In orthodontics practice, anchorage denotes the preservation of stability and immobility in specific teeth or dentition, acting as steadfast reference points within the oral cavity. The significance of anchorage becomes apparent when delving into the multifaceted treatment goals of orthodontic therapy. The primary objective is to facilitate regulated tooth movement, aligning teeth and jaws in a harmonious manner. Anchorage serves as the linchpin for achieving intended tooth motions while averting unintended shifts in adjacent or anchored teeth. Orthodontic forces, when applied, inherently impact not only the targeted teeth but also adjacent ones. Inadequate management of anchorage can lead to adverse outcomes, such as tooth tilting, rotation, or undesired dental displacement. Moreover, anchorage control significantly enhances treatment effectiveness. While anchorage holds importance across all orthodontic procedures, it takes on a distinctive relevance within the realm of distalization approaches. The effective attainment of distalization often requires the application of significant magnitudes of force, owing to the vast distance between posterior teeth and the targeted destination. If these forces are not carefully controlled, they can unintentionally impact anchorage teeth, resulting in undesired tooth displacement. To address the nuanced particulars of anchorage loss during distalization, this systematic review offers a thorough analysis of the associated difficulties and evidence-based perspectives and strategic planning of orthodontic intervention. This systematic review, which as already been registered on the prospero platform as an original study, not only aims to bridge the existing gaps in knowledge but also aspires to provide a nuanced understanding of the current evidence surrounding anchorage loss in distalization appliances. 

Keywords: Anchorage loss, Distalization appliances, Orthodontic anchorage, Class II malocclusion, Randomized controlled trial