Sirri Mohamad Radwan, Hajeer Mohammad Y, Baba Feras, Aljabban Ossama, Burhan Ahmad S, Namera Mohammad Osama
Department of Orthodontics, Faculty of Dentistry, University of Damascus, Fayez Mansour Street, Al-Mazzah, Damascus 12110, Syria.
Department of Orthodontics, School of Dentistry, University of Jordan, Queen Rania Al-Abdullah Street, Al-Jubaiha, Amman 11942, Jordan.
Eur J Orthod. 2025 Jun 12;47(4). doi: 10.1093/ejo/cjaf035.
Root resorption (RR) is a critical concern in orthodontics. It is influenced by treatment duration and techniques. Minimally invasive surgically accelerated orthodontics (MISAO) aims to reduce treatment time but may impact RR, necessitating a systematic evaluation of its effects.
This review aims to evaluate the impact of MISAO techniques on RR across different types of orthodontic movements compared to conventional techniques.
A systematic search of nine databases and a manual screening of journals were conducted following PRISMA guidelines, with no restrictions on language or publication date (up to June 2024).
Studies evaluating RR before/after MISAO in humans, with ≥ 5 participants per group, were included. Animal studies, non-surgical interventions, and studies lacking RR data were excluded.
Bias risk was assessed using the RoB 2.0 tool for RCTs and the ROBINS-I tool for CCTs. RR assessment quality was evaluated using the McHarm tool, and evidence certainty was determined using the GRADE approach.
A review of 23 studies (585 participants, ≈ 2,420 teeth) showed varied MISAO effects on RR. MOPs and piezocision had no significant impact on RR during leveling, alignment, and canine retraction (P > 0.05), except for isolated cases where piezocision reduced RR (P < 0.05). IN En-masse retraction, piezocision reduced RR in central incisors and the right canine (P = 0.030, 0.046, 0.025), while MOPs had no effect (P = 0.175). Upper molar distalization with MOPs increased RR in mesiobuccal roots (P = 0.043) but decreased it in distobuccal roots (P < 0.001). Piezocision reduced RR during lower second molar protraction (P = 0.005), while MOPs and piezocision increased RR during buccal tipping (P = 0.029 and P = 0.001, respectively). Evidence quality ranged from 'very low' to 'moderate'.
This review indicates that while MISAO affects RR similarly to conventional methods during leveling and alignment, its impact varies for other orthodontic movement types. Minimizing surgical invasiveness is key to reducing RR risk while maximizing the benefits of accelerated treatment. Direct resorption occurs due to poorly planned procedures applied too close to the root, while indirect resorption is influenced by bone density and tooth movement. Further research is needed to standardize RR assessment methods and explore long-term outcomes to refine MISAO techniques for safer and more predictable results.
The protocol was registered in the PROSPERO database (ID: CRD42023393763).
牙根吸收（RR）是正畸治疗中的一个关键问题。它受治疗持续时间和技术的影响。微创外科加速正畸（MISAO）旨在缩短治疗时间，但可能会影响RR，因此有必要对其效果进行系统评估。
本综述旨在评估与传统技术相比，MISAO技术对不同类型正畸移动中RR的影响。
按照PRISMA指南对九个数据库进行系统检索，并对手工筛选的期刊进行检索，对语言或出版日期（截至2024年6月）没有限制。
纳入评估人类在MISAO前后RR情况的研究，每组≥5名参与者。排除动物研究、非手术干预以及缺乏RR数据的研究。
使用RoB 2.0工具评估随机对照试验（RCT）的偏倚风险，使用ROBINS-I工具评估非随机对照试验（CCT）的偏倚风险。使用McHarm工具评估RR评估质量，并使用GRADE方法确定证据的确定性。
对23项研究（585名参与者，约2420颗牙齿）的综述显示，MISAO对RR的影响各不相同。在整平、排齐和尖牙后移过程中，微种植体支抗（MOPs）和超声骨刀切开术对RR没有显著影响（P>0.05），但在个别情况下，超声骨刀切开术可降低RR（P<0.05）。在整体后移中，超声骨刀切开术可降低中切牙和右侧尖牙的RR（P=0.030、0.046、0.025），而MOPs则无影响（P=0.175）。使用MOPs进行上颌磨牙远移会增加近中颊根的RR（P=0.043），但会降低远中颊根的RR（P<0.001）。超声骨刀切开术在低位第二磨牙前移过程中可降低RR（P=0.005），而在颊向倾斜过程中，MOPs和超声骨刀切开术均会增加RR（分别为P=0.029和P=0.001）。证据质量从“极低”到“中等”不等。
本综述表明，虽然MISAO在整平与排齐过程中对RR的影响与传统方法相似，但其对其他正畸移动类型的影响各不相同。尽量减少手术侵入性是降低RR风险同时最大化加速治疗益处的关键。直接吸收是由于在牙根附近应用的程序规划不当所致，而间接吸收则受骨密度和牙齿移动的影响。需要进一步研究以规范RR评估方法并探索长期结果，以完善MISAO技术，实现更安全、更可预测的结果。
该方案已在PROSPERO数据库中注册（ID：CRD42023393763）。
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