Success Rate and Factors Affecting Stability of Buccal Shelf Miniscrew Implants in Orthodontic Patients: A Systematic...

The primary role of buccal-shelf miniscrew implants (BS-MSI) in orthodontic treatment is to provide extra-alveolar anchorage that alleviates severe crowding and allows for distalization of the entire mandibular arch and may obviate the need for orthognathic surgery, particularly in patients with skeletal malocclusion. The stability of these screws is crucial to their successful function throughout orthodontic treatment. Therefore, this systematic review aimed to assess the success rate and various factors affecting the stability of BS-MSI. The databases were searched electronically using PubMed/MEDLINE, EMBASE, Scopus, and the Cochrane databases on 7th February 2025 and re-searched on 22nd February 2026. The reference list and additional bibliographic databases, including clinical trial registries and Google Scholar, were also searched. This review includes clinical trials published in English, comprising prospective randomised controlled trials (RCTs), non-randomised trials (NRCTs), and retrospective cohort studies (RCs) that described the success rate of BS-MSI for orthodontic anchorage in human subjects. Success rates and associated risk factors for BS-MSI were determined utilising a random-effects model. The determinants influencing stability were categorised into patient, mechanics, and implant-related aspects, and subsequently underwent subgroup analysis and meta-regression. The evaluation of study quality was performed using the Cochrane risk-of-bias tools for randomised trials (RoB 2.0) and non-randomised trials (ROBINS-I). This meta-analysis included nine studies: three RCTs, two NRCTs, and four RCs. A total of 2366 BS-MSI were aggregated in a random-effects model, revealing an overall success rate of 93% (95% CI 0.81-1.00; prediction interval = 0.39-1). In a sensitivity analysis, experiments using more than 100 screws exhibited a 91% success rate, comparable to those with fewer than 100 screws. A meta-regression study indicated an inverse relationship between age and success rate. A considerable heterogeneity was observed across all subgroups. Three assessments indicated a low-, two indicated a moderate-, and four indicated a high-risk of bias. BS-MSI demonstrated a high success rate and therefore can provide a reliable source of orthodontic anchorage. However, given the low certainty and high heterogeneity in the existing evidence, the results should be interpreted with caution. Although numerous factors appear to influence BS-MSI stability, most require further investigation due to inadequate data and data quality. Furthermore, future studies are necessary to corroborate the findings of this meta-analysis and investigate other critical factors, such as location, dental cleanliness, gender, insertion torque, and operator experience, which could not be evaluated due to insufficient data. Trial Registration: PROSPERO registration: CRD420250653597.