UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
SYSTEMATIC REVIEW DOI: https://doi.org/10.4322/bds.2025.e4551
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Braz Dent Sci 2025 Jan/Mar;28 (1): e4551
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
The effectiveness of temporary anchorage devices (TADs) in the
orthodontic management of impacted canines: a systematic review
A eficácia dos dispositivos de ancoragem temporária (DATs) no manejo ortodôntico de caninos impactados: uma revisão
sistemática
Ahlam ASSALI1 , Houda NEANI1 , Fatima ZAOUI1 , Abdelali HALIMI1
1 - Mohammed V University, Department of Dentofacial Orthopedics and Orthodontics. Rabat, Morocco.
How to cite: Assali A, Neani H, Zaoui F, Halimi A. The effectiveness of temporary anchorage devices (TADs) in the orthodontic
management of impacted canines: a systematic review. Braz Dent Sci. ANO;28(1):e4551. https://doi.org/10.4322/bds.2025.e4551
ABSTRACT
Background: Orthodontic traction of impacted canines is challenging, requiring precise biomechanical planning
to prevent complications like root resorption. Objective: The systematic review aims to assess the efciency of
skeletal anchorage devices in orthodontic traction of these canines. Material and Methods: Following PRISMA
2020 guidelines, this review searched databases such as Medline and Scopus for clinical trials from 2016 onwards.
It focused on studies from 2016 in English or French, specically on orthodontic traction of impacted canines,
excluding literature reviews, case reports and non-comparative studies. Results: Of the 2396 articles initially
identied, 4 met the inclusion criteria. These studies compared outcomes of anchorage techniques, primarily
TADs versus transpalatal arches, examining aspects like root resorption, traction duration, and force efciency.
Each study’s assessment for bias risk (RoB) was evaluated based on its design-type. Conclusion: TADs are
advantageous for the orthodontic management of impacted canines, offering signicant benets in terms of
stability and reduced side effects.
KEYWORDS
Anchorage procedures, orthodontic; Canine tooth; Impacted teeth; Orthodontic extrusions; Technique, Orthodontic
Anchorage.
RESUMO
O tracionamento ortodôntico de caninos impactados é desaador, exigindo um planejamento biomecânico preciso
para evitar complicações como a reabsorção radicular. Objetivo: O objetivo desta revisão sistemática é avaliar
a eciência dos dispositivos de ancoragem esquelética no tracionamento ortodôntico desses caninos. Material e
Métodos: Seguindo as diretrizes PRISMA 2020, esta revisão pesquisou bancos de dados como Medline e Scopus
para ensaios clínicos a partir de 2016. Ela se concentrou em estudos de 2016, em inglês ou francês, especicamente
sobre o tracionamento ortodôntico de caninos impactados, excluindo revisões de literatura, relatos de casos e
estudos não comparativos. Resultados: Dos 2.396 artigos inicialmente identicados, 4 atenderam aos critérios
de inclusão. Esses estudos compararam os resultados das técnicas de ancoragem, principalmente DATs versus
arcos transpalatais, examinando aspectos como reabsorção radicular, duração da tração e eciência da força. A
avaliação do risco de viés (RoB) de cada estudo foi avaliada com base em seu tipo de desenho. Conclusão: Os
DATs são vantajosos para o tratamento ortodôntico de caninos impactados, oferecendo benefícios signicativos
em termos de estabilidade e redução dos efeitos colaterais.
PALAVRAS-CHAVE
Dente canino; Dente impactado; Extrusão ortodôntica ;Procedimentos de ancoragem ortodôntica; Técnica,
Ancoragem Ortodôntica.
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Braz Dent Sci 2025 Jan/Mar;28 (1): e4551
Assali A et al.
The effectiveness of temporary anchorage devices (TADs) in the orthodontic management of impacted canines: a systematic review
Assali A et al. The effectiveness of temporary anchorage devices (TADs)
in the orthodontic management of impacted canines: a
systematic review
INTRODUCTION
Canines play a major role in maintaining
dental arches integrity, and facial harmony [1].
