ORIGINALARTICLE

MOST COMMON COMPLICATIONS AFTER MINISCREWS PLACEMENT IN ORTHODONTIC

PATIENTS: A CROSS-SECTIONAL STUDY

Umara Khalid¹, Hiba Sajjad¹, Kiran Khan¹, Ifrah Ishfaq¹, Fatima Bibi¹, Ahsan Mehmood Shah²

How to cite this article

ABSTRACT

OBJECTIVES

Khalid U, Sajjad H, Khan K, Ishfaq I,

This study aimed to determine the frequency of the most common

complications after mini-screw insertion.

Bibi F, Shah AM. Most Common

Complications after Miniscrews

METHODOLOGY

This cross-sectional study was conducted at the Department of Orthodontics,

Khyber College of Dentistry, from October 20, 2022, to March 20, 2023.

Ninety-one participants aged 14-30 years, in the permanent dentition stage

and requiring absolute anchorage, were included. Discomfort and mobility of

miniscrews were assessed using questionnaires administered immediately

after insertion and 24 hours later. Participants were instructed on completing

the questionnaire and asked to return the completed forms. Chi-square and

Fisher’s exact tests were used for analysis.

Placement in Orthodontics Patients: A

Cross-Sectional Study. J Gandhara

Med Dent Sci. 2026;13(2):104-108.

https://doi.org/10.37762/jgmds.13-2.844

Date of Submission: 01-01-2026

Date Revised:

12-03-2026

14-03-2026

RESULTS

Date Acceptance:

The mean age was 21.04ꢀ±ꢀ4.38 years (range: 14-30), with 54 females

(59.34%) and 37 males (40.66%). Immediately after miniscrew placement, 16

(17.58%) reported severe pain, 29 (31.87%) moderate, and 46 (50.55%)

mild. After 24 hours, severe pain reduced to 12 (13.19%), moderate to 26

(28.57%), and mild increased to 53 (58.24%). Discomfort during movement

was reported by 17 (18.68%), speech diﬃculty by 10 (10.99%), swelling by

17 (18.68%), and redness by 19 (20.88%). Miniscrews were mobile in 14

(15.38%) and loose in 12 (13.19%). Signiﬁcant associations were found

between age group and mobility (p=0.001), looseness (p=0.003), and

postoperative swelling/redness (p=0.033), with younger patients showing

higher rates.

¹Post Graduate Resident, Department of

Orthodontics, Khyber College of

Dentistry, Peshawar

Correspondence

²Ahsan Mehmood Shah, Associate

Professor, Department of Orthodontics,

Khyber College of Dentistry, Peshawar

CONCLUSION

+92-333-9117622

Miniscrews are associated with pain and discomfort in all patients, with the

majority experiencing mild to moderate pain and a smaller proportion

reporting severe pain. Mobility of miniscrews is more common in younger

age groups.

ahsanmshah@gmail.com

KEYWORDS: Complication, Discomfort, Pain, Miniscrew.

