Evaluation of Treatment Effects of en Masse Mandibular Arch Distalization Using Skeletal Temporary Anchorage Devices: A Systematic Review

Mandibular arch distalization using temporary anchorage devices (TADs) is effective in correcting borderline Class lll cases without surgery. This review analysed the existing literature evaluating the dental, skeletal, and soft tissue changes after en masse mandibular arch distalization using TADs. We followed PRISMA guidelines and registered this review in PROSPERO database CRD42023450524. PubMed, Google Scholar, Cochrane, Web of Science, and SCOPUS databases were searched. Orthodontic patients requiring en masse mandibular distalization using TADs were compared with different modalities of distalization. Dental changes were evaluated along with skeletal and soft tissue changes and treatment duration. Randomized controlled trials (RCTs), cohort studies, longitudinal studies, and retrospective studies were eligible to be included. The risk of bias was assessed using ROBINS-I tool ("Risk Of Bias In Non-randomized Studies-of Interventions"). Of 1764 identified records, seven studies (one non-RCT, one prospective clinical trial, and five retrospective cohort studies) were included. One study had a low risk of bias, three had moderate bias, two had serious bias, and one had critical bias. All studies showed molar distalization and distal tipping with significant retraction of the lower lip. Miniplates showed greater distalization compared to miniscrews. Interradicular miniscrews exhibited the least distal tipping. Changes in SNB, ANB, occlusal plane angle, and mandibular plane angle were reported. Retromolar screws and ramal plates reported reduced treatment duration. TADs are effective in en masse distalization of mandibular dentition with intrusive or extrusive effects.