Recent studies highlighted an important role of
genetic factors in canine eruption and impaction.
Genetic variations could inuence the position
and eruption pattern of canines; therefore, these
genetic factors must be considered in treatment
plans [2,3].
However, these teeth can also be impacted
due to various environmental factors, such
as barriers along the eruptive path, soft
tissue lesions, or developmental pathologic
conditions [2]. Furthermore, palatally impacted
maxillary canines are attributed to hereditary
inuence, whereas buccally impacted maxillary
canines have been attributed to arch length tooth
size discrepancies [3]
Impacted maxillary canines are the
second-most frequently impacted teeth in the
dental arch following the third molars—with
a prevalence of 1 to 3%. They primarily occur
palatally (85%) rather than labially (15%). These
impactions can lead to serious adverse effects,
including resorption of adjacent incisors and the
development of cysts [4].
The preferred management strategy for
impacted canines typically involves surgical
exposure followed by guided orthodontic
eruption. However, this approach is complex
and requires careful consideration of several
factors: the selection of an appropriate surgical
technique and orthodontic traction modality is
critical for achieving satisfactory periodontal
health and aesthetic outcomes; additional space
must be created within the arch to align the
canine properly; precise anchorage preparation is
essential; and, the treatment of the impaction must
be integrated into the comprehensive treatment
planning for the entire malocclusion [5,6].
Effective planning of orthodontic traction is
crucial for clinical success. Various methods are
available, including cantilevers, power chains,
ligature wires, springs, and double archwires.
However, meticulous biomechanical planning
is essential to avoid root contact, preserve
anchorage, and maintain periodontal health of
the affected teeth. Furthermore, it is important
that the magnitude of the force applied remains
within a physiological range to ensure optimal
outcomes [7].
Although there are several types of studies,
case reports and some reviews on this topic, it
is still difcult for the clinician to nd reliable
data regarding impacted canine management.
The purpose of this systematic review is to
evaluate the effectiveness of anchorage devices
in managing the impacted canines.
MATERIAL AND METHODS
Registration of protocol
Registration of the research protocol was
carried out at PROSPERO to avoid any duplication
(Registration # CRD42024575877). All the
phases of this systematic was conducted with
a strict respect of PRISMA 2020 guidelines for
reporting items [8].
Study selection and search strategy
Meticulous electronic research was carried
out extending from 2016 to 2024 by exploring
the following databases:
• PUBMED (MEDLINE)
• SCIENCE DIRECT
• COCHRANE LIBRARY
• GOOGLE SCHOLAR
The research was aiming mainly clinical
trials extending from 2016 up to now
The medical subject heading terms were
gathered by a Boolean operator AND forming the
following search equations:
1 – impacted teeth AND canine AND orthodontic
anchorage
2 – impacted teeth AND canine AND orthodontic
extrusion
3- impacted canine AND orthodontic anchorage
4- impacted canine AND orthodontic extrusion
A well-defined research question using
PICO principle: Population, Intervention,
Comparator, and outcome was established and
followed. Characteristics of PICO question are all
summarized in Table I.
Inclusion and exclusion criteria
The inclusion and exclusion criteria used for
selecting articles for the analysis are summarized
in Table II.
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Assali A et al.
The effectiveness of temporary anchorage devices (TADs) in the orthodontic management of impacted canines: a systematic review
Assali A et al. The effectiveness of temporary anchorage devices (TADs)
in the orthodontic management of impacted canines: a
systematic review
Data extraction method
Two independent reviewers, A.A and H.N,
conducted a qualitative synthesis by discussing
the results obtained from evaluating the titles and
abstracts of the studies. They excluded those that
did not meet our inclusion criteria and eliminated
duplicate articles.
Subsequently, A.A and H.N independently
extracted data from the selected studies using a
data extraction sheet, which included:
• Author name
• Year of publication
• Study design
• Aim of the study
• Intervention group
• Types of appliances used for anchorage
reinforcement
• Method of evaluation
• Results
A third researcher, A.H, then reevaluated the
collected data. Our selection process is illustrated
in the ow chart (Figure 1).
