Comparison of Connected Mini-Implants and Surgical Mini-Plates for Skeletal Anchorage During Maxillary En-Masse Retraction: A Prospective Clinical Study

Objective: To compare the clinical performance and skeletal stability of connected mini-implants and surgically placed mini-plates as skeletal anchorage systems during maxillary anterior en-masse retraction. Materials and Methods: A prospective split-mouth clinical study was conducted on 10 patients requiring maximum anchorage following extraction of the maxillary first premolars. Connected mini-implants were placed on the right side, while surgical mini-plates were placed on the left side. The inter-radicular distance was measured 4 mm apical to the cementoenamel junction using cone-beam computed tomography (CBCT), and customized connector plates were fabricated accordingly. Mini-implants were inserted at an angulation of 45°–70°, whereas mini-plates were fixed in the infrazygomatic crest. Clinical outcomes including tissue overgrowth, postoperative pain, discomfort, oral hygiene, healing, patient acceptance, implant mobility, and placement time were recorded. Skeletal stability was assessed using CBCT by measuring positional changes relative to the Orbitale before and after anterior en-masse retraction. All measurements were performed twice by a single examiner, demonstrating excellent intraobserver reliability (ICC = 0.971). Results: Both anchorage systems provided effective skeletal anchorage during anterior en-masse retraction. CBCT analysis demonstrated no statistically significant differences in positional stability between connected mini-implants and mini-plates. Surgical mini-plates exhibited superior clinical stability with no mobility during treatment. However, connected mini-implants required significantly shorter placement time and were associated with greater patient acceptance and reduced postoperative pain. Tissue overgrowth occurred more frequently around connected mini-implants, although this did not compromise treatment outcomes. Conclusion: Connected mini-implants demonstrated skeletal anchorage stability comparable to surgically placed mini-plates while offering the advantages of a minimally invasive procedure, shorter operative time, and improved patient acceptance. This customized connected mini-implant system may represent a promising alternative to surgical mini-plates for maximum anchorage during maxillary anterior en-masse retraction. Further multicenter studies with larger sample sizes are warranted to validate these findings