Orthodontic root resorption associated with surgical adjunctive procedures for accelerating tooth movement: a systematic review of randomised controlled trials

Shukla, Khilan; Currell, Scott Derek; Knight, Beau; Baghaie, Hooman; Nikolarakos, Dimitrios; Dreyer, Craig

doi:10.2478/aoj-2022-0020

Figures & Tables

PRISMA flow diagram of article selection process. PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analyses.

GRADE Summary of Findings: Effect of Surgical Adjunctive Procedures Accelerating Tooth Movement on Root Resorption_

Intervention	No. of participants (studies)	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Effect	Overall quality of evidence
Corticotomy (piezocision)	143 (6 RCTs)	Unclear	No	Serious^#	Serious^†	Not suspected	A single study showed an increase in resorption	LOW
Corticotomy (corticision)	52 (1 RCT)	Low	No	No	Serious^†	Not suspected	Failed to demonstrate increased resorption	LOW
Corticotomy (traditional)	40 (2 RCT)	Serious^*	No	No	Serious^†	Not suspected	A single study showed an increase in resorption	LOW
MOPs	125 (6 RCTs)	Low	No	Serious^#	Serious^†	Not suspected	A single study showed both an increase and decrease in resorption	LOW

Search strategy for PubMed_

Search	Search term	Results
1	exp Orthodontics/	83,695
2	orthodontic*.mp.	76,962
3	braces.mp.	12,605
4	1 OR 2 OR 3	96,104
5	exp Tooth Resorption/	8,911
6	resorp* or resorb*	72,843
7	root AND (erosion OR shortening OR blunting OR length).mp.	19,798
8	5 OR 6 OR 7	92,085
9	exp Randomized Controlled Trial/	694,278
10	randomized controlled trial’ OR ‘randomised controlled trial’	565,492
11	rct.mp.	25,824
12	9 OR 10 OR 11	703,071
13	4 AND 8 AND 12	130

Outcomes of Included Studies_

Study	Year	Effect of SAPATM on OIERR	Secondary Outcomes of SAPATM
Abbas et al.²⁹	2016	Reduced OIERR	Increased canine crown tipping^*
Aboalnaga et al.³⁰	2019	No significant difference	Increased canine tip movementIncreased canine centre and apex movement^*
Alkasaby et al.³¹	2022	Increased OIERR for mesiobuccal roots^*Reduced OIERR for distobuccal roots^#	Increased molar distalisation^# Decreased bone density in the middle and apical thirds of root length^#
Alkebsi et al.³²	2018	Reduced OIERR	No significant difference
Alqadasi et al.³³	2020	Reduced OIERR	Increased overall net movement of teethDecreased canine palatal bone height^*
Charavet et al.³⁴	2016	No significant difference	Reduced treatment time^# Patient satisfaction^*
Chavaret et al.³⁵	2019	No significant difference	Reduced treatment time^Decreased time to archwire change^Patient satisfaction^*
Hatrom et al.³⁶	2021	Reduced OIERR	No significant difference
Raj et al.³⁷	2020	No significant difference	Increased rate of tooth retraction^# Decrease in relative attachment level^*
Shahrin, Abdul Ghani & Norman.³⁸	2021	No significant difference	Nil assessed
Sirri et al.³⁹	2021	No significant difference	Reduced treatment time^#
Shoreibah et al.⁴⁰	2012	Reduced OIERR^*	Reduced treatment time^*Lower decrease in bone density
Thomas et al.⁴¹	2021	No significant difference	Increased initial tooth movement^#

