Systematic review
Effectiveness of orthodontic miniscrew implants in anchorage reinforcement during en-masse retraction: A systematic review and meta-analysis

https://doi.org/10.1016/j.ajodo.2016.08.029Get rights and content

Highlights

  • Effectiveness of temporary intraoral skeletal anchorage devices (TISADs) was assessed.

  • Fourteen articles representing 616 patients with TISADs were selected for meta-analysis.

  • Quality of the included studies was moderate.

  • TISADs were more effective than conventional methods of anchorage reinforcement.

  • The average difference of 2 mm was statistically and clinically significant.

Introduction

The aim of this systematic review was to compare the effectiveness of orthodontic miniscrew implants—temporary intraoral skeletal anchorage devices (TISADs)—in anchorage reinforcement during en-masse retraction in relation to conventional methods of anchorage.

Methods

A search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science was performed. The keywords were orthodontic, mini-implants, miniscrews, miniplates, and temporary anchorage device. Relevant articles were assessed for quality according to Cochrane guidelines and the data extracted for statistical analysis. A meta-analysis of raw mean differences concerning anchorage loss, tipping of molars, retraction of incisors, tipping of incisors, and treatment duration was carried out.

Results

Initially, we retrieved 10,038 articles. The selection process finally resulted in 14 articles including 616 patients (451 female, 165 male) for detailed analysis. Quality of the included studies was assessed as moderate. Meta-analysis showed that use of TISADs facilitates better anchorage reinforcement compared with conventional methods. On average, TISADs enabled 1.86 mm more anchorage preservation than did conventional methods (P <0.001).

Conclusions

The results of the meta-analysis showed that TISADs are more effective than conventional methods of anchorage reinforcement. The average difference of 2 mm seems not only statistically but also clinically significant. However, the results should be interpreted with caution because of the moderate quality of the included studies. More high-quality studies on this issue are necessary to enable drawing more reliable conclusions.

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

References (28)

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