Skeletal Versus Conventional Palatal Anchorage for Orthodontic Traction of Impacted Maxillary Canines: A Systematic Review and Meta-Analysis

Impacted maxillary canines occur in 1–3% of the population, and adequate anchorage control during orthodontic traction is essential to prevent incisor root resorption and molar mesialisation. This systematic review and meta-analysis aimed to compare skeletal anchorage (TADs) with conventional palatal anchorage for orthodontic traction of impacted maxillary canines, evaluating anchorage loss, traction duration, root resorption, eruption success, and patient-reported outcomes. Four databases (PubMed/MEDLINE, Web of Science, Scopus, Cochrane) were searched from January 2016 to March 2026 following PRISMA 2020 guidelines. RCTs and controlled clinical studies were included; risk of bias was assessed with Cochrane RoB 2 and the Newcastle–Ottawa scale; evidence certainty was rated using GRADE. Nine studies (n = 481 patients; 241 TADs, 240 conventional anchorage) met the inclusion criteria. Skeletal anchorage was associated with significantly less anchorage loss (WMD −1.24 mm; 95% CI [−1.56, −0.92]; p < 0.001; I2 = 62%), shorter traction duration (WMD −1.89 months; 95% CI [−2.71, −1.07]; p < 0.001), and reduced odds of incisor root resorption (OR 0.41; 95% CI [0.22, 0.77]; p = 0.006); eruption success and patient discomfort were comparable between groups. GRADE certainty was moderate for anchorage loss and low-to-very-low for secondary outcomes. TADs provide clinically meaningful advantages over conventional palatal anchorage, particularly in complex palatal impactions; well-designed multicentre RCTs remain warranted.