most prevalent complication is injury to the periodontal

ligament, along with distress, looseness, pain, mobility,

INTRODUCTION

Anchorage management is critical for clinical

orthodontic success since it is necessary to maximize

desirable tooth movements while minimizing undesired

forces. For more than a century, many intraoral and

extra oral anchoring devices have been developed and

used.¹ Orthodontic miniscrews, also known as

temporary anchorage devices (TADs), are an alternative

to traditional anchorage systems that do not require

compliance. TADs, according to current research, can

provide more secure anchorage than previous

approaches.² Various miniscrew systems have been

developed to obtain skeletal anchorage and avoid the

use of the most common intra- and extra oral

orthodontic appliances, which patients often dislike.³

Nonetheless, the clinical use of miniscrews is

associated with potential side eﬀects and complications

that can occur during use, removal, and insertion.⁴ The

perforation of the ﬂoor of the nasal cavity, maxillary

sinus, abrasion of the buccal mucosa at the insertion

site, and soft-tissue necrosis.⁵ Several studies have been

conducted recently to determine patient-related and

miniscrew-related factors that aﬀect the success rate of

orthodontic miniscrews.⁶ Various factors can be

associated with the failure rate of miniscrews, such as

gender, viscoelastic properties of bone, type of

retraction, time of loading, and arch for placement.⁷ A

study conducted by Shingo Kuroda et al.⁸ evaluated

success rates and postoperative discomfort after

miniscrew placement. It was concluded that most

patients reported pain 1 hour after placement surgery-

approximately 95% with miniscrews and 100% with

miniplates - and most patients required pain medication.

However, the frequency dropped to 10% on day 1. On

day 5, more than half of the patients continued to report

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104

Most Common Complications after Miniscrews Placement

pain, and after day 7, approximately 10% still reported was obtained from willing participants. A self-drilling

pain. Another study by Gurdán et al.⁹ found that soft- titanium orthodontic implant was placed under aseptic

tissue infections (peri-implantitis) ranged from 6.3% to conditions in accordance with the treatment plan. After

33.3% of cases, while screw mobility ranged from 3.1% administration of local anesthesia, the insertion site was

to 20.8% across anatomic locations. Screw mobility selected based on available bone and interradicular

was signiﬁcantly more frequent in the buccal fold than space. As a self-drilling technique was used, no pilot

in the palate (p<0.05), and more frequent in intrusions hole was prepared, and the miniscrew was inserted

than extrusions (p<0.05). The convenience that directly into the bone using a hand driver with

miniscrews have brought to biomechanics has often led controlled pressure. A titanium screw measuring 1.3 ×

to their side eﬀects being overlooked. The introduction 7 mm was placed on the buccal side, while a 1.3 × 10

of miniscrews has largely replaced loop mechanics in mm screw was placed on the palatal side to ensure

our department, making it important to investigate even adequate stability. The implants were inserted until the

fewer common complications. The rationale for this head was ﬂush with the soft tissue, and primary

study is to identify the most frequent complications stability was clinically veriﬁed. Participants completed

following miniscrew insertion at the Department of a questionnaire at two intervals: immediately after

Orthodontics at Khyber College of Dentistry, so that insertion and 24 hours after insertion. Pain was

appropriate precautions can be taken in the future to

prevent or minimize these issues. While many studies

assessed using the Visual Analogue Scale (VAS) and

categorized as mild (1-3), moderate (4-7), or severe (7-

have focused on the clinical applications and 10). Discomfort, deﬁned as uneasiness at the implant

effectiveness of orthodontic miniscrews, few have

examined their adverse eﬀects and challenges

encountered in clinical practice. The objective of this

study was to determine the frequency of the most

common complications after miniscrew insertion.

site, was assessed immediately after placement.

Looseness was deﬁned as slight movement (<0.5 mm)

on palpation immediately after placement. A miniscrew

was considered loose when it showed visible

displacement or rotation within the bone upon gentle

manual pressure, indicating loss of primary stability.

Mobility was deﬁned as movement >0.5 mm upon

palpation after 7 days. Miniscrew mobility was assessed

clinically by the orthodontist during follow-up visits.

Mobility was evaluated by applying gentle pressure

with a dental instrument (explorer or tweezer) in a

buccolingual direction. Postoperative swelling/redness

was assessed clinically 24 hours after placement by the

operator. Data were analyzed using SPSS version 22.

Normality was assessed with the Shapiro-Wilk test.

