Effects of micro-osteoperforations performed with Propel system on tooth movement, pain/quality of life, anchorage loss, and root resorption: a systematic review and meta-analysis

Micro-osteoperforation for enhancement of orthodontic movement: A mechanical analysis using the finite element method

BACKGROUND

Micro-osteoperforation is a minimally invasive technique aimed at accelerating tooth movement. The goal of this novel experimental study was to assess tooth movement and stress distribution produced by the force of orthodontic movement on the tooth structure, periodontal ligament, and maxillary bone structure, with and without micro-osteoperforation, using the finite element method.

MATERIALS AND METHODS

Cone-beam computed tomography was used to obtain a virtual model of the maxilla and simulate the extraction of right and left first premolars. Three micro-osteoperforations (1.5 x 5 mm) were made in the hemiarch on the distal and mesial surfaces of upper canines, according to the power tip geometry of the Propel device (Propel Orthodontics, Ossining, New York, USA). An isotropic model of the maxilla was fabricated according to the finite element method by insertion of mechanical properties of the tooth structures, with orthodontic force (1.5 N) simulation in the distal movement on the upper canine of a hemiarch.

RESULTS

Initial movement was larger when micro-osteoperforations were performed on the dental crown (24%) and on the periodontal ligament (29%). In addition, stress distribution was higher on the bone structure (31%) when micro-osteoperforations were used.

CONCLUSIONS

Micro-osteoperforations considerably increased the movement of both the dental crown and periodontal ligament, which highlights their importance in the improvement of orthodontic movement, as well as in stress distribution across the bone structure. Important stress absorption regions were identified within micro-osteoperforations.

The effect of micro-osteoperforation on root resorption, pulp vitality, and biological changes of teeth subjected to orthodontic tooth movement: A systematic review study

Background

These days minimally invasive micro-osteoperforation (MOPs) has accelerated orthodontic tooth movement (OTM). However, there are some conflicting reports about their various impacts; hence, the present systematic review study aimed to evaluate the effect of MOP on root resorption, pulp vitality, and the biological changes of teeth subjected to OTM.

Materials and Methods

Search in electronic databases of English literature including PubMed, Scopus, Web of sciences, Cochrane, and Google scholar as well as a manual search was performed from 2013 to 2022. Most of the studies included in this article were randomized controlled trials.

Results

From the total number of 321 found articles, 31 duplicated and 268 irrelevant articles were excluded regarding the defined inclusion and exclusion criteria. Consequently, 22 articles were subjected to the quality assessment process, and finally, 18 articles were selected for the review phase. Root resorption during tooth movement using the MOP approach was reported only in one study. Besides, except for two animal studies, all of the relevant included articles showed that MOPs significantly increased the expression of some inflammatory biomarkers known to recruit osteoclast precursors and increase the number of osteoclast cells. On the other hand, two animal studies showed no differences in osteoclast counts by using MOPs in comparison to their control groups, which was consequently the result of biologic variability between animal and human and also probably the small sample sizes of these two studies.

Conclusion

In this systematic review, according to the adverse effects of MOP on root resorption, one study showed higher levels of root resorption among patients undergoing MOP. However, this outcome was due to the different methods used to evaluate the effect of MOPs on root resorption. Moreover, a high certainty of evidence supports that MOP causes biological changes and an elevation in cytokines, chemokines, and other biomarkers that stimulates osteoclasts differentiation which in turn accelerate OTM. There was no change in pulp vitality status based on available evidence.

The effect of micro-osteoperforations on the rate of orthodontic tooth movement in animal model: A systematic review and meta-analysis

Introduction

The long passing time for tooth movement (TM) is one of the challenges in orthodontic. complications such as gingival recession, root resorption, and caries are common in orthodontic. To address this, there is an increased tendency to find safe and effective methods to accelerating tooth movement. A surgical method such as micro-osteoperforations (MOP) accelerating the TM. The current meta-analysis aims to investigate the outcome of MOP in accelerating TM in animal studies.

Methods

In the present meta-analysis, we evaluated 6 studies that focused on the effect of MOP on TM with the following keywords: (((MOP* OR micro-osteoperforations*) AND (("accelerating tooth movement " OR " tooth movement" AND " orthodontic tooth movement " OR " orthodontic ") until May 2021.

Results

The results have shown there is significant difference in TM after using MOP (MD: 0.31, 95%CI: 0.20, 0.42, P < 0.00001, I2 = 76%). Subgroup analysis revealed that though experimental duration in both less than 4-week and more than 4-week, the TM were significant difference between MOP and controls. Besides, in both force subgroups including less than 100 g and more than 100g, the TM was a significant difference between MOP and controls.

Conclusion

This meta-analysis found that generally MOP has a positive effect on TM.