Methodological and risk of bias assessment
(RoB)
Search evaluation and risk of bias assessment
were conducted independently by two researchers,
A.A and N.H. In the event of any disagreement,
a third reviewer, A.H, reexamined the results.
The assessment of RoB was completed in
each study, depending upon its type and design:
- RoB2 tool was used to assess the quality of
included randomized controlled trials [9];
- Risk of Bias in Non-randomised Studies of
Interventions (ROBINS-I) tool was used
to assess the quality of included non-
randomized trials [9];
- Joanna Briggs Institute (JBI) tools was used
to assess the quality of included retrospective
case-control and cohort studies [10].
RESULTS
Study selection
We identied 2,396 studies from the initial
search, of which 2,348 were duplicates or did
not meet our inclusion criteria. We retained
48 studies for pre-selection to undergo abstract
screening. After eliminating irrelevant studies and
assessing the full text, 4 studies were included in
our systematic review.
The overview of the study selection process
is illustrated in the ow chart (Figure 1).
Study characteristics and RoB
The included studies consisted of a
combination of a randomized clinical trial
published in 2021 [5], a non-randomized clinical
trial published in 2016 [11], a retrospective
cohort study and a retrospective case–control
study published in 2018 [4,12]. The four studies
shared a common objective: to evaluate the
effectiveness of orthodontic traction devices in
guiding the eruption of impacted canines.
Three studies compared by using CBCT
records the outcomes before and after canine
orthodontic traction with the same anchorage
technique, while the fourth study compared
results using 2 anchorage techniques (temporary
anchorage devices TADS and transpalatal arch
TPA).
Using the RoB2 tool, the randomized clinical
trial was assessed to have a moderate risk of bias
(Table III). In contrast, the ROBIN I tool for non-
randomized clinical trials indicated that the study
was classied as low risk (Table IV). Additionally,
based on the JBI critical appraisal checklist for
retrospective case-control and cohort studies,
both studies were categorized as moderate risk
(Tables V and VI).
Q1: Q11 refers to questions 1–11 derived
from the JBI risk assessment. The risk of bias was
classied as high when the study achieved up to
49% of “yes” responses, moderate for 50 to 69%
of “yes” responses, and low for over 70% of “yes”
Table I - PICO question
Population Patients with unilateral or bilateral impacted maxillary canine
Intervention Guided orthodontic eruption
Comparison Orthodontic traction devices
Outcome Amplitude of movement, traction duration, root resorption
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Assali A et al.
The effectiveness of temporary anchorage devices (TADs) in the orthodontic management of impacted canines: a systematic review
Assali A et al. The effectiveness of temporary anchorage devices (TADs)
in the orthodontic management of impacted canines: a
systematic review
Table II - Inclusion and exclusion criteria
Inclusion criteria Exclusion criteria
- Articles in English or French - Animal studies
- Full text accessible - Simulation or virtual study methods
- Published from 2016 - Case reports
- Prospective and retrospective studies - Literature reviews and opinion articles
- Randomized and non-randomized clinical trials - Studies assessing interceptive treatment for managing impacted
maxillary canines
- Clinical trials focusing exclusively on successful orthodontic-
surgical methods for treating impacted maxillary canines - Studies that include patients with clefts in their sample
- Studies that clearly describe the anchorage strategies employed - Articles introducing new anchorage systemsor devices for
treating impacted maxillary canines
Figure 1 - Flow chart.
Table III - Risk of bias assessment using the RoB2 tool
D1 D2 D3 D4 D5 Overall risk
Miglioratietal. [5] + - - + + -
Domains: D1: Bias arising from the randomization process; D2: Bias arising from deviations from the intended interventions provided; D3: Bias
from missing outcome data; D4: Bias in measurement of the outcome; D5: Bias in selection of the reported result. (-) = Some concerns; (+) = Low.