Age was presented as mean ± standard deviation or

median and range, while categorical variables (gender,

implant placement, pain, discomfort, looseness,

mobility, and postoperative swelling/redness) were

expressed as frequencies and percentages. Age, gender,

and miniscrew purpose (anchorage/space closure) were

stratiﬁed by outcome variables using the chi-square test

METHODOLOGY

This cross-sectional study was conducted at the

Department

Orthodontics

and

Dentofacial

Orthopedics, Khyber College of Dentistry, from

October 20, 2022, to March 20, 2023, using a non-

probability, consecutive sampling technique. Using the

WHO sample size calculator, the total sample size was

91, with a 6.3% frequency of peri-implantitis, a 5%

margin of error, and a power of 95%.¹⁰ The inclusion

criteria were patients in the permanent dentition period,

aged above 14 years and below 30 years, those in need

of absolute anchorage as determined by clinical

examination and treatment planning, patients whose

lateral cephalograms had already been obtained, and

those with almost completed growth as assessed

through lateral cephalometric radiographs using the or Fisher’s exact test when the expected cell count was

cervical vertebrae maturation method (CVM stage 5

and above). Exclusion criteria included patients with an

allergy to local anesthesia, bleeding disorders, bone-

metabolic diseases, and those who had undergone

radiotherapy within the previous 6 months. Ethical

approval was obtained from the RRB-KCD with

approval number (No: 65/ADR/KCD, dated: 13-12-

2021). Patients seeking treatment at the Orthodontic

<5. A p-value < 0.05 was considered statistically

significant.

RESULTS

The mean age was 21.04ꢀ±ꢀ4.38 years, ranging from 14

to 30 years. There were 54 females (59.34%) and 37

males (40.66%). The most common age group was 14-

Department were invited to participate if they fulﬁlled 20 years with 50 participants (54.95%), followed by the

the selection criteria. The rationale for the study, the 21-25 years’ group with 25 participants (27.47%)

procedure details, and the associated risks and beneﬁts (Table 1). Most of the participants belonged to the

were explained to the patients. Patients had full medium socio-economic status group (n=48, 52.75%),

autonomy to participate or withdraw. Written consent followed by the low socio-economic status group

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105

Most Common Complications after Miniscrews Placement

Table 2: Frequency Distribution of Miniscrew Purpose, Pain,

(n=33, 36.26%) (Fig 1). In 60 (65.93%) cases, the

miniscrews were used for anchorage, and in 31

(34.07%) cases for space closure. Immediately after

miniscrew placement, severe pain was found in 16

(17.58%), moderate in 29 (31.87%), and mild in 46

(50.55%). After 24 hours of miniscrew placement,

severe pain was found in 12 (13.19%), moderate in 26

(28.57%), and mild in 53 (58.24%). Discomfort during

movement was present in 17 (18.68%) participants.

Problem during speaking was present in 10 (10.99%).

Swelling and redness were found in 17 (18.68%) and 19

(20.88%), respectively. Miniscrews were mobile in 14

(15.38%) and loose in 12 (13.19%) (Table 2). Two

parameters, i.e., immediate pain and looseness of

miniscrews, were statistically diﬀerent among genders.

Among females, immediate pain was more frequently

moderate in 19 (35.19%), while in males it was 10

(27.03%). Severe immediate pain was found in 14

(25.93%) females and in 2 (5.41%)males. Mobile

miniscrews were more common in males (n=9, 24.32%)

than in females (n=3, 5.56%). The remaining details are

given in Table 3. A signiﬁcant association was found

between age group and miniscrew mobility (p=0.001),

Discomfort, Mobility, and Postoperative Swelling/Redness

Variable

n (%)

Mini screws are used for

Anchorage

Space closure

Mild

60 (65.93)

31 (34.07)

46 (50.55)

29 (31.87)

16 (17.58)

53 (58.24)

26 (28.57)

12 (13.19)

74 (81.32)

17 (18.68)

81 (89.01)

10 (10.99)

77 (84.62)

14 (15.38)

74 (81.32)

17 (18.68)

72 (79.12)

19 (20.88)

79 (86.81)

12 (13.19)

