Effects of mini-implant facilitated micro-osteoperforations in alleviating mandibular anterior crowding: A randomized controlled clinical trial

Convalescing Mandibular Anterior Crowding through Piezocision and the Micro-Osteoperforation Surgical Procedure-A Clinical Comparative Study

BACKGROUND

Minimally invasive periodontic (perio) surgical procedures, piezocision, and micro-osteoperforation are useful techniques for accelerating tooth movement. These techniques also offer advantages in the orthodontic (ortho) and aesthetic domains. This study aimed to evaluate and compare the rates of lower anterior decrowding with piezocision and micro-osteoperforation.

METHODS

This clinical study included 24 patients requiring fixed orthodontic treatments. Two periodontic techniques (piezocision (PZ) and micro-osteoperforation (MOP)) were considered for the orthodontic treatments. Each patient was randomly allocated to either the piezocision (PZ) group or the micro-osteoperforation (MOP) group. The piezocision group received five radiographically guided incisions on the labial surface of the alveolar bone, whereas the micro-osteoperforation group received one to three MOPs each using a mini-implant drill between the six lower anterior teeth, and later, an initial arch wire was ligated to each bracket. Little's irregularity index (LII) was calculated using a digital vernier caliper on study models every four weeks until decrowding was achieved. The difference in the rates of lower anterior crowding between the piezocision and micro-osteoperforation groups was analyzed to determine the statistical significance.

RESULTS

The rates of irregularity index change during decrowding were 4.38 ± 0.61 in the piezocision group and 3.82 ± 0.47 in the micro-osteoperforation group. Piezocision was found to be 1.2 times faster than micro-osteoperforation in terms of the rate of decrowding.

CONCLUSION

The advanced perio-ortho combination technique was advantageous in accelerated decrowding. In comparison to MOP, there was an increase in the rate of decrowding with PZ. Decrowding can be completed quickly with PZ, and it can thus be used to treat crowding effectively in a limited time frame.

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 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.

Impact of micro-osteoperforations on root resorption and alveolar bone in en-masse retraction in young adults: A CBCT randomized controlled clinical trial

BACKGROUND

Micro-osteoperforations (MOPs) as a surgical technique is increasingly being used as a method to enhance orthodontic tooth movement. However, its iatrogenic effects on root and alveolar bone morphology have been less studied.

OBJECTIVE

This parallel-groups single-centered trial aimed to assess the impact of micro-osteoperforations (MOPs) on orthodontically induced inflammatory root resorption (OIIRR) and alveolar bone during en-masse retraction stage of maxillary and mandibular anterior teeth.

METHODS

Fifty-two patients (mean age 21.35±2.2 years) with Class I bi-dentoalveolar protrusion, requiring all 1st premolar extractions and miniscrews for anchorage, were randomly distributed into two groups (n=26 each): MOP group treated using single application of MOP's and control group treated with routine sliding mechanics, for en-masse retraction. The primary outcomes were assessed using CBCT-based measurements.

RESULTS

Anterior teeth in MOP group showed increased mean OIIRR than control group, though the difference was statistically non-significant [maxillary anteriors, MOP group - OIIRR=0.78±0.29mm and control group OIIRR=0.73±0.36mm; mandibular anteriors, MOP group - OIIRR=0.733±0.20mm and control group OIIRR=0.70±0.24mm]. Levander and Malmgren's Index for objective scoring of OIIRR revealed only mild resorption with most teeth in both the groups (47% and 51%, respectively). Lateral incisors showed highest OIIRR followed by central incisors and canines in both groups. Lingual side bone thickness and height decreased significantly, however, the differences between the two groups were non-significant (P>0.05).

CONCLUSION

Within the settings of the current RCT, en-masse retraction when combined with single application of micro-osteoperforations did not pose an increased risk of root resorption or alveolar bone changes compared to routine sliding mechanics.

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.

Adverse Effects of Surgically Accelerated Orthodontic Techniques: A Systematic Review

Evidence on the potential adverse effects of surgically accelerated orthodontic techniques is scarce. The aim of this review was to evaluate the available scientific evidence regarding the adverse effects on periodontium, tooth vitality, and root resorption, associated with these surgical procedures in children, adolescents, and adults. The reporting of this review was based on the PRISMA2020 guidelines. Seven databases and three registers were searched for randomized clinical trials (RCTs) and controlled clinical trials (CCTs) published up to 22 June 2022. Hand searching of the reference lists of the included studies was also performed. The quality of the evidence was assessed with the Cochrane risk of bias and ROBINS-I tools. A total of 887 records were initially screened. Finally, 33 RCTs (713 patients), six CCTs (103 patients), and six ongoing protocols were eligible for this systematic review. The current review indicated that there are no significant adverse effects of surgically accelerated orthodontic techniques on periodontium, root length, or tooth vitality. High-quality clinical trials with less risk of bias should be conducted to allow reliable conclusions regarding the adverse effects of the surgical procedures associated with the acceleration of orthodontic treatment on children, adolescents, and adults.

