Review

. 2025 Mar 3;26(1):9.

doi: 10.1186/s40510-025-00556-4.

Skeletal versus conventional anchorage in dentofacial orthopedics: an international modified Delphi consensus study

Lorenzo Franchi¹, Maria Denisa Statie², Tommaso Clauser², Marco Migliorati³, Alessandro Ugolini³, Rosaria Bucci⁴, Roberto Rongo⁴, Riccardo Nucera⁵, Marco Portelli⁵, James A McNamara⁶, Michele Nieri², Sercan Akyalcin⁷, Fernanda Angelieri⁸, Daniele Cantarella⁹, Paolo Cattaneo¹⁰, Lucia Cevidanes⁶, Luca Contardo¹¹, Marie Cornelis¹⁰, Renzo De Gabriele¹², Carlos Flores Mir¹³, Daniela Garib¹⁴, Giorgio Iodice⁴, Antonino Lo Giudice¹⁵, Luca Lombardo¹⁶, Björn Ludwig¹⁷, Cesare Luzi¹⁸, Maria Costanza Meazzini¹⁹, Peter Ngan²⁰, Tung Nguyen²¹, Alexandra Papadopoulou²², Spyridon N Papageorgiou²³, Jae Hyun Park⁹, Sabine Ruf²⁴, Bernardo Souki²⁵, Benedict Wilmes²⁶, Heinz Winsauer²⁷

Affiliations

¹ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. lorenzo.franchi@unifi.it.
² Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
³ Department of Sciences Integrated Surgical and Diagnostic, University of Genoa, Genoa, Italy.
⁴ Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.
⁵ Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
⁶ Department of Orthodontics and Pediatric Dentistry, The University of Michigan, Ann Arbor, USA.
⁷ Department of Developmental Biology, Harvard School of Dental Medicine, Boston, USA.
⁸ , Private practice, Porto Feliz, São Paulo, Brazil.
⁹ Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, USA.
¹⁰ Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
¹¹ Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
¹² , Private practice, Lecce, Italy.
¹³ Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Canada.
¹⁴ Bauru Dental School, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil.
¹⁵ Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
¹⁶ Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy.
¹⁷ Saarland University, Saarbrücken, Germany.
¹⁸ Private practice, Rome, Italy.
¹⁹ San Paolo Hospital, University of Milan and San Gerardo Hospital, Monza, Italy.
²⁰ Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, USA.
²¹ School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, USA.
²² Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
²³ Clinic of Orthodontics and Pediatric Dentistry, Center for Dental Medicine, University of Zürich, Zürich, Switzerland.
²⁴ Department of Orthodontics, University of Giessen, Giessen, Germany.
²⁵ School of Dentistry, Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil.
²⁶ Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany.
²⁷ , Private practice, Bregenz, Austria.

PMID: 40025259
PMCID: PMC11872959
DOI: 10.1186/s40510-025-00556-4

Review

Skeletal versus conventional anchorage in dentofacial orthopedics: an international modified Delphi consensus study

Lorenzo Franchi et al. Prog Orthod. 2025.

. 2025 Mar 3;26(1):9.

doi: 10.1186/s40510-025-00556-4.

Authors

Affiliations

¹ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. lorenzo.franchi@unifi.it.
² Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
³ Department of Sciences Integrated Surgical and Diagnostic, University of Genoa, Genoa, Italy.
⁴ Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy.
⁵ Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
⁶ Department of Orthodontics and Pediatric Dentistry, The University of Michigan, Ann Arbor, USA.
⁷ Department of Developmental Biology, Harvard School of Dental Medicine, Boston, USA.
⁸ , Private practice, Porto Feliz, São Paulo, Brazil.
⁹ Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, USA.
¹⁰ Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
¹¹ Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
¹² , Private practice, Lecce, Italy.
¹³ Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Canada.
¹⁴ Bauru Dental School, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil.
¹⁵ Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
¹⁶ Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy.
¹⁷ Saarland University, Saarbrücken, Germany.
¹⁸ Private practice, Rome, Italy.
¹⁹ San Paolo Hospital, University of Milan and San Gerardo Hospital, Monza, Italy.
²⁰ Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, USA.
²¹ School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, USA.
²² Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
²³ Clinic of Orthodontics and Pediatric Dentistry, Center for Dental Medicine, University of Zürich, Zürich, Switzerland.
²⁴ Department of Orthodontics, University of Giessen, Giessen, Germany.
²⁵ School of Dentistry, Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil.
²⁶ Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany.
²⁷ , Private practice, Bregenz, Austria.