Effectiveness of surgical procedures in the acceleration of orthodontic tooth movement: Findings from systematic reviews and meta‐analyses

The current overview aimed to summarise the findings provided by systematic reviews (SRs) on the effect of surgical procedures in the acceleration of tooth movement and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs addressing the effects of surgical procedures on the acceleration of tooth movement were included. The methodological quality of the included SRs was assessed using the updated version of “A Measurement Tool to Assess Systematic Review” (AMSTAR‐2). Twenty-eight (28) SRs were included. The methodological quality of the included reviews ranged between critically low (6 studies) and high (12 studies). The most common critical weakness in the included reviews was the absence of clearly a‐prior established review methods and any significant deviations from the protocol. The most studied surgical procedure was corticotomy, followed by micro-osteoperforation, piezocision and periodontally accelerated osteogenic orthodontics. The majority of the included SRs supported short-term favourable effects of corticotomy on treatment time and tooth movement rate, in the short-term. However, the authors of the included SRs reported that results were based on weak quality evidence. Conflicting results arise from the existent SRs with regards to the effectiveness of piezocision and micro-osteoperforation. Few SRs summarised complications and side effects of surgical techniques, supporting absence of loss of tooth vitality, periodontal problems, or severe root resorption. The current overview of SRs highlighted the need of high quality SRs comparing different surgical approaches for tooth movement acceleration though network meta-analysis, in order to determine the most efficient instrument for orthodontic movement acceleration.

Biological mechanism of surgery-mediated acceleration of orthodontic tooth movement: A narrative review

Surgery-mediated acceleration of orthodontic tooth movement (SAOTM) has been proven effective for decades. Research has confirmed that surgical approaches play an important role in adult patients with a short orthodontic treatment time. The mechanism of SAOTM involves short-term acceleration of localized hard and soft tissue remodeling, known as the regional acceleratory phenomenon. However, no relevant review on the biological mechanism of SAOTM has been performed to date. The proposed biological mechanism of acceleration of OTM involves the participation of various cells, cytokines, and signaling pathways. We herein review the relevant literature and summarize the biological mechanism of SAOTM to provide new insights for further research on acceleration of OTM.

Orthodontic root resorption

External apical root resorption (EARR) is one of the most frequently reported iatrogenic side effects of orthodontic movement. Nevertheless, no robust and unequivocal scientific evidence is yet available in the literature regarding the clinical and biological factors that trigger EARR. The purpose of the present position paper is to provide clinicians, residents, and investigators a summary of our current understanding about root resorption caused by orthodontic tooth movement, based on up-to-date available scientific evidence. Morphological, structural, biomechanical, and biological differences account for predisposing the apical third to EARR compared to other root surfaces during orthodontic treatment. In addition, a relevant number of patient and treatment-related factors increase risk of EARR. The main patient-related factors are reviewed and discussed: genetic factors, tooth anatomy, demographic factors, malocclusion factors, previous endodontic treatment, medical history, short root anomaly. Similarly, the influence of treatment-related factors are analyzed with regard to the effect of: biomechanical factors, type of orthodontic appliance, adjunctive therapies to accelerate tooth movement, early treatment, maxillary expansion, teeth extractions, the duration of treatment and the amount of apical displacement. Clinical management of EARR from pre-treatment records to the monitoring strategy as well as recommendations for the post orthodontic-treatment period are presented as a guide for the clinician. Despite years of studies, we still do not fully understand EARR, but the future is promising. True three-dimensional imaging with higher resolution and low radiation, and predictive tools towards an earlier detection without radiographs, will mark future developments in the field of EARR in orthodontics.

The effect of single/multiple micro-osteoperforation on the rate of orthodontic tooth movement and its possible complications: A systematic review and meta-analysis

OBJECTIVE

Different surgical and non-surgical approaches have been proposed to accelerate tooth movement and decrease the duration of orthodontic treatments. Recently, less invasive techniques such as micro-osteoperforation (MOP) are becoming more common. Several clinical trials have been performed to analyse the effect of MOP. This systematic review with meta-analyses was done to evaluate the effect of MOP on the rate of orthodontic tooth movement (OTM) and its complications.

MATERIAL AND METHODS

Electronic search was done in PubMed and Cochrane database for studies published until January 2021. Comparative randomized clinical trial studies with 10 or more participants per group were included. The risk of bias (ROB) of the studies was assessed according to the Cochrane Collaborations tool. Meta-analyses were performed to assess the mean difference in tooth movement rate and compare the level of pain between MOP and control groups.

