Micro-osteoperforation effectiveness on tooth movement rate and impact on oral health related quality of life

The effect of micro-osteoperforations on the rate of maxillary incisors' retraction in orthodontic space closure: a randomized controlled clinical trial

BACKGROUND

This single-centered randomized controlled clinical trial aimed to evaluate the effectiveness of micro-osteoperforations (MOPs) in accelerating the orthodontic retraction of maxillary incisors.

METHODS

Forty-two patients aged 16-40 were recruited and randomly assigned into two groups, one which underwent MOPs (MOPG) in the buccal and palatal region of all maxillary incisors immediately before the start of retraction and one which did not (CG). Eligibility criteria included the orthodontic need for maxillary first premolars extraction and space closure in two phases. The primary outcome of the study consisted of measuring the rate of space closure and, consequently, the rate of incisors' retraction using digital model superimposition 14 days later and monthly thereafter for the next 4 months. The secondary outcomes included measuring anchorage loss, central incisors' inclination, and root length shortening, analyzed using cone beam computed tomography scans acquired before retraction and 4 months after retraction. Randomization was performed using QuickCalcs software. While clinical blinding was not possible, the image's examinator was blinded.

RESULTS

Twenty-one patients were randomly assigned to each group. However, due to various reasons, a total of 37 patients (17 male and 20 female) were analyzed (mean age: 24.3 ± 8.1 years in the MOPG; 22.2 ± 4.2 years in the CG) during the trial. No statistically significant difference was found between the MOPG and the CG regarding the incisors' retraction measured at different time points at the incisal border (14 days, 0.4 mm vs. 0.5 mm; 1 month, 0.79 mm vs. 0.77 mm; 2 months, 1.47 mm vs. 1.41 mm; 3 months, 2.09 mm vs. 1.88 mm; 4 months, 2.62 mm vs. 2.29 mm) and at the cervical level (14 days, 0.28 mm vs. 0.30 mm; 1 month, 0.41 mm vs. 0.32 mm; 2 months, 0.89 mm vs. 0.61 mm; 3 months, 1.36 mm vs. 1.10 mm; 4 months, 1.73 mm vs. 1.39 mm). Similarly, no statistically significant differences were detected in the space closure, anchorage loss, central incisors' inclination, and radicular length between groups. No adverse effect was observed during the trial.

CONCLUSIONS

MOPs did not accelerate the retraction of the maxillary incisors, nor were they associated with greater incisor inclination or root resorption. Trial registration ClinicalTrials.gov NCT03089996. Registered 24 March 2017- https://clinicaltrials.gov/ct2/show/NCT03089996 .

Comparison of the effectiveness of piezocision-aided canine retraction augmented with micro-osteoperforation: a randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of micro-osteoperforation (MOP) on the rate of piezocision-aided canine retraction (CR).

MATERIALS AND METHODS

The split-mouth study included 25 participants at the stage of commencing CR. The participants received flapless piezocision bilaterally at T0 (0 months) and MOP only on one side at T3 (3 months). The quadrant that received MOP at T3 served as the intervention, whereas the other quadrant served as the control. The primary outcome was the rate of CR, assessed using digital models. The angular change (AC) of the canine and the change in the buccal cortical bone thickness (BCBT) from before to after CR were also assessed using cone beam computed tomography.

RESULTS

The rate of CR was 0.82 ± 0.39 mm/month in the control quadrant vs 0.75 ± 0.44 mm/month in the intervention quadrant (P > .05). The AC of the canine was 2.00° ± 0.88° in the control quadrant vs 1.98° ± 0.86° in the intervention quadrant (P > .05). The crestal bone gain was 0.50 mm in the control quadrant vs 0.28 mm of bone loss in the intervention quadrant. The bone thickness at a 3-mm height was increased by 0.11 mm in the control quadrant vs a 0.29-mm decrease in the intervention quadrant. The bone thickness at a 6-mm height was decreased by 0.12 mm in the control quadrant vs a 0.15-mm decrease in the intervention quadrant. However, none of the changes or group differences in bone height or thickness were statistically significant (P > .05).

