Root resorption associated with minimally invasive surgical acceleration of orthodontic tooth movement: a systematic review.

Background: 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.

Objective: This review aims to evaluate the impact of MISAO techniques on RR across different types of orthodontic movements compared to conventional techniques.

Search methods: 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).

Selection criteria: 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.

Data collection and analysis: 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.

Results: 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'.

Conclusions: 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.

Registration: The protocol was registered in the PROSPERO database (ID: CRD42023393763).