RESULTS

Among a total of 15 included studies, eight studies were at low ROB, while others had unclear ROB. Ten studies evaluated the effect of MOP on OTM rate in canine retraction, and related meta-analysis showed a significant difference between the MOP and control group [SMD=0.42; 95% CI=0.20 to 0.63, P<0.01]. Besides, quantitative analysis showed MOP caused no significant higher anchorage loss [SMD=0.01; 95% CI=-0.15 to 0.13, P=0.89] and pain [SMD=0.54; 95% CI=-0.25 to 1.33, P=0.18].

CONCLUSIONS

Overall, both single and multiple applications of MOP increased the rate of OTM. However, the meta-analysis results of the four studies with low risk of bias showed that there is no significant difference in the rate of tooth movement between MOP and control groups. Besides, it has been shown that MOP did not significantly increase the level of pain, anchorage loss, and periodontal complications.

Effect of micro-osteoperforations on rate of space closure by mini-implant supported maxillary anterior en-masse retraction: A randomized clinical trial

Background

Micro-osteoperforations is one of the non-invasive surgical techniques used in attempt to accelerate OTM. Conflicting reports on its effectiveness has been reported in the literature.

Objectives

The objectives of this trial were to investigate the effect of micro-osteoperforations on the rate of space closure and on molar anchorage loss during mini-implant supported maxillary anterior en-masse retraction.

Trial design

A single center, parallel arm, randomized controlled trial was conducted.

Method

Sixty, male and female subjects (age range 16-25 years) having Class I bimaxillary protrusion or Class II div 1 malocclusion, who required fixed mechanotherapy with either upper 1st premolar or all four 1st premolar extractions were allocated into two groups using 1:1 allocation ratio. The allocation was done by block randomization method with a block size of 6. In the experimental group, 5 MOPs per side were performed only once just before the en-masse anterior retraction. Mini-screws were placed in order to obtain maximum anchorage. Impressions were taken every month till 4 months and rate of space closure was measured on 3D study models.

Results

Data of 27 subjects in control (attrition ​= ​3) and 28 subjects in experimental group (attrition ​= ​2) were analyzed at the end of this trial. There was a statistically significant increase in the rate of en-masse retraction for the 1st month(p ​= ​0.001,95%CI, 0.17, 0.37 ​mm) but there was no statistically significant difference for the subsequent 2nd (p ​= ​0.450,95%CI,0.13,0.43 ​mm), 3rd(p ​= ​0.204,95%CI,0.23,0.47 ​mm) and 4th month (p ​= ​0.680,95%CI,0.21,0.41 ​mm) between experimental and control groups. There was also no difference (p ​> ​0.05) in molar anchorage loss between both groups at all time intervals.

Conclusion

Micro-osteoperforations (MOPs) did not accelerate the rate of anterior en-masse retraction over a period of 4 months; however, it temporarily increases the rate of retraction only for first month and no affect on molar anchorage.

Trial registration

The trial was registered at www.ctri.nic.in with CTRI No- CTRI/2019/03/018140).

Simplifying the approach of open bite treatment with aligners and selective micro-osteoperforations: An adult case report

INTRODUCTION

Open bite treatment represents one of the most challenging malocclusions because it has a multifactorial aetiology and in particular because its dental correction strongly depends on the possibility to manage the posterior intrusion with a reliable system controlling the vertical position of upper and lower molars. Clear Aligner system proved to be an efficient way to control the hyper divergent patients performing posterior intrusion and managing the counterclockwise rotation of the mandible. This technique has shown to be predictable for molar intrusion up to 1mm.

METHODS

This case report shows a successful open bite orthodontic treatment in which the molar intrusion effect has been amplified in the digital setup and facilitated by means of micro-osteo perforations (MOPs) performed selectively only in the molar areas in order to stimulate the bone in a specific movement direction. The digital setup was set to create molar intrusion in upper and lower molars up to 3mm and thus favouring a counterclockwise mandible rotation, supported and controlled by elastics. The posterior intrusion was combined with an anterior extrusion following smile arc exposure and the treatment was completed in 16 months overall.

RESULTS

The final cephalometric analysis showed a significant reduction of SN/Go-Gn angle of 4° with consequent counterclockwise rotation of the mandible. The mandibular superimposition showed a 2.5mm molar intrusion without root resorption and with a controlled incisor proclination. A solid Class I bilateral occlusion was achieved with normal overjet and overbite, the dental arches were well aligned and levelled with good intra-arch symmetry and regular arch form. The frontal aesthetic analysis showed an improvement of the dental exposure with a normalized smile arc due to a combination of relative and pure extrusion.

CONCLUSION

The present alternative approach to treat severe open bite combining selective MOPs in the posterior and lateral sectors and clear aligners could predictably control molar vertical position avoiding the use of auxiliary and eliminating the risk of root resorption. Arch development, molar intrusion, and overbite correction with counterclockwise mandible rotation could be predictably achieved respecting digital setup and creating proper Class I bilateral occlusion.