Long-term stability of maxillary group distalization with interradicular miniscrews in a patient with a Class II Division 2 malocclusion Shingo Kuroda, a Natsuko Hichijo, b Minami Sato, b Akiko Mino, b Nagato Tamamura, c Mitsuhiro Iwata, d and Eiji Tanaka e Tokushima, Amagasaki, and Okayama, Japan, and Jeddah, Saudi Arabia We successfully treated a Class II Division 2 patient with maxillary group distalization using interradicular mini- screws. A woman, aged 28 years 11 months, had a convex profile and an excessive overjet caused by a skeletal Class II jaw-base relationship. After leveling and alignment, titanium miniscrews were obliquely implanted be- tween the maxillary second premolar and first molar. To distalize the maxillary dentition, nickel-titanium closing coil springs with a 2-N load were placed between the screws and the hooks on the archwire. After 28 months of active orthodontic treatment, a proper facial profile and an acceptable occlusion were achieved with a 4-mm dis- talization of the maxillary dentition. The resultant occlusion was stable throughout a 5-year retention period. Interradicular miniscrews were useful to distalize the maxillary dentition for correcting a Class II malocclusion. This new strategy, group distalization with miniscrews, can make the treatment simpler with greater predictabil- ity. (Am J Orthod Dentofacial Orthop 2016;149:912-22) I n the treatment of a Class II malocclusion, tooth extraction or nonextraction is a subject of much debate. 1-3 In growing patients, growth modification is often tried to improve their anteroposterior jaw discrepancies without extractions. 2 If a nongrowing pa- tient has excessive overjet or a severe arch length discrep- ancy, orthodontists are likely to choose extraction treatment. 3 However, most patients desire nonextraction treatment, if possible, and some do not accept extractions. In such patients, orthodontists must seek other treat- ment options. Molar distalization can be an alternative to correct a Class II malocclusion. However, it is not easy to distalize the maxillary dentition completely with traditional orthodontic mechanics. 2 Various types of molar distalizers have been developed and clinically used, but they cannot prevent counteractions: eg, flar- ing of the maxillary incisors. 4-7 In addition, a group distalization of the maxillary dentition was almost impossible in most patients. Recently, implant-anchored orthodontics has been shown to be effective in treating a wide variety of mal- occlusions. 8-13 In particular, miniscrews have gained acceptance because they can provide stable anchorage for various types of tooth movement despite their small diameter and short length. 12 Miniscrew anchorage can provide maxillary molar distalization without pa- tient compliance and undesirable counteractions; there- fore, now they are well regarded as a new treatment strategy for Class II correction. 14-17 However, their long-term stability is still unknown. In this case report, we demonstrate the 5-year reten- tion of a group distalization of the maxillary dentition with interradicular miniscrews in an adult patient with a Class II Division 2 malocclusion. DIAGNOSIS AND ETIOLOGY A woman, aged 28 years 11 months, had a chief complaint of esthetic problems of her maxillary inci- sors. Her facial profile was convex, and the frontal a Associate professor, Department of Orthodontics and Dentofacial Orthopedics, Institute of Biomedical Sciences, Graduate School, Tokushima University, To- kushima, Japan. b Postgraduate student, Department of Orthodontics and Dentofacial Orthope- dics, Graduate School of Oral Sciences, Tokushima University, Tokushima, Japan. c Private practice, Amagasaki, Japan. d Private practice, Okayama, Japan. e Professor and chair, Department of Orthodontics and Dentofacial Orthopedics, Institute of Biomedical Sciences, Graduate School, Tokushima University, To- kushima, Japan; distinguished adjunct professor, King Abdulaziz University, Jed- dah, Saudi Arabia. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported. Address correspondence to: Eiji Tanaka, Department of Orthodontics and Dento- facial Orthopedics, Institute of Biomedical Sciences, Tokushima University Grad- uate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8504, Japan; e-mail, etanaka@tokushima-u.ac.jp. Submitted, January 2015; revised and accepted, July 2015. 0889-5406/$36.00 Copyright Ó 2016 by the American Association of Orthodontists. http://dx.doi.org/10.1016/j.ajodo.2015.07.045 912 CASE REPORT