Characteristics of Included Studies_

Study (Year)	Study design	Participants	Treatment Goal	Intervention + Comparison	Outcomes	Diagnostic modality	Follow-up
Abbas et al. (2016)²⁹	RCT, SMD, parallel	20 patients (gender not stated); ages 15–25 y; mean age not stated	Orthodontic canine retraction with NiTi closed coil spring (150 mg)	G1: Corticotomy + Orthodontic retractionG2: Piezocision + Orthodontic retractionCo: Conventional orthodontic treatment	– Change in root length – Change in root angulation – Antero-posterior crown tip movement	CBCT	12 weeks
Aboalnaga et al. (2019)³⁰	RCT, SMD, parallel	18 patients (18 F, 0 M); ages, 16–30 y; mean, 20.5 ± 3.85 y	Orthodontic canine retraction (after first premolar extraction) with TADs and NiTi closed coil spring (150 g)	G1: Flapless MOPs + Orthodontic treatmentCo: Conventional orthodontic treatment	– Canine root resorption – Rate of canine retraction – Total distance canine movement – Effect of MOPs on anchorage loss – Pain	CBCT	16 weeks (4 months)
Alkasaby et al. (2022)³¹	RCT, parallel	20 patients (20 F, 0 M); ages, 16–20 y; mean, 18.05 ± 1.15 y	En-masse distalisation of maxillary molars with miniscrew-supportedFast-Buck appliance via closed coil spring (300 g)	G1: Flapless MOPs + Orthodontic treatmentCo: Conventional orthodontic treatment	– Root resorption – Alveolar bone density – Rate of tooth movement	CBCT	No specific time statedAll participants followed up until distalisation (2.9–3 mm) achieved
Alkebsi et al. (2018)³²	RCT, SMD, parallel	32 patients (24 F, 8 M); ages, 16–24 y; mean, 19.26 ± 2.48 y	Orthodontic canine retraction (after upper first premolar extraction) with miniscrews and NiTi closed coil spring (150 g)	G1: Flapless MOPs + Orthodontic treatmentCo: Conventional orthodontic treatment	– Root resorption – Rate of canine retraction, canine rotation – Periodontal index, gingival index & anchorage loss – Pain level, satisfaction, degree of ease, willingness to repeat & recommendation to others	IOPA	12 weeks (3 months)
Alqadasi et al. (2020)³³	RCT, SMD, parallel	21 patients (12 F, 9 M); ages, 15–40 y; mean, 20.89 ± 4.46 y	Orthodontic canine retraction (after first premolar extraction) with TADs and NiTi closed coil spring (150 g)	G1: Flapless MOPs + Orthodontic treatmentG2: Piezocision + Orthodontic treatmentCo: Conventional orthodontic treatment	– Root resorption – Rate of canine retraction – Buccal + palatal bone height	CBCT	12 weeks (3 months)
Charavet et al. (2016)³⁴	RCT, parallel	32 patients (15 F, 9 M); ages, 21–39 y; mean, 30 y	Orthodontic alignment and finishing of maxillary and mandibular dentition with copper NiTi and stainless steel archwires	G1: Piezocision + Orthodontic treatmentCo: Conventional orthodontic treatment	– Change in root length – Treatment duration – Alveolar cortical plate thickness, dehiscence and fenestration, recession, probing depth, plaque index, papillary bleeding, scarring – Pain, satisfaction, patient apprehension	Computed Tomography	G1: 44.3 weeksCo: 77.9 weeks
Chavaret et al. (2019)³⁵	RCT, parallel	24 patients (15F, 9M); ages (21 – 37y; mean 27.9y	Orthodontic alignment and finishing (with copper NiTi and stainless steel archwires) of maxillary and mandibular dentition into Class I occlusion	G1: Piezocision + CAD/CAM orthodontic appliancesCo: CAD/CAM orthodontic appliances	– Root resorption – Orthodontic treatment duration, cumulate time to archwire change, time of fine tuning phase – Recession depth, pocket depth, dehiscence and fenestration, plaque index, papilla bleeding, gingival scars, bone healing	CBCT	No specific time statedAll participants followed up until Class I occlusion achieved
Hatrom et al. (2021)³⁶	RCT, parallel	26 patients (13 F, 13M); 16–26y, mean G1: 19.27y, Co: 20.83	En-masse retraction of maxillary anterior teeth (after first premolar extraction) with NiTi closed coil spring (250 g)	G1: Piezocision + Extraction + Orthodontic treatmentCo: Extraction + Conventional orthodontic treatment	– Change in root length – Pulp volume	CBCT	17.5 weeks (122.74 ± 3.06 days)
Raj et al. (2020)³⁷	RCT, SMD, parallel	20 patients (14 F, 6 M); 20 – 25y, mean 23.18y	Orthodontic canine retraction with NiTi closed coil spring (150 g)	G1: Piezocision + Orthodontic treatmentCo: Conventional orthodontic treatment	– Change in root length – Probing depth, relative attachment level	CBCT	26 weeks (6 months)
Shahrin, Abdul Ghani & Norman (2021)³⁸	RCT, SMD, parallel	30 patients (25 F, 5 M); ages, 18–45 y; mean, 22.66 ± 3.27 y	Orthodontic alignment of maxillary and mandibular dentition with NiTi archwires	G1: Flapless MOPs + Orthodontic treatmentCo: Conventional orthodontic treatment	– Root resorption	IOPA	26 weeks (6 months)
Sirri et al. (2021)³⁹	RCT, Parallel	52 patients (38 F, 14 M); ages, 18–24 y; mean, 21.38 y	Orthodontic levelling and alignment with NiTi and stainless steel archwires	G1: Flapless Corticision + Orthodontic treatmentCo: Conventional orthodontic treatment	– Root resorption – Dehiscence formation	CBCT	No specific time stated
Shoreibah et al. (2012)⁴⁰	RCT, parallel	20 patients (17F, 3M); 18.4–25.6y, mean	Orthodontic anterior levelling, alignment and finishing of mandibular dentition with NiTi and stainless steel archwires	G1: Corticotomy + Orthodontic treatmentCo: Conventional orthodontic treatment	– Change in root length – Canine movement rate – Pocket depth, bone density, marginal bone level	IOPA	G1: 17.5 weeksCo: 49 weeks
Thomas et al. (2021)⁴¹	RCT, SMD, parallel	33 patients (24 F, 9 M); ages, 19–25 y; mean, 22.1 ± 2.19 y	Orthodontic canine retraction (after first premolar extraction) with TADs and NiTi closed coil spring (150 g)	G1: Flapless MOPs + Orthodontic treatmentCo: Conventional orthodontic treatment	– Canine movement rate and tipping – Change in root length – Probing depth, relative attachment level	CBCT	12.86 weeks (90 days)

Orthodontic root resorption associated with surgical adjunctive procedures for accelerating tooth movement: a systematic review of randomised controlled trials

Figures & Tables

Figure 1.

Figure 2.

GRADE Summary of Findings: Effect of Surgical Adjunctive Procedures Accelerating Tooth Movement on Root Resorption_

Search strategy for PubMed_

Outcomes of Included Studies_

Characteristics of Included Studies_

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