Orthodontic Miniscrew Implants Research Articles

Assessment of Bone Thickness at the Infra Zygomatic Crest Region for Various Orthodontic Miniscrew Implant (OMSI) Insertion Angles: A Cone-Beam Computed Tomographic Study.

To evaluate the infrazygomatic crest (IZC) bone and develop guidelines for the optimum placement of orthodontic miniscrew implants (OMSIs) along the distobuccal root of the permanent maxillary first molar. Bone thickness of the IZC region of 50 young adults (25 males and 25 females) aged 18-30 years were evaluated using cone-beam computed tomography images. The infrazygomatic bone thickness along the distobuccal root of the permanent maxillary first molar was assessed at various insertion angles (40° to 75° i.r.t the maxillary occlusal plane) with an increment of 5°. Student's t-test was used to compare the IZC bone thickness and height at the orthodontic miniscrew insertion site for males and females on the right and left sides. The bone thickness of the IZC region above the distobuccal root of the permanent maxillary first molar was estimated between 4.39±0.25 mm and 9.03±0.45 mm for insertion angles from 40° to 75° to the maxillary occlusal plane. The corresponding OMSI insertion heights were 17.71±0.61 mm to 13.69±0.75 mm, respectively, above the maxillary occlusal plane. There were statistically significant gender and side-wise variations in bone thickness at the IZC area and insertion height. The safe position for OMSI placement at the IZC was 13.69-16 mm from the maxillary occlusal plane with an insertion angle between 55° and 75°. These parameters provide the optimum placement of OMSIs along the distobuccal root of the permanent maxillary first molar.

A Comparative Evaluation of Surface and Elemental Changes in Stainless Steel and Titanium Orthodontic Mini-screw Implants: A Multi-arm Randomized Control Trial.

The present study aimed to compare and quantify the surface changes seen in two most commonly used orthodontic miniscrew implants (MSI) materials; titanium and stainless steel after their clinical use. 40 MSIs (20 titanium and 20 stainless steel) were retrieved from the maxillary arch of 20 subjects (13 females and 7 males) in the age group of 18 - 27 years (mean age=22.4 ± 3.83 years) after their intended use. 40 (20 titanium and 20 stainless steel) asreceived MSIs were used as control. All the MSIs were analyzed under a Scanning Electron Microscope (SEM) for the characterization of their morphological condition (blunting of tip, surface defects and corrosion). Furthermore, Energy Dispersive X-ray (EDX) microanalysis was carried out to study the changes in surface characterization. When imaged using SEM, as-received Titanium and Stainless Steel MSIs demonstrated a relatively smooth surface with no surface defects. However, the retrieved titanium and stainless-steel implants showed increased surface defects (both corrosion and cracks) with the difference being statistically significant. The retrieved Titanium MSIs (115.31±24.38μm) showed 4 times more blunting compared to the retrieved Stainless-steel MSIs (29.74±8.56 μm), with the latter showing 2-3 times more surface corrosion. Clinical usage had pronounced effects on both Titanium and Stainless steel MSI alloys in terms of changes in the surface characteristics. While stainless steel MSIs are more susceptible to surface corrosion, Titanium MSIs exhibit greater alterations in the form of tipblunting and cracks in screw threads.

A pattern of microbiological colonization of orthodontic miniscrew implants

Current orthodontic literature reveals a lack of studies on bacterial colonization of orthodontic miniscrew implants (MSI) and their role in the stability of MSI. This study aimed to determine the pattern of microbiological colonization of miniscrew implants in 2 major age groups, to compare it with the microbial flora of gingival sulci in the same group of patients and to compare microbial flora in successful and failed miniscrews. The study involved 102 MSI placed in 32 orthodontic subjects in 2 age groups: (1) aged≤14 years and (2) aged>14 years. Gingival and peri-mini implant crevicular fluid samples were collected using sterile paper points (International Organization for Standardization no. 35)>3 months and processed by conventional microbiologic culture and biochemical techniques. A microbiologist characterized and identified the bacteria, and the results were subjected to statistical analysis. Initial colonization was reported within 24 hours, with Streptococci being the dominant colonizer. The relative proportion of anaerobic bacteria over aerobic bacteria increased over time in peri-mini implant crevicular fluid. Group 1 had greater Citrobacter (P= 0.036) and Parvimonas micra (P= 0.016) colonizing MSI than group 2. Failed MSI showed a significantly higher presence of Parvimonas micra (P= 0.008) in group 1 and Staphylococci (P= 0.008), Enterococci (P= 0.011), and Parvimonas micra (P<0.001) in group2. Microbial colonization around MSI is established within 24 hours. Compared to gingival crevicular fluid, peri-mini implant crevicular fluid is colonized by a higher proportion of Staphylococci, facultative enteric commensals and anaerobic cocci. The failed miniscrews showed a higher proportion of Staphylococci, Enterobacter, and Parvimonas micra, suggesting their possible role in the stability of MSI. The bacterial profile of MSI varies with age.

