Temporary Anchorage Devices in Orthodontic Traction: Evidence, Biomechanics, and Clinical Applicability of Miniscrews

Objective: This narrative review synthesizes the current evidence on temporary anchorage devices (TADs), with emphasis on orthodontic miniscrews, addressing their historical development, biomechanical principles, clinical indications, insertion technique, success and failure rates, and quantitative effectiveness. Methods: A structured search of the literature was performed, focusing on systematic reviews, meta-analyses and randomized clinical trials published between 2009 and 2025 addressing miniscrew anchorage, survival rates, biomechanics and patient-reported outcomes. Results: Reported failure rates are 16.4% (95% CI 13.4–20.1%) for miniscrews, 10.5% for palatal implants, 7.3% for miniplates and 17.2% for onplants. In maxillary en masse retraction, skeletal anchorage reduces horizontal anchorage loss by a weighted mean of 2.79 mm (95% CI −3.56 to −2.03 mm) compared with conventional mechanics. Miniscrew-assisted anterior intrusion outperforms intrusion arches, utility arches and J-hook headgear in overbite correction, and maxillary molar distalization achieves approximately 3.2–3.7 mm of movement regardless of the anchorage site. Root proximity identified on cone-beam computed tomography is strongly associated with early failure: 52.4% of miniscrews in contact with roots failed within the first month, against 0% of those without root proximity. Miniscrew-assisted rapid palatal expansion produces greater skeletal expansion than tooth-borne devices with acceptable oral health-related quality of life. Conclusions: Miniscrews are a reliable, minimally invasive and cost-effective means of achieving absolute skeletal anchorage, with effectiveness demonstrably superior to conventional anchorage in en masse retraction and anterior intrusion. Success depends critically on insertion-site planning, avoidance of root proximity, adequate cortical bone thickness, appropriate insertion torque and rigorous biomechanical control of force vectors. Collectively, these data support miniscrews as the first-line skeletal anchorage device in daily orthodontic practice. In view of this evidence, miniscrews should be considered the default anchorage strategy whenever the treatment plan requires anchorage-critical tooth movements, provided that insertion-site planning and biomechanical control are rigorously observed.