Abstract
Objective: The aim of this systematic review was to compare the clinical failure rate of orthodontic miniscrews in maxilla and mandible. Material and Methods: Randomized controlled trials of patients in orthodontic treatment, which required miniscrews for orthodontic intervention reporting the failure rate of miniscrews in the maxilla and mandible were searched in Pubmed database. Two authors independently reviewed all identified titles and abstracts for eligibility. Comparison between failures in maxilla and mandible were estimated using pairwise meta-analysis to calculate the relative risk (RR) of failure and the 95% confidence intervals using a random-effect model. The reports of randomized trials were assessed for bias using the Cochrane risk of bias tool. Results: Four studies fulfilled the eligibility criteria. 299 patients with a total of 628 miniscrews installed were included in the analysis. The analysis showed a 0.55 RR (95% CI 0.23–1.29) and I2 = 85%. All studies had an unclear risk of bias regarding to the two following items: allocation concealment, blinding of participants and personnel. All studies had a low risk of bias with regard to incomplete outcome data and selective reporting. The results did not demonstrate statistical difference between risk of failure of miniscrew between maxilla and mandible. Conclusion: The results of the meta-analysis showed that miniscrews installed in maxilla presents reduced risk of failure. A tendency of higher number of failures in mandible was also demonstrated. However, results should be interpreted with caution because of the very low quality of included studies and the differences among methodologies. KeywordsMeta-analysis; Orthodontic anchorage procedures; Review.
Highlights
Several forms of orthodontic anchorage have been described in the literature
Among all temporary skeletal anchorages those are the ones that best suit the characteristics required for this type of anchorage when conventional anchorage cannot be achieved or is insufficient to promote the desirable orthodontic movements
This systematic review was based on Cochrane Handbook Guidelines for Intervention Systematic Reviews [7] and followed the four phases of Flowchart based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement [8]
Summary
Several forms of orthodontic anchorage have been described in the literature. When treating severe occlusion problems, the indication of temporary anchorage devices (TADs) may optimize results with simpler mechanics or reducing the treatment time [1]. Among the desirable characteristics of MS are their reduced size, easy placement, resistance to applied orthodontic forces, ability to receive immediate loading, use in conjunction with various orthodontic mechanics, easy installation, easy removal and low cost [2,3]. It is a consensus in orthodontic literature that some dental movements may be considered more complex, such as dental intrusion due to loss of vertical dimension or absence of the opposing teeth, retraction of the anterior teeth or even distalization of posterior teeth [4]. Even representing one of the main innovations in the clinical orthodontic practice over the last 20 years, one of the most frustrating complications of MS is their loss during use as absolute anchorage [5]
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