Mini-implant Supported Temporary Replacement of Teeth in ChildrenA Case Report

Dental agenesis or hypodontia is a frequent cause of tooth loss in children, most common being the maxillary lateral incisors. The absence of teeth affects aesthetics and results in functional impairment that hampers the psychological development of the young child. Treatment options available for replacement of congenitally missing teeth include fixed and removable dentures, resin-related retention devices, and single-tooth implants. The main deterring factor for implant placement in young children is the impending growth. To overcome this drawback, one can use self-drilling, one-piece orthodontic mini screw implants as a temporary abutment for the replacement of congenitally missing teeth. Mini-implant with temporary crown can serve as a permanent dental restoration for a growing child as the mini-implant is well maintained throughout his/her growth period without significant changes in skeletal morphology. This case report deals with a 12-year-old young girl patient, who has been treated with self-drilling orthodontic miniimplant with a strip crown for her congenitally missing bilateral lateral incisors, without any complications with six months follow-up.

The association between thread pitch and cortical bone thickness influences the primary stability of orthodontic miniscrew implants: a study in human cadaver palates

ObjectiveThe purpose of this study was to mathematically evaluate the influence of variations in thread pitch and cortical bone thickness on the maximum insertion torque (MIT) and implant stability (IS) of miniscrew implants (MIs). MethodsSixty custom made MIs with a 0.4-, 0.6-, 0.8-, 1.0-, or 1.2-mm thread pitch,12 for each pitch, were randomly placed into the palates of 10 embalmed human maxillae. The MIT was measured with a hand-operated digital torque reader screwdriver with a holding guide, and the IS test was performed using Anycheck. Conebeam computerized tomography was used to measure the cortical bone thickness(CBT) at each MI site. One-way ANOVA, Tukey post hoc test, Pearson's correlation,and multiple linear regression models were performed using the SPSS program. ResultsThe MIT and IS tests demonstrated a pitch-dependent decrease. The pitch had a strong negative correlation with MIT and IS, while the CBT had a strong positive correlation with those outcomes. The association between pitch and CBT significantly influenced MI primary stability. Moreover, a strong correlation was found between MIT and IS. ConclusionsThe MI primary stability, MIT, and IS are strongly influenced by theassociation between MI thread pitch and CBT.

Cytotoxicity effect of orthodontic miniscrew-implant in different types of mouthwash: An in-vitro study.

CONTEXT:Orthodontic miniscrew implants (OMIs) are widely used as anchorage alternatives, but recent studies revealed the corrosion behavior of OMIs when they come in contact with mouthwashes. The corrosion materials that are released can cause toxicity, allergy, and mutagenicity.AIMS:This study aims to analyze the cytotoxicity effects of OMIs exposed to different types of mouthwash using human gingival fibroblast (HGFs).SETTINGS AND DESIGN:Experimental laboratory research.METHODS AND MATERIAL:Twenty-eight samples of Ti alloy OMIs immersed separately in four groups of different types of mouthwash (chlorhexidine gluconate 0.2% mouthwash (CHX), fluoridated (sodium fluoride 0.2%) mouthwash, chitosan mouthwash 1.5%, and aquadest) for 28 d. Elution of each group and the mouthwash itself were added to the cell culture and incubated for 24 h. Changes in cell viability were performed by MTT Assay.STATISTICAL ANALYSIS USED:Data were tested for normality with Shapiro–Wilk, homogeneity with Levene test, and analyzed using an independent T-test (P < 0.05).RESULTS:The differences between the cytotoxicity of the elution of MIO and the mouthwash solution itself in the group of CHX and Fluoride were statistically significant (P < 0.05). No significant differences were found in the group of chitosan and aquadest (P > 0.05).CONCLUSIONS:The 1.5% chitosan mouthwash can be offered to patients with Ti alloy-based OMIs rather than the 0.2% chlorhexidine gluconate and 0.2% sodium fluoride mouthwashes.

