Temporary anchorage devices in the infrazygomatic crest: Systematic review of placement guidelines and clinical case series

This study aimed to evaluate the anatomical guidelines and clinical protocols for the safe placement of temporary anchorage devices (TADs) in the infrazygomatic crest (IZC), comparing conventional manual insertion techniques with template-guided approaches based on cone beam computed tomography (CBCT). A systematic review was conducted in accordance with the PRISMA guidelines and registered in PROSPERO (ID: 1005853). Electronic searches were performed in PubMed, Scopus, and Web of Science for studies published between January 2010 and February 2025. Studies investigating IZC TAD placement using CBCT or other radiographic assessments were included. Eligible study designs comprised randomized controlled trials, prospective studies, retrospective studies, and observational studies. In addition, a retrospective clinical case series of patients treated with IZC miniscrews inserted without surgical guides was analyzed. A total of 173 records were identified through database searches. After removal of 79 duplicates, 94 articles were screened based on title and abstract. Thirty-three full-text articles were subsequently assessed for eligibility, and 14 studies met the inclusion criteria and were included in the qualitative synthesis. The infrazygomatic crest represents a reliable extra-alveolar anchorage site for orthodontic miniscrews. CBCT-based surgical guides may improve insertion accuracy and reduce the risk of maxillary sinus perforation. However, predictable clinical outcomes can also be achieved with manual insertion techniques when careful radiographic planning and adequate clinical experience are present. A comprehensive understanding of IZC anatomy and insertion protocols is essential to enhance the safety and predictability of orthodontic skeletal anchorage.