Abstract
The present article describes data from systematic review and meta-analysis investigating the efficacy and safety outcomes comparing mini-implants (MIs) and conventional anchorage reinforcement in patients with maximum dentoalveolar protrusion. All relevant RCTs and non-RCTs published up to 2018 were collected from PubMed, Embase and Cochrane database. Thirteen studies assessing the effect of mini-implants were included, of which 4 were randomized controlled trials (RCTs) and 9 observational studies. The efficacy parameters include mesiodistal movements of molars and incisors and vertical movements of molars and incisors. Whereas, the safety parameters were angular and linear measurement of soft tissue change. Subgroup analysis data was provided in terms of patients average age (<18 years and ≥18 years) at the initiation of treatment. This dataset is suitable for research purpose in the field of orthodontics and also helps dental doctors to determine their treatment preferences in the choice of anchorage reinforcement.
Keywords: Mini-implants, Orthodontic anchorage devices, Dentoalvelor protrusion, Mesial movement of molar and incisor, Nasolabial angle, Facial convexity, Meta-analysis
Value of the Data
-
•
These dataset combines the results of the RCTs and observational (prospective and retrospective) studies assessing the efficacy and safety profile of mini-implants and conventional anchorage reinforcement.
-
•
The data contained in the present dataset regarding the treatment outcomes (dental, skeletal and soft tissue changes) among the mini-implants and conventional anchorage devices which had been carried out with multiple study types and at different locations. Hence, these data could be useful to researchers and treating doctors, and benefits in selection of preferred orthodontic anchorage reinforcement in patients with maximum dentoalvelor protrusion.
-
•
The dataset generated can provide further insights in future trials assessing effectiveness and safety profile of MIs and conventional anchorage devices for treatment choices.
-
•
The method of data collection is through systematic review and meta-analysis. Therefore, the methods described and the data contained in this study can be useful for future trials and meta-analysis.
Specifications Table
| Subject | Clinical research, Meta-analysis |
|---|---|
| Specific subject area | Dental |
| Type of data | Table |
| How data were acquired | Articles were screened using the electronic database search. |
| Data format | Analysed. Secondary data |
| Parameters for data collection | Electronic database such PubMed, Embase and Cochrane using the keywords, literature searched from inception to 2018 |
| Description of data collection | 3720 articles were screened using the electronic database search, and after removing duplicates and excluding articles as per exclusion criteria, 87 full text articles remained for further evaluation by reviewer. Finally, 13 articles remained for final data analysis. Efficacy of the anchorage devices were measured by mesiodistal movement of molars and incisors, and vertical movement of molars and incisors. Safety was measured in terms of angular and linear measurements. |
| Data source location | Secondary data was sourced from electronic databases. Primary database sources: PubMed, Embase, Cochrane |
| Data accessibility | With the article. Secondary data |
| Related research article | Author names: YAN LIU, ZHEN-JIN YANG, JING ZHOU, PING XIONG, QUAN WANG, YAN YANG, YU HU, JIANG-TIAN HU. Title: Soft Tissue Changes in Patients with Dentoalveolar Protrusion Treated with Maximum Anchorage: A Systematic Review and Meta-Analysis. Journal: The Journal of EVIDENCE-BASED DENTAL PRACTICE DOI: https://doi.org/10.1016/j.jebdp.2019.01.006 Author names: YAN LIU, ZHEN-JIN YANG, JING ZHOU, PING XIONG, QUAN WANG, YAN YANG, YU HU, JIANG-TIAN HU. Title: Comparison of Anchorage Efficiency of Orthodontic Mini-Implant and Conventional Anchorage Reinforcement in Patients Requiring Maximum Orthodontic Anchorage: A Systematic Review and Meta-Analysis. Journal: The Journal of EVIDENCE-BASED DENTAL PRACTICE DOI: https://doi.org/10.1016/j.jebdp.2020.101401 |
1. Data
In total, 3720 articles were screened using the electronic database search, and after removing duplicates and excluding articles as per exclusion criteria, 87 full text articles remained for further evaluation by reviewer. Finally, 13 articles remained for final data analysis.
