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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
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
  1. 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
  2. bThe studies presented inconsistency in results, some reporting faster orthodontic tooth movement on MOPs’ groups, and others showing no difference between intervention and control
  3. cPuetter et al. showed an error in measurement of the outcome
  4. 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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