Are orthodontic distalizers reinforced with the temporary skeletal anchorage devices effective? Piotr Fudalej a and Joanna Antoszewska b Nijmegen, The Netherlands, and Wroclaw, Poland Introduction: Our objective was to perform a systematic review of studies pertaining to the distalization of teeth with appliances reinforced with temporary skeletal anchorage devices. Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Knowledge, Ovid, and Scopus were searched until the second week of August 2010 to identify all articles reporting on the use of orthodontic implants or miniplates in distalization of teeth. The quality of the relevant studies was ranked on an 11-point scale, from low to high quality. Results: Twelve relevant articles were identified. The distal movement of the maxillary molars was from 3.3 to 6.4 mm; the concomitant molar distal tipping was from 0.80  to 12.20  . The maxillary incisors re- mained stable during molar distalization. The assessment of study quality showed that 8 studies were of low and 4 of medium quality. Conclusions: Molar distalizers reinforced with the temporary skeletal anchorage devices seem to effectively move molars distally without unwanted mesial incisor tipping. Because of the lack of high-quality studies, however, the findings of this study should be interpreted with caution. (Am J Orthod Dentofacial Orthop 2011;139:722-9) D istalization of the molars has become a popular nonextraction treatment alternative in some patients with Class II malocclusions. There are nu- merous methods to move teeth distally; some techniques require a patient’s active compliance, whereas others do not. Because patients’ cooperation during orthodontic treatment is frequently problematic, the appliances that eliminate the need for compliance are usually deemed su- perior to those demanding cooperation. Although popu- lar noncompliance appliances, such as the pendulum 1 and the distal jet, 2 are effective in distalizing molars, the distalization process is associated with the concomitant loss of anterior anchorage. Sfondrini et al 3 critically eval- uated various appliances used for molar distalization and found that most noncompliant appliances were associ- ated with mesial movement or tipping of the incisors, synonymous with loss of anchorage. Similar conclusions were made by Antonarakis and Kiliaridis, 4 who systemat- ically reviewed the effects of noncompliance tooth-borne distalizers. They found that distalization of molars is re- lated to unavoidable loss of anchorage, which was observed as premolar mesial movement and incisor mesial crown and tipping movements. To reinforce anchorage and reduce unwanted move- ment of the incisors and premolars, a temporary skele- tal anchorage device (TSAD) can be used. The TSAD is defined as a device that is temporarily fixed in bone for reinforcement of orthodontic anchorage. 5 Because a TSAD is stable, it provides absolute anchorage. To date, many distalization appliance designs incorporat- ing TSADs have been developed. They range from the skeletal anchorage system (SAS) with miniplates placed in the zygomatic region in the maxilla 6 or retromolar region of the mandible 7 to appliances supported by a single orthodontic implant in the anterior palate. 8 Al- though the current studies suggest that these appli- ances might be effective in moving molars distally, an in-depth analysis is needed to investigate also other as- pects of distalization, such as a rate and duration of molar movement. Therefore, the objectives of this sys- tematic review were to evaluate the effectiveness of the distalization of molars with distalizers supported with TSADs and to compare the effectiveness of TSAD- reinforced distalizers with tooth-borne noncompliance distalization appliances. a Assistant professor, Department of Orthodontics and Oral Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Assistant professor, Department of Orthodontics, Palacky University, Olomouc, Czech Republic. b Assisstant professor, Department of Dentofacial Orthopedics and Orthodon- tics, Wroclaw Medical University, Wroclaw, Poland. The authors report no commercial, proprietary, or commercial interest in the products of companies described in this article. Reprint requests to: Piotr Fudalej, Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB Nijmegen, The Netherlands; e-mail, P.Fudalej@dent.umcn.nl. Submitted, August 2010; revised, December 2010; accepted, January 2011. 0889-5406/$36.00 Copyright Ó 2011 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2011.01.019 722 SYSTEMATIC REVIEW