CONCLUSIONS

The periodic activation of a piezocision-aided CR site using MOP had no significant positive effect on the rate of CR, angulation of the canine, or changes in BCBT.

The effect of micro-osteoperforation on the rate of tooth movement during the alignment stage in patients with mandibular crowding: a randomised controlled trial

BACKGROUND

Orthodontic treatment is a long process that requires patient cooperation. Risks of side effects such as caries formation, periodontal problems, and root resorption increases as well as problems in patient cooperation arises with longer treatments. Several different techniques were developed that may shorten the treatment time.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of micro-osteoperforations (MOPs) performed during the alignment stage.

TRIAL DESIGN

Randomized controlled trial.

METHODS

Twenty-eight subjects who had crowding in the mandibular arch were included in the study. The first group (4 boys and 10 girls, mean age = 17.21 ± 3.76 years) was treated with MOP (MOP) and the second group (8 boys and 6 girls, mean age = 15.29 ± 1.77 years) was treated without MOP (control). Cephalometric variables, periodontal parameters, Little irregularity index, alignment duration, patient satisfaction, and ease of operation were evaluated. The level of statistical significance was P ≤ 0.05.

RESULTS

Alignment duration was shorter (P = 0.000) in the MOP group (105.57 ± 18.34 days) compared to control group (135.86 ± 15.12 days). Alleviating of the crowding was more in the MOP group, compared to the control group in all time points. The pain level in the MOP group in the first appointment was higher compared to control group (P = 0.002). There was no significant difference between the groups in cephalometric parameters. Higher increases were found for gingival index (P = 0.008) and bleeding index (P = 0.039) in the control group compared to MOP group at the end of treatment.

LIMITATIONS

The study was a single-centre study.

CONCLUSION

Alignment stage was shortened with MOP application. There was no difference between groups for patient satisfaction and pain level except for the first appointment. No difference was observed between the groups regarding cephalometric values. Clinically insignificant inflammation was observed in periodontal tissues for both groups.

REGISTRATION

This study was registered at the Clinical Trials Registry (ClinicalTrials.gov NCT03652454).

The transparency of reporting 'harms' encountered with the surgically assisted acceleration of orthodontic tooth movement in the published randomized controlled trials: a meta-epidemiological study

BACKGROUND

Surgical-assisted accelerated orthodontics (SAAO) has become very popular recently. Therefore, this study aimed to investigate the extent to which researchers adhere to Item 19 (harms) of the Consolidated Standards of Reporting Trials (CONSORT) in the published studies in the field of SAAO. In addition, the study evaluated the possible association between harm reporting and the human development index (HDI) of the recruited research sample country, CiteScore-based quartile (CSBQ) of the publishing journal, invasiveness of the surgical intervention (ISI), and the type of orthodontic tooth movement (TOTM). Moreover, it aimed to summarize the different possible harms and complications that maybe encountered in the course of SAAO.

MATERIALS AND METHODS

Electronic searching of six databases was conducted for SAAO-related English RCTs published between January 2000 and April 2022. For the RCTs that did not report harms, information was sought by contacting the corresponding authors. Descriptive statistics of the evaluated variables were performed. The association between 'harm reporting' and the HDI of the research team, the BDRQ of the publication journal, the ISI, and the TOTM were investigated. Binary logistic regression was used, and the odds ratios (ORs) with 95% confidence interval (CIs) of the evaluated variables were obtained. Moreover, the risk of bias of the included RCTs was assessed using the RoB2 tool.

