Effectiveness of minimally invasive surgical procedures in the acceleration of tooth movement: a systematic review and meta-analysis

Alfawal, Alaa M. H.; Hajeer, Mohammad Y.; Ajaj, Mowaffak A.; Hamadah, Omar; Brad, Bassel

doi:10.1186/s40510-016-0146-9

Progress in Orthodontics

Table 3 Summary of findings table according to the GRADE guidelines for the included trials

From: Effectiveness of minimally invasive surgical procedures in the acceleration of tooth movement: a systematic review and meta-analysis

Patient or population: patients need orthodontic treatments, settings: upper canines (RCT), intervention: minimally invasive surgical procedures, comparison: conventional treatment
Outcomes	Weighted mean difference (95 % CI) between minimally invasive surgical assisted vs. conventional retraction	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
Orthodontic tooth movement in mm (2 months)	The mean canine retraction in the intervention groups was 1.41 higher (0.81 to 2.01 higher). Relative effect (95 % CI): not estimable	28 (2 studies SP)	⊕⊕⊝⊝^a Low	This outcome also measured at 1 month in 3 studies (38 patients): mean canine retraction in the intervention groups was 0.65 higher (0.54 to 0.76 higher) with a quality of evidence very low ⊕⊝⊝⊝^b. Also, this outcome was assessed at 3 months in one study (18 patients). This study reported higher tooth movement by 2 mm with the minimally invasive surgical procedure, a statistically significant finding (MD = 2: 95 % CI 1.20 to 2.80) with a quality of evidence very low ⊕⊝⊝⊝^c.
Pain and discomfort	See comments Relative effect (95 % CI): not estimable	10 (1 study, COMP)	⊕⊝⊝⊝^d Very low	The difference between the control and experimental groups was not significant (p > 0.5) at 1, 7, 14 and 28 days after retraction.
Pain and discomfort	See comments Relative effect (95 % CI): not estimable	13 (1 study, PG)	⊕⊕⊝⊝^e Low	There was no significant difference in the level of pain between the two groups immediately, 1 and 12 h and 7 days after piezocision (p > 0.05). We could not pool the results of the previous 2 trials which evaluated this outcome to quantitative synthesis due to differences in specific treatments (non-extraction vs. extraction).
Adverse effects (periodontal problems)	See comments Relative effect (95 % CI): not estimable	10 (1 study, SP)	⊕⊕⊝⊝^f Low	There was no significant difference in mobility scores of canines between the control and experimental groups pre- and post-distalization (p > 0.05). Similarly, there was no significant difference in gingival indices between both groups pre- and post-distalization (p > 0.05).
Adverse effects anchorage loss	See comments Relative effect (95 % CI): not estimable	10 (1 study, SP)	⊕⊕⊝⊝^f Low	There was significant difference in loss of anchorage between control and experimental groups (p < 0.05), the anchorage loss was lesser in the piezocision group.
Adverse effects (unwanted tooth movement)	See comments Relative effect (95 % CI): not estimable	18 (1 study, SP)	⊕⊕⊝⊝^g Low	There was no significant difference between control and experimental sides for canine tipping and rotation (p > 0.05).
Adverse effects (unwanted tooth movement)	See comments Relative effect (95 % CI): not estimable	10 (1 study, SP)	⊕⊕⊝⊝^f Low	There was no significant difference between control and experimental sides for transversal changes (p > 0.05).

High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate
CI confidence interval, PG parallel-group design, SP split-mouth design, COMP compound design, GRADE working group grades of evidence
^aDecline one level for risk of bias (blinding of outcome assessment unclear [39], blinding of participants and personnel and allocation concealment unclear in [40]) and one level for indirectness*
^bDecline two levels for risk of bias (blinding of participants and personnel and allocation concealment unclear [17, 40], blinding of outcome assessment unclear [39]), random sequence generation and bias due to conflict of interest unclear [17]) and one level for indirectness*
^cDecline one level for risk of bias (blinding of outcome assessment unclear [39]), and one level for indirectness*, and one level for imprecision**
^dDecline two levels for risk of bias (unclear risk of bias of randomization, allocation concealment, blinding of participants and personnel and conflict of interest [17]) and one level for imprecision**
^eDecline one level for risk of bias (unclear risk of bias of blinding of participants and personnel [17]) and one level for imprecision**
^fDecline one level for risk of bias (unclear risk of bias of blinding of participants and personnel and allocation concealment [40]) and one level for imprecision**
^gDecline one level for risk of bias (unclear risk of bias of blinding of outcome assessment [39]) and one level for imprecision**
*Outcome is not directly related; the included trials involved only adult patients, so the efficacy of minimally invasive surgical procedures could not be confirmed on adolescent patients. Also, patient-centred outcomes were very limited
**Limited number of trials, of limited sample size

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