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

Abstract

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.

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

“…Afterwards, 38 manuscripts were included for full text reading, of which 10 were excluded according to the pre‐determined exclusion criteria and the most common exclusion criterion was the absence of a systematic search strategy (see Table S1 for the references of the excluded full-text and reasons). Finally, 28 SRs were included in the current overview [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] . The selection process is given in Fig.…”

“… Periodontal parameters (periodontal probing depth, gingival index, plaque index, recession); Bone density; Buccal bone thickness (crestal level, midroot level, apical level); Current evidence suggests a very low to low level of certainty in regard to quantified effects after corticotomy. Although corticotomy procedures show an insignificant increase in the density following the use of bone graft and anchorage loss, they appear to accelerate the tooth movement during the first few months, to increase the buccal bone thickness and to show good tolerance by the patients; the clinical significance of these changes may be considered questionable Darwiche et al, 2020 [21] up to January 2018 PubMed and Google Scholar SR of 29 studies NR corticotomy conventional orthodontic treatment NR RTM, time of tooth movement, periodontal parameters, Although the current review indicates that accelerated orthodontic treatment is characterized by a temporary phase of tooth movement that can fasten the treatment duration by 2.2–3 folds compared to conventional orthodontic treatment, there is limited available evidence about effectiveness of corticotomy-assisted accelerated orthodontics Dos Santos et al, 2020 [22] until May 2020. PubMed, Cochrane, Web of Science, LILACS, Google Scholar, Scopus, and OpenGrey.…”

“…MOP was addressed in 9 SRs [17] , [18] , [22] , [23] , [27] , [31] , [37] , [39] , [41] , and it was generally described as a procedure in which small pinhole perforations are created in the bone around the teeth to be orthodontically displaced. Dos Santos and co-workers, observed no differences between conventional method and MOP, related to rate of canine retraction or total anterior retraction per month [22] . Similarly, also Fu and colleagues found no accelerated tooth movement in the MOP group [27] .…”

Methods supporting orthodontic treatment – a literature-based review

“…Different results were obtained by Aboalanga et al and Alkebsi et al who, on the basis of canine retraction studies, did not obtain statistically significant results showing a positive effect of micro-osteoperforation on accelerating orthodontic tooth movement (31,32). The above research was referred to by Santos et al Based on systematic database reviews regarding the effectiveness of osteoperforation using the Propel system, and other conventional miniscrews similar to the Propel system, they did not demonstrate their effects on accelerating orthodontic tooth movement (33).…”

“…Do powyższych badań odnieśli się Santos i wsp. Na podstawie przeglądów systematycznych baz danych nad skutecznością osteoperforacji przy użyciu systemu Propel, oraz innych konwencjonalnych miniśrub podobnych do systemu Propel, nie wykazali oni ich wpływu na przyspieszenie ortodontycznego ruchu zębów (33). Metodą coraz powszechniej stosowaną, wpływającą na skrócenie czasu leczenia ortodontycznego, jest zakotwienie szkieletowe, które nie wymaga współpracy pacjenta.…”