Effects of micro-osteoperforations performed with Propel system on tooth movement, pain/quality of life, anchorage loss, and root resorption: a systematic review and meta-analysis

dos Santos, Cibelle Cristina Oliveira; Mecenas, Paulo; de Castro Aragón, Mônica Lidia Santos; Normando, David

doi:10.1186/s40510-020-00326-4

Progress in Orthodontics

Table 3 Evaluation of the level of evidence by GRADE PRO assessment tool

From: Effects of micro-osteoperforations performed with Propel system on tooth movement, pain/quality of life, anchorage loss, and root resorption: a systematic review and meta-analysis

Certainty assessment							Impact	Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Impact	Certainty	Importance
Rate of tooth movement in mm per month
12	Randomized trials	Serious ^a	Serious ^b	Not serious	Not serious	None	Twelve RCTs evaluated the rate of tooth movement. Four showed high RoB, four were classified as some concerns, and four were classified as low RoB. Seven studies related acceleration of tooth movement; however, just two of them showed low risk of bias. Five studies did not find MOPs’ effect on tooth movement.	⨁⨁◯◯ low	Critical
Pain and discomfort
8	Randomized trials	Serious ^c	Serious ^d	Not serious	Not serious	None	Eight RCTs assessed pain or discomfort after MOPs’ procedure. One showed high RoB, three were classified as some concerns, and four presented low RoB. Two RCTs, one showing low RoB and another classified as some concerns, reported pain after the intervention. Six studies did not report pain after the procedure, one with high RoB, two were classified as some concerns, and three with low RoB.	⨁⨁◯◯ low	Critical
Anchorage loss
5	Randomized trials	Serious ^a	Not serious	Not serious	Not serious	None	Five RCTs evaluated anchorage loss. One showing high RoB, two were classified as some concerns and two showing low RoB. None of them found differences on anchorage loss between groups.	⨁⨁⨁◯ moderate	Critical
Root resorption
3	Randomized trials	Not serious	Not serious	Not serious	Not serious	None	Three RCTs assessed root resorption after MOPs’ accomplishment. Two showed low RoB and one was classified as some concerns. None of them found differences on root resorption.	⨁⨁⨁⨁ high	Critical

^aHaliloglu-Ozkan et al. [18] and Sivarajan et al. [26] presented bias in randomization process; Fattori et al. [19] presented deviations from intended interventions; Puetter et al. [20] showed an error in measurement of the outcome
^bThe studies presented inconsistency in results, some reporting faster orthodontic tooth movement on MOPs’ groups, and others showing no difference between intervention and control
^cPuetter et al. showed an error in measurement of the outcome
^dThe studies presented inconsistency in the results, some reporting pain after the MOPs’ procedure, others showing no difference between intervention and control

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