Table 8. Summary of findings according to the GRADE guidelines for the included trials.
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: We are very uncertain about the estimate
CI: confidence interval; SP: split-mouth design; COMP: compound design; LLLT: low-level laser therapy MOPs: micro-osteoperforations
a, bDecline in one level for risk of bias (bias due to deviations from intended interventions [35,38], bias arising from the randomization process, bias in the measurement of the outcome, and bias in the measurement of the outcome [35]), one level for indirectness**, and one level for imprecision***
c, h, jDecline in one level for risk of bias (bias due to deviations from intended interventions), one level for imprecision*** [37]
dDecline in one level for risk of bias (bias due to deviations from intended interventions, bias in the measurement of the outcome), one level for indirectness**, and one level for imprecision*** [35]
e, gDecline in one level for risk of bias (bias due to deviations from intended interventions), one level for imprecision*** [36]
f, gDecline in one level for risk of bias (bias arising from the randomization process, bias due to deviations from intended interventions, bias in the measurement of the outcome), one level for indirectness**, and one level for imprecision [16]
*Differences in results; **Outcome is not directly related; ***Limited number of trials
| Quality assessment criteria | Summary of findings | Comments | ||||||||
| Number of studies | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Number of patients | Effects | Certainty | ||
| Absolute (95% CI) | Relative (95% CI) | |||||||||
| Rate of canine retraction accelerated by multiple MOPs (every 4 weeks versus every 8 weeks) | ||||||||||
| 2 RCTs (COMP) | Serious | Not serious | Serious | Serious | None | 34 | - | Relative effect (95% CI): MD 0.24 (-0.28-0.77) | Very low ⊕⊖⊖⊖a | |
| Rate of canine retraction accelerated by multiple MOPs (every 4 weeks versus every 12 weeks) | ||||||||||
| 2 RCTs (COMP) | Serious | Not serious | Serious | Serious | None | 40 | - | Relative effect (95% CI): MD 0.06 (-0.14-0.27) | Very low ⊕⊖⊖⊖b | |
| Rate of canine retraction accelerated by multiple MOPs (2 times versus 1 time) | ||||||||||
| 1 RCT (SP) | Serious | Not serious | Not serious | Serious | None | 16 | - | Relative effect (95% CI): not estimable | Low ⊕⊕⊖⊖c | Application two-time MOP was more efficient than the one-time MOP (p<0.001) |
| Rate of upper canine retraction accelerated by combined techniques and a single application of technique | ||||||||||
| 1 RCT (COMP) | Serious | Not serious | Serious | Serious | None | 30 | - | Relative effect (95% CI): not estimable | Very low ⊕⊖⊖⊖d | The combination of MOPs + LLLT is superior to the application of each technique separately |
| 1 RCT (SP) | Serious | Not serious | Not serious | Serious | None | 16 | - | Relative effect (95% CI): not estimable | Low ⊕⊕⊖⊖e | The combination of corticotomy + LLLT was not more efficient than the application of corticotomy only |
| Time of upper canine retraction accelerated by combined techniques and a single application of technique | ||||||||||
| 1 RCT (COMP) | Serious | Not serious | Serious | Serious | None | 30 | - | Relative effect (95% CI): not estimable | Very low ⊕⊖⊖⊖f | Canine retraction took more time in multiple osteoperforations side than multiple osteoperforations + corticotomy side |
| Adverse effects: anchorage loss | ||||||||||
| 1 RCT (SP) | Serious | Not serious | Not serious | Serious | None | 16 | - | Relative effect (95% CI): not estimable | Low ⊕⊕⊖⊖g | Anchorage loss was greater on the corticotomy side than on the LLLT + corticotomy side |
| 1 RCT (SP) | Serious | Not serious | Not serious | Serious | None | 16 | - | Relative effect (95% CI): not estimable | Low ⊕⊕⊖⊖h | There was an insignificant difference in loss of anchorage between the one-time MOP side and the side of the two-time MOP (p<0.05) |
| Adverse effects: canine angulation | ||||||||||
| 1 RCT (COMP) | Serious | Not serious | Serious | Serious | None | 30 | - | Relative effect (95% CI): not estimable | Very low ⊕⊖⊖⊖i | Distal tipping and buccal inclination of canine were greater in the multiple osteoperforation + corticotomy side than the multiple osteoperforation side |
| 1 RCT (SP) | Serious | Not serious | Not serious | Serious | None | 16 | - | Relative effect (95% CI): not estimable | Low ⊕⊕⊖⊖j | There was an insignificant difference in canine tipping between the one-time MOP side and the side of the two-time MOP (p<0.05) |