Which anchorage device is the best during retraction of anterior teeth? An overview of systematic reviews

Abstract

Objective To evaluate the available evidence regarding the clinical effectiveness of different types of anchorage devices. Methods A comprehensive literature search of different electronic databases was conducted for systematic reviews investigating different anchorage methods published up to April 15, 2021. Any ongoing systematic reviews were searched using PROSPERO, and a grey literature search was undertaken using Google Scholar and OpenGrey. No language restriction was applied. Screening, quality assessment, and data extraction were performed independently by two authors. Information was categorized and narratively synthesized for the key findings from moderate- and high-quality reviews. Results Fourteen systematic reviews were included (11 were of moderate/high quality). Skeletal anchorage with miniscrews was associated with less anchorage loss (and sometimes with anchorage gain). Similarly, skeletal anchorage was more effective in retracting anterior teeth and intruding incisors and molars, resulting in minor vertical skeletal changes and improvements in the soft tissue profile. However, insufficient evidence was obtained for the preference of any anchorage method in terms of the duration of treatment, number of appointments, quality of treatment, patient perception, or adverse effects. The effectiveness of skeletal anchorage can be enhanced when directly loaded, used in the mandible rather than the maxilla, used buccally rather than palatally, using dual rather than single miniscrews, used for en-masse retraction, and in adults. Conclusions The level of evidence regarding anchorage effectiveness is moderate. Nevertheless, compared to conventional anchorage, skeletal anchorage can be used with more anchorage preservation. Further high-quality randomized clinical trials are required to confirm these findings.

Pain, Discomfort, and Functional Impairments When Retracting Upper Anterior Teeth Using Two-Step Retraction With Transpalatal Arches Versus En-Masse Retraction With Mini-implants: A Randomized Controlled Trial

“…It ensures that the supporting teeth do not move as other teeth are being moved [ 13 ]. Several methods have been proposed to assure good anchorages, such as headgear [ 14 ], transpalatal arches (TPAs), with or without a Nance button [ 15 ], lingual arches, bonding of second molars, or intermaxillary elastics [ 16 ], and most recently, mini-implants [ 17 ].…”

A comparative study on anterior teeth retraction-related hard and soft tissue changes with physiologic anchorage control technique

“…Anchorage preparation is considered to be the most important step in clinical orthodontics [13,14]. TADs are recognized to be the prominent anchorage reinforcement devices because of more anchorage preservation than conventional devices [15] and controlled tipping of anterior teeth [16]. This study represented significant improvement of profile in Damon group, which could partly contribute to the low-friction movement and assistance of TADs in half of cases.…”

“…Previous study systematically reviewed anchorage methods and found the evidence of a preference of any anchorage method lacked sufficient evidence [15]. Moreover, regarding adverse effects of TADs containing tooth root injury and mucosa lesion [22], the use of TADs may be limited in adolescents or patients who require non-invasive treatment.…”

Bimaxillary protrusion: A literature review

“…Enmasse retraction after extraction of maxillary and mandibular premolars may require the use of reinforced anchorage. This could be in the form of conventional anchorage devices such as transpalatal arch, headgear, and Nance appliance; or by the use of temporary anchorage devices (TADS) using miniscrew implants [24,25]. Skeletal anchorage using TADS have resulted in better skeletal, dental and soft tissue changes in bimaxillary protrusion compared to conventional anchorage devices [24,25].…”