RESULTS

Among the 91 included RCTs, 54 RCTs (59.3%) did not adhere to reporting harm associated with the SAAO. The non-adherence was significantly associated with the ISI (OR 0.16; CI 0.03-0.73; p < 0.018) for invasive methods compared with minimally invasive ones). There was a significant positive correlation between harm reporting and both the CSBQ of the publishing journal and the HDI of the recruited research sample country (p = 0.001, p = 0.003, respectively). On the contrary, a non-significant association was found between harm reporting and the type of OTM (p = 0.695). The incidence of harms associated with SAAO was approximately 17.5%.

LIMITATIONS

Assessment was restricted to English RCTs related to SAAO.

CONCLUSION AND IMPLICATIONS

The adherence to reporting harms in the field of SAAO was deficient. Efforts should be made by authors, peer reviewers, and editors to improve compliance with the CONSORT guidelines regarding harms reporting. Additionally, there is a wide spectrum of harms that could be associated with SAAO that the practitioner should pay attention to and alert the patient to the possibility of their occurrence.

Comparison of the effectiveness of piezocision and microosteoperforation in leveling mandibular anterior teeth

INTRODUCTION

The primary aim of this study was to evaluate the effectiveness of piezocision and microosteoperforation (MOP) in accelerating the leveling of mandibular anterior teeth. The secondary aim was to evaluate the changes in periodontal parameters and the differences in patient comfort.

METHODS

Forty-five patients in the study were randomly divided into 3 groups. After bonding mandibular teeth, the patients in the first group (9 girls, 6 boys) underwent piezocision, and the patients in the second group (10 girls, 5 boys) underwent MOP. Patients in the third group (7 girls, 8 boys) comprised the control group. The patients were asked to complete a visual analog scale for pain assessment during the first week of treatment and to complete the Oral Health Impact Profile-14 questionnaire at the end of the week. Little's irregularity index was measured from plaster models taken at the start of the mandibular bonding process, 4 weeks, 8 weeks, 12 weeks, and 16 weeks after the mandibular bonding process. Periodontal parameters were also recorded at baseline and 16 weeks.

RESULTS

Our study results showed statistically significantly more orthodontic tooth movement in the piezocision group (mean difference, 7.60 ± 1.55) than in the control group (mean difference, 5.95±1.28) during the total study period (P = 0.015). In the MOP group, no significant difference in the alignment rate was observed at any time compared to the piezocision and control groups (P >0.05).

CONCLUSIONS

The leveling of mandibular anterior teeth was accelerated by piezocision over 16 weeks, predominantly in the first 12 weeks, whereas MOP had no effect. It was concluded that piezocision is an acceptable procedure and has no destructive effect on the periodontal tissue.

The effect of micro-osteoperforations on orthodontic space closure investigated over 12 weeks: a split-mouth, randomized controlled clinical trial

OBJECTIVES

To evaluate the effects of minimally invasive micro-osteoperforations (MOPs) on orthodontic tooth movement and pain.

DESIGN

Prospective, split-mouth, randomized controlled trial.

SETTING

Single-centre, university hospital.

METHODS

Twenty subjects requiring maxillary first premolar extractions were included. Right and left sides of the maxilla were randomly allocated into experimental and controls. Space closure was initiated following alignment on 0.20″ stainless steel archwires, using 150 g force, applied by coil springs on power arms. Nance-TPA was used for anchorage. On the experimental side, two 5 mm deep MOPs in vertical alignment on distal aspect of the maxillary canine mid-root region were performed prior to space closure.

OUTCOMES

The primary outcome was the amount of tooth movement during space closure, measured every 4 weeks for 12 weeks (T1, T2, and T3). Secondary outcome was the pain levels related to MOP, measured using Visual Analogue Scale (VAS) questionnaires. Significance was set at P < 0.01.

RANDOMIZATION

Randomization was generated using a randomization table, and allocation was concealed in sequentially numbered, opaque, sealed envelopes.

BLINDING

Blinding was not possible during the experiment but assessor was blinded during outcome assessment.

