Orthodontic treatment is used to correct the alignment of teeth that are crooked or sticking out by moving the affected teeth. The teeth are straightened by using a brace. Sometimes there is unwanted movement of other teeth during the treatment. This is controlled by what is known as anchorage, or methods for stabilising these teeth. Conventionally, anchorage sites are inside the mouth (intraoral) using teeth for example, or alternatively outside the mouth (extraoral), using headgear devices attached to the head or neck. As an alternative to these conventional methods, surgical techniques have been developed to put dental implants into bone in the mouth to provide a firm structure for anchorage. This research reviews the evidence on these methods to find out which is most effective for anchorage in orthodontic treatment.
What was the research?
A systematic review of the evidence to assess the effects of using implants surgically placed in bone in the mouth in order to stabilise (anchor) teeth during treatment with orthodontic braces, and compares implants with the use of conventional methods. It also assess the effects of different surgical anchorage techniques
Who conducted the research?
The research was conducted by a team led by Safa Jambi, on behalf of the Cochrane Oral Health Group. Tanya Walsh, Jonathan Sandler, Philip E. Benson, Richard M. Skeggs and Kevin D. O’Brien were also on the team.
What evidence was included in the review?
Data was extracted from15 randomised controlled trials. A total of 561 people participated in the trials, which took place in Europe, India, China, South Korea and the USA. All participants in the studies needed a course of orthodontic treatment with additional anchorage control. None of the studies included any data on adverse effects.
What did the evidence say?
When surgically implanted devices were compared to conventional anchorage devices, they were better in providing stabilization for preventing unwanted movement in teeth during orthodontic treatment. There was limited information on patient-reported outcomes such as pain and how acceptable the devices were found to be. However, when direct comparisons were made between two types of surgical anchorage, there was a lack of evidence to suggest that any one technique was better than another.
How good was the evidence?
The quality of the evidence for the important outcomes in this review ranged from moderate to low quality. The main shortcomings of all of the studies were related to issues with their design and the way they were carried out, with insufficient and low quality reporting of the study methods and outcomes.
What are the implications for dentists and the general public?
From this review update there is some evidence of moderate quality to suggest that surgical anchorage is more effective than conventional anchorage. Results from mini-screw implants are particularly promising. Importantly, surgical anchorage is not associated with the inherent risks and compliance issues related to headgear. There was no evidence of a difference in duration of treatment between surgical and conventional anchorage.
What should researchers look at in the future?
Future trials should ensure that an adequate number of participants are recruited to the trials. Outcomes should consider an appropriate start and endpoint to measure molar movement, and should look at other issues such as anchorage loss, failure rates, financial costs, assessment of discomfort and related quality of life issues. Areas for research include determining the best size and shape of the dental implants used for anchorage, the type of implant material to use and the timing of the implant. It is also important that future trials measure patient perception and acceptability
Jambi S, Walsh T, Sandler J, Benson PE, Skeggs RM, O’Brien KD. Reinforcement of anchorage during orthodontic brace treatment with implants or other surgical methods. Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD005098. DOI: 10.1002/14651858.CD005098.pub3