OBJECTIVE: To compare the clinical effectiveness of the mid-palatal implant as a method of reinforcing anchorage during orthodontic treatment with that of conventional extra-oral anchorage. DESIGN: A prospective, randomized, clinical trial Setting: Chesterfield and North Derbyshire Royal Hospital NHS Trust and the Charles Clifford Dental Hospital, Sheffield. SUBJECTS AND METHODS: 51 orthodontic patients between the ages of 12 and 39, with a class II division 1 malocclusion and ‘absolute anchorage’ requirements were randomly allocated to either receive a mid-palatal implant or headgear to reinforce orthodontic anchorage. The main outcome of the trial was to compare the mesial movement of the molars and incisors of the two treatment groups between T1 (start) and T2 (end of anchorage reinforcement) as measured from cephalometric radiographs. RESULTS: The reproducibility of the measuring technique was acceptable. There were significant differences between the T1 and T2 measurements within the implant group for the position of the maxillary central incisor (p<0.001), position of the maxillary molar (p=0.009) and position of the mandibular molar (p<0.001). There were significant differences within the headgear group for the position of the mandibular central incisor (p<0.045), position of the maxillary molar (p=<0.001) and position of the mandibular molar (p<0.001). All the skeletal and dental points moved mesially more in the headgear group during treatment than in the implant group. These ranged from an average of 0.5mm more mesial for the mandibular permanent molar to 1.5mm more mesial for the maxillary molar and mandibular base. None of the treatment changes between the implant and headgear groups were statistically significant. CONCLUSIONS: Mid-palatal implants are an acceptable technique for reinforcing anchorage in the orthodontic patient.