Evaluation of patient-reported outcome measures (PROMs) during surgically-assisted acceleration of orthodontic treatment: a systematic review and meta-analysis

BACKGROUND

With the widespread of surgically-assisted orthodontic acceleration, the analysis of patient-reported outcome measures (PROMs) has become very important to assure patient acceptance and satisfaction before adopting any acceleration procedure.

OBJECTIVE

This review aimed to critically appraise the available evidence regarding the levels of pain, discomfort, functional impairments, and other patient-reported outcome measures during surgically-assisted acceleration of orthodontic treatment compared with the traditional non-accelerated treatment.

SEARCH METHODS

Eight electronic bibliographic databases were searched from January 1990 till May 2022. A manual search of the selected orthodontic journals was also undertaken.

SELECTION CRITERIA

Randomized controlled trials (RCTs) were included in this systematic review on patients undergoing orthodontic treatment with one group subjected to an acceleration procedure.

DATA COLLECTION AND ANALYSIS

Cochrane's risk of bias tool (RoB2 tool) was used to assess the risk of bias of the included RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence.

RESULTS

Thirteen RCTs were included in this review (333 patients), and only minimally invasive surgically-assisted acceleration studies were included. Two RCTs were included in the quantitative synthesis of data. After the first day of surgical intervention, the levels of pain and discomfort ranged from mild to moderate in the surgical groups (mean values ranged from 0.8 to 6.8), while it was mild in the control groups. However, on the seventh day after the surgical intervention, the levels of pain, discomfort, swelling, and functional impairments were almost similar between groups. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low.

CONCLUSIONS

All surgical interventions were minimally invasive. There was very low to low evidence that acceleration caused mild to moderate pain and discomfort on the first day after the surgical intervention and disappeared completely at one week following surgery. Functional impairments were found within acceptable limits immediately and in the short-term follow-up. More high-quality randomized controlled clinical trials are needed to establish good evidence in this field.

REGISTRATION

The protocol of this systematic review was registered in PROSPERO database (CRD42021274481) during the first stages of this review.

Effect of mini-implant facilitated micro-osteoperforations on the alignment of mandibular anterior crowding: A randomised controlled clinical trial

OBJECTIVE

To assess the effects of mini-implant assisted micro-osteoperforations (MI-MOPs) in the alignment of mandibular anterior teeth, and to explore the intervention's associated pain perception (PP) and root resorption (RR) in adults treated by fixed appliance.

DESIGN

Multicentre, two-arm and single-blinded randomised clinical trial.

SETTING

College of Dentistry, University of Baghdad.

PARTICIPANTS

Adolescents (mean age = 18.97 years) undergoing non-extraction orthodontic therapy for the management of mandibular anterior crowding.

METHODS

A total of 33 participants (mean age = 18.97 years) undergoing non-extraction orthodontic therapy for the management of moderate mandibular anterior crowding were allocated to the experimental (MI-MOPs, n = 17) or control groups (non-MI-MOPs, n = 16). A series of lower study models were obtained at week 4 (T1), week 8 (T2) and week 12 (T3) in the MI-MOPs group and continued to week 16 (T4) and week 20 (T5) in the non-MI-MOPs group, with all models analysed digitally. Periapical radiographs (PA) were taken before commencing treatment (T0) and T3. Participants were asked to complete a 10-point visual analogue scale (VAS) daily during the first week of treatment.

