MBS miniscrews were highly successful (approximately 93%), but there was no significant difference between placement in MM or AG. Failures were more common on the patient's left side and in younger adolescent patients. Having 16 patients with bilateral failures suggests that a small fraction of patients (1.9%) are predisposed to failure with this method.

Objectives: To compare failure rates for stainless steel (SS) and titanium alloy (TiA) bone screws (BSs) placed in the infrazygomatic crest (IZC). Materials and Methods: A total of 386 consecutive patients (76 male, 310 female; mean age 24.3 years, range 10.3–59.4 years) received IZC BSs (SS or TiA) via a double-blind, split-mouth design. BSs penetrated attached gingiva (AG) or moveable mucosa (MM) with 5 mm of soft tissue clearance. All BSs were immediately loaded and reactivated monthly with ≤14 oz (397 g or 389 cN) applied directly to the upper archwire bilaterally for 6 months to retract the maxilla to correct Class II or bimaxillary protrusion. Results: Of the 772 devices, there were 49 (6.3%) failures: 27 SS (7.0%) and 22 TiA (5.7%). The 1.3% difference was not statistically significant (P = .07). There was no significant relationship between SS or TiA failures relative to (1) right vs left side, (2) unilateral vs bilateral, or (3) age at failure. Significantly (P < .05) increased failure rates were noted for SS screws in only two subgroups: AG site (7.4%) and right side (7.8%). Unilateral failure occurred in 21 patients (5.4%), and bilateral failures occurred in 14 of the total 772 patients (1.8%). Conclusions: The overall success rate of 93.7% indicates that both SS and TiA are clinically acceptable for IZC BSs.

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Highlights:1. Without extractions or orthognathic surgery, a differential diagnosis, utilizing three methods (DI, 3-Ring and Extraction Decision Tree) revealed that the patient's desire for conservative treatment was feasible.2. Despite 12mm of asymmetric crowding in the maxillary arch, the problem was treated to an optimal result without excessive arch expansion and incisal flaring by using PSL brackets.3. For the present patient, the anterior cross bite and deep bite were corrected simultaneously in ~5 months, utilizing anterior BTs and early light class III elastics as the principle active mechanics. Pink and White (P&W) dental esthetic score of 3. The worksheets for the DI, CRE, and P&W scores are attached within this case report.

Introduction: A 12-yr old female presented with a Class II division 1 malocclusion, complicated