Anchorage effectiveness of orthodontic miniscrews compared to headgear and transpalatal arches: a systematic review and meta-analysis

Background: Anchorage in orthodontics can be provided through several extra- and intra-oral sources including headgear, teeth, cortical bone and soft tissue. Objective: The aim of this review was to systematically review the effectiveness of miniscrews in reinforcing anchorage during en-masse retraction of anterior teeth in comparison to conventional anchorage appliances. Search method: Comprehensive searching of the electronic databases was undertaken up to March 2018 in the Cochrane Database of Systematic review, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed and Scopus databases. Additional searching for on-going and unpublished data and hand search of relevant journals were also undertaken, authors were contacted, and reference lists screened. Eligibility criteria: Searches were restricted to randomized clinical trials (RCTs) published in English, which compared anchorage reinforcement using mechanically-retained miniscrews (diameter of 2 mm or less) to conventional anchorage appliances during en-masse retraction of anterior teeth in participants of any age treated with fixed appliances combined with extraction of maxillary premolars. Data collection and analysis: Blind and induplicate study selection, data extraction and risk of bias assessment were undertaken. The primary outcome was the amount of mesial movement of the upper first permanent molar (anchorage loss) while secondary outcomes included treatment duration, number of visits, adverse effects and patient-centered outcomes. The risk of bias was assessed using Cochrane risk of bias tool. A random-effects model with its corresponding 95% confidence interval (CI) were generated for comparable outcomes. Statistical heterogeneity across the studies were assessed using the I2 and Chi2 test. Additional sensitivity tests were implemented. Results: Seven RCTs met the inclusion criteria, however, data of 241 participants from 6 RCTs (250 miniscrews and 134 conventional anchorage appliances) were meta-analyzed. Qualities of the included RCTs varied from low to high. The standardized mean difference (SMD) of the anchrage loss between the two intervention groups was 2.07 mm ((95% CI (–3.05) to (–1.08), p I2 = 88%, 6 RCTs)) in favour of miniscrews, which was also preserved after excluding the high risk of bias studies (SMD 1.94 mm, 95% CI (–2.46) to (–0.42) p I2 = 93%, 3 RCTs)). Information on overall treatment duration, space closure duration, quality of treatment, patient-reported outcomes, adverse effects and number of visit were limited. Conclusion: The result of the meta-analysis suggested that there is moderate quality of evidence that miniscrews are clinically and statistically more effective in preserving orthodontic anchorage than conventional appliances. However, this conclusion is supported by a small number of studies with variable qualities. High-quality RCTs would give a better understanding of miniscrews effectiveness in providing orthodontic anchorage.