Bimaxillary anterior dentoalveolar protrusion of both upper and lower jaws is challenging to clinician, which is further complicated by availability of multiple treatment modalities. Therefore, we presented the data comparing the efficacy and safety profile of orthodontic MIs and conventional anchorage reinforcement among patients with maximum dentoalveolar protrusion. Efficacy of the anchorage devices were measured by mesiodistal movement of molars and incisors, and vertical movement of molars and incisors. Whereas, safety was measured in terms of angular and linear measurements.
The mean and standard deviation based on the endpoint of interest of the included studies were pooled together. We used I2 statistics to assess the heterogeneity among studies included. Random-effect meta-analysis models, to calculate the weighted overall mean and standard deviation of the pooled data were used in the presence of significant heterogeneity of study-level data. Otherwise, fixed-effects (FE) models were used. To account for any bias in the reporting units of the studies included, the standard mean difference (SMD) with 95% confidence intervals (CI) were used. The data from the different studies might have unknown biases which were rendered negligible by the statistical pooling of data.
The skeletal, dental and soft tissue measurement with respect to efficacy and safety included in both RCTs and non-RCTs were presented in Table 1. Also, as patient's age seemed to play a vital role, sub-group analysis assessing the difference in the treatment outcomes with respect to patients age (<18 years and ≥18 years) were carried out (Table 2).
Table 1.
Efficacy and safety outcomes of mini-implants (MIs) compared to conventional anchorage.
| EFFICACY |
SAFETY |
||||||||
|---|---|---|---|---|---|---|---|---|---|
| Randomized Controlled Trials (RCTs) | |||||||||
| Slr No. | Author name, Year | Mesiodistal movement of molars | Vertical movement of molars | Mesiodistal movement of incisors | Vertical movement of incisors | SNA | ANB | Nasolabial angle | Upper lip changes |
| SMD (95% CI) | SMD (95% CI) | SMD (95% CI) | SMD (95% CI) | SMD (95% CI) | SMD (95% CI) | SMD (95% CI) | SMD (95% CI) | ||
| 1 | Upadhyay M. et al., 2008 | −3.22 (−4.21, −2.23) | −0.91 (−1.59, −0.22) | −0.37 (−1.03, 0.29) | 0.19 (−0.47, 0.84) | −0.95 (−1.64, −0.26) | 1.35 (0.63, 2.08) | −0.25 (−0.91, 0.41) | |
| 2 | Al−Sibaie S. et al., 2013 | −2.94 (−3.70, −2.18) | −0.51 (−1.04, 0.02) | −0.05 (−0.57, 0.48) | 0.12 (−0.41, 0.64) | 0.72 (0.18, 1.26) | −0.31 (−0.83, 0.22) | ||
| 3 | Y.H Liu et al., 2009 | −1.17 (−1.89, −0.44) | −1.49 (−2.25, −0.73) | −1.21 (−1.94, −0.48) | −1.39 (−2.14, −0.64) | −0.24 (−0.92, 0.43) | −0.61 (−1.30, 0.07) | 0.22 (−0.45, 0.90) | −0.77 (−1.47, −0.07) |
| 4 | J Sandler et al., 2014 | −0.58 (−1.05, −0.10) | |||||||
| Non-RCTs | |||||||||
| 5 | Park et al., 2012 | −1.33 (−2.21, −0.45) | −0.03 (−0.83, 0.77) | −1.75 (−2.69, −0.81) | −1.00 (−1.85, −0.15) | ||||
| 6 | Koyama et al., | −1.97 (−2.87, −1.07) | 1.03 (0.24, 1.82) | 0.21 (−0.54, 0.95) | 1.19 (0.39, 1.99) | −0.14 (−0.88, 0.60) | −2.05 (−2.96, −1.13) | ||
| 7 | A-Y Lee et al., | 1.26 (0.58, 1.94) | 0.77 (0.13, 1.41) | 0.75 (0.11, 1.39) | 0.96 (0.30, 1.61) | 0.63 (−0.00, 1.27) | 0.57 (−0.06, 1.20) | ||
| 8 | C-C Yao et al., | −0.64 (−1.23, −0.06) | −0.69 (−1.28, −0.10) | 0.70 (0.11, 1.29) | 0.61 (0.03, 1.20) | ||||
| 9 | E H-H Lai et al., 2008 | −0.79 (−1.44, −0.13) | −0.20 (−0.84, 0.43) | −0.80 (−1.46, −0.14) | 0.48 (−0.16, 1.13) | ||||
| 10 | Mu Chen et al., 2015 | −0.81 (−1.55, −0.08) | −1.08 (−1.84, −0.33) | −0.58 (−1.30, 0.13) | 0.10 (−0.61, 0.80) | −0.02 (−0.73, 0.68) | |||
| 11 | Upadhyay M. et al., 2008 | −2.56 (−3.53, −1.60) | −0.66 (−1.40, 0.07) | −0.20 (−0.91, 0.52) | −1.84 (−2.69, −0.98) | ||||
| 12 | Col S.S. Chopra et al., 2017 | −3.39 (−4.26, −2.53) | 0.14 (−0.41, 0.70) | 0.64 (0.07, 1.21) | 0.38 (−0.18, 0.94) | −0.59 (−1.15, 10.02) | |||
| 13 | Kuroda et al., 2009 | 0.58 (−0.27, 1.44) | |||||||
Table 2.