Pain immediately after

insertion

Moderate

Severe

Pain after 24 hours

Mild

Moderate

Severe

Buccal mucosa discomfort Absent

during movement

Problems with speaking

Present

Absent

Present

Mobility of mini screws

Absent

Present

Postoperative

swelling/redness

Postoperative

swelling/redness

Looseness

Absent

Present

Absent

Present

Immobile

Completely mobile

Table 3: Comparison of Discomfort, Mobility, Looseness, and

Peri-Implantitis among Genders

Variable

Characteristic Female,

N=54

Male,

N=37

value^*

looseness

(p=0.003),

and

swelling

due

Pain immediate Mild

21(38.89) 25(67.57) 0.01

19(35.19) 10(27.03)

peri-implantitis (p=0.033). Mobility, looseness, and

swelling/postoperative redness were more common in

the younger age group than in the older age groups

(Table 4).

Moderate

Severe

Mild

14(25.93) 02(5.41)

Pain 24hr

28(51.85) 25(67.57) 0.146

16(29.63) 10(27.03)

Moderate

Severe

10(18.52) 02(5.41)

Buccal mucosa Absent

44(81.48) 30(81.08) >0.999

10(18.52) 07(18.92)

Table 1: Frequency of Gender, Age Group, and Socio-Economic

Status

discomfort

Problem

speaking

Present

Absent

Present

47(87.04) 34(91.89) 0.699

07(12.96) 03(8.11)

VariableCharacteristic

n (%)

Gender

Female

54 (59.34)

37 (40.66)

50 (54.95)

25 (27.47)

16 (17.58)

33 (36.26)

48 (52.75)

10 (10.99)

Mobility of MI Absent

49(90.74) 28(75.68) 0.097

05(9.26) 09(24.32)

Male

Present

Age group

14-20

21-25

26-30

Low

Looseness

Immobile

Mobile

Absent

Present

Absent

Present

51(94.44) 28(75.68) 0.022

03(5.56) 09(24.32)

Swelling

43(79.63) 31(83.78) 0.821

11(20.37) 06(16.22)

Socio-economic

Status

peri-implantitis

Redness

Medium

High

45(83.33) 27(72.97) 0.351

09(16.67) 10(27.03)

Peri-implantitis

*chi-square test/Fisher’s exact test

Figure 1: Socio-Economic Status of the Participants

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Most Common Complications after Miniscrews Placement

Table 4: Comparison of Discomfort, Mobility, Looseness, and

study using a retrospective questionnaire in 75 patients

found that those who received screws or miniplates

Peri-Implantitis among Age Groups

Variable

PI ain

Characte 14-20,

21-25,

N=25

26-30,

N=16

with

mucoperiosteal

ﬂap

surgery

commonly

ristic

N=50

value*

experienced pain one day post-surgery, with 35% still

in pain after a week, along with discomfort and

swelling. In contrast, only 35% of patients who

received miniscrews without ﬂap surgery reported mild

pain immediately, 8% after one day, and none after a

week. Thus, ﬂapless miniscrew placement is associated

with less pain and discomfort, making it a favorable

option for orthodontic anchorage.⁸Screws inserted

through non-keratinized or movable gingiva can irritate

surrounding soft tissues and may lead to postoperative

swelling and redness. It has been found that placing

miniscrews in non-keratinized tissue can result in screw

failure.¹⁷Additionally, when screws are covered by

movable mucosa, they can cause pain and discomfort.

Therefore, it is preferable to place miniscrews within

attached or keratinized gingiva. Because females tend

to seek orthodontic care more often than males for

esthetic reasons, the proportion of females was

significantly higher in most studies. A meta-analysis

found no signiﬁcant diﬀerence across the 13 studies,

but males had higher bone mineral density than

females. However, the success rate of miniscrews did

not signiﬁcantly diﬀer between the two genders.¹⁸Our

findings showed that failure of mini-implants is more

Mild

24 (48.00) 13 (52.00) 09 (56.25) 0.48

Immediate Moderate 14 (28.00) 09 (36.00) 06 (37.50)