RESULTS

At T0, the mean Little irregularity index (LII) was 5.1 mm (95% confidence interval [CI] = 4.95-5.23) with no statistically significant difference between groups (P = 0.766). At T1, T2 and T3, t-test showed statistically significant differences in the LII (P < 0.05) in favour of the MI-MOPs group; mean differences (MD) were -1.16mm (95% CI = -1.36 to -0.96), -1.77 mm (95% CI = -1.93 to -1.59) and -1.58 mm (95% CI = -1.67 to -1.48), respectively. Mean treatment time from baseline to final alignment was 10.41 weeks (95% CI = 9.92-10.89) in the MI-MOPs group and 16.62 weeks (95% CI = 16.11-17.13) in the non-MI-MOPs groups, which was statistically significant (MD -6.21 mm, 95% CI = -6.88 to -5.53, P < 0.05). Conversely, Mann-Whitney U-test and Wilcoxon signed-rank test showed no significant differences in terms of PP and RR between the groups (P > 0.05). The participants in the MI-MOPs group experienced a higher degree of RR (P < 0.05) secondary to intervention. No other significant adverse events were reported during the trial.

CONCLUSION

This trial found that combining MI-MOPs with non-extraction-based fixed orthodontic therapy in adults mildly shortens the duration of the alignment phase. RR should be monitored throughout the treatment when using MI-MOPs (ClinicalTrials.gov NCT04778241).

Effect of low-level laser therapy on the time needed for leveling and alignment of mandibular anterior crowding

OBJECTIVES

To assess the effect of low-level laser therapy (LLLT) on overall leveling and alignment time of mandibular anterior crowding and associated pain after initial archwire placement.

MATERIALS AND METHODS

Thirty-two females (18-25 years) with mandibular anterior crowding were randomly allocated into laser and control groups. Eligibility criteria included Angle Class I molar relationship and Little's irregularity index (LII) from 4 to 10 mm. Randomization was accomplished with a computer-generated random list. A 0.014-inch copper-nickel-titanium (Cu-NiTi) wire was inserted immediately after bonding of 0.022-inch Roth brackets followed by 0.016-inch Cu-NiTi, 0.016 × 0.022-inch NiTi then 0.017 × 0.025-inch stainless steel wire after completion of alignment. In-Ga-As laser was applied to the mandibular anterior segment in the laser group on days 3, 7, and 14, then at 1 month followed by every 2 weeks until completion of leveling and alignment. Visual analogue scale questionnaires were completed by each patient over 7 days from initial archwire placement. Digital models were used to monitor changes in the irregularity index. Blinding was applicable for outcome assessors only.

RESULTS

The mean time for leveling and alignment was significantly lower in the laser compared to the control group (68.2 ± 28.7 and 109.5 ± 34.7 days, respectively). The laser group displayed a significantly higher mean alignment improvement percentage as well as lower pain scores compared to the control group.

CONCLUSIONS

Within the constraints of the current study, LLLT has a potential for acceleration of anterior segment alignment as well as reduction of the pain associated with placement of initial archwires.

The Effect of Vitamin D3 on the Alignment of Mandibular Anterior Teeth: A Randomized Controlled Clinical Trial

Objectives

To investigate the effect of vitamin D₃ level on the alignment of mandibular anterior teeth in adults and explore the associated root resorption and pain perception. Trial Design. Multicentre, double blinded randomized clinical trial. Subjects and Methods. Adult patients aged 18–30 years, with moderate mandibular incisor crowding [Little's Irregularity index (LII) 3–6 mm], needing nonextraction treatment with fixed orthodontic appliance, were randomly allocated into two groups with 1 : 1 allocation ratio. In the 1^st group (normal vitamin D₃ level group [ND₃G]), vitamin D level was measured and corrected to normal before starting orthodontic treatment, while in the 2^nd group [control group (CG)] the vitamin D level was kept unknown until completion of the alignment phase. Outcome measures included mandibular incisor crowding using LII, orthodontically induced root resorption (OIRR), and pain perception. Independent sample t-test was used to compare the duration of treatment, the effectiveness of alignment, and OIRR between groups, while differences in pain perception were analysed by Mann–Whitney U-test (P < 0.05).

Results

Out of 87 patients recruited from four centres, 33 patients were randomly allocated into two groups (17 patients to ND₃G and 16 patients to CG). Time elapsed for the complete alignment of the mandibular incisor crowding was one month shorter in ND₃G (23.532% faster), and the improvement percentage was significantly higher in all periods when compared to the CG. The amount of OIRR was not significantly different between groups; however, pain during the first three days of alignment was significantly less in ND₃G.

Conclusions

Having optimal vitamin D₃ level reduced the alignment time and pain associated with orthodontic treatment, but it had no role in reducing OIRR. Registration. The trial was registered with ClinicalTrials.gov on 12^th April 2021 (registration number: NCT04837781).