Table IV - Risk of bias assessment using ROBIN-I tool
Study D1’ D2’ D3’ D4’ D5’ D6’ D7’ Overall risk
Heravetal. [11] Moderate Low Moderate Low Low Low Moderate Low
Domains: D1’: Bias due to confounding; D2’: Bias in the selection of study participants; D3’: Bias in classification of interventions; D4’: Bias due
to deviations from intended interventions; D5’: Bias due to missing data; D6’: Bias in measurement of outcomes; D7’: Bias in selection of the
reported result.
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Assali A et al.
The effectiveness of temporary anchorage devices (TADs) in the orthodontic management of impacted canines: a systematic review
Assali A et al. The effectiveness of temporary anchorage devices (TADs)
in the orthodontic management of impacted canines: a
systematic review
responses. A “✓” signies yes, an “X” denotes no,
and a “?” indicates unclear. JBI: Joanna Briggs
Institute.
We provide a summary of the included
articles in Table VII.
DISCUSSION
Orthodontic anchorage can be dened as
the means to resist unwanted reactive forces and
moments related to movements of teeth. This,
tropes well into the third law of Newton, namely,
every action has an equal reaction back towards
the opposite direction [13].
Maxillary canine impactions are a very
frequently seen clinical problem. The cause of
impaction of the canine could be attributed to
localized, systemic, or genetic factor(s). Thus,
the most important step in management of
impacted canines, according to both clinical and
radiographic examinations, is a precise diagnosis
and the 3D localization of the tooth [14].
Orthodontic treatment of impacted maxillary
canines requires an interdisciplinary approach
involving meticulous surgical techniques as well
as orthodontic biomechanical considerations in
light of the 3D force system that will be applied
to the canines along the horizontal, vertical, and
sagittal planes.
The anchorage strategy should adapt to
various changes in traction direction to achieve
alignment of the canine in the dental arch, either
vertical or oblique in the rst phase for straightening
its axis while moving away from the roots of the
neighboring teeth, before moving to a second phase
of traction that is most often horizontal toward its
place in the dental arch [13,15].
Becker et al. [16] in his study stated that
poor anchorage is the leading cause for failure
of treatment in the impacted maxillary canines
(approximately 48.6% cases).
When comparing conventional anchorage
systems such as transpalatal arches (TPAs) and
temporary anchorage devices (TADs) in the
management of impacted maxillary canines,
several critical aspects must be considered,
including their effectiveness in controlling tooth
movement, the risk of side effects such as root
resorption, treatment time, and overall stability.
Effectiveness in controlling tooth movement
Arriola-Guillén et al. [12] investigated the
changes in interpremolar width following traction
of maxillary impacted canines (MICs) with a
reinforced conventional anchorage device (a
transpalatal arch).
This study shows similar maxillary premolar
expansion change without signicative differences
of the impaction type (unilateral/bilateral) or
impaction location (palatal/buccal). It could be
explained by the fact that heavy anchorage plays
a signicant role in helping to control Newton’s
third law.
Moreover, in cases of unilateral impaction,
transversal asymmetry was reported after traction
of MICs. These changes were greater on the
affected side than the unaffected side (2 mm of
expansion vs. <1 mm, respectively, P < 0.05).
In other words, despite the application of a
reinforced transpalatal arch, the authors still
recognized a loss of the transversal anchorage in
the cases of unilateral impaction [12].
Furthermore, vertical anchorage control
plays an essential role in managing MICs ; loss
of anchorage is common wherever traction
biomechanics are not respected or not well-
planned. Clinically, this produces mesial tipping
of the maxillary molars, occlusal plane alterations,
and poor treatment outcomes. It also gives the
appearance of an anterior or lateral open bite [11].
One study by Migliorati et al. [5] investigated
the mesial tipping of permanent teeth under
Table V - The JBI (Joanna briggs institute) critical appraisal for retrospective case control studies
Checklist questions 1 2 3 4 5 6 7 8 9 10 %yes Risk
Arriola-Guillénetal. [12] ✓✓✓X✓XXX✓ ✓ 60% Moderate
Table VI - The JBI critical appraisal for retrospective cohort studies
Check list questions 1 2 3 4 5 6 7 8 9 10 11 % yes Risk
Potrubaczetal. [4] X ✓✓✓X ? ✓ ✓ ✓ X✓64% Moderate
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Assali A et al.
