Table I.
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 |
Figure 1.
PRISMA flow diagram of article selection process. PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analyses.
Table II.
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 retraction G2: Piezocision + Orthodontic retraction Co: Conventional orthodontic treatment |
| 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 treatment Co: Conventional orthodontic treatment |
| 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-supported Fast-Buck appliance via closed coil spring (300 g) | G1: Flapless MOPs + Orthodontic treatment Co: Conventional orthodontic treatment |
| CBCT | No specific time stated All 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 treatment Co: Conventional orthodontic treatment |
| 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 treatment G2: Piezocision + Orthodontic treatment Co: Conventional orthodontic treatment |
| 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 treatment Co: Conventional orthodontic treatment |
| Computed Tomography | G1: 44.3 weeks Co: 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 appliances Co: CAD/CAM orthodontic appliances |
| CBCT | No specific time stated All 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 treatment Co: Extraction + Conventional orthodontic treatment |
| 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 treatment Co: Conventional orthodontic treatment |
| 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 treatment Co: Conventional orthodontic treatment |
| 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 treatment Co: Conventional orthodontic treatment |
| 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 treatment Co: Conventional orthodontic treatment |
| IOPA | G1: 17.5 weeks Co: 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 treatment Co: Conventional orthodontic treatment |
| CBCT | 12.86 weeks (90 days) |
Figure 2.
RoB Assessment.
Table III.
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 movement Increased 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 teeth Decreased 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# |
Table IV.
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 |
2 *The evidence was downgraded by two levels because of very serious concern regarding the risk of bias; one or more included studies have high risk of bias.
3 #The evidence was downgraded by one level because of a high degree of heterogeneity in methodology.
4 †The evidence was downgraded by one level because the results were derived from small scale studies, with low number of participants, and insufficient event rates for dichotomous and continuous outcomes. GRADE Working Group Grades of Evidence 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: Any estimate of effect is very uncertain.