The aim of this systematic review was to examine, in an evidence-based way, what kind of orthodontic anchorage systems/applications are evaluated and their effectiveness. A literature survey from the Pub Med and Cochrane databases covering the period from January 1966 to December 2004 was performed. Randomized controlled trials (RCT), prospective and retrospective controlled studies, and clinical trials comparing at least two anchorage situations were included. Two reviewers selected and extracted the data independently and also assessed the quality of the retrieved studies. The search strategy resulted in 494 articles, of which 14 met the inclusion criteria. Two main anchorage situations were identified: anchorage of molars during space closure after premolar extractions and anchorage loss in the incisor or premolar region (or both) during molar distalization. Because of contradictory results and the vast heterogeneity in study methods, the scientific evidence was too weak to evaluate anchorage efficiency during space closure. Intraoral molar distalization leads to anchorage loss in various amounts depending on the choice of distalization unit. Most of the studies had serious problems with small sample size, confounding factors, lack of method error analysis, and no blinding in measurements. To obtain reliable scientific evidence, controlled RCT's with sufficient sample sizes are needed to determine which anchorage system is the most effective in the respective anchorage situation. Further studies should also consider patient acceptance and cost analysis as well as implants as anchorage.

OBJECTIVE: To evaluate the reliability of a questionnaire that assessed the expectations and experiences of adolescent patients about orthodontic treatment. MATERIALS AND METHODS: The study included two groups of patients: 30 consecutive patients (19 girls and 11 boys, mean age 14.6 years, SD 2.3 years) naïve to orthodontic treatment, and 30 consecutive adolescent patients (17 girls and 13 boys, mean age 15.1 years, SD 2.0 years) in active orthodontic treatment with fixed appliances in both jaws. A questionnaire comprising 46 items was developed, based upon focus group interviews and previous established questionnaires. The questionnaire covered the following domains: Treatment motivation; treatment expectations; pain and discomfort from teeth, jaws, and face; functional jaw impairment; and questionnaire validity. Internal consistency as well as temporal stability with the test-retest method was investigated. RESULTS: A majority of the questions exhibited acceptable test-retest reliability, and composite scores yielded excellent reliability for all domains. Internal consistency was acceptable and good face validity was found for all domains. CONCLUSION: The questionnaire can be recommended for use in the assessment of expectations and experiences of orthodontic treatment.

OBJECTIVE: To evaluate and compare perceived pain intensity and discomfort between the placement of two different orthodontic anchoring units designed for osseointegration and premolar extraction in adolescent patients. MATERIALS AND METHODS: A total of 120 adolescent patients (60 girls and 60 boys) were recruited and randomized into three groups. Group A underwent installation of an onplant, group B installation of an Orthosystem implant, and group C premolar extraction. Pain intensity and discomfort, analgesic consumption, limitations in daily activities, and functional jaw impairment were evaluated the first evening and one week after the intervention. RESULTS: Pain intensity following surgical installation of an onplant was comparable to the pain intensity experienced after premolar extraction, but there was significantly less pain after surgical installation of an Orthosystem implant compared to installation of an onplant (P = .002) or premolar extraction (P = .007). The protective, vacuum-formed stent caused great discomfort, even more discomfort than the surgical sites following installation of the onplant or the Orthosystem implant. CONCLUSION: The Orthosystem implant was better tolerated than the onplant in terms of pain intensity, discomfort, and analgesic consumption and was, therefore, the anchorage system of choice in a short-term perspective.

INTRODUCTION: Our aim in this investigation was to evaluate and compare orthodontic anchorage capacity of 4 anchorage systems during leveling/aligning and space closure after maxillary premolar extractions. METHODS: One hundred twenty patients (60 girls, 60 boys; mean age, 14.3 years; SD 1.73) were recruited and randomized into 4 anchorage systems: Onplant (Nobel Biocare, Gothenburg, Sweden), Orthosystem implant (Institut Straumann AG, Basel, Switzerland), headgear, and transpalatal bar. The main outcome measures were cephalometric analysis of maxillary first molar and incisor movement, sagittal growth changes of the maxilla, and treatment time. The results were also analyzed on an intention-to-treat basis. RESULTS: The maxillary molars were stable during the leveling/aligning in the Onplant, Orthosystem implant, and headgear groups, but the transpalatal bar group had anchorage loss (mean, 1.0 mm; P <.001). During the space-closure phase, the molars were still stable in the Onplant and Orthosystem groups, whereas the headgear and transpalatal bar groups had anchorage loss (means, 1.6 and 1.0 mm, respectively; P <.001). Thus, the Onplant and the Orthosystem implant groups had significantly higher success rates for anchorage than did the headgear and transpalatal bar groups. Compared with the Orthosystem implant, there were more technical problems with the Onplant. CONCLUSIONS: If maximum anchorage is required, the Orthosystem implant is the system of choice.