The effectiveness of temporary anchorage devices (TADs) in the orthodontic management of impacted canines: a systematic review
Assali A et al. The effectiveness of temporary anchorage devices (TADs)
in the orthodontic management of impacted canines: a
systematic review
traction with transpalatal arch, showing that this
movement caused signicant mesial tipping of the
rst permanent molars. Nevertheless, this study
did not give details about molars displacement
or quantity of anchorage loss in the vertical
dimension.
This could explain why other authors
had included a palatal acrylic button to the
transpalatal arch [17-20], in which the anterior
palatine vault serves as additional anchorage.
These studies did not mention any anchorage loss
in the vertical dimension nor molar movement;
Table VII - Studies characteristics and results
Author Aim Study design Intervention
group Comparison Mean of com-
parison Outcome Results
Miglioratietal. [5]
To compare the
effectiveness
of two different
anchorage
systems for
the traction
of impacted
maxillary
canines.
Randomized
clinical trial
16 patients
mean age:
13.4 years,
undergoing
orthodontic
treatment
for impacted
maxillary
canines (both
labial and
palatal)
Group 1: n 8 mm
long miniscrew
Group 2:
transpalatal
arch as
anchorage
a calibrated
traction force of
50 g
- CBCT
-Before and
after 3 months
of guided
eruption
- Crown
movement
- Root
movement
- Crown velocity
- Root velocity
- Duration of
guided eruption
-No statistically
significant
difference
between the two
groups about
the amount and
speed of canine’s
crown and apex
movement.
-In the TADs
group, no
miniscrews were
lost during the
traction period
- In the
transpalatal arch
group, there was
significant loss
of anchorage and
mesialization of
the molars.
Potrubacz [4]
To assess the
time required
for orthodontic
traction of
impacted teeth
with varying
severity levels,
utilizing a
device capable
of consistently
applying forces
below 0.6 N.
Retrospective
study
Twenty-two
patients were
treated for
unilateral
or bilateral
palatally
impacted
canines using
a stainless-
steel cantilever
soldered onto
a transpalatal
arch.
Intervention
group before
and after
treatment
Panoramic
- Force applied
by the traction
device
- Duration of
traction
-Force generated
by the system
close to the
recommended
0.6 N.
-Guided eruption
achieved in an
average duration
of 3.5 months.
Arriola-Guillénetal.
[12]
to compare the
root resorption
of maxillary
incisors after
traction of
unilateral
vs bilateral
impacted
canines with
temporary
anchorage
devices (TADs)
Retrospective
longitudinal
study
Two groups:
15 patients
with unilateral
maxillary
impacted
canines and 15
with bilateral
maxillary
impacted
canines.
Before and after
orthodontic
traction
CBCT: scans
before and after
orthodontic
traction
Root resorption
of maxillary
insisors
-The reinforced
anchorage
minimizes
undesirable
side effects
and reduces
the risk of root
resorption.
Heravetal. [11]
To asses the
movement
of impacted
canines away
from the roots
of adjacent
teeth using
TADs before
to full-mouth
bracket
placement.
non-randomized
parallel-
designed clinical
controlled trial
study
26 patients
(15 in the
experimental
group and 11
in the control
group) with
34 palatally
impacted
canines
with axial
inclinations<45°
Group 1: n =
15 with two
miniscrews
for anchorage
reinforcement,
along with a
cantilever spring
inserted into
the miniscrew
slot (0.018 x
0.025).
Group 2: n = 11
with a 0.016
x 0.022-inch
stainless steel
arch and a
transpalatal
arch.
CBCT: scans
before and after
orthodontic
traction
-Incisor and
canine root
resorption
-Traction
duration
-Higher pain
levels in group 2
in the first weeks
of traction (p =
0.012)
-The volume of
lateral incisor
root resorption
in group 2 was
significantly
greater than
group
-No statistically
significant
difference
according to
traction duration
between the two
groups
CBCT = Cone Beam Computed Tomography; TADs = Temporary Anchorage Devices.