Orthodontic treatment for crowded teeth in children

BACKGROUND

Crowded teeth develop when there is not enough space in the jaws into which the teeth can erupt. Crowding can affect baby teeth (deciduous dentititon), adult teeth (permanent dentition), or both, and is a common reason for referral to an orthodontist. Crowded teeth can affect a child's self-esteem and quality of life. Early loss of baby teeth as a result of tooth decay or trauma, can lead to crowded permanent teeth. Crowding tends to increase with age, especially in the lower jaw.

OBJECTIVES

To assess the effects of orthodontic intervention for preventing or correcting crowded teeth in children. To test the null hypothesis that there are no differences in outcomes between different orthodontic interventions for preventing or correcting crowded teeth in children.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 11 January 2021 and used additional search methods to identify published, unpublished and ongoing studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that evaluated any active interventions to prevent or correct dental crowding in children and adolescents, such as orthodontic braces or extractions, compared to no or delayed treatment, placebo treatment or another active intervention. The studies had to include at least 80% of participants aged 16 years and under.

DATA COLLECTION AND ANALYSIS

Two review authors, independently and in duplicate, extracted information regarding methods, participants, interventions, outcomes, harms and results. We resolved any disagreements by liaising with a third review author. We used the Cochrane risk of bias tool to assess the risk of bias in the studies. We calculated mean differences (MDs) with 95% confidence intervals (CI) for continuous data and odds ratios (ORs) with 95% CIs for dichotomous data. We undertook meta-analysis when studies of similar comparisons reported comparable outcome measures, using the random-effects model. We used the I2 statistic as a measure of statistical heterogeneity.

MAIN RESULTS

Our search identified 24 RCTs that included 1512 participants, 1314 of whom were included in analyses. We assessed 23 studies as being at high risk of bias and one as unclear.  The studies investigated 17 comparisons. Twenty studies evaluated fixed appliances and auxiliaries (lower lingual arch, lower lip bumper, brackets, archwires, lacebacks, headgear and adjunctive vibrational appliances); two studies evaluated removable appliances and auxiliaries (Schwarz appliance, eruption guidance appliance); and two studies evaluated dental extractions (lower deciduous canines or third molars). The evidence should be interpreted cautiously as it is of very low certainty. Most interventions were evaluated by a single study. Fixed appliances and auxiliaries One study found that use of a lip bumper may reduce crowding in the early permanent dentition (MD -4.39 mm, 95% CI -5.07 to -3.71; 34 participants). One study evaluated lower lingual arch but did not measure amount of crowding. One study concluded that coaxial nickel-titanium (NiTi) archwires may cause more tooth movement in the lower arch than single-stranded NiTi archwires (MD 6.77 mm, 95% CI 5.55 to 7.99; 24 participants). Another study, comparing copper NiTi versus NiTi archwires, found NiTi to be more effective for reducing crowding (MD 0.49 mm, 95% CI 0.35 to 0.63, 66 participants). Single studies did not show evidence of one type of archwire being better than another for Titinol versus Nitinol; nickel-titanium versus stainless steel or multistrand stainless steel; and multistranded stainless steel versus stainless steel.  Nor did single studies find evidence of a difference in amount of crowding between self-ligating and conventional brackets, active and passive self-ligating brackets, lacebacks added to fixed appliances versus fixed appliances alone, or cervical pull headgear versus minor interceptive procedures. Meta-analysis of two studies showed no evidence that adding vibrational appliances to fixed appliances reduces crowding at 8 to 10 weeks (MD 0.24 mm, 95% CI -0.81 to 1.30; 119 participants). Removable appliances and auxiliaries One study found use of the Schwarz appliance may be effective at treating dental crowding in the lower arch (MD -2.14 mm, 95% CI -2.79 to -1.49; 28 participants). Another study found an eruption guidance appliance may reduce the number of children with crowded teeth after one year of treatment (OR 0.19, 95% CI 0.05 to 0.68; 46 participants); however, this may have been due to an increase in lower incisor proclination in the treated group. Whether these gains were maintained in the longer term was not assessed. Dental extractions One study found that extracting children's lower deciduous canines had more effect on crowding after one year than no treatment (MD -4.76 mm, 95 CI -6.24 to -3.28; 83 participants), but this was alongside a reduction in arch length. One study found that extracting wisdom teeth did not seem to reduce crowding any more than leaving them in the mouth (MD -0.30 mm, 95% CI -1.30 to 0.70; 77 participants).

