Systematic review and network meta-analysis of the accuracy of the orthodontic mini-implants placed in the inter-radicular space by image-guided-based techniques

Abstract

Objective: The aim of the present systematic review and network meta-analysis (NMA) is to analyze the accuracy of image-guided-based orthodontic mini-implants placement techniques in the inter-radicular space.

Methods: The study was conducted under the PRISMA recommendations. Three databases were searched up to July 2022. In vitro randomized experimental trials (RETs) including static computer-aided implant surgery (s-CAIS), mixed reality (MR), soft tissue static computer-aided implant surgery (ST s-CAIS) and conventional free-hand technique (FHT) for the orthodontic mini-implants placement in the inter-radicular space were selected. The risk of bias was assessed using the Current Research Information System scale. A random effects model was used in the NMA. Direct comparisons were combined with a random effects model in a frequentist NMA to estimate indirect comparisons, and the estimated effect size of the comparisons between techniques were analyzed by difference of means. Inconsistency was assessed with the Q test, with a significance level of p < 0.05, and a net heat plot.

Results: A total of 92 articles was identified, and 8 RETs (8 direct comparisons of 4 techniques) were included in the NMA, which examined 4 orthodontic mini-implants placement techniques: s-CAIS, MR, ST s-CAIS, and FHT. Taking FHT as reference, s-CAIS and ST s-CAIS showed statistically significant coronal and apical deviation. In addition, s-CAIS showed statistically significant angular deviation. However, MR did not show statistically significant differences with respect to FHT, which presented the highest p-score. At the coronal deviation, ST s-CAIS presented the highest P-score (0.862), followed by s-CAIS (0.721). At the apical deviation, s-CAIS presented the highest P-score (0.844), followed by ST s-CAIS (0.791). Finally, at the angular deviation s-CAIS presented again the highest P-score (0.851).

Conclusions: Within the limitations of this study, it was found that the image-guided-based orthodontic mini-implants placement techniques showed more accuracy than the free-hand conventional placement technique; specially the computer-aided static navigation techniques for the orthodontic mini-implants placed in the inter-radicular space.

Keywords: Micro-screws; Mini-implants; Orthodontic anchorage; Orthodontics; Temporary anchorage devices.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram

Fig. 2

NETWORK plot of orthodontic mini-implant placement techniques at the coronal entry-point. Eight pairs of comparisons between four orthodontic mini-implant techniques and four direct comparisons included

Fig. 3

Forest plot of the mean differences (MD) between MR, s-CAIS and ST s-CAIS orthodontic mini-implants placement techniques respect the conventional free-hand technique at coronal entry-point. Column 1 lists the orthodontic mini-implants placement techniques included in the meta-analysis. Column 2 is the forest plot itself, the graphic part of the representation. It plots the coronal deviation between the orthodontic mini-implants placement techniques on both sides of the null effect line, represented by the conventional free-hand technique. Column 3 describes the mean deviation of each orthodontic mini-implants placement techniques respect the conventional free-hand technique, and column 4 presents the confidence interval

Fig. 4

Net heat plot at the coronal entry-point. Gray boxes signify the importance of the direct estimate of one treatment comparison in the column to the network estimation of another treatment comparison in the row. Larger boxes indicate more important comparisons

Fig. 5

NETWORK plot of orthodontic mini-implant placement techniques at the apical end-point. Seven pairs of comparisons between four orthodontic mini-implant techniques and four direct comparisons included

Fig. 6

Forest plot of the mean differences (MD) between MR, s-CAIS and ST s-CAIS orthodontic mini-implants placement techniques respect the conventional free-hand technique at apical end-point

Fig. 7

Net heat plot at the apical end-point

Fig. 8

NETWORK plot of orthodontic mini-implant placement techniques at the angular deviation. Eight pairs of comparisons between four orthodontic mini-implant techniques and four direct comparisons included

Fig. 9

Forest plot of the mean differences (MD) between MR, s-CAIS and ST s-CAIS orthodontic mini-implants placement techniques respect the conventional free-hand technique at angular deviation

Fig. 10

Net heat plot at the angular deviation

Fig. 11

Ranking of the orthodontic mini-implant placement techniques and P-score