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Assali A et al.
The effectiveness of temporary anchorage devices (TADs) in the orthodontic management of impacted canines: a systematic review
Assali A et al. The effectiveness of temporary anchorage devices (TADs)
in the orthodontic management of impacted canines: a
systematic review
however, further studies must be done to draw
consistent conclusions.
On the other hand, it has been stablished
that a transpalatal arch connecting upper rst
molars, experiences intrinsic forces generated by
tongue action during swallowing and mastication.
At the same time, the extrusive force, applied
to the impacted canines, produces reactive
intrusive forces that in turn cause a moment,
leading to mesial tipping of the molars. These
ndings enhance the need of further anchorage
techniques to a better vertical dimension control
during canine traction [21,22].
In contrast, TADs, such as mini-screws, offer
signicantly better control over tooth movement.
Mini-screws, by providing absolute anchorage
directly to the bone, eliminate forces on adjacent
teeth and avoiding unwanted tooth movements.
Several studies have highlighted the advantages of
TADs in providing more predictable and controlled
3D movement of impacted canines [18,22].
Herav et al. [11], inserted two 8 mm mini-
screws with a 1.4 mm diameter in the palatal
region for each impacted maxillary canine prior
to the initiation of orthodontic treatment. Later,
a palatal cantilever spring of TMA was used to
apply traction force thereby obtaining extrusive
and distal forces on canines. The cantilever spring
was activated to upright and expose the canine’s
crown by applying a mainly extrusive force before
the erupted canine is moved bucally using NITI
overlay. The results of this study show that skeletal
anchorage allows for controlled movement of the
impacted tooth in both the vertical and sagittal
dimensions with no need to bracket maxillary arch
before total canine correction [11].
Migliorati et al. [5] in their study used
8mm long mini-screws as anchorage in a “canine
rst” approach where no anchorage preparation
was done. Traction biomechanics included
beta-titanium cantilever spring applying 3D
forces on the canines. The insertion sites for the
mini-screws varied depending on the positional
representation of the canine within the human
mouth. The results showed no anchorage loss nor
any considerable differences with respect to the
apical and tip dislocation of canines.
Risk of root resorption
Root resorption is a major concern
when treating impacted canines. Arriola-
Guillén et al. [12] in their work compared the
root resorption of maxillary incisors pre- and post-
orthodontic treatment of impacted unilateral or
bilateral maxillary canines using transpalatal arch
and concluded no signicant differences on the
basis that root resorption in both groups was less
than 2 mm and 5 mm, which was clinically not
signicant. The approach employed to maintain a
greater space between the impacted canines and
the roots of the neighboring teeth, as well as the
substantial anchors used to regain direct dental
support, were the main causes of the decrease in
root resorption.
Conversely, TADs offer even greater advantage,
by providing more direct control over the forces
applied, reducing the risk of root resorption and
minimizing unwanted tooth movement of the
adjacent teeth. Herav et al. [11] indicated that
TADs, such as mini-screws, could effectively
control direction and magnitude of force applied to
extrude impacted canines and cause no damage to
adjacent roots. For instance, Kocsis et al. [23] noted
that mini-screws caused less root resorption as
compared to the conventional anchorage methods.
Treatment duration
Treatment time is another important factor
to consider and has been a subject of controversy.
The transpalatal arch with a cantilever
system allows for easy and efcient procedure,
according to Potrubacz et al. [4]. The orthodontic
extrusion took on average of 3.5 months to
complete. Tepedino et al.’s [24] ndings, which
show an average extrusion time of 3.6 months,
are in good agreement with this investigation.
The average treatment time was correlated
to patient´s age. That is, a younger patient will
need less time for tooth extrusion. No statistically
signicant correlation was drawn between the
canine’s position and treatment time.
The authors found, also, an effect of gender
on treatment time: Males required a shorter
time for tooth extrusion. This can be explained
by the differential timing of skeletal maturation
between the two genders .Males typically mature
later than females, and this delayed maturation
could allow their skeletal bones to respond more
efciently to orthodontic forces, leading to faster
tooth extrusion [4].
