Background: To establish consensus of skeletal anchorage versus conventional anchorage in treating: 1. Maxillary transverse deficiency in growing and adult patients, 2. Class II skeletal disharmony due to mandibular retrusion in growing patients, 3. Class III skeletal disharmony in growing patients.

Methods: A four-rounds modified Delphi method was conducted. A steering committee performed a literature selection and compiled a list of 33 statements. An international panel of 25 experts in orthodontics agreed to participate. In each round, panelists were asked to rate their level of agreement with each statement using a 5-point Likert scale and provide comments. Statements that reached consensus were either accepted or rephrased. Statements that did not reach consensus were either rephrased, rejected, or split into two statements or merged with another.

Results: After the four rounds, 24 statements achieved consensus while 9 were rejected. The distribution of consensus statements was as follows: Maxillary transverse deficiency: 4 statements; Class II skeletal disharmony: 10 statements; Class III skeletal disharmony: 10 statements.

Conclusions: This modified Delphi consensus study aimed to provide guidance for orthodontists in choosing between skeletal and conventional anchorage for various treatment conditions. The study generated 24 consensus statements across three key domains. While the Delphi method provides valuable expert opinions, future studies, including randomized controlled trials, are needed to confirm these findings and address remaining uncertainties. Such efforts will aid in refining orthodontic treatment protocols and enhancing patient outcomes.