Non-Cochrane · intervention · PM42675466
Methods of incisor inclination control during the non-accelerated retraction of upper anterior teeth with fixed orthodontic appliances: a systematic review and meta-analysis.
Kalloumeh Majd Abdullah, Hajeer Mohammad Y, Burhan Ahmad S, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-09162-0
Findings
Population Patients with class II division 1 malocclusion or class I bimaxillary protrusion undergoing upper first-premolar extraction
12 findings
| Sliding en-masse retraction | Pre-intervention baseline | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Overall; 15 groups | MD -8.78 [-11.04, -6.51] Moderate Downgraded: risk of bias 13 studies · 239 participants |
| Sliding en-masse retraction | Pre-intervention baseline | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Sensitivity: excluding high risk of bias studies | MD -7.83 [-10.6, -5.06] GRADE not reported 10 studies · 174 participants |
| Sliding en-masse retraction | Pre-intervention baseline | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Methodologically selected subgroup; 11 groups | MD -9.79 [-11.54, -8.04] Moderate Downgraded: risk of bias 9 studies · 157 participants |
| Loop-based en-masse retraction | Pre-intervention baseline | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Overall | MD -10.72 [-15.05, -6.38] Moderate Downgraded: risk of bias 4 studies · 59 participants |
| Loop-based en-masse retraction | Pre-intervention baseline | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Sensitivity: excluding Al-Bozaie et al. 2024 | MD -13.31 [-15.01, -11.61] Moderate Downgraded: risk of bias 3 studies · 44 participants |
| Two-step retraction | Pre-intervention baseline | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Sensitivity: excluding high risk of bias studies; 5 groups | MD -9.09 [-12.45, -5.73] GRADE not reported 4 studies · 94 participants |
| Two-step retraction | Pre-intervention baseline | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Overall; 7 groups | MD -7.77 [-11.27, -4.27] Moderate Downgraded: risk of bias 6 studies · 129 participants |
| Sliding en-masse retraction | Loop-based en-masse retraction | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Overall | MD 2.49 [0.71, 4.27] Moderate Downgraded: imprecision 3 studies · 90 participants |
| En-masse retraction | Two-step retraction | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Overall | MD 1.01 [-1.6, 3.63] Very low Downgraded: risk of bias, imprecision 5 studies · 231 participants |
| En-masse retraction | Two-step retraction | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Sensitivity: excluding high risk of bias studies | MD 2.18 [-1.12, 5.48] GRADE not reported 3 studies · 155 participants |
| En-masse retraction | Two-step retraction | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Sensitivity: excluding Al-Sibaie and Hajeer 2014 | MD -0.03 [-3.02, 2.97] GRADE not reported 4 studies · 175 participants |
| Loop-based two-step retraction | Pre-intervention baseline | Change in upper incisor inclination (degrees) Pre- to post-retraction; timing varied by study · Loop-based two-step retraction | MD -8.94 [-13.09, -4.78] Moderate Downgraded: risk of bias 2 studies · 29 participants |
Included primary studies 40
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Karakasli and Erdur, 2021 Congenital adrenal hyperplasia: simultaneous determination of plasma aldosterone and 17-hydroxyprogesterone. PMID:202131 | 1978 | 3 other reviews | not stated | not extracted yet |
| Sreenivasagan et al., 2024 [Tumor induction in mice treated with hydrocortisone and innoculated with polyoma transformed hamster cells]. PMID:202419 | 1977 | 3 other reviews | not stated | not extracted yet |
| Hatrom 2020 Effect of piezocision corticotomy on en-masse retraction. PMID:33378476 | 2020 | 2 other reviews | not stated | not extracted yet |
| Al-Bozaie 2024 An Evaluation of the Rate and Type of Orthodontic Tooth Movement When Injecting Platelet-Rich Plasma During Mini-Implant-Based Segmented… PMID:38882220 | 2024 | 1 other review | not stated | not extracted yet |
| Al-Bozaie et al., 2024 Irradiation induced kyphosis. PMID:202426 | 1977 | 1 other review | not stated | not extracted yet |