Effects of root contact length on the failure rate of anchor screw.

This study aimed to evaluate the causal relationship between root contact and root contact length of orthodontic miniscrew implants (miniscrews), and assessed factors for implant failure through cone-beam computed tomography (CBCT) images. First, a logistic regression analysis was performed to investigate the most relevant factors for implant failure based on sex, age, vertical skeletal pattern, horizontal skeletal pattern, and presence of root contact in 59 patients (mean age: 21.2, age range: 13-54 years) who had miniscrew implants. Next, 38 miniscrews (1.6 mm in diameter and 8.0 mm in length) with root contact were investigated in the patients. Root contact length was measured using CBCT taken after miniscrew implant placement. The results showed that root contact was the most critical risk factor for failure of miniscrew implants in patients. Logistic regression analysis showed that the risk approximately doubled as the root contact length increased by 1.0 mm. Avoiding proximity to the root during miniscrew implant placement is essential to prevent implant failure.

Cortical bone microdamage produced by micro-osteoperforation screws versus orthodontic miniscrews: an in vitro study

Abstract Background/objective The alternative use of Orthodontic Miniscrew Implants (OMIs), traditionally used for skeletal anchorage, to facilitate micro-osteoperforations (MOPs) for accelerating orthodontic tooth movement has been reported in previous studies. The objective of the present in vitro study was to compare the microdamage generated by OMIs and MOP-purposed screws of similar dimensions in porcine cortical bone. Materials and methods Forty rectangular porcine cortical bone specimens of 1.5 mm thickness were produced and divided into two equal groups. According to group allocation, either a single MOP screw or OMI was inserted and later removed. A sequential staining protocol was carried out to distinguish true microdamage created upon screw insertion and removal from iatrogenic damage. The bone specimens were imaged by a confocal laser scanning microscope, and five histomorphometric measurements described and quantified the generated microdamage. Results On the entry (outer) bone surface, the OMI screws produced greater microdamage which reached statistical significance across all of the histomorphometric parameters. In contrast, a statistically significant increase in microdamage was created following MOP screw insertion on the exit (inner) bone surface, but only in three assessment parameters, recorded as total damage area, as well as diffuse damage area and radius. Conclusions Overall, the present study showed that 1.5 mm OMIs produced slightly greater microcrack-type and diffuse damage-type microdamage than the 1.6 mm diameter MOP screws. However, these differences were small and considered clinically insignificant.

Reduction of Insertion Torque on Orthodontic Mini-screw Implant by means of Reduced Friction

In this article, the reduction of insertion torque on the orthodontic mini-screw implants (OMI) was studied. Three types of diamond-like carbon (DLC) films (DLC, Si-DLC, and F-DLC) were deposited on the OMIs by plasma-based ion implantation technique. The maximum insertion torque (MIT) value was measured using a physiodispenser during insertion on a mandibular pig jaw. Ten OMIs of each condition were used to evaluate the MIT values compared to the Ti-6Al-4V typed OMI. The statistical analysis of data was analyzed by One-way analysis of variance (ANOVA) and Tukey HSD. The results indicated that the Ti-6Al-4V showed the highest MIT but not significantly different from the F-DLC (P &gt;0.05). DLC and Si-DLC showed a significant reduction in MIT comparing to the Ti-6Al-4V (P &lt;0.05). However, the Si-DLC showed the lowest MIT among groups (P &lt;0.05). This phenomenon was due to the decreasing friction coefficient during OMI's insertion on a mandibular pig jaw. Therefore, the DLC coating, especially Si-DLC, could reduce the MIT value of OMI. It is thought that the lowering friction coefficient yields the lowering of MIT value. Keywords: Diamond-like carbon, Friction, Insertion torque, Mini-screw implant

Influence of low-level-laser therapy on the stability of orthodontic mini-screw implants. A systematic review and meta-analysis.

