Authors' response

Abstract

We thank the authors for their interest and feedback on our article.1Sivarajan S. Ringgingon L.P. Fayed M.M.S. Wey M.C. The effect of micro-osteoperforations on the rate of orthodontic tooth movement: a systematic review and meta-analysis.Am J Orthod Dentofacial Orthop. 2020; 157: 290-304Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar As the purpose of our review was to provide evidence for making the best clinical judgments, we have adhered strictly to the Cochrane guidelines for systematic review.2Higgins J.P. Savovic J. Page M.J. Sterne J.A. Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). RoB2 Development Group, 2019https://drive.google.com/file/d/19R9savfPdCHC8XLz2iiMvL_71lPJERWK/viewDate accessed: May 21, 2020Google Scholar We acknowledge the value of each and every one of the studies we reviewed and commend the good work by Alikhani et al.3Alikhani M. Raptis M. Zoldan B. Sangsuwon C. Lee Y.B. Alyami B. et al.Effect of micro-osteoperforations on the rate of tooth movement.Am J Orthod Dentofacial Orthop. 2013; 144: 639-648Abstract Full Text Full Text PDF PubMed Scopus (146) Google Scholar We rationalized their unique study design, and we acknowledge that no efforts were spared in order to obtain more accurate data. We understand the superiority of a controlled clinical trial, notwithstanding the influence of split-mouth characteristics, and this has not negatively impacted our risk-of-bias assessment of this study. We do also note that similar reviews have assigned similar overall judgments for this study with high risk of bias variously being ascribed for sequence generation and other bias.4Patterson B.M. Dalci O. Darendeliler M.A. Papadopoulou A.K. Corticotomies and orthodontic tooth movement: a systematic review.J Oral Maxillofac Surg. 2016; 74: 453-473Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar We do also accept that some degree of inconsistency in the conduct and interpretation of risk-of-bias assessment is commonplace.5Seehra J. Pandis N. Koletsi D. Fleming P.S. Use of quality assessment tools in systematic reviews was varied and inconsistent.J Clin Epidemiol. 2016; 69: 179-184.e5Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar We appreciate the researchers' efforts to address the device patent; however, we had to report this association as part of the review process. Furthermore, canine movement was measured against adjacent lateral incisors without clear indication whether this was a stable reference point, thereby also contributing to the unclear status. Despite randomization being done, there was no description of Random Sequence Generation.3Alikhani M. Raptis M. Zoldan B. Sangsuwon C. Lee Y.B. Alyami B. et al.Effect of micro-osteoperforations on the rate of tooth movement.Am J Orthod Dentofacial Orthop. 2013; 144: 639-648Abstract Full Text Full Text PDF PubMed Scopus (146) Google Scholar The method for allocation sequence concealment was also not described in detail, and therefore, we could not be certain that allocations could not have been foreseen before or during enrollment. The other 3 studies deemed to be high risk were due to observation periods,5Seehra J. Pandis N. Koletsi D. Fleming P.S. Use of quality assessment tools in systematic reviews was varied and inconsistent.J Clin Epidemiol. 2016; 69: 179-184.e5Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar,6Haliloglu-Ozkan T. Arici N. Arici S. In-vivo effects of flapless osteopuncture-facilitated tooth movement in the maxilla and the mandible.J Clin Exp Dent. 2018; 10: e761-e767PubMed Google Scholar conflicting data,7Feizbakhsh M. Zandian D. Heidarpour M. Farhad S.Z. Fallahi H.R. The use of micro-osteoperforation concept for accelerating differential tooth movement.J World Fed Orthod. 2018; 7: 56-60Abstract Full Text Full Text PDF Scopus (18) Google Scholar and use of unreliable measurement reference landmarks.6Haliloglu-Ozkan T. Arici N. Arici S. In-vivo effects of flapless osteopuncture-facilitated tooth movement in the maxilla and the mandible.J Clin Exp Dent. 2018; 10: e761-e767PubMed Google Scholar We also identified quality and reporting issues, including the absence of sample size calculations5Seehra J. Pandis N. Koletsi D. Fleming P.S. Use of quality assessment tools in systematic reviews was varied and inconsistent.J Clin Epidemiol. 2016; 69: 179-184.e5Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 6Haliloglu-Ozkan T. Arici N. Arici S. In-vivo effects of flapless osteopuncture-facilitated tooth movement in the maxilla and the mandible.J Clin Exp Dent. 2018; 10: e761-e767PubMed Google Scholar, 7Feizbakhsh M. Zandian D. Heidarpour M. Farhad S.Z. Fallahi H.R. The use of micro-osteoperforation concept for accelerating differential tooth movement.J World Fed Orthod. 2018; 7: 56-60Abstract Full Text Full Text PDF Scopus (18) Google Scholar and CONSORT flow chart or related descriptions.5Seehra J. Pandis N. Koletsi D. Fleming P.S. Use of quality assessment tools in systematic reviews was varied and inconsistent.J Clin Epidemiol. 2016; 69: 179-184.e5Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 6Haliloglu-Ozkan T. Arici N. Arici S. In-vivo effects of flapless osteopuncture-facilitated tooth movement in the maxilla and the mandible.J Clin Exp Dent. 2018; 10: e761-e767PubMed Google Scholar, 7Feizbakhsh M. Zandian D. Heidarpour M. Farhad S.Z. Fallahi H.R. The use of micro-osteoperforation concept for accelerating differential tooth movement.J World Fed Orthod. 2018; 7: 56-60Abstract Full Text Full Text PDF Scopus (18) Google Scholar We are aware that many studies4Patterson B.M. Dalci O. Darendeliler M.A. Papadopoulou A.K. Corticotomies and orthodontic tooth movement: a systematic review.J Oral Maxillofac Surg. 2016; 74: 453-473Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar, 5Seehra J. Pandis N. Koletsi D. Fleming P.S. Use of quality assessment tools in systematic reviews was varied and inconsistent.J Clin Epidemiol. 2016; 69: 179-184.e5Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 6Haliloglu-Ozkan T. Arici N. Arici S. In-vivo effects of flapless osteopuncture-facilitated tooth movement in the maxilla and the mandible.J Clin Exp Dent. 2018; 10: e761-e767PubMed Google Scholar, 7Feizbakhsh M. Zandian D. Heidarpour M. Farhad S.Z. Fallahi H.R. The use of micro-osteoperforation concept for accelerating differential tooth movement.J World Fed Orthod. 2018; 7: 56-60Abstract Full Text Full Text PDF Scopus (18) Google Scholar, 8Kundi I. Effect of flapless cortical perforation on canine retraction rate: a randomized clinical trial.Int Med J. 2018; 25: 116-118Google Scholar, 9Sivarajan S. Doss J.G. Papageorgiou S.N. Cobourne M.T. Wey M.C. Mini-implant supported canine retraction with micro-osteoperforation: a split-mouth exploratory randomized clinical trial.Angle Orthod. 2019; 89: 183-189Crossref PubMed Scopus (29) Google Scholar suggesting accelerated movement were excluded because of unfavorable appraisal; this does not always reflect a true lack of quality, but rather may sometimes relate to inadequate reporting. As this does affect our conclusion, we urge all future researchers to be mindful of CONSORT guidelines for optimal reporting of clinical trials in order to contribute meaningfully to future reviews. After an additional overall quality-of-evidence appraisal across all outcomes, our conclusion that single application micro-osteoperforations have no acceleration effect when observed over a short observation period, was based on only 2 studies10Attri S. Mittal R. Batra P. Sonar S. Sharma K. Raghavan S. et al.Comparison of rate of tooth movement and pain perception during accelerated tooth movement associated with conventional fixed appliances with micro-osteoperforations—a randomised controlled trial.J Orthod. 2018; 45: 225-233Crossref PubMed Scopus (25) Google Scholar,11Altman D.G. Schulz K.F. Moher D. Egger M. Davidoff F. Elbourne D. et al.The revised CONSORT statement for reporting randomized trials: explanation and elaboration.Ann Intern Med. 2001; 134: 663-694Crossref PubMed Scopus (2903) Google Scholar and the overall quality of the evidence was low. In essence, there is insufficient high-quality evidence to support that micro-osteoperforation is or is not effective for accelerating tooth movement. Researchers should not be disheartened but should instead continue to investigate and to publish more high-quality studies. Thank you for your kind feedback. We hope this discussion contributes to better understanding of the rigors of a systematic review in maintaining high evidence reporting standards and at the same time, draws attention to the limitations that surround such an exercise. MOPs and accelerated tooth movement: A biased conclusion?American Journal of Orthodontics and Dentofacial OrthopedicsVol. 158Issue 2PreviewWe read with interest the manuscript entitled, “The effect of micro-osteoperforations on the rate of orthodontic tooth movement: a systematic review and meta-analysis” by Sivarajan et al (Sivarajan S, Ringgingon LP, Fayed MMS, Wey MC. The effect of micro-osteoperforations on the rate of orthodontic tooth movement: a systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2020;157:290-304). After our careful and thorough reading of the work by Sivarajan et al, we are compelled to address significant flaws in their methodology that influence their conclusions. Full-Text PDF