Severe

Pain 24hr Mild

12 (24.00) 03 (12.00) 01 (6.25)

29 (58.00) 15 (60.00) 09 (56.25) 0.573

Moderate 12 (24.00) 08 (32.00) 06 (37.50)

Severe

Absent

Present

09 (18.00) 02 (8.00) 01 (6.25)

42 (84.00) 20 (80.00) 12 (75.00) 0.71

08 (16.00) 05 (20.00) 04 (25.00)

Buccal

Mucosa

Discomfort

Problem

Absent

Present

Absent

Present

46 (92.00) 21 (84.00) 14 (87.50) 0.567

00 (08.00) 04 (16.00) 02 (12.50)

36 (72.00) 25 (100.0) 16 (100.0) 0.001

14 (28.00) 00 (0.00) 00 (0.00)

Speaking

Mobility

Looseness Immobile 38 (76.00) 25 (100.0) 16 (100.0) 0.003

Mobile

Absent

12 (24.00) 00 (0.00) 00 (0.00)

36 (72.00) 24 (96.00) 14 (87.50) 0.033

Swelling

Periimplan

titis

Redness

Periimplan

titis

Present

Absent

14 (28.00) 01 (04.00) 02 (12.50)

35 (70.00) 23 (92.00) 14 (87.50) 0.058

Present

15 (30.00) 02 (08.00) 02 (12.50)

*Fisher’s exact test

DISCUSSION

This study aimed to determine the frequency of the

most common complications after miniscrew insertion.

Our ﬁndings showed that severe pain was present in

17.58% of patients immediately after insertion and in

13.19% after 24 hours. Moderate pain was found in 26

(28.57%) participants, discomfort during movement in

18.68%, and problems during speaking in 10.99% of

the subjects. Swelling and redness were found in

18.68% and 20.88%, respectively. Miniscrews were

mobile in 15.38% and loose in 13.19%. Although

miniscrews are routinely used in orthodontic practice

for various purposes, such as intrusion, retraction,

molar distalization, correction of occlusal can’t, and

midline correction, they may sometimes become mobile

during treatment and fail to serve as stationary anchors,

necessitating removal.^11,12Thus, orthodontists need to

know the factors responsible for their failure.

Mini-screw failure is multifactorial and is classiﬁed

common in younger age groups. Age is

patient-dependent factor. The failure rate is higher in

adolescents than in adults due to diﬀerences in the

thickness of the buccal plate.¹⁹Most studies have noted

that younger patients have lower success rates. The

‘

reason for this diﬀerence may be adolescents (≤20

years old) higher metabolic rate compared to adults,

which may inﬂuence success rates. Patients’ oral

hygiene may also contribute. As age increases, oral

hygiene tends to improve as patients become more

careful, adopt a more mature approach, and take better

care of their teeth.¹⁶

LIMITATIONS

The cross-sectional design limits the ability to establish

causal relationships between risk factors and miniscrew

complications. The relatively small sample size from a

single center may restrict the generalizability of the

results to broader populations. Additionally, the use of a

non-probability consecutive sampling technique may

introduce selection bias. Pain and discomfort were

assessed using self-reported questionnaires, which are

subject to reporting bias and individual perception

variability. Furthermore, the short follow-up period

(primarily immediate and 24 hours, with limited longer-

into

patient-related,

operator-related,

and

implant-related factors.⁶Several studies revealed that

factors such as age, gender, soft tissue type at the

insertion site, as well as the location, length, diameter,

and design pattern of the mini-implant, are associated

with its failure. 11–14 Lee et al.¹⁵reported that

miniscrews show signiﬁcantly higher success rates in

adults (93.8%) than in adolescents (82.4%). It has also

been reported that palatal placement results in lower

success rates (70%) than buccal placement (95.5%).¹⁶

Additionally, the maxilla (86.9%) has signiﬁcantly

term assessment) does

not capture late-onset

complications or long-term miniscrew stability

outcomes.

higher success rates than the mandible (76.1%).¹²

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Most Common Complications after Miniscrews Placement

11. Miyawaki S, Koyama I, Inoue M, Mishima K, Sugahara T,

CONCLUSIONS

Takano-Yamamoto T. Factors associated with the stability of

titanium screws placed in the posterior region for orthodontic

anchorage. Am J Orthod Dentofacial Orthop. 2003;124(4):373-

378. https://doi.org/10.1016/S0889-5406(03)00565-1 PMID:

14560265.

