American Journal of Orthodontics and Dentofacial Orthopedics
Systematic reviewEffectiveness of orthodontic miniscrew implants in anchorage reinforcement during en-masse retraction: A systematic review and meta-analysis
Section snippets
Material and methods
We performed this study according to PRISMA guidelines, and the main research question was defined in PICO format (Table I).
Retrieved studies and data extraction
The PRISMA diagram depicting the flow of the 10,038 initially retrieved articles is presented in Figure 1. Review of the abstracts excluded 10,002 of them, leaving 36 full-text articles. Subsequently, 21 studies were found to be ineligible for further analysis because of insufficient sample size or lack of relevant outcome data. Two of the retrieved 15 eligible studies were based on the same sample of patients; therefore, only 1 was used in this systematic review.11, 12 Eventually, we obtained
Primary outcome measure: Mesial molar movement
The rate of mini-implants that served successfully throughout the treatment was 87.6%. The mean difference and 95% confidence interval (95% CI) in mesial molar movement between the TISADs and conventional anchorage is given in Fig 3, Fig 4 for total and subgroup analyses, respectively. In the total analysis, the TISAD group had significantly less anchorage loss than the control group (P <0.001). Statistical heterogeneity analysis showed a Q statistics value of 34.57 with P <0.001, I2 = 65.28%
Tipping of the molars
Five studies allowed the analysis of molar tipping in 111 patients (74 female, 37 male; mean age, 17.82 years) in the TISADs group and 109 patients (72 female, 32 male; mean age, 17.19 years) in the control group. The TISADs success rate was 87.9%. In both total and subgroup analyses, the Raw Mean Difference (95% CI) was in favor of the TISADs group, although the differences were statistically insignificant (P >0.05; Fig 5, Fig 6). The heterogeneity level was high: the Q statistics value
Summary of the evidence
According to the Cochrane study assessment tool, 7 main aspects must be thoroughly screened to provide a reliable quality evaluation of RCTs. Randomization methods in the studies by Benson et al,11 Feldmann and Bondemark,8 Upadhyay et al,13 Al-Sibae and Hajeer,17 and Sandler et al,18 were of high standard and met the criteria for robust randomization. The authors of the other studies broadly referred to random assignment; this resulted in an assessment of unclear risk of bias.
Anchorage
Conclusions
On the basis of this systematic review and meta-analysis, we concluded the following.
- 1.
The use of TISADs enables better anchorage preservation compared with traditional reinforcement methods.
- 2.
Tipping of both molars and incisors during space closure does not differ between the 2 anchorage reinforcement methods.
- 3.
More retraction of the incisors may be achieved with TISADs.
- 4.
Use of TISADs enables, to a small extent, reduction of the treatment time.
- 5.
Due to the moderate quality of evidence, the results
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2022, Journal of the World Federation of OrthodontistsCitation Excerpt :The use of miniscrews for skeletal anchorage can help in moving teeth without the use of headgear and intraoral elastics. Skeletal anchorage with miniscrews has been widely incorporated in orthodontic treatment to expand the envelope of orthodontic tooth movement without patient compliance [1–4]. The major advantages of miniscrews in comparison to dental implants or miniplates are their smaller size, which allows placement in many intraoral areas; lower cost; and ease of placement and removal.