| Al-Sibaie and Hajeer, 2014 Depressed herpes simplex virus-induced lymphocyte blastogenesis in individuals with severe recurrent herpes infections. PMID:201413 | 1978 | 1 other review | not stated | not extracted yet |
| Attia et al., 2024 [Etiologic aspects of peripheral neuropathies observed in Senegal]. PMID:202414 | 1977 | 1 other review | not stated | not extracted yet |
| Chandak 2022 Effect of platelet-rich plasma on the rate of orthodontic tooth movement. PMID:35473999 | 2022 | 1 other review | not stated | not extracted yet |
| Chandak and Patil, 2022 Murine cytomegalovirus infection in a non-permissive line of mouse fibroblasts. PMID:202228 | 1977 | 1 other review | not stated | not extracted yet |
| Dora et al., 2024 Pyrophosphate levels and magnesium oxide therapy in osteogenesis imperfecta. PMID:202425 | 1977 | 1 other review | not stated | not extracted yet |
| Hatrom et al., 2020 Origins of prokaryotes, eukaryotes, mitochondria, and chloroplasts. PMID:202030 | 1978 | 1 other review | not stated | not extracted yet |
| Ma et al., 2008 Leukemia following Reye's syndrome treated with exchange transfusions: search for type-C viral infection. PMID:200832 | 1977 | 1 other review | not stated | not extracted yet |
| Magdi et al., 2024 Persistence of enteroviruses in sewage sludge. PMID:202416 | 1977 | 1 other review | not stated | not extracted yet |
| Sardana et al., 2023 The role of plastidic cytochrome c in algal electron transport and photophosphorylation. PMID:202317 | 1978 | 1 other review | not stated | not extracted yet |
| Tuncer 2017 Efficiency of piezosurgery technique in miniscrew supported en-masse retraction: a single-centre, randomized controlled trial. PMID:28402521 | 2017 | 1 other review | not stated | not extracted yet |
| Al-Imam 2019 Evaluation of the effectiveness of piezocision-assisted flapless corticotomy in the retraction of four upper incisors: A randomized… PMID:31794163 | 2019 | this review only | not stated | not extracted yet |
| Al-Imam et al., 2019 The nature of pain: with some personal notes. PMID:201927 | 1977 | this review only | not stated | not extracted yet |
| Al-Sibaie 2014 Assessment of changes following en-masse retraction with mini-implants anchorage compared to two-step retraction with conventional… PMID:23787192 | 2014 | this review only | not stated | not extracted yet |
| Attia 2024 Evaluation of anchorage loss after en masse retraction in orthodontic patients with maxillary protrusion using friction vs frictionless… PMID:39230024 | 2024 | this review only | not stated | not extracted yet |
| Bakhit 2025 Position and root resorption of the incisors following anterior segment retraction using friction versus frictionless mechanics: A… PMID:39049618 | 2025 | this review only | not stated | not extracted yet |
| Bakhit et al., 2025 [Pituitary-gonadal system in women (author's transl)]. PMID:202515 | 1977 | this review only | not stated | not extracted yet |
| Davoody 2013 A prospective comparative study between differential moments and miniscrews in anchorage control. PMID:22898749 | 2013 | this review only | not stated | not extracted yet |
| Davoody et al., 2013 A method for investigating neurotransmission in the basal ganglia using combined stimulation and intracerebral drug injection [proceedings]. PMID:201329 | 1977 | this review only | not stated | not extracted yet |
| Dehis 2025 Effect of low-level laser therapy on en masse retraction in females with bimaxillary dentoalveolar protrusion : A single-center randomized… PMID:38842738 | 2025 | this review only | not stated | not extracted yet |
| Dehis et al., 2025 A new metabolite of vitamin D the small sea-urchin Psammechinus miliaris [proceedings]. PMID:202524 | 1977 | this review only | not stated | not extracted yet |
| Dora 2024 En masse retraction of anterior teeth through rapid periodontal distraction by a retraction screw: A randomized control trial. PMID:38508997 | 2024 | this review only | not stated | not extracted yet |
| Karakasli 2021 The effect of platelet-rich fibrin (PRF) on maxillary incisor retraction rate. PMID:33347530 | 2021 | this review only | not stated | not extracted yet |