Subgroup analysis of skeletal, soft tissue and dental variants with respect to age (<18 and ≥18 years).
| Skeletal measurements | |||
|---|---|---|---|
| SNA | ANB | ||
| <18 years | <18 years | ||
| Author name, Year | SMD (95% CI) | Author name, Year | SMD (95% CI) |
| Upadhyay M. et al., 2008 | 0.19 (−0.47, 0.84) | Upadhyay M. et al., 2008 | −0.95 (−1.64, −0.26) |
| Col S.S. Chopra et al., 2017 | 0.64 (0.07, 1.21) | Col S.S. Chopra et al., 2017 | 0.38 (−0.18, 0.94) |
| ≥18 years | ≥18 years | ||
| C-C Yao et al., | 0.70 (0.11, 1.29) | C-C Yao et al., | 0.61 (0.03, 1.20) |
| Al-Sibaie S. et al., 2013 | −0.05 (−0.57, 0.48) | Al-Sibaie S. et al., 2013 | 0.12 (−0.41, 0.64) |
| Koyama et al., | −0.14 (−0.88, 0.60) | Koyama et al., | −2.05 (−2.96, −1.13) |
| A-Y Lee et al., | 0.63 (−0.00, 1.27) | A−Y Lee et al., | 0.57 (−0.06, 1.20) |
| Mu Chen et al., | 0.10 (−0.61, 0.80) | Mu Chen et al., | −0.02 (−0.73, 0.68) |
| Y.H Liu et al., 2009 | −0.24 (−0.92, 0.43) | Y.H Liu et al., 2009 | −0.61 (−1.30, 0.07) |
| Soft tissue measurements | |||
| Nasolabial angle | Upper lip changes | ||
| <18 years | <18 years | ||
| Author name, Year | SMD (95% CI) | Author name, Year | SMD (95% CI) |
| Upadhyay M. et al., 2008 | 1.35 (0.63, 2.08) | Upadhyay M. et al., 2008 | −0.25 (−0.91, 0.41) |
| Col S.S. Chopra et al., 2017 | −0.59 (−1.15, 10.02) | ||
| Kuroda et al., 2009 | 0.94 (0.19, 1.68) | ||
| ≥18 years | ≥18 years | ||
| Al-Sibaie S. et al., 2013 | 0.72 (0.18, 1.26) | Al-Sibaie S. et al., 2013 | −0.31 (−0.83, 0.22) |
| Y.H Liu et al., 2009 | 0.22 (−0.45, 0.90) | Y.H Liu et al., 2009 | −0.77 (−1.47, −0.07) |
| Kuroda et al., 2009 | 0.53 (0.16, 0.91) | ||
| Dental variants | |||
| Mesiodistal movement of molars | Vertical movement of molars | ||
| <18 | <18 | ||
| Author name, Year | SMD (95% CI) | Author name, Year | SMD (95% CI) |
| Upadhyay M. et al., 2008 | −3.22 (−4.21, −2.23) | Upadhyay M. et al., 2008 | −0.91 (−1.59, −0.22) |
| J Sandler et al., 2014 | −0.58 (−1.05, −0.10) | ||
| Col S.S. Chopra et al., 2017 | −3.39 (−4.26, −2.53) | ||
| >18 | >18 | ||
| Upadhyay M. et al., 2008 | −2.56 (−3.53, −1.60) | Upadhyay M. et al., 2008 | −0.66 (−1.40, 0.07) |
| C-C Yao et al., | −0.64 (−1.23, −0.06) | Koyama et al., | 1.03 (0.24, 1.82) |
| Al-Sibaie S. et al., 2013 | −2.94 (−3.70, −2.18) | A-Y Lee et al., | 0.77 (0.13, 1.41) |
| Koyama et al., | −1.97 (−2.87, −1.07) | E H-H Lai et al., 2008 | −0.20 (−0.84, 0.43) |
| A-Y Lee et al., | 1.26 (0.58, 1.94) | Park et al., 2012 | −0.03 (−0.83, 0.77) |
| E H-H Lai et al., 2008 | −0.79 (−1.44, −0.13) | Y.H Liu et al., 2009 | −1.49 (−2.25, −0.73) |
