Effects of micro-osteoperforations performed with Propel system on tooth movement, pain/quality of life, anchorage loss, and root resorption: a systematic review and meta-analysis

BACKGROUND: The aim of this systematic review was to evaluate the effect of micro-osteoperforations (MOPs) performed with Propel and other mini-screws on the rate of tooth movement, pain/discomfort, periodontal health, anchorage loss, and root resorption in patients undergoing orthodontic retraction compared to a control group. MATERIALS AND METHODS: PubMed, Cochrane, Web of Science, LILACS, Google Scholar, Scopus, and OpenGrey were searched without restriction. A manual search was also carried out. Only randomized clinical trials (RCT) were included. The risk of bias (RoB) was assessed using RoB 2.0 and the certainty of evidence through the GRADE tool. RESULTS: Among the twelve RCTs reviewed, five used the Propel system. Overall, the RoB was classified as low (4), moderate (5), and high (3). Two RCTs with moderate and one with a low RoB using the Propel system reported mild increases on rate of tooth movement associated with MOPs. One RCT with a moderate and another with high RoB did not find a significant effect of Propel on orthodontic movement. Regarding tooth movement, a subgroup meta-analysis found no differences between control and Propel movement (95% CI = − 0.01 to 0.75) or other mini-screws (− 0.02 to 0.31) related to rate of tooth movement per month. There was no effect of MOPs on root resorption, periodontal health, anchorage loss, and a mild effect on pain and oral health related to quality of life regardless of mini-screw type. The level of certainty was graded as low for the rate of tooth movement and pain/discomfort, as moderate for anchorage loss, and high for root resorption. CONCLUSION: A low certainty of evidence supports that MOPs performed with Propel seem to have no significant effect on the rate of tooth movement. Moreover, this intervention does not seem to cause an increase in root resorption, periodontal heath, pain/discomfort, or anchorage loss. Thus, the Propel system does not appear to produce different results from those observed for other mini-screws.