Effectiveness and Safety of Minimally Invasive Orthodontic Tooth Movement Acceleration: A Systematic Review and Meta-analysis

Abstract

Doctors and patients attempt to accelerate orthodontic tooth movement with a minimally invasive surgery approach. The purpose of this systematic review was to evaluate the evidence of accelerated tooth movement in minimally invasive surgery and the adverse effects from it. A systematic search of the literature was performed in the electronic databases of PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), Embase, Scopus, Web of Science, Science Direct, and Medline and was complemented by a manual search until February 2019. The inclusion criteria were prospective clinical studies of patients treated with a fixed appliance, and the intervention was accelerated orthodontic treatment with minimally invasive surgery. Nineteen articles (538 participants) were included in the review: 9 studies assessed the rate of upper canine movement; 5 considered the treatment time; 1 evaluated the en masse retraction time; and 4 studied adverse effects. We performed a meta-analysis for the rate of canine movement and treatment time and described the results for the adverse effects in a systematic review. The results of the subgroup analysis according to micro-osteoperforation and piezocision were included in the study. No accelerated tooth movement was found in the micro-osteoperforation group. After flapless corticotomy procedures, increased tooth movement rates were identified by weighted mean differences of 0.63 (95%CI = 0.22, 1.03, P = 0.003) and 0.64 (95% CI, −25 to 1.53; P = 0.16) for 1 and 2 mo, respectively. The mean treatment time was 68.42 d (95% CI, −113.19 to −23.65; P = 0.003) less that than for minimally invasive surgery. Moreover, no significant adverse effect was found. Because of the high heterogeneity of the meta-analysis, the results must be validated by additional large-sample multicenter clinical trials. There is not sufficient evidence to support that the single use of micro-osteoperforation could accelerate tooth movement, and there is only low-quality evidence to prove that flapless corticotomy could accelerate tooth movement.

Effect of piezocision on mandibular second molar protraction

“…However, the 1-month gain of time during treatment does not justify such a procedure even if it is minimally invasive. This was in agreement with Liu et al, 23 who found only low-quality evidence to support that flapless corticotomy could accelerate tooth movement.…”

Is Piezocision effective in accelerating orthodontic tooth movement: A systematic review and meta-analysis

“…These findings demonstrate the effectiveness of the piezocision procedure in accelerating the canine retraction rate with a statistically significant difference. Similar results regarding accelerating tooth movement were made in other studies [12,16,17,36,[45][46][47] but differed in the effect size. Interestingly, Fu et al [17] reported similar results in their meta-analysis, but they included five different surgical interventions, one of them was in combination with laser and pooled heterogeneous methodological and clinical studies in the same meta-analysis.…”

“…The present meta-analysis has more strength in terms of studies included than other studies [12,[17][18][19], as much related primary research has emerged in the last two years. Also, these studies were not registered in PROSPERO.…”

“…However, the statistical heterogeneity among studies ramped up the inconsistency about the estimate, and more subgroup analyses were not possible. In contrast, a recent meta-analysis [17]pooled five different interventions and different outcomes in their meta-analysis.…”

“…[15] Many systematic reviews studied the effect of surgical and non-surgical adjunct procedures on the acceleration of orthodontic tooth movement, but none of them reported the pure quantitative effect of the piezocision. [12,[16][17][18][19]…”