The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on mini/micro screw implantation for orthodontic anchorage.


This procedure is most commonly undertaken by orthodontists. Orthodontic mini- and microscrew systems have been developed from maxillofacial fixation techniques; they use mechanical retention for anchorage. They are small self-tapping titanium screws.

Under local anaesthesia a pilot hole is drilled into the maxilla or mandible and the screw is inserted through the bone cortex and into the alveolar bone using a screwdriver-like tool. More than one screw can be inserted if necessary.

Orthodontic loading can be achieved immediately after insertion, although it is often undertaken at a second visit. Following completion of the orthodontic treatment the screw(s) can be extracted and the incision site can be expected to heal spontaneously.

Coding and clinical classification codes for this guidance.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.