RESULTS

All subjects completed the study, with tooth movement measurements available for all 20 patients for T0-T2. In three patients, space was closed on one side at T2. The average tooth movement between sides at three intervals (T0-T1, T1-T2, and T2-T3) were not significantly different. Overall difference following 12 weeks (T0-T3) was 0.69 mm higher on the experimental side (P < 0.001). No harms were observed.

LIMITATIONS

Short-term study, cast measurements done with digital callipers.

CONCLUSION

This 12-week randomized split-mouth controlled clinical trial showed two MOPs that are 5 mm deep, applied once prior to space closure, did not create clinically significant increase in maxillary premolar space closure.

PROTOCOL

The protocol was not published before trial commencement.

REGISTRATION

Trial was not registered.

FUNDING

The Australian Society of Orthodontists Foundation for Research and Education.

Biological Anchorage and Canine Orthodontic Movement Rate with a New Technique for Micro-Osteoperforations

Introduction

The differential management of anchorage and the acceleration of tooth movement are some of the current greatest challenges for orthodontists. Diverse techniques and devices to reinforce anchorage and increase the rate of tooth movement have been proposed. Whether micro-osteoperforations (MOPs) can be used for both purposes is currently investigated.

Objectives

To propose and describe a new technique for biological anchorage, which involves six MOPs performed every four weeks, and to present its results in a clinical case of upper premolar extraction. Intervention. In a dental class II patient who met the selection criteria, three MOPs both on the buccal and palatine sides on the intervention side were performed on the extraction area following the protocol described. No MOPs were performed on the control side. The allocation of the intervention was randomised. The MOPs were performed three times at an interval of four weeks. A 0.019 × 0.025-inch stainless steel wire was activated with calibrated NiTi springs. The three-dimensional movement of the first molars and upper canines was evaluated. In addition, the comfort, periodontal status, and canine root resorption of the patient were evaluated.

Results

Clinical and radiographic results suggest that the MOPs had a positive effect in reducing the loss of biological anchorage of the posterior sector and in the rate of canine tooth movement, without damaging changes in the soft and hard tissues.

Conclusion

The proposed protocol involving six MOPs every four weeks improved the behaviour of biological anchorage and increased distalization on the intervention side in this clinical case.

Effects of miniscrew-facilitated micro-osteoperforations on the rate of orthodontic tooth movement : A split-mouth, randomized controlled trial

PURPOSE

The aim of the present split-mouth randomized controlled trial was to evaluate the effects of miniscrew-facilitated micro-osteoperforations (MOPs) on the rate of orthodontic tooth movement during canine retraction.

METHODS

A total of 20 young adult patients (mean age 16.5 years) with the indication for bilateral maxillary first premolar extraction were included in the study. The MOPs were randomly applied to either the right or left side of the mouth with miniscrews (1.5 mm width, 8 mm length) to the extraction area, 28 days apart. The canine distalization continued for 3 months. The closure of the extraction space was measured by using a digital analysis program on the pre- and postdigital study models for both the control and experiment sides.

RESULTS

The mean rate of extraction space closure on the MOP side was 2.51 ± 1.41 mm and on the control side was 2.88 ± 1.32 mm. There was no statistically significant difference between the groups (p > 0.05).

CONCLUSION

Overall, we found that MOPs did not significantly affect the rate of orthodontic tooth movement during canine retraction.

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.

Observational Study Regarding Possible Side Effects of Miniscrew-Assisted Rapid Palatal Expander (MARPE) with or without the Use of Corticopuncture Therapy

Simple Summary

In this observational study, we evaluated possible complications at the skeletal and dentoalveolar level after palatal split using miniscrew-assisted rapid palatal expansion (MARPE) associated or not with corticopuncture (CP) therapy. The study included 27 patients with maxillary transverse deficiency and unilateral or bilateral cross-bite. Skeletal and dentoalveolar changes were evaluated using cone beam computed tomography (CBCT) images acquired before and after expansion. Changes of the occlusal planes were observed in 10 cases (37%). Maxillary canines tended to show symmetric buccal inclinations relative to the maxillary basal bone. Six patients; 22.22% showed hypertrophy/hyperplasia of the palatal mucosa associated with ulcerations, erythema, itching, and discomfort in the area. Swelling at the mid-palatal suture after split was observed in all cases and was caused by the resultant force. No cases of necrosis of the palatal mucosa were observed. Although occlusal modifications occur after palatal split, especially in unilateral cross-bite cases, these changes can be treated with the help of fixed orthodontic appliances.

