Cochrane · intervention · CD005098
Reinforcement of anchorage during orthodontic brace treatment with implants or other surgical methods
Jambi, S, Walsh, T, Sandler, J, et al. · Cochrane Database of Systematic Reviews · 2014 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
22
current version
GRADE rated
2
No studies
8
Included studies
15
as reported
No studies 8 · 36.4%Ungraded 12 · 54.5%Very low 0 · 0%Low 1 · 4.5%Moderate 1 · 4.5%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients of any age undergoing orthodontic treatment with fixed appliances and requiring surgical or conventional anchorage | 561 randomised patients (543 analysed) from 15 studies; 7 studies adolescents, 6 young adults, 2 adults up to 48-54 years; conducted in Europe, India, China, South Korea and the USA |
| Intervention | Mid-palatal implants; onplants; mini-screw implants; spider screws; titanium plates; zygomatic wires | Mid-palatal osseointegrated implant (n=25); Nobel-Biocare onplant (n=29); Orthosystem mid-palatal implant (n=30); mini-screw implants (multiple studies) |
| Comparison | Headgear; chin caps; face masks; transpalatal arches (including Nance buttons); lingual arches; interarch elastics | Headgear; transpalatal/palatal arch; banding of second molars; differential moments |
| Outcomes | Mesiodistal movement of upper first molars (primary); residual overjet; success or failure of the anchorage device; duration of active treatment; duration of space closure; number of visits; patient perceptions (pain and discomfort); acceptability of the anchorage device; adverse effects; economic factors | Mesiodistal movement of upper first molar (n=7 pooled); success/failure of anchorage device (n=5); duration of active treatment (n=3); duration of space closure (n=3); number of visits (n=1); patient perception pain (n=1); discomfort (n=2); acceptability (n=1) |
| Study designs | Parallel-group, randomised controlled trials (split-mouth and quasi-randomised trials excluded) | Parallel-group randomised controlled trials (n=15) |
| Timing | Not specified | Various endpoints: end of anchorage reinforcement / end of space closure / end of active treatment |
Search date: 2013-10. Databases: Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform
Questions and results
Current version onlySurgical anchorage (mini-screw or mid-palatal implant) vs Conventional anchorage (headgear, transpalatal/palatal arch, etc.)
Population: Patients of any age undergoing orthodontic treatment with fixed appliances and requiring anchorage (adolescents to adults up to 48-54 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient acceptability | Reported narratively in 1 study (Feldmann 2007): limitations in daily life and jaw function were low to moderate throughout the trial with no differences between anchorage groups; impact on mood and appearance peaked… | 1 study · 113 participants | Ungraded |
Residual overjet at the end of treatment | No studies reported on residual overjet at the end of treatment | 0 studies | No studies |
Adverse events | This outcome was unreported in all included studies | 0 studies | No studies |
Duration of overall treatment | SMD -0.25 [-0.62, 0.12] -0.15 [-0.37, 0.07] years (shorter) | 3 studies · 111 participants | Low Downgraded: risk of bias, imprecision |
Patient perception: discomfort | Reported narratively in 2 studies (Chesterfield 2007, 47 patients; Feldmann 2007, 113 patients) on a VAS 0-100; discomfort most severe the evening after surgery (Nobel-Biocare onplant median 33, IQR 0-96) and after… | 2 studies · 160 participants | Ungraded |
Mesiodistal movement of the upper first permanent molar End of anchorage reinforcement / space closure | MD -1.68 [-2.27, -1.09] -1.68 [-2.27, -1.09] mm (lower) | 7 studies · 308 participants | Moderate Downgraded: risk of bias, inconsistency |
Success or failure of the anchorage device | Reported in 5 studies but not pooled due to variability in the definition of success and incomplete reporting. Success rates: mini-implants 71.43% (10/14) (Basha 2010); Orthosystem mid-palatal implant 91.30% (21/23) vs… | 5 studies | Ungraded |
Duration of space closure | SMD -0.09 [-0.54, 0.35] -12 [-72, 47] days (shorter) | 3 studies · 80 participants | Ungraded |
Number of visits | MD 7.01 [3.47, 10.55] | 1 study · 47 participants | Ungraded |
Patient perception: pain | Reported narratively in 1 study (Feldmann 2007) on a VAS 0-100; the first evening after the intervention pain was significantly higher for surgical group A (P=0.002) and conventional group C (P=0.007) than surgical… | 1 study · 113 participants | Ungraded |
Economic factors | No studies reported on economic evaluation | 0 studies | No studies |
Dual mini-screw implant vs Single mini-screw implant
