Paradigms have started to shift in the orthodontic world since the introduction of mini-implants in the anchorage armamentarium. Various forms of skeletal anchorage, including miniscrews and miniplates, have been reported in the literature. Recently, great emphasis has been placed on the miniscrew type of temporary anchorage device (TAD). These devices are small, are implanted with a relatively simple surgical procedure, and increase the potential for better orthodontic results. Therefore, miniscrews not only free orthodontists from anchorage-demanding cases, but they also enable clinicians to have good control over tooth movement in 3 dimensions. The miniplate type also produces significant improvements in treatment outcomes and has widened the spectrum of orthodontics. The purpose of this paper is to update clinicians on the current concepts and versatile uses and clinical applications of skeletal anchorage in orthodontics. 1. Introduction The goal of orthodontic treatment is to improve the patient’s life through enhancement of dentofacial functions and esthetics. Anchorage, defined as a resistance to unwanted tooth movement [1], is a prerequisite for the orthodontic treatment of dental and skeletal malocclusions [2, 3]. Controlling anchorage helps to avoid undesirable tooth movements. However, even a small reactive force can cause undesirable movements; it is important to have absolute anchorage to avoid them [4, 5]. Absolute or infinite anchorage is defined as no movement of the anchorage unit (zero anchorage loss) as a consequence to the reaction forces applied to move teeth [1]. Such an anchorage can only be obtained by using ankylosed teeth or dental implants as anchors, both relying on bone to inhibit movement [6]. Anchorage provided by devices, such as implants or miniscrew implants fixed to bone, may be obtained by enhancing the support to the reactive unit (indirect anchorage) or by fixing the anchor units (direct anchorage), thus facilitating skeletal anchorage. Orthodontic anchorage is an important factor in obtaining good treatment results. Stable anchorage is a pre-requisite for orthodontic treatment with fixed appliances. Traditional appliances for reinforcement of anchorage have included headgear and intraoral elastics. The inclusion of implants for skeletal anchorage can move a tooth without the use of headgear and intraoral elastics. Skeletal anchorage with temporary anchorage devices (TADs) has been widely incorporated into orthodontic treatment for expanding the boundary of tooth movement without patient compliance [7–10]. TAD
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