The influence of low-level-laser therapy (LLLT) on the stability of orthodontic mini-screw implants (MSIs) has not been systematically reviewed. The aim was to assess the influence of LLLT on the stability of orthodontic MSIs. An unrestricted search of indexed databases was performed. Randomized controlled clinical trials (RCTs) investigating the influence of LLLT on orthodontic MSI stability. Two authors independently performed study retrieval and selection, and data extraction. The risk of bias (RoB) of individual studies was assessed using the Cochrane RoB Tool for RCTs. Meta-analyses were performed separately for RCTs using periotest and resonance frequency analysis (RFA) to measure MSI stability; and a random effects model was applied. Subgroup analyses were performed based on the time-points of MSI stability evaluation. The quality of available evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation approach. Initially, 1332 articles were screened. Six RCTs with a split-mouth design were included. The periotest was used in 4 RCTs and 2 RCTs used RFA to measure MSI stability. All RCTs had a low RoB. Subgroup analyses based on periotest indicated that MSIs treated with LLLT had significantly higher stability than untreated MSIs at 21 and 30 days [weighted mean difference (MD) = -2.76, confidence interval (CI): [-4.17, -1.36], P-value = 0.0001) and at 60 days (weighted MD = -3.47, CI: [-4.58, -2.36], P < 0.00001); and the level of certainty was high. Subgroup analyses based on RFA showed higher stability of MSIs treated with than without LLLT at 56 and 60 days (standardized MD = 0.82, CI: [0.32, 1.32], P = 0.001), and at 70 and 90 days (standardized MD = 0.86, CI: [0.36, 1.36], P = 0.0007); and the level of certainty was moderate. Due to limited number of relevant studies, it was not possible to perform sensitivity analysis, subgroup analyses for patient and intervention-related characteristics, and reporting biases assessment. The role of LLLT on the secondary stability of MSIs placed in patients undergoing OT remains debatable. PROSPERO (CRD42021230291).

Complications reported with the use of orthodontic miniscrews: A systematic review.

ObjectiveThe aim of this systematic review was to evaluate the complications and side effects associated with the clinical use of orthodontic miniscrews by systematically reviewing the best available evidence.MethodsA survey of articles published up to March 2020 investigating the complications associated with miniscrew insertion, in both the maxilla and mandible, was performed using 7 electronic databases. Clinical studies, case reports, and case series reporting complications associated with the use of orthodontic miniscrew implants were included. Two authors independently performed study selection, data extraction, and risk-of-bias assessment.ResultsThe database survey yielded 24 articles. The risk-of-bias assessment revealed low methodological quality for the included studies. The most frequent adverse event reported was root injury with an associated periradicular lesion, vitality loss, pink discoloration of the tooth, and transitory loss of pulp sensitivity. Chronic inflammation of the soft tissue surrounding the miniscrew with mucosal overgrowth was also reported. The other adverse events reported were lesion of the buccal mucosa at the insertion site, soft-tissue necrosis, and perforation of the floor of the nasal cavity and maxillary sinus. Adverse events were also reported after miniscrew removal and included secondary bleeding, miniscrew fracture, scars, and exostosis.ConclusionsThese findings highlight the need for clinicians to preliminarily assess generic and specific insertion site complications and side effects.

Cytotoxic effects of titanium alloy orthodontic mini-screw implants: Clinical prospective study

Objectives: to evaluate possible cytotoxic effects of titanium alloy (Ti alloy) orthodontic mini-screw implants on the surrounding oral mucosal cells. Materials and Methods: Thirty orthodontic mini-screw implants (MSIs) installed to serve as anchorage for maxillary canine retraction after maxillary first premolar extraction. Fifteen female orthodontic patients with mean age of 16.11 ± 1.68 years were consented to participate in the study, which ran for four months. The orthodontic appliance consisted of direct-bonded Roth monocrystalline ceramic brackets, and teflon-coated preformed archwires. Clinical evaluation of MSIs and oral hygiene condition were evaluated throughout the study period. Percentage of oral mucosa cells’ DNA fragmentation were analyzed before insertion of MSIs, after one week, one month, three months and four months of MSIs insertion with the Comet assay analysis. Results: ANOVA test showed statistically significant decrease in oral hygiene condition during the study period. Statistically insignificant difference was evident in DNA fragmentation index of the collected oral mucosal cell in different time intervals. Conclusions: Orthodontic titanium alloy MSIs were biocompatible and demonstrated no cytotoxic effects on oral mucosal cells.

Assessment of the effect of the length of orthodontic mini-screw implants on their long-term stability

Assessment of the effect of the length of orthodontic mini-screw implants on their long-term stability

Three-dimensional Evaluation of Interradicular Areas and Cortical Bone Thickness for Orthodontic Miniscrew Implant Placement Using Cone-beam Computed Tomography.

