The use of lingual brackets and miniscrews as anchorage in orthodontic treatment in high angle skeletal Class II cases

There is a high demand for lingual brackets especially in Asian countries because of esthetic concerns. However, there have been some suggested disadvantages with lingual brackets such as extrusion of molars and decreased axial inclination of incisors. Thus, extrusion of molars and incisors during anterior retraction must be prevented in high angle cases. Miniscrews have been effectively used during orthodontic tooth movement such as to reinforce anchorage, intrude molars, and protract mandibular molars. Palatal miniscrews with long retraction hook seem to produce ideal force and moment during anterior retraction with lingual brackets. Mandibular buccal miniscrew and the use of extension hook bonded to the mandibular molars could produce ideal force during protraction of the mandibular molars. In this report, we effectively used lingual brackets to treat three high angle skeletal Class II extraction case with the use of miniscrews for vertical control of molars and incisor torque control that resulted in successful treatment outcome with long term stability.