| Park et al., 2012 | −1.33 (−2.21, −0.45) | ||
| Mu Chen et al., 2015 | −0.81 (−1.55, −0.08) | ||
| Y.H Liu et al., 2009 | −1.17 (−1.89, −0.44) | ||
| Mesiodistal movement of incisors | |||
| <18 | >18 | ||
| Author name, Year | SMD (95% CI) | Author name, Year | SMD (95% CI) |
| Upadhyay M. et al., 2008 | −0.37 (−1.03, 0.29) | Upadhyay M. et al., 2008 | −0.20 (−0.91, 0.52) |
| Col S.S. Chopra et al., 2017 | 0.14 (−0.41, 0.70) | C-C Yao et al., | −0.69 (−1.28, −0.10) |
| Al-Sibaie S. et al., 2013 | −0.51 (−1.04, 0.02) | ||
| Koyama et al., | 0.21 (−0.54, 0.95) | ||
| A-Y Lee et al., | 0.75 (0.11, 1.39) | ||
| E H-H Lai et al., 2008 | −0.80 (−1.46, −0.14) | ||
| Park et al., 2012 | −1.75 (−2.69, −0.81) | ||
| Mu Chen et al., 2015 | −1.08 (−1.84, −0.33) | ||
| Y.H Liu et al., 2009 | −1.21 (−1.94, −0.48) | ||
2. Experimental Design, Materials, and Methods
We searched electronic database through PubMed, Embase and Cochrane using the keywords “Skeletal anchorage”, “temporary anchorage devices”, “miniscrew implant”, “mini-implant”, “micro-implant” and searched the literature from inception to 2018. The search was conducted adhering to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis) guidelines. Thirteen studies were identified including 4 RCTs [1], [2], [3], [4] and 9 observational studies [5], [6], [7], [8], [9], [10], [11], [12], [13]. Methodological quality of the RCTs were assessed using Cochrane's Risk of Bias Tool, whereas non-RCTs were assessed using Newcastle-Ottawa scale. A data extraction protocol was defined and data were extracted using a customized data extraction sheet. The data were extracted from the full-text articles independently by 2 reviewer's and any disagreements was resolved through mutual consensus between the reviewers. Standard mean difference and 95% confidence interval was used as the absolute treatment effect estimate. The data was extracted and analysed using the Review Manager 5.3 software. The dental, skeletal and soft tissue changes were compared between the MIs and conventional anchorage devices. A subgroup analysis with patients aged <18 years and ≥18 years were also performed. A P value of <0.05 was considered to be statistically significant.
Ethics Statement
No humans or animals were involved in the data collection, the secondary data was sourced retrieved from PubMed, Embase and Cochrane databases.
Competing Interests
The authors declare that they have no known competing financial interests or personal relationships which have, or could be perceived to have, influenced the work reported in this article.
Acknowledgments
None
Declaration of Competing Interest
None.