ABSTRACTBackground:Factors that influence anchorage of the orthodontic miniscrew implants are interradicular areas and cortical bone thickness.Aims and Objectives:The aim of this study was to evaluate the three-dimensional interradicular areas and the buccal cortical bone thickness in Indian patients using cone beam computed tomography (CBCT) images, and to find the suitable and safe sites for orthodontic miniscrew implant placement.Materials and Methods:CBCT images of 20 patients were divided into three planes as axial, coronal, and sagittal. Measurements, that is, mesiodistal distance and buccal cortical bone thickness were taken at five different heights from the cementoenamel junction (CEJ) toward apical region.Results:In the maxilla, the safe sites for placing miniscrew implant were between the second premolar and first molar at 10-mm height, whereas in the mandible, the safe sites for placing miniscrew implant were between the first and second premolar at 6-, 8-, and 10-mm height, between the second premolar and first molar at 10-mm height, and between the first and second molar at 8- and 10-mm height.Conclusion:CBCT can be effectively used to evaluate interradicular areas and cortical bone thickness in predicting the safe and suitable sites for placing orthodontic miniscrew implants.

Assessment of microdamage caused by orthodontic miniscrew pilot holes

Abstract Introduction The clinical success of orthodontic miniscrew implants may be improved after pre-drilling a pilot hole. However, the amount of microdamage to the bone surface produced by the pilot hole is largely unknown. The present study aimed to quantify the damage to cortical bone after the creation of a pilot hole. Materials and methods Porcine tibia bone was prepared into 30 rectangular bone block specimens with widths of 1.5, 2.0 or 2.5 mm. A pilot hole (0.9 mm diameter) was drilled into each bone specimen. Sequential staining allowed the microdamage on the entry and exit surfaces to be imaged by a confocal laser scanning microscope. Image analysis software was used to measure histomorphometric parameters. Results The specimens had a mean total damage area of 0.95 mm2, a maximum damage radius of 0.66 mm and a maximum crack length of 0.18 mm. There were no significant differences between the three bone thicknesses for any of the histomorphometric parameters on the entry and exit surfaces (p &gt; 0.05). The total damage area was significantly greater on the exit surface compared to the entry surface (p &lt; 0.0001). Conclusions Microdamage caused by the creation of a pilot hole in the cortical bone was minimal and did not appear to be influenced by bone thickness. Therefore, pilot hole pre-drill protocols may be implemented without introducing significant cortical bone microdamage.

Preliminary testing for reduction of insertion torque of orthodontic mini-screw implant using diamond-like carbon films

Nowadays, titanium alloy is widely used as orthodontic mini-screw implants due to its suitable mechanical properties and excellence in biocompatibility. However, the excessive torques applied during the insertion of orthodontic mini-screw implant can cause necrosis of the surrounding bone. In this article, the insertion torque of orthodontic mini-screw implants is aimed to reduce during treatment by means of surface coating. The three types of coatings, namely, DLC, F-DLC 2:1 and Si-DLC 2:1 coated on orthodontic mini-screw implants were chosen to take into account the insertion torque values compared with uncoated surface. The friction behaviors of the films in ambient air and dry air were assessed using ball-on-disk friction testing. Cytotoxicity tests were performed using MTT assay. The insertion torque values were measured by physiodispenser. The results indicated that, both measured in ambient air and dry air, the addition of F into the DLC films slightly influenced the friction coefficients, while doping with Si strongly influenced the films. These films also exhibited less cytotoxicity on their surfaces. Furthermore, the insertion torque values decreased when coated orthodontic mini-screw implants with F-DLC 2:1 and Si-DLC 2:1 films. Therefore, the F-DLC 2:1 and Si-DLC 2:1 films can be considered to apply on orthodontic mini-screw implant for reducing the insertion torque.

An Innovative Use of Vacuum-Formed Appliance for Molar Intrusion and Immediate Aesthetic Rehabilitation

A number of methods are available for correcting an isolated supra-erupted molar. The most commonly used method involves using orthodontic miniscrew implants with supporting spring and elastics. This article describes a simple, non-invasive and versatile method of intrusion of the isolated supra-erupted molar. The method used provides additional benefits in not only being pain-free while providing continuous force but also being flexible enough to inculcate other design modifications to suit the patient’s need.

