纳入报告基于CBCT的IZC骨厚度的研究。使用随机效应模型进行荟萃分析，并应用元回归评估植入高度、角度和骨厚度之间的关系。使用STROBE清单评估纳入的观察性研究的质量。纳入了17项研究，共1840次基于CBCT的测量。元回归显示植入高度与骨厚度之间存在显著负相关（β = -0.53；<0.001），与角度呈正相关（β = 0.09；<0.001）。U67区域指上颌第一和第二磨牙之间的解剖区域，毗邻颧下嵴和颧突，在植入高度为9.9 mm和角度为80°时，显示出最高的平均皮质骨厚度（3.52 mm）。没有证据表明面部模式与骨厚度之间存在显著关联（P = 0.878）。本综述提出了基于元回归的IZC微型螺钉植入的首个预测模型。研究结果支持将高度为9.9 mm和角度为80°的U67部位作为最佳植入方案。这些数据驱动的指南为临床医生提供了实用的、基于证据的指导，以提高微型螺钉的稳定性并减少并发症。