This interval of time is shorter than reported
in other studies [25] but similar to that reported
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The effectiveness of temporary anchorage devices (TADs) in the orthodontic management of impacted canines: a systematic review
Assali A et al. The effectiveness of temporary anchorage devices (TADs)
in the orthodontic management of impacted canines: a
systematic review
by Becker and Chaushu [26] for adolescent
patients.
On the other hand, Kocsis et al. [23] studied
the traction of impacted maxillary canines using
1.5 mm LEONE TM mini-screws in a sample
of 69 canines. The sample included unilateral
and bilateral buccal or palatal impaction with
different levels of impaction. Success of 88.41%
was reported with a mean traction time of
6.8 months, which is a relatively a long period
compared to other studies [11,12].
In contrast, Migliorati et al. [5] didn’t nd
evidence that skeletal anchorage using miniscrews
could make canine disimpaction faster than
anchorage on a TPA. The rate of canine eruption
was on average 1.08 and 1.96 mm in 1 month
in the TADs and TPA groups respectively by
applying always a 50–60 g force.
Management of impacted maxillary
canines remains challenging. Both conventional
anchorage devices and TADs have their respective
advantages and limitations.
Our ndings indicate that while conventional
anchorage is a more recognized method, the
evidence supporting TADs presents a trend
towards controlled and predictable treatments.
As we advance in our practice as orthodontists, it
is essential to integrate the conventional approach
and innovations that TADs offer, in order to create
the most effective treatment plan customized to
each individual case. Recent studies on advanced
techniques provide valuable insights into expected
improvements for patients with impacted canines.
CONCLUSION
Orthodontic management of impacted
canines relies on surgical exposure and guided
orthodontic traction; hence, it requires an
appropriate treatment protocol. Plus, it is
important for both patients and clinicians to
be aware of the expected time of the whole
treatment, degree of predictability of success,
and side effects that could arise.
Anchorage is crucial to the effective control of
canine traction. A transpalatal arch, is usually used
as an anchorage device for stabilizing the upper
arch during canine traction, it protects adjacent
teeth and soft tissues from reaction forces.
TADs such as mini-screw represent an
alternative method to the conventional anchorage
strategy; they became increasingly popular
because of ease of placement and removal, as
well as for decreasing patient compliance.
By maintaining relatively good stability in
the bone and enhancing anchorage effectiveness
with fewer negative effects on neighboring teeth
or problems that could affect treatment outcomes,
this systematic study shows that TADs are
advantageous in clinical practice. Further studies
are necessary to make more denitive ndings
about their 3D effectiveness.
Acknowledgements
None.
Author’s Contributions
AA: Conceptualization, Data Curation, Formal
Analysis, Investigation, Methodology, Project
Administration, Ressources, Writing – Original
Draft Preparation. NH: Conceptualization,
Data Curation, Formal Analysis, Investigation,
Methodology, Project Administration, Supervision.
ZF: Conceptualization, Supervision, Writing
– Review & Editing. HA: Conceptualization,
Supervision, Writing – Review & Editing.
Conict of Interest
The authors have no conicts of interest to
declare.
Funding
This research did not receive any specic
grant from funding agencies in the public,
commercial, or not-for-prot sectors.
Regulatory Statement
The systematic review was conducted
through a search strategy in electronic databases.
The search was restricted to publications in peer-
reviewed journals, in which approval for ethics
committee were obtained in their original work.
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Braz Dent Sci 2025 Jan/Mar;28 (1): e4551
Assali A et al.
The effectiveness of temporary anchorage devices (TADs) in the orthodontic management of impacted canines: a systematic review
Assali A et al. The effectiveness of temporary anchorage devices (TADs)
in the orthodontic management of impacted canines: a
systematic review
Date submitted: 2024 Oct 17
Accept submission: 2025 Mar 04
Ahlam Assali
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Mohammed V University, Faculty of Dentistry, Department of Dentofacial
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