Abstract

The use of maxillary expanders has the effect of distancing the maxillary bones at the level of the median palatal suture. During maxillary expansion, the main resistance forces occur at the zygomatico-maxillary sutures, and not in the median palatal suture, which is the basic principle on which this method is based. In this observational study, we evaluated possible complications at the skeletal and dentoalveolar level after palatal split using miniscrew-assisted rapid palatal expansion (MARPE) associated or not with corticopuncture (CP) therapy. The study included 27 patients with maxillary transverse deficiency and unilateral or bilateral cross-bite. Skeletal and dentoalveolar changes were evaluated using cone beam computed tomography (CBCT) images acquired before and after expansion. The mid-palatal suture was separated in 88.88% of cases, buccal bone height of the alveolar crest had decreased at first molar both at oral and palatal level by approximately 2.07 mm in 40.7% of cases whilst the remaining 59.3% showed insignificant bone loss, with canines exhibiting buccal tipping of 4.10° in 62.5% of cases. Changes of the occlusal planes were observed in 10 cases (37%). Maxillary canines tended to show symmetric buccal inclinations relative to the maxillary basal bone. Six patients; 22.22% showed hypertrophy/hyperplasia of the palatal mucosa associated with ulcerations, erythema, itching, and discomfort in the area. Swelling at the mid-palatal suture after split was observed in all cases and was caused by the resultant force. No cases of necrosis of the palatal mucosa were observed. Although occlusal modifications occur after palatal split, especially in unilateral cross-bite cases, these changes can be treated with the help of fixed orthodontic appliances.

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).

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

BACKGROUND

The aim of this systematic review was to evaluate the effect of micro-osteoperforations (MOPs) performed with Propel and other mini-screws on the rate of tooth movement, pain/discomfort, periodontal health, anchorage loss, and root resorption in patients undergoing orthodontic retraction compared to a control group.

MATERIALS AND METHODS

PubMed, Cochrane, Web of Science, LILACS, Google Scholar, Scopus, and OpenGrey were searched without restriction. A manual search was also carried out. Only randomized clinical trials (RCT) were included. The risk of bias (RoB) was assessed using RoB 2.0 and the certainty of evidence through the GRADE tool.

RESULTS

Among the twelve RCTs reviewed, five used the Propel system. Overall, the RoB was classified as low (4), moderate (5), and high (3). Two RCTs with moderate and one with a low RoB using the Propel system reported mild increases on rate of tooth movement associated with MOPs. One RCT with a moderate and another with high RoB did not find a significant effect of Propel on orthodontic movement. Regarding tooth movement, a subgroup meta-analysis found no differences between control and Propel movement (95% CI = - 0.01 to 0.75) or other mini-screws (- 0.02 to 0.31) related to rate of tooth movement per month. There was no effect of MOPs on root resorption, periodontal health, anchorage loss, and a mild effect on pain and oral health related to quality of life regardless of mini-screw type. The level of certainty was graded as low for the rate of tooth movement and pain/discomfort, as moderate for anchorage loss, and high for root resorption.

CONCLUSION

A low certainty of evidence supports that MOPs performed with Propel seem to have no significant effect on the rate of tooth movement. Moreover, this intervention does not seem to cause an increase in root resorption, periodontal heath, pain/discomfort, or anchorage loss. Thus, the Propel system does not appear to produce different results from those observed for other mini-screws.