This study found that while most patients experienced

mild to moderate pain after miniscrew placement, some

reported notable discomfort and complications. Pain

generally decreased within 24 hours. Females reported

more immediate pain, whereas miniscrew mobility was

more common in males. Younger patients showed a

higher incidence of mobility, looseness, and peri-

implantitis. These ﬁndings underscore the need to

consider age and tissue characteristics when planning

miniscrew placement to minimize postoperative issues.

12. Manni A, Cozzani M, Tamborrino F, De Rinaldis S, Menini A.

Factors inﬂuencing the stability of miniscrews: a retrospective

study on 300 miniscrews. Eur J Orthod. 2011;33(4):388-395.

https://doi.org/10.1093/ejo/cjq090 PMID: 20805280.

13. Park HS, Jeong SH, Kwon OW. Factors aﬀecting the clinical

success of screw implants used as orthodontic anchorage. Am J

Orthod

Dentofacial

Orthop.

2006;130(1):18-25.

https://doi.org/10.1016/j.ajodo.2004.09.020 PMID: 16849067.

14. Moon CH, Lee DG, Lee HS, Im JS, Baek SH. Factors

associated with the success rate of orthodontic miniscrews

placed in the upper and lower posterior buccal region. Angle

Orthod. 2008;78(1):101-106. https://doi.org/10.2319/122206-

521.1 PMID: 18193967.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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AUTHORS CONTRIBUTION

Umara Khalid - Concept & Design; Data Acquisition; Date

6. Tarigan SHP, Sufarnap E, Bahirrah S. Orthodontic mini-implant

failures based on patient outcomes: a systematic review. Eur J

Dent. 2024;18(2):417-429. https://doi.org/10.1055/s-0043-

1777308 PMID: 37802192.

Analysis/Interpretation;

Revision; Final Approval

Drafting

Manuscript;

Critical

Hiba Sajjad - Concept & Design; Data Acquisition; Data

Analysis/Interpretation;

Revision; Final Approval

Drafting

Manuscript;

Critical

7. Alharbi F, Almuzian M, Bearn D. Miniscrews failure rate in

orthodontics: systematic review and meta-analysis. Eur

Kiran Khan - Concept & Design; Data Acquisition; Data

Orthod. 2018;40(5):519-530. https://doi.org/10.1093/ejo/cjx083

PMID: 29216345.

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Final Approval

8. Kuroda S, Sugawara Y, Deguchi T, Kyung HM, Takano-

Yamamoto T. Clinical use of miniscrew implants as orthodontic

anchorage: success rates and postoperative discomfort. Am J

Ifrah Ishfaq - Concept & Design; Data Acquisition; Data

Analysis/Interpretation;

Revision; Final Approval

Drafting

Manuscript;

Critical

Orthod

Dentofacial

Orthop.

2007;131(1):9-15.

Fatima Bibi - Concept & Design; Data Acquisition; Data

https://doi.org/10.1016/j.ajodo.2005.02.032 PMID: 17208102.

9. Gurdan Z, Szalma J. Evaluation of the success and complication

rates of self-drilling orthodontic mini-implants. Niger J Clin

Pract.2018;21(5):546-556.

Analysis/Interpretation;

Revision; Final Approval

Drafting

Manuscript;

Critical

Ahsan Mehmood Shah - Concept & Design; Data Acquisition;

Drafting Manuscript; Critical Revision; Supervision; Final

Approval

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