Population: Patients undergoing orthodontic treatment requiring surgical (mini-screw implant) anchorage
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Economic factors | Economic factors were not reported in any of the studies comparing two types of surgical anchorage | 0 studies | No studies |
Number of visits | No studies reported on the number of visits for the comparison of two types of surgical anchorage | 0 studies | No studies |
Residual overjet at the end of treatment | No studies reported on residual overjet at the end of treatment for the comparison of two types of surgical anchorage | 0 studies | No studies |
Duration of space closure | MD -2.19 [-6.35, 1.97] | 1 study · 25 participants | Ungraded |
Success of the anchorage device | RR 1.01 [0.84, 1.22] | 1 study · 25 participants | Ungraded |
Mesiodistal movement of the upper first permanent molar | MD 1.62 [0.98, 2.26] | 1 study · 25 participants | Ungraded |
Patient acceptability | Acceptability was not reported in any of the studies comparing two types of surgical anchorage | 0 studies | No studies |
Adverse effects | Adverse effects were not reported in any of the studies comparing two types of surgical anchorage | 0 studies | No studies |
Early loading of mini-screw implant vs Delayed loading of mini-screw implant
Population: Patients undergoing orthodontic treatment requiring surgical (mini-screw implant) anchorage
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of the anchorage device | RR 1.00 [0.83, 1.20] | 2 studies · 36 participants | Ungraded |
Pre-drilling mini-screw implant vs Self-drilling mini-screw implant
Population: Patients undergoing orthodontic treatment requiring surgical (mini-screw implant) anchorage
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of the anchorage device | RR 1.12 [0.91, 1.38] | 1 study · 62 participants | Ungraded |
Patient perception: pain | Self-reported pain on insertion (0-4 scale): pre-drilling mean 0.73 (SD 1.1; median 0.00, IQR 0-3) vs self-drilling mean 1.87 (SD 1.13; median 2.0, IQR 0-4); 1 study (Lehnen 2011), 30 participants | 1 study · 30 participants | Ungraded |
Mid-palatal osseointegrated implant vs Headgear
Population: Patients undergoing orthodontic treatment with braces; the included trial recruited patients with 'absolute anchorage' requirements (Class II Division 1 malocclusion)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient acceptability | The included trial did not report data on patient acceptance | 0 studies | No studies |
Success or failure of the anchorage device | The included trial did not report data on failure rates | 0 studies | No studies |
Mesial movement of the upper first permanent molar (radiograph) T1 (treatment start) to T2 (end of anchorage reinforcement) | MD -1.5 [-3.23, 0.23] | 1 study · 47 participants | Ungraded |
Patient perception: discomfort | The included trial did not report data on patient discomfort | 0 studies | No studies |
Duration of overall treatment (treatment time) | Treatment times were 2.23 years (SD 0.62) in the headgear group and 2.15 years (SD 0.59) in the implant group; reported narratively with no formal between-group comparison | 1 study · 47 participants | Ungraded |
One type of surgically assisted anchorage reinforcement vs A different type of surgically assisted anchorage reinforcement
Population: Patients of any age undergoing orthodontic treatment with braces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | The single included trial compared surgical anchorage (mid-palatal implant) with conventional anchorage (headgear); no trial comparing two methods of surgically assisted anchorage was identified. | 0 studies | No studies |
Surgically assisted anchorage reinforcement (mid-palatal implants, onplants, mini screws, spider screws, titanium plates, zygomatic wires) vs Conventional anchorage (headgear, transpalatal arches including Nance buttons, lingual arches, interarch elastics)
Population: Patients of any age undergoing orthodontic treatment with braces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Protocol (published 24 January 2005): planned comparison of surgically assisted anchorage versus conventional anchorage. No studies included (protocol defines methods only). | 0 studies | No studies |
One type of surgically assisted anchorage reinforcement vs A different type of surgically assisted anchorage reinforcement
Population: Patients of any age undergoing orthodontic treatment with braces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Protocol (published 24 January 2005): planned head-to-head comparison of two methods of surgically assisted anchorage. No studies included (protocol defines methods only). | 0 studies | No studies |