AUTHORS' CONCLUSIONS

Most interventions were assessed by single, small studies. We found very low-certainty evidence that lip bumper, used in the mixed dentition, may be effective for preventing crowding in the early permanent dentition, and a Schwarz appliance may reduce crowding in the lower arch. We also found very low-certainty evidence that coaxial NiTi may be better at reducing crowding than single-stranded NiTi, and that NiTi may be better than copper NiTi. As the current evidence is of very low certainty, our findings may change with future research.

Duration of tooth alignment with fixed appliances: A systematic review and meta-analysis

INTRODUCTION

A key goal of orthodontic treatment with fixed appliances is alignment of the dentition, and this remains a commonly selected outcome in clinical studies investigating orthodontic tooth movement. This systematic review has evaluated treatment duration to achieve alignment of the mandibular dentition using fixed appliances.

METHODS

Systematic literature searches without restrictions were undertaken in 9 databases for randomized clinical trials (RCTs) assessing duration and rate of tooth alignment using fixed appliances with or without treatment adjuncts published up to January 2021. After duplicate study selection, data extraction, and risk of bias assessment according to Cochrane, random-effects meta-analyses of aggregate data, and individual patient data were conducted.

RESULTS

Thirty-five trials were included with 2258 participants (39% male; mean age 17.8 years), giving a pooled duration to achieve whole-arch alignment of the mandibular dentition of 263.0 days (4 trials; 95% confidence interval [CI], 186.7-339.4 days) and incisor alignment in the mandibular arch of 100.7 days (9 trials; 95% CI, 84.1-117.4 days). Surgical-assisted orthodontics was associated with reduced duration of incisor alignment: mean difference of 44.3 days less (4 trials; 95% CI, 20.0-68.9 days; P <0.001; high quality of evidence), whereas subgroup and meta-regression analyses indicated significant effects of baseline crowding and premolar extractions. Individual patient data analysis from 3 RCTs indicated that for each additional participant age year, whole-arch alignment of the mandibular dentition took 13.7 days longer (3 trials; 95% CI, 7.7-17.7 days; P <0.001) and for each additional mm of irregularity, 17.5 days more were needed (2 trials; 95% CI, 9.8-25.2 days; P <0.001).

CONCLUSIONS

Patient and treatment-related characteristics can significantly affect the duration of tooth alignment and should be taken into account both clinically and when designing trial outcomes. Future research studies investigating rates of orthodontic tooth alignment would benefit from adequate sample sizes and a more consistent methodology in outcome assessment. Data in this systematic review provides a basis for appropriate trial design for future RCTs investigating the rate of orthodontic tooth alignment with fixed appliances.

Effectiveness of microosteoperforations in accelerating alignment of maxillary anterior crowding in adults: A randomized controlled clinical trial

INTRODUCTION

This trial aimed to investigate the effectiveness of microosteoperforations (MOPs) in overall time taken for alignment of maxillary anterior crowding and to evaluate the alignment improvement percentage within 6 months between MOPs and control groups.

METHODS

Thirty adult participants (25 females and 5 males; mean age, 22.66 ± 3.27 years) with moderate upper labial segment crowding were randomly assigned into intervention and control groups using block randomization. All participants had first premolar extractions, bonded conventional fixed appliances, and 0.014-in, followed by 0.018-in nickel-titanium archwire placement for initial alignment. The intervention group received a 3-mm deep MOPs procedure under local anesthesia using a Propel device (Propel Ortho Singapore, Pte, Ltd, Winstedt Rd, Singapore) on the labial attached gingivae of maxillary incisors at monthly visits until complete alignment. Little's irregularity index was used to assess the overall changes and measure the change of tooth alignment of the 6 maxillary anterior teeth. Assessor blinding was employed.

RESULTS

There was no statistically significant difference in the median overall alignment duration between MOPs and control groups (139 days [95% confidence interval, 115.32-161.83] vs 143 days [95% confidence interval, 107.12-179.74]; hazard ratio, 0.829; P = 0.467). The MOPs procedure had no significant effect on the alignment duration (P = 0.657) and no overall significant difference in alignment improvement percentage among 2 groups on the basis of time (F = 2.53; P = 0.124). No harm was encountered.

CONCLUSIONS

The application of MOPs is no more effective in accelerating initial orthodontic alignment than conventional treatment.

TRIAL REGISTRATION

This trial was registered at the ISRCTN registry with the study ID ISRCTN15080404.

PROTOCOL

https://doi.org/10.1186/ISRCTN15080404.

FUNDING

This work was supported by the Postgraduate Trust Fund, Faculty of Dentistry, Universiti Teknologi MARA.

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.