A recent Delphi consensus study led by Prof. Franchi and colleagues, was published in Progress in Orthodontics (2025), explores the effectiveness of skeletal vs. conventional anchorage in:
1️⃣ Maxillary transverse deficiency (growing & adult patients)
2️⃣ Class II malocclusion (growing patients)
3️⃣ Class III malocclusion (growing patients)
🔬 What is a Delphi Consensus Study?
A structured method where experts review research and refine key statements through multiple voting rounds until agreement is reached.
📊 Key Findings:
✅ Maxillary Transverse Deficiency: Skeletal expanders are effective for maxillary expansion, reducing unwanted tooth tipping in growing patients. However, in adults and late adolescents, their success declines with age, especially after 25–30 years, due to the midpalatal suture’s resistance to opening.
✅ Class II Skeletal Disharmony: Skeletal anchorage enhances mandibular advancement, provides better control of lower incisor proclination, and offers more predictable outcomes than conventional methods. While miniscrews are preferred for their lower invasiveness, patient acceptance of bone-anchored appliances remains a challenge.
✅ Class III Skeletal Disharmony: Bone-anchored appliances improve skeletal correction, enhance vertical control, and reduce unwanted tooth movement. The Alt-RAMEC protocol is more effective with skeletal anchorage. However, younger patients (<11 years) face a higher risk of miniplate failure, particularly when devices emerge through non-keratinized tissue.
💡 Key Takeaway:
Skeletal anchorage provides better skeletal effects, improved dentoalveolar control, and superior treatment outcomes. Case selection is critical, factoring in age, skeletal maturity, and patient compliance.
📄 Read the full study:
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