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Cousley RR, Turner MJ. J Orthod 2014; 41 (Suppl 1): s54–61

Compared with mini-implants, maxillofacial screws are of larger diameter, increased length and have a bulky head. If these are used to enable tooth movement, potentially this could lead to unfavourable leverage and screw failure. In the late 1990s, maxillofacial bone screws were modified significantly. The resulting mini-implants were used as temporary anchorage devices (TADs) facilitating orthodontic tooth movement. The use of mini-implants has made possible a 'Surgery First' approach when treating patients who would benefit from orthognathic surgery. This strategy requires only minimal presurgical orthodontics, thereby avoiding a 'worsening of their malocclusion and facial profile' before surgery. A 'Surgery First' approach employing mini-implants, also encompasses their use as temporary anchors for those requesting correction of a Class III malocclusion and to enable mandibular-only surgery for those who may have been considered candidates for bimaxillary osteotomies. Mini-implants can also be used in those for whom orthognathic surgery may be indicated but have a reduced number of tooth units including hypodontia.