Effectiveness of Orthodontic Mini-Screw Implants in Adult Deep Bite Patients during Incisor Intrusion: A Systematic Review.

Aims:The aim of this systematic review was to compare the effectiveness of temporary anchorage devices (TADs) and conventional segmented arches (CSAs) during incisor intrusion in adult patients with a deep bite and their adverse effects.Settings and Design:Four electronic databases were searched. In addition, articles were manually searched for using the reference lists of relevant articles, grey literature, and peer-reviewed orthodontic journals.Subjects and Methods:Data from the retrieved articles were selected and evaluated by two independent reviewers using a new systematic review software program, DistillerSR. A meta-analysis of raw mean differences was performed.Results:Initially, we retrieved 9600 articles, but the selection process resulted in six articles. The included studies ranged from low to high in quality. Meta-analysis showed that TADs enabled 0.78 mm more upper incisor intrusion than the conventional method (95% confidence interval [CI] = 0.28–1.29). There was no significant anchorage loss difference in the CSA group compared to the TAD group (mean difference [MD] −3.68; 95% CI −7.41–0.05). Furthermore, a significant molar tipping of 1.03° was observed in the CSA group (P = 0.008) compared to the TAD group (MD −1.03; 95% CI −1.79–−0.27).Conclusions:The results of this meta-analysis showed that patients receiving TADs had 0.78 mm greater upper incisor intrusion than patients receiving the conventional treatment. This was statistically significant, but not clinically relevant. No clinical difference was found between TADs and the conventional method of anchorage loss.

EFFECT OF SURFACE TREATMENT OF ORTHODONTIC MINI-SCREW IMPLANTS ON THEIR STABILITY; IN VIVO STUDY

Purpose: To evaluate the effect of anodization surface treatment on the stability of minimplants ( MIs ) during en-masse retraction. Materials and Methods: The sample of this split mouth; clinical trial, consisted of 27 patients with an allocation ratio of 1:1. Forty five MIs (1.8 mm diameter and 8 mm length) were divided into: 27 MIs with surface treatment by anodization technique while the other 27 were with smooth surface (group B). Finishing, leveling and alignment, the surface treated MIs and the smooth ones were randomly inserted between the roots of maxillary 2nd bicuspid and 1st molar at the mucogingival junction on both sides of each patient. After two weeks healing period, bilateral extraction of maxillary 1st bicuspids were done. Closed coil spring was extended from the MI head to along hock secured onto the main arch wire between the maxillary lateral incisor and canine on both sides, delivering 200 g force per side to en-masse retract the upper anterior teeth. The average observation period lasted 9–12 months. Results: In total, 40 of 54 minimplants were able to achieve the treatment goals. In group A, 22 (81.5%) mini-screw implants presented long-term stability, while in group B, only 18 (66%) minimplants were stable throughout the treatment. This difference was statistically significant (P =.0311). The total success rate for all inserted miniscrew implants was 74%. Conclusion: Anodized surface treated orthodontic mini-screw implants are more stable than smooth surface one during en-mass retraction.

Effectiveness of orthodontic miniscrew implants in anchorage reinforcement during en-masse retraction: A systematic review and meta-analysis.

The aim of this systematic review was to compare the effectiveness of orthodontic miniscrew implants-temporary intraoral skeletal anchorage devices (TISADs)-in anchorage reinforcement during en-masse retraction in relation to conventional methods of anchorage. A search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science was performed. The keywords were orthodontic, mini-implants, miniscrews, miniplates, and temporary anchorage device. Relevant articles were assessed for quality according to Cochrane guidelines and the data extracted for statistical analysis. A meta-analysis of raw mean differences concerning anchorage loss, tipping of molars, retraction of incisors, tipping of incisors, and treatment duration was carried out. Initially, we retrieved 10,038 articles. The selection process finally resulted in 14 articles including 616 patients (451 female, 165 male) for detailed analysis. Quality of the included studies was assessed as moderate. Meta-analysis showed that use of TISADs facilitates better anchorage reinforcement compared with conventional methods. On average, TISADs enabled 1.86mm more anchorage preservation than did conventional methods (P<0.001). The results of the meta-analysis showed that TISADs are more effective than conventional methods of anchorage reinforcement. The average difference of 2mm seems not only statistically but also clinically significant. However, the results should be interpreted with caution because of the moderate quality of the included studies. More high-quality studies on this issue are necessary to enable drawing more reliable conclusions.