PMID: 40025259
PMCID: PMC11872959
DOI: 10.1186/s40510-025-00556-4

Erratum in

Correction to: Skeletal versus conventional anchorage in dentofacial orthopedics: an international modified Delphi consensus study.
Franchi L, Statie MD, Clauser T, Migliorati M, Ugolini A, Bucci R, Rongo R, Nucera R, Portelli M, McNamara JA, Nieri M, Akyalcin S, Angelieri F, Cantarella D, Cattaneo P, Cevidanes L, Contardo L, Cornelis M, De Gabriele R, Mir CF, Garib D, Iodice G, Giudice AL, Lombardo L, Ludwig B, Luzi C, Meazzini MC, Ngan P, Nguyen T, Papadopoulou A, Papageorgiou SN, Park JH, Ruf S, Souki B, Wilmes B, Winsauer H. Franchi L, et al. Prog Orthod. 2025 Sep 19;26(1):31. doi: 10.1186/s40510-025-00579-x. Prog Orthod. 2025. PMID: 40971098 Free PMC article. No abstract available.

Abstract

Background: To establish consensus of skeletal anchorage versus conventional anchorage in treating: 1. Maxillary transverse deficiency in growing and adult patients, 2. Class II skeletal disharmony due to mandibular retrusion in growing patients, 3. Class III skeletal disharmony in growing patients.

Methods: A four-rounds modified Delphi method was conducted. A steering committee performed a literature selection and compiled a list of 33 statements. An international panel of 25 experts in orthodontics agreed to participate. In each round, panelists were asked to rate their level of agreement with each statement using a 5-point Likert scale and provide comments. Statements that reached consensus were either accepted or rephrased. Statements that did not reach consensus were either rephrased, rejected, or split into two statements or merged with another.

Results: After the four rounds, 24 statements achieved consensus while 9 were rejected. The distribution of consensus statements was as follows: Maxillary transverse deficiency: 4 statements; Class II skeletal disharmony: 10 statements; Class III skeletal disharmony: 10 statements.

Conclusions: This modified Delphi consensus study aimed to provide guidance for orthodontists in choosing between skeletal and conventional anchorage for various treatment conditions. The study generated 24 consensus statements across three key domains. While the Delphi method provides valuable expert opinions, future studies, including randomized controlled trials, are needed to confirm these findings and address remaining uncertainties. Such efforts will aid in refining orthodontic treatment protocols and enhancing patient outcomes.

Keywords: Class II malocclusion; Class III malocclusion; Maxillary transverse deficiency; Skeletal anchorage.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: All Authors consent to publication. Competing interests: The authors declare that they have no competing interests.

References

1. Alhammadi MS, Halboub E, Fayed MS, Labib A, El-Saaidi C. Global distribution of malocclusion traits: A systematic review. Dental Press J Orthod. 2018;23(6):40.e1-40.e10. - PMC - PubMed
1. Creekmore TD, Eklund MK. The possibility of skeletal anchorage. J Clin Orthod. 1983;17(4):266–9. - PubMed
1. Baccetti T, Franchi L, Cameron CG, McNamara JA Jr. Treatment timing for rapid maxillary expansion. Angle Orthod. 2001;71(5):343–50. - PubMed
1. Lin L, Ahn H-W, Kim S-J, Moon S-C, Kim S-H, Nelson G. Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence. Angle Orthod. 2015;85(2):253–62. - PMC - PubMed
1. Lione R, Franchi L, Cozza P. Does rapid maxillary expansion induce adverse effects in growing subjects? Angle Orthod. 2013;83(1):172–82. - PMC - PubMed

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Skeletal versus conventional anchorage in dentofacial orthopedics: an international modified Delphi consensus study

Affiliations

Skeletal versus conventional anchorage in dentofacial orthopedics: an international modified Delphi consensus study

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources