Orthodontic mechanotherapies and their influence on external root resorption: A systematic review

Abstract

Introduction: This systematic review assesses the literature regarding the association between orthodontic tooth movement and external root resorption. By determining the evidence level supporting the association, the results could provide clinical evidence for minimizing the deleterious effect of orthodontic tooth movement. Methods: Electronic databases, including MEDLINE, PubMed, Embase, Scopus, CINAHL, Cochrane Library, and LILACS, were searched up to February 2018, with hand searching of selected orthodontic journals undertaken to identify any preelectronic publications. Searches were undertaken with no restrictions on year, publication status, or language. Selection criteria included randomized controlled trials conducted with the use of fixed orthodontic appliances or sequential thermoplastic aligners on human patients. The quality of included studies was assessed with the use of the Cochrane Risk of Bias Tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Inter‐rater agreement of the review authors was used for the inclusion of primary articles, risk of bias assessment, and evaluation of the quality of evidence (GRADE), and it was calculated with the use of the Cohen kappa statistic. Results: A total of 654 articles were retrieved in the initial search. After the review process, 25 articles describing 24 individual trials met the inclusion criteria. Sample sizes ranged from 6 to 154 patients. Most articles were classified as having unclear risks of bias and very low to low quality of evidence. Conclusions: There is very low to low evidence for supporting positive associations between root resorption and increased force levels, force continuity, intrusive forces, and treatment duration. Moreover, by including a pause in treatment for patients experiencing root resorption, it may be possible for the clinician to reduce the severity of the condition. Of the included studies, the most common methodologic flaws include the absence of a control group, appropriate randomization strategy, and adequate examinations before and after treatment. HIGHLIGHTSThis systematic review included 24 unique randomized controlled trials on orthodontic root resorption.This is the first systematic review to use both the Cochrane risk of bias tool and the GRADE approach.Most studies were classified as having unclear risks of bias and very low to low quality of evidence.Increased magnitude, continuity and intrusion of force, and duration increase severity.Including a pause in treatment for patients experiencing root resorption decreases severity.