Midpalatal implants vs headgear for orthodontic anchorage—a randomized clinical trial: Cephalometric results

Introduction: The purpose of this study was to compare the clinical effectiveness of the midpalatal implant as a method of reinforcing anchorage during orthodontic treatment with that of conventional extraoral anchorage. This was a prospective, randomized, clinical trial at Chesterfield and North Derbyshire Royal Hospital NHS Trust and the Charles Clifford Dental Hospital, Sheffield, in the United Kingdom. Methods: Fifty-one orthodontic patients between the ages of 12 and 39, with Class II Division 1 malocclusion and absolute anchorage requirements, were randomly allocated to receive either a midpalatal implant or headgear to reinforce orthodontic anchorage. The main outcome was to compare the mesial movement of the molars and the incisors of the 2 treatment groups between the start and the end of anchorage reinforcement as measured from cephalometric radiographs. Results: The reproducibility of the measuring technique was acceptable. There were significant differences between T1 and T2 in the implant group for the positions of the maxillary central incisor (P <.001), the maxillary molar (P = .009), and the mandibular molar (P <.001). There were significant differences between T1 and T2 in the headgear group for the positions of the mandibular central incisor (P <.045), the maxillary molar (P <.001), and the mandibular molar (P <.001). All skeletal and dental points moved mesially more in the headgear group during treatment than in the implant group. These ranged from an average of 0.5 mm more mesially for the mandibular permanent molar to 1.5 mm more mesially for the maxillary molar and the mandibular base. No treatment changes between the groups were statistically significant. Conclusions: Midpalatal implants are an acceptable technique for reinforcing anchorage in orthodontic patients.