Orthodontic maximum anchorages in malocclusion treatment: A systematic review and network meta‐analysis

We did a network meta-analysis and systematic review among patients seeking for maximum anchorage and provided a guidance of selecting certain systems in clinical practice.Seven databases were searched, and randomized controlled trials (RCTs) published with no language restrictions from January 1994 to February 2021 comparing any of the following seven anchorage systems for maximum anchorage orthodontic treatment were selected(PROSPERO: CRD42019117995). A network meta-analysis (NMA) was then conducted to integrate direct evidence with indirect evidence based on logical inference to compare and rank treatments for maximum anchorages in the capacity of maintaining anchorage and duration of total treatment time.Nine publications with 522 participants were considered eligible and were taken into evaluation. According to the capacity of anchorage reinforcement, three skeleton anchorages including miniscrew implants, midpalate implants and Onplant midpalate implants were significantly more effective than conventional anchorages including headgears, TPAs and Nance buttons respectively. According to conventional anchorages, headgears and Nance buttons were significantly more effective than TPA. The strategy ranking reflected the same results as above. However, miniscrew implants required the longest total treatment time.In general, miniscrew impants are most effective in reserving anchorage. Nance buttons require the least total treatment time. Total evidence is graded as moderate. Midpalatal implants might be the best choice when doing treatment planning because it has the most favorable balance between effectiveness and treatment time. But data analysis of the acceptability and acquisition cost of those anchorage systems must be done to make final decisions.