| Ma 2008 Comparative evaluation of micro-implant and headgear anchorage used with a pre-adjusted appliance system. PMID:18540016 | 2008 | this review only | not stated | not extracted yet |
| Magdi 2024 Friction versus frictionless mechanics during maxillary en-masse retraction in adult patients with Class I bimaxillary dentoalveolar… PMID:39011819 | 2024 | this review only | not stated | not extracted yet |
| Sardana 2023 Rate and anchorage loss during en-masse retraction between friction and frictionless mechanics: A randomized clinical trial. PMID:36919990 | 2023 | this review only | not stated | not extracted yet |
| Schneider 2019 Comparison of anterior retraction and anchorage control between en masse retraction and two-step retraction: A randomized prospective… PMID:30475647 | 2019 | this review only | not stated | not extracted yet |
| Schneider et al., 2019 Voltage dependence of amplitude and time course of inhibitory synaptic current in crayfish muscle. PMID:201918 | 1977 | this review only | not stated | not extracted yet |
| Sreenivasagan 2024 Comparison of treatment effects during en-masse retraction of upper anterior teeth placed using mini-implants placed at infrazygomatic… PMID:37292042 | 2024 | this review only | not stated | not extracted yet |
| Tunçer et al., 2017 Sensory conduction in medial plantar nerve: normal values, clinical applications, and a comparison with the sural and upper limb sensory… PMID:201733 | 1977 | this review only | not stated | not extracted yet |
| Upadhyay 2008 Treatment effects of mini-implants for en-masse retraction of anterior teeth in bialveolar dental protrusion patients: a randomized… PMID:18617099 | 2008 | this review only | not stated | not extracted yet |
| Upadhyay et al., 2008 [Indications for conservative and surgical therapy of peripheral nerve injuries]. PMID:200820 | 1977 | this review only | not stated | not extracted yet |
| Xu 2010 Randomized clinical trial comparing control of maxillary anchorage with 2 retraction techniques. PMID:21055588 | 2010 | this review only | not stated | not extracted yet |
| Xu et al., 2010 [The role of radioisotope scanning of the bone in the exploration of infectious spondylodiscitis]. PMID:201034 | 1977 | this review only | not stated | not extracted yet |
| Zhang 2022 Three-dimensional evaluation of maxillary tooth movement in extraction patients with three different miniscrew anchorage systems: a… PMID:36529797 | 2022 | this review only | not stated | not extracted yet |
| Zhang at al., 2022 Portacaval shunt and hyperlipidemia. PMID:202223 | 1978 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients aged 12-35 years with Class II division 1 malocclusion or Class I bimaxillary dentoalveolar protrusion, complete permanent dentition, requiring upper first premolar extraction and anterior retraction | 568 patients (n=568) in 20 RCTs; mean age 12.6 to 25.1 years; Class II div 1 and Class I bimaxillary protrusion |
| Intervention | Any sliding or non-sliding method to retract the six anterior teeth or canines then incisors with buccal appliances, with or without inclination control aids or anchorage devices; non-accelerated groups only | Sliding en-masse (13 RCTs), loop-based en-masse (4 RCTs), two-step retraction (6 RCTs), with various anchorage and accelerating adjuncts (accelerated arms excluded) |
| Comparison | Any other retraction method or no intervention; non-accelerated groups only | Baseline (pre-retraction) for single-group change; loop-based vs sliding en-masse (3 RCTs, n=90); en-masse vs two-step (5 RCTs, n=231) |
| Outcomes | Primary: change in incisor inclination during retraction; secondary: vertical change of incisal edge | Change in upper incisor inclination (pooled in 19 RCTs); vertical change of incisal edge (13 RCTs, narrative, very low certainty) |
| Study designs | Randomized controlled trials; no time or language restrictions | 20 RCTs; risk of bias low in 11, some concerns in 4, high in 5 |
| Timing | Not specified | Not specified |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | No | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: N/A | NRSI: N/A · RCT: No | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |