Abstract
BackgroundMost orthodontic treatment plans need some form of anchorage to control the reciprocal forces of tooth movement. Orthodontic mini implants (OMIs) have been hailed for having revolutionized orthodontics, because they provide anchorage without depending on the collaboration of patients, they have a favorable effectiveness compared with conventional anchorage devices, and they can be used for a wide scale of treatment objectives. However, surveys have shown that many orthodontists never or rarely use them. To understand the rationale behind this knowledge-to-action gap, we will conduct a systematic review that will identify and quantify potential barriers and facilitators to the implementation of OMIs in clinical practice for all potential stakeholders, i.e., patients, family members, clinicians, office staff, clinic owners, policy makers, etc. The prevalence of clinicians that do not use OMIs will be our secondary outcome.MethodsThe Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 Statement was adopted as the framework for reporting this manuscript. We will apply broad-spectrum search strategies and will search MEDLINE and more than 40 other databases. We will conduct searches in the gray literature, screen reference lists, and hand-search 12 journals. All study designs, stakeholders, interventions, settings, and languages will be eligible. We will search studies that report on barriers or facilitators to the implementation of orthodontic mini implants (OMIs) in clinical practice. Implementation constructs and their prevalence among pertinent stakeholders will be our primary outcomes. All searching and data extraction procedures will be conducted by three experienced reviewers. We will also contact authors and investigators to obtain additional information on data items and unidentified studies. Risk of bias will be scored with tools designed for the specific study designs. We will assess heterogeneity, meta-biases, and the robustness of the overall evidence of outcomes. We will present findings in a systematic narrative synthesis and plan meta-analyses when pertinent criteria are met.DiscussionKnowledge creation on this research topic could identify and quantify both expected and unexpected implementation constructs and their stakeholders. Such knowledge can help develop strategies to address implementation issues and redirect future studies on OMIs towards knowledge translation. This could lead to improved patient-health experiences and a reduction in research waste.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0198-4) contains supplementary material, which is available to authorized users.
Highlights
Most orthodontic treatment plans need some form of anchorage to control the reciprocal forces of tooth movement
Summary measures for a quantitative synthesis The prevalence data for our primary outcomes will be presented as event rates, e.g., 0.70, which indicate that 70 stakeholders scored a particular construct as a barrier to the implementation of Orthodontic mini implants (OMIs) out of a total sample of 100 stakeholders that scored on the role of this particular construct as a barrier to the implementation of OMIs in clinical practice
Event rates will be recorded for our secondary outcomes, which represent the number of clinicians that do not use OMIs/the total number of surveyed clinicians that reported on the use of OMIs in clinical practice
Summary
Most orthodontic treatment plans need some form of anchorage to control the reciprocal forces of tooth movement. The introduction of a new technique into a health-care system is a complex process, depends on the successful interaction between a variety of stakeholders, but often fails [1,2,3,4] This failure is a global problem and has created a knowledge-to-action (KTA) gap, which is the gap between evidence-based knowledge and the use of this information in practice [5]. Anchorage is necessary in most orthodontic treatment plans and is usually obtained by applying forces to groups of teeth or through extra-oral sources, for example, the neck or cranium [10] These techniques pose serious limitations such as (1) their restricted area of application, (2) they may still cause loss of anchorage, and (3) they depend on the collaboration of the patient [10]. Implementation can be conditioned by variables such as (1) the lack of knowledge and skills of clinicians to conduct such interventional procedures; (2) the lack of knowledge-management skills of pertinent stakeholders; (3) lack of an adequate organization; (4) lack of time and resources; (5) attitudes towards new knowledge; (6) perceptions of various stakeholders regarding the quality and validity of the evidence on OMIs; (7) resistance within the organization; and (8) resistance from the patient [5]
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