Abstract
BackgroundNumerous surveys have shown that orthodontic mini implants (OMIs) are underused in clinical practice. To investigate this implementation issue, we conducted a systematic review to (1) identify barriers and facilitators to the implementation of OMIs for all potential stakeholders and (2) quantify these implementation constructs, i.e., record their prevalence. We also recorded the prevalence of clinicians in the eligible studies that do not use OMIs.MethodsMethods were based on our published protocol. Broad-spectrum eligibility criteria were defined. A barrier was defined as any variable that impedes or obstructs the use of OMIs and a facilitator as any variable that eases and promotes their use. Over 30 databases including gray literature were searched until 15 January 2016. The Joanna Briggs Institute tool for studies reporting prevalence and incidence data was used to critically appraise the included studies. Outcomes were qualitatively synthesized, and meta-analyses were only conducted when pre-set criteria were fulfilled. Three reviewers conducted all research procedures independently. We also contacted authors of eligible studies to obtain additional information.ResultsThree surveys fulfilled the eligibility criteria. Seventeen implementation constructs were identified in these studies and were extracted from a total of 165 patients and 1391 clinicians. Eight of the 17 constructs were scored by more than 50 % of the pertinent stakeholders. Three of these constructs overlapped between studies. Contacting of authors clarified various uncertainties but was not always successful. Limitations of the eligible studies included (1) the small number of studies; (2) not defining the research questions, i.e., the primary outcomes; (3) the research design (surveys) of the studies and the exclusive use of closed-ended questions; (4) not consulting standards for identifying implementation constructs; (5) the lack of pilot testing; (6) high heterogeneity; (7) the risk of reporting bias; and (8) additional shortcomings. Meta-analyses were not possible because of these limitations. Two eligible studies found that respectively 56.3 % (952/1691) and 40.16 % (439/1093) of clinicians do not use OMIs.ConclusionsNotwithstanding the limitations of the eligible studies, their findings were important because (1) 17 implementation constructs were identified of which 8 were scored by more than 50 % of the stakeholders; (2) the various shortcomings showed how to improve on future implementation studies; and (3) the underuse of OMIs in the selected studies and in the literature demonstrated the need to identify, quantify, and address implementation constructs. Prioritizing of future research questions on OMIs with all pertinent stakeholders is an important first step and could redirect research studies on OMIs towards implementation issues. Patients, clinicians, researchers, policymakers, insurance companies, implant companies, and research sponsors will all be beneficiaries.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0336-z) contains supplementary material, which is available to authorized users.
Highlights
Numerous surveys have shown that orthodontic mini implants (OMIs) are underused in clinical practice
Getting effective healthcare innovations into practice is often suboptimal [1,2,3]. This implementation issue applies to orthodontic mini implants (OMIs) because surveys worldwide have shown that many clinicians rarely or never use these devices [4,5,6,7,8] notwithstanding their promising success rates, effectiveness, and applicability [9,10,11]
The 34 excluded articles with their references were listed together with the rationale for their exclusion in Additional file 3. Most of these studies were excluded because patient health experiences or data on the use of OMIs were recorded but not implementation constructs
Summary
Numerous surveys have shown that orthodontic mini implants (OMIs) are underused in clinical practice To investigate this implementation issue, we conducted a systematic review to (1) identify barriers and facilitators to the implementation of OMIs for all potential stakeholders and (2) quantify these implementation constructs, i.e., record their prevalence. Getting effective healthcare innovations into practice is often suboptimal [1,2,3] This implementation issue applies to orthodontic mini implants (OMIs) because surveys worldwide have shown that many clinicians rarely or never use these devices [4,5,6,7,8] notwithstanding their promising success rates, effectiveness, and applicability [9,10,11]. Numerous anchorage systems have been developed for this purpose They generally apply forces to groups of teeth or use extraoral traction to the neck or cranium. OMIs are usually loaded immediately with orthodontic forces, and they are removed after the completion of the orthodontic treatment objectives
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