A systematic review aims to synthesize the findings from individual studies and, based on them, formulate conclusions. Taking this into consideration, we agree with Dr Winsauer that the biomechanical aspects of action of the distalizers supported by TSADs are important, but the addressees of this comment should be the researchers designing and carrying out studies, not the authors of this systematic review. Only when biomechanical designs of distalizers are explained in reports can their possible role be summarized in a systematic review.
We completely disagree with the statement of Dr Winsauer, implying that posttreatment outcome and stability are not associated with the use of TSADs. We have no evidence supporting this assumption because, to our knowledge, no study has evaluated this problem. Extraction of permanent teeth can often be an alternative to distalization of molars. It is possible that treatment outcome, length of treatment, cost, or long-term stability is more favorable after extraction treatment. The research to date has not answered these important questions yet.
We also do not agree with the claim that “Assigning TSAD appliances to Class II treatment in general, for example, has no merit.” In the first sentence of our article, we stated, “Distalization of the molars has become a popular nonextraction treatment alternative in some patients with Class II malocclusions.” It is obvious that skeletal Class II malocclusions cannot be treated with distalization of the maxillary molars. Instead, alternative methods such as functional appliances, headgears, or orthognathic surgery should be considered.
It is unclear to us why Dr Winsauer assumed that anchorage loss is different in distalizers supported by palatal TSADs and in those supported by palatal TSADs plus other anchorage methods. It is the TSAD that provides the greatest stability to the distalizer. If there was no failure of the TSAD, the action of the distalizers should be the same.