Navigating Orthodontics: Expert Insights on Anchorage Methods

Skeletal Anchorage in Orthopaedic Orthodontics – do they really deliver what they promise?

The choice of anchorage methods remains a polarizing topic among practitioners. The recent study by Franchi et al. (2025), published in Progress in Orthodontics, takes an insightful dive into this debate through a modified Delphi consensus approach, aiming to illuminate the clinical preferences for skeletal versus conventional anchorage in treating varying dentofacial orthopedic conditions.

Methodological Insights

Employing a modified Delphi method—a structured communication technique originally developed as a systematic, interactive forecasting method relying on a panel of experts—the study solicited input from 25 internationally recognized orthodontic experts. Over four rounds, the experts evaluated and refined 32 statements across three major orthodontic challenges: maxillary transverse deficiency, Class II skeletal disharmony due to mandibular retrusion, and Class III skeletal disharmony.

While the Delphi process is adept at aggregating expert opinion where data is sparse or inconsistent, it does not replace empirical evidence. Notwithstanding, it serves as a critical tool for guidance in clinical decisions, especially when faced with the complex interplay of biomechanics and patient-specific factors prevalent in orthodontics.

Clinical Consensus

Maxillary Transverse Deficiency:

The study achieved consensus that bone-anchored expanders are effective in producing maxillary skeletal expansion, particularly in adolescents and adults—though success diminishes with age. More predictably, these devices mitigate the buccal inclination of posterior teeth seen with tooth-borne expanders, therefore preserving periodontal health. However, issues such as unpredictability in suture opening past 30 years of age remain.

Class II Skeletal Disharmony:

Consensus highlighted advantages of skeletal anchorage in enhancing sagittal skeletal effects and controlling lower incisor proclination over tooth-anchored devices. Skeletal anchorage devices, despite higher biological risks and economic costs, present a compelling case for use in specific indications, providing superior control in complex orthodontic scenarios.

Class III Skeletal Disharmony:

For Class III correction, bone-anchored devices were often favored due to their potential for greater skeletal effects and reduced dentoalveolar consequences. However, the invasiveness and potential complications associated with these devices necessitate careful patient selection and thorough risk-benefit discussions.

Future Directions

The study underscores the limited, albeit valuable, role of the Delphi method in shaping contemporary orthodontic practice. More robust clinical trials and longitudinal studies are essential to validate these preliminary findings and refine protocols, particularly in optimizing the balance between surgical intervention and patient-specific orthodontic needs.

Ultimately, while skeletal anchorage offers promising enhancements in treatment efficacy and orthodontic outcomes, practitioners must remain vigilant of the challenges and complexities associated with its application. Such studies pave the way for enriched patient outcomes by informing decision-making processes with expert consensus and highlighting areas ripe for future research.

For those deeply invested in orthodontic advancements, this consensus study provides an invaluable compass in navigating the evolving dynamics of anchorage techniques, though the call for more definitive evidence continues to resonate. As we advance, such studies form the backbone of informed clinical practice, situating expert consensus alongside emerging research in ever-evolving treatment landscapes.

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