## 4 Discussion  
In this case, tooth-borne anchorages, combined with an RPE appliance, were used for nine months in the early phase of the treatment[PERSON] However, due to the mobility of the anchoring teeth, these were  
Figure 6: Changes in cephalometric radiograph after the orthopedic treatment. (**A**) At the time of the first visit. (**B**) Immediately after the surgery. (**C**) 3 months after the surgery. (**D**) 8 months after the surgery. Figure 7: Changes in overbite and overjet in centric occlusion after the maxillary protraction treatment with the skeletal anchorage. (**A**) Immediately after the minipilate fixation surgery. (**B**) 3 months after the surgery[PERSON] (**C**) 8 months after the surgery. (**D**) 1 year after the surgery. replaced with skeletal anchorage. In the studies of [PERSON] et al., and [PERSON] et al., the facemask with miniplate allowed greater forward movement of the maxilla, less posterior repositioning and opening rotation of the mandible, and less undesired dentoalveolar effects than the facemask with a tooth-borne anchorage appliance [13; 14][PERSON] Therefore, skeletal anchorage can be beneficial in growing children of mixed dentition requiring greater anchorage force. The straight, conventional miniplates need to be bent according to the bone surface before fixation, resulting in longer surgical time, increased fatigue, and an incomplete fit [15][PERSON] Since the customized miniplate had been prefabricated as designed, no additional effort or time was required for bending the miniplate. This process also allowed the miniplate to be made more firm and rigid, reducing the possibility of fracture or deformation of the plates during protraction. In the study of [PERSON] et al., the customized fixation system with a topologically optimized structure was claimed to be superior in the biomechanical aspect to the conventional system, presenting less stress, strain, and displacement inside the plate [16]. A use of temporarily placed miniscrews was first mentioned for orthodontic anchorage in 1997 [17] and has now become an established orthodontic anchorage aid used commonly in a variety of ways. For optimum patient safety and success of the miniscrew fixation, local anatomical structure, soft tissue around the plate, and patient home care are the essential factors to consider. According to several works of literature, orthodontic screws show a success rate of 70-90% [18]. Complications may include root contact, inflammation, insufficient stability, and perforation of the maxillary sinuses. [PERSON] et al. identified that a significant risk factor for their failure is root contact [19]. In growing patients of mixed dentition, it is also essential to avoid further damage to the developing buds of the permanent teeth. When inserting miniscrews near delicate anatomical structures, a surgical guide can be used to accurately locate the place and the direction to avoid potential damage to the adjacent structures. Furthermore, [PERSON] et al. demonstrated that infection infrequently occurs in about 10% of patients, and that plate loosening has occurred in only 1% of all cases [20]. It is thought that plate loosening or infection may occur because the ready-made plate does not adhere to the bone surface accurately. With the use of a customized plate, it is possible to overcome the problems of a ready-made plate because it can be precisely adhered to the curved surface of an individual patient. For the success of fixation, a thorough understanding of bone density and shape is essential. When it comes to the location, the miniplate for maxilla protraction is usually placed in the infrazygomatic crest. Previous studies confirmed that the infrazygomatic crest generally shows a good quality of bone, which provides sufficient anchorage to keep the screw in load [21; 22; 23]. On the other hand, [PERSON], [PERSON] et al. placed miniplates laterally on the piriform aperture of the maxilla.