Mini-screws in orthodontics: when are they needed and do they hurt?

When the orthodontist says "this case would benefit from a mini-screw", many people are taken aback: a screw in the bone? Does it hurt, is it dangerous, is it really necessary? In fact, mini-screws are a fairly common aid in orthodontics today. They are placed temporarily and removed once they are no longer needed. This article explains what a mini-screw is, why orthodontists use one, and how placement and care work, so you can discuss it calmly with your orthodontist.

In short: • A mini-screw is a very small titanium screw placed temporarily in the jaw bone as an anchor, helping move teeth more precisely; it is removed once no longer needed. • Not every case needs one; the orthodontist decides based on your X-rays and an analysis of your bite. • Placement is a short procedure under local anaesthetic; it may feel tender for a few days afterwards. • Cleaning around the screw, not wiggling it, and telling the clinic early if it feels loose are your main jobs.

What is a mini-screw?

A mini-screw (also called a mini-implant, an orthodontic anchorage screw or a TAD, temporary anchorage device) is a very small screw made of medical-grade titanium alloy. It is placed temporarily in the jaw bone, usually between tooth roots or in the palate, and its head sits in the mouth so the orthodontist can attach elastics or springs to it.

Unlike a dental implant that replaces a missing tooth, a mini-screw is not designed to fuse with the bone for good and carries no tooth. It is simply a temporary anchor for a few months, removed once the plan no longer needs it.

Why do braces need an anchor?

When the orthodontist pulls on a tooth or a group of teeth, the force always works both ways: the tooth that needs to move is pulled, but the teeth used as the anchor are pulled a little too. In many cases this does not matter. But sometimes the orthodontist wants the back teeth to stay completely still while the front teeth move back, or needs a direction of force that the teeth themselves cannot provide.

In the past, orthodontists could add anchorage with headgear or inter-arch elastics, both of which need a lot of cooperation from the patient. A mini-screw creates an anchor in the bone that barely moves, so the force goes where it is needed.

When might the orthodontist suggest a mini-screw?

Not every case needs one. Orthodontists usually consider it when the plan includes steps such as:

• Retracting the front teeth after extractions in someone with protruding teeth, while keeping the back teeth from drifting forward.
• Moving a whole group of teeth back to create space, in some non-extraction cases.
• Intruding over-erupted teeth, for example front teeth that show too much gum when smiling or cause a deep bite, or molars that have drifted down after the opposing tooth was lost years ago.
• Uprighting tilted teeth that have leaned into a gap, for instance before an implant or bridge.
• Correcting a shifted midline when the whole arch needs to move to one side.

The decision is based on X-rays, a lateral skull X-ray and an analysis of each person's bite. At Asahii Dental Clinic, when the orthodontic plan is drawn up, Dr. Chu Thuy Trinh states clearly whether your case needs a mini-screw, at what stage and why; the plan is written down item by item with its costs, so you know in advance whether a mini-screw is part of it.

Before the placement visit

A mini-screw is placed according to the plan, not decided on the spot in the chair. Before the visit, the orthodontist usually:

• Reviews your X-rays to choose the position: the space between two roots, the thickness of the bone, nearby structures. When needed, a cone beam CT scan shows that area of bone in three dimensions.
• Explains what the screw is for in the plan: which teeth it holds still, which teeth it pulls and where, and roughly how long it will be used.
• Explains what can happen, such as tenderness after placement, gum inflammation around the screw or loosening, so you agree knowing the facts.
• Asks about your general health and any medicines you take, as for any procedure with anaesthetic.

Have a light meal before you come, brush your teeth well, and don't hesitate to ask about anything that still worries you.

What happens at the placement visit?

Placing a mini-screw is a minor procedure, usually taking only a few minutes per screw. The general steps are below; the details can vary with the position and the clinic:

1. Checking the position. The orthodontist compares the X-ray with your mouth, sometimes marking the spot on the gum to avoid the roots.
2. Disinfecting and local anaesthetic. The area is cleaned, a numbing gel is applied and then a local anaesthetic is given. You stay awake throughout and can signal to the orthodontist at any time.
3. Placing the screw. The orthodontist places the screw through the gum into the bone with a dedicated instrument; often no cut or stitches are needed.
4. Checking it is firm. The orthodontist checks that the screw is stable and correctly angled, and may take an X-ray to check if needed.
5. Adding force when it is time. Depending on the plan, elastics or springs may be attached to the screw at the same visit or at a later one.
6. Care instructions. You are told how to brush, rinse and eat in the first few days, and which signs to report.

Does placing a mini-screw hurt?

This is the question people ask most.

Thanks to the anaesthetic, most people feel only pressure or a slight vibration during placement. Once it wears off, the gum around the screw may feel tight or tender for a day or a few days; this usually settles. Everyone feels it differently, so if you are anxious, tell the orthodontist beforehand and ask them to talk you through each step.

The first few days after placement

• Eat soft food, cut small, for the first few days; chew slowly, and avoid chewing right on the side of the screw if it feels tender.
• Ease tenderness with an ordinary painkiller if the orthodontist says so; take the dose you were told and don't add other medicines on your own.
• Keep brushing as usual, gently around the screw, and rinse as instructed.
• Get used to the screw. The tongue and cheek tend to be "curious" about a new object for a few days; try not to push the screw with your tongue.
• Watch the gum. Slight redness and mild tightness are common; increasing swelling, increasing pain or pus need a call to the clinic.

Caring for a mini-screw

A mini-screw is small but passes through the gum, so keeping it clean is important to avoid inflammation:

• Brush gently around the head of the screw with a small, soft brush each time you brush your teeth.
• Rinse as the orthodontist advises, especially in the first few days.
• Don't wiggle the screw with your tongue or fingers, and don't bite hard food right where it sits.
• If the head rubs your cheek, cover it with orthodontic wax, as you would a bracket.
• Keep your check-ups so the orthodontist can check the screw and change elastics or springs. At Asahii, check-ups are reminded automatically through the Zalo Mini App, and the clinic is open every day of the week, 08:30 to 19:00.

For general cleaning tips, see Eating and oral hygiene with braces.

Tip from Dr. Chu Thuy Trinh: Many patients are surprised how quick and manageable placing a mini-screw is. What matters most afterwards is keeping the area clean every day.

Can a mini-screw come loose?

Yes. Some mini-screws loosen during use, often because the bone at that spot is thin, the area around the screw is inflamed, or the force on it is not right. A loose screw is not dangerous: the orthodontist removes it and, if the plan still needs it, places it again in another spot or at another time. What matters is letting the clinic know early when a screw feels loose, rather than leaving it or pulling it out yourself.

How is a mini-screw removed?

When the teeth have reached the planned position and the anchor is no longer needed, the orthodontist removes the mini-screw. Removal is usually quicker than placement, often with just a numbing gel. The small hole in the gum usually heals within a few days. Nothing is left behind in the bone.

After removal, keep the area clean as usual, brushing gently for the first few days. The spot in the bone where the screw sat fills in gradually over time. Your treatment carries on with braces or aligners as before, and you keep coming to your check-ups.

When to contact the clinic straight away

• The screw is loose, turns, or has fallen out.
• The gum around the screw is swollen, red, increasingly painful, or there is pus.
• Strong pain that has not eased a few days after placement.
• The screw head or spring is rubbing a sore on your cheek or tongue that wax does not help.

Whether your case needs a mini-screw can only be answered by an orthodontist after an examination, X-rays and an analysis of your bite. See our orthodontics and braces page, Do braces always mean having teeth taken out?, or book a consultation by hotline 0928 888 121, Zalo or the Mini App.