Three-dimensional orthodontic anchorage management of impacted maxillary canines: A systematic review

Our work aims to provide scientific evidence by conducting a serious systematic review of the efficacy of three-dimensional (3D) anchorage devices for orthodontic traction of impacted maxillary canines. An electronic search extending from 2012 to 2022, targeting mainly clinical trials was performed on the following databases PUBMED (MEDLINE), The Cochrane Library, SCIENCE DIRECT, EBSCO HOST DATABASES, and GOOGLE SCHOLAR. The search was established on a well-defined research question following the PICO principle: population, intervention, comparator, and outcome. Search evaluation and the assessment of the risk of bias (RoB) were undertaken in each study following its type and design. Thirteen studies were included for qualitative analysis, with a low to moderate RoB. Ten studies used only heavy conventional palatal anchorage such as a fixed trans palatal arch (TPA), while one study used skeletal anchorage to manage the orthodontic traction of impacted maxillary canines. Two studies compared trans palatal arch and mini-screws efficiency to treat impacted maxillary canines. Studies proved that the trans palatal arch (TPA) presents a particular anchorage unpredictability in the sagittal, transversal, and vertical dimensions. Whereas, anchorage management using mini-screws proved to be very beneficial clinically; however, further studies must be implemented to evaluate the 3D efficacy of skeletal anchorage to place an impacted maxillary canine to its rightful position into the arch.