The effectiveness of surgical adjunctive procedures in the acceleration of orthodontic tooth movement: A systematic review of systematic reviews and meta-analysis

Abstract

Objective: To identify and evaluate the body of the evidence regarding the effectiveness of surgical adjunctive procedures (SAPs) in accelerating orthodontic tooth movement (OTM). Data sources: Unrestricted search of three electronic databases and manual search up to 12 June 2020 were undertaken. Data selection: All systematic reviews of randomised and non-randomised controlled trials that investigate the effectiveness of the SAPs in accelerating OTM were included. Data extraction: Study selection and data extraction were undertaken independently and in duplicate by two reviewers. A random-effects model with a 95% confidence interval (CI) was generated for comparable outcomes. Two reviewers assessed the quality of the included studies using AMSTAR2 and GRADE. Results: Fourteen systematic reviews were included; however, four systematic reviews were assessed quantitatively. Meta-analysis showed that mean difference (MD) of canine retraction rate, for the first month after SAPs, was mild (MD = 0.65 mm/month). Compared to control, micro-osteoperforations (MOPs) statistically but temporally accelerate lower canine retraction and en masse retraction by 0.25 mm/month and 0.31 mm/month, respectively. There was no significant effect ( P>0.05) in terms of molar anchorage loss (MAL) between control and MOP groups. Piezocision non-significantly shortens the duration of en masse retraction (4.30 months, P>0.05), but significantly shortens incisors retraction (101.64 days, P<0.001). MAL is mild but significantly less in the piezocision group compared to the control group (MD = 0.53 mm, P=0.03). Low-level evidence showed that SAPs have no significant effect on root resorption or periodontal health; however, piezocision is associated with transient acute inflammation and noticeable scars. Conclusion: Low-level evidence concludes that SAPs accelerate OTMs and reduce treatment duration, but the acceleration is minor and transient. The effect on anchorage loss is variable and technique related. Side effects of SAPs are transient, but some might be aesthetically noticeable. A cost-benefit analysis of SAPs should be considered while making the treatment decision.

The Effectiveness of Repetition or Multiplicity of Different Surgical and Non-Surgical Procedures Compared to a Single Procedure Application in Accelerating Orthodontic Tooth Movement: A Systematic Review and Meta-Analysis

“…This is somewhat consistent with a previous trial, which suggested a possible reduction in the treatment duration of up to 30% [ 38 ]. Although surgical methods have been proven to be effective in accelerating OTM [ 24 ], different acceleration rates have been published in the literature. A study evaluating traditional corticotomy (with flap elevation) reported that canine retraction increased by two to four times when compared to the non-accelerated group [ 5 ], whereas a laser-assisted flapless corticotomy accelerated the canine retraction by 2.5 times when compared to the conventional retraction [ 40 ].…”

Visualising the results of clinical trials to draw conclusions

“…The basis for this piece will be a recently published overview of systematic reviews on the effectiveness of surgical adjunctive procedures (corticotomy, micro-osteoperforation, and piezocision among others) in the acceleration of orthodontic tooth movement ( Mheissen et al, 2021 ). In that paper, all systematic reviews of randomised and non-randomised clinical studies investigating the effectiveness of surgical adjunctive procedures in accelerating orthodontic tooth movement were included and their results were pooled among included studies through meta-analysis.…”

The effect of two low-level laser irradiation protocols on molar anchorage loss (A randomized controlled clinical trial)

“…suggestion has not been advocated in some studies, such as the systematic review by Sivarajan et al (9), where insignificant differences have been reported regarding the amount of molar anchorage loss with and without micro-osteoperforations, which is a minimally invasive surgical method proposed for acceleration. On the other hand, Mheissen et al (10) in their systematic review, documented a significantly higher amount of mesial molar movement in the control groups, when compared to the piezocision groups in their enlisted studies, and they concluded that the amount of molar anchorage loss might be technique-related.…”