References
- 1.Al-Sibaie S., Hajeer M.Y. Assessment of changes following en-masse retraction with mini-implants anchorage compared to two-step retraction with conventional anchorage in patients with class II division 1 malocclusion: a randomized controlled trial. Eur J Orthod. 2014;36:275–283. doi: 10.1093/ejo/cjt046. [DOI] [PubMed] [Google Scholar]
- 2.Upadhyay M., Yadav S., Nagaraj K., Patil S. Treatment effects of mini-implants for en-masse retraction of anterior teeth in bialveolar dental protrusion patients: A randomized controlled trial. Am. J. Orthod. Dentofac. Orthop. 2008;134 doi: 10.1016/j.ajodo.2007.03.025. 18-29.e1. [DOI] [PubMed] [Google Scholar]
- 3.Liu Y.H., Ding W.H., Liu J., Li Q. Comparison of the differences in cephalometric parameters after active orthodontic treatment applying mini-screw implants or transpalatal arches in adult patients with bialveolar dental protrusion. J. Oral Rehabil. 2009;36:687–695. doi: 10.1111/j.1365-2842.2009.01976.x. [DOI] [PubMed] [Google Scholar]
- 4.Sandler J., Murray A., Thiruvenkatachari B., Gutierrez R., Speight P., O'Brien K. Effectiveness of 3 methods of anchorage reinforcement for maximum anchorage in adolescents: A 3-arm multicenter randomized clinical trial. Am. J. Orthod. Dentofac. Orthop. 2014;146:10–20. doi: 10.1016/j.ajodo.2014.03.020. [DOI] [PubMed] [Google Scholar]
- 5.Kuroda S., Yamada K., Deguchi T., Kyung H.-M., Takano-Yamamoto T. Class II malocclusion treated with miniscrew anchorage: comparison with traditional orthodontic mechanics outcomes. Am. J. Orthod. Dentofac. Orthop. 2009;135:302–309. doi: 10.1016/j.ajodo.2007.03.038. [DOI] [PubMed] [Google Scholar]
- 6.Chopra S.S., Mukherjee M., Mitra R., Kochar G.D., Kadu A. Comparative evaluation of anchorage reinforcement between orthodontic implants and conventional anchorage in orthodontic management of bimaxillary dentoalveolar protrusion. Med J Armed Forces India. 2017;73:159–166. doi: 10.1016/j.mjafi.2016.01.003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Lee A.-Y., Kim Y.H. Comparison of movement of the upper dentition according to anchorage method: orthodontic mini-implant versus conventional anchorage reinforcement in class I malocclusion. ISRN Dent. 2011. 2011 doi: 10.5402/2011/321206. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Yao C.-C.J., Lai E.H.-H., Chang J.Z.-C., Chen I., Chen Y.-J. Comparison of treatment outcomes between skeletal anchorage and extraoral anchorage in adults with maxillary dentoalveolar protrusion. Am. J. Orthod. Dentofac. Orthop. 2008;134:615–624. doi: 10.1016/j.ajodo.2006.12.022. [DOI] [PubMed] [Google Scholar]
- 9.Koyama I., Iino S., Abe Y., Takano-Yamamoto T., Miyawaki S. Differences between sliding mechanics with implant anchorage and straight-pull headgear and intermaxillary elastics in adults with bimaxillary protrusion. Eur. J. Orthod. 2011;33:126–131. doi: 10.1093/ejo/cjq047. [DOI] [PubMed] [Google Scholar]
- 10.Chen M., Li Z.-M., Liu X., Cai B., Wang D.-W., Feng Z.-C. Differences of treatment outcomes between self-ligating brackets with microimplant and headgear anchorages in adults with bimaxillary protrusion. Am. J. Orthod. Dentofac. Orthop. 2015;147:465–471. doi: 10.1016/j.ajodo.2014.11.029. [DOI] [PubMed] [Google Scholar]
- 11.Upadhyay M., Yadav S., Patil S. Mini-implant anchorage for en-masse retraction of maxillary anterior teeth: a clinical cephalometric study. Am. J. Orthod. Dentofac. Orthop. 2008;134:803–810. doi: 10.1016/j.ajodo.2006.10.025. [DOI] [PubMed] [Google Scholar]
- 12.Park H.-M., Kim B.-H., Yang I.-H., Baek S.-H. Preliminary three-dimensional analysis of tooth movement and arch dimension change of the maxillary dentition in Class II division 1 malocclusion treated with first premolar extraction: conventional anchorage vs. mini-implant anchorage. Korean J. Orthod. 2012;42:280–290. doi: 10.4041/kjod.2012.42.6.280. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Lai E.H.-H., Yao C.-C.J., Chang J.Z.-C., Chen I., Chen Y.-J. Three-dimensional dental model analysis of treatment outcomes for protrusive maxillary dentition: comparison of headgear, miniscrew, and miniplate skeletal anchorage. Am. J. Orthod. Dentofac. Orthop. 2008;134:636–645. doi: 10.1016/j.ajodo.2007.05.017. [DOI] [PubMed] [Google Scholar]