The Clinical Efficacy and Stability of Skeletal Anchorage Devices in Managing Class II Malocclusion: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to quantify whether skeletal anchorage alters the dentoskeletal response, device stability, and efficiency of Class II correction compared with conventional anchorage.Following a protocol registered in the International Prospective Register of Systematic Reviews (PROSPERO) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, seven databases and registers were searched without language restriction.Randomized controlled trials (RCTs) comparing skeletal anchorage with conventional anchorage, alternative protocols, or untreated controls in Class II patients were eligible.Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool.Mean differences (MDs) were pooled with restricted maximum-likelihood random-effects models and Hartung-Knapp-Sidik-Jonkman confidence intervals (CIs); certainty was rated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Twenty-four RCTs (27 reports; at least 871 randomized participants) were included; 21 raised some concerns, and three were at high risk of bias.Versus conventional anchorage (15 trials), skeletal anchorage produced a more distal maxillary first-molar position (MD 0.95 mm; 95% CI 0.08 to 1.82), less maxillary incisor proclination (-3.37°; -6.08 to -0.67), less mandibular incisor proclination (-4.20°; -6.54 to -1.85) and protrusion (-1.09 mm; -1.91 to -0.27), less mandibular molar mesialization (-0.68 mm; -1.26 to -0.09), and greater overjet reduction (-0.74 mm; -1.39 to -0.08).Maxillary restraint was marginal (sella-nasion-A point angle (SNA) -0.28°; -0.48 to -0.07), whereas the A point-nasion-B point angle (ANB), the sella-nasion-B point angle (SNB), mandibular length, and the mandibular plane angle did not differ.Pooled device failure was 8.3% (5.6% to 12.0%); active treatment duration was unchanged (0.54 months; -0.68 to 1.75).Certainty was low to very low.Skeletal anchorage improves dentoalveolar anchorage control, particularly by limiting incisor compensation, rather than enhancing skeletal Class II correction.