More evidence on speeding up treatment with MOPs.
Localised trauma with micro-osteoperforation (MOPs) to speed up orthodontic treatment was one of the extensively promoted developments a few years ago. However, since then, investigators have done studies that showed little evidence to suggest that this innovation worked. This new study adds to the evidence on its effectiveness.
Micro-osteoperforation creates localised alveolar bone trauma that activates the “regional acceleratory” effect. The developers and KOLs, who all had a financial interest in the success of the intervention, heavily promoted this treatment. Unfortunately, recent studies have shown that this treatment does not increase the rate of tooth movement. Nevertheless, these trials have tended to be confined to the measurement of single tooth movement. This new trial looked at the effect of MOPS on the rate of incisal alignment.
A team from Malaysia did this trial. The AJO-DDO published the paper.
Azaitun Akma Shahrin. AJO-DDO: Advanced access.
What did they ask?
They wanted to:
“Compare the overall time taken to complete the alignment of maxillary anterior crowding”.
What did they do?
They did a parallel randomised controlled trial with a 1:1 allocation. The PICO was:
Participants: Orthodontic patients aged 18-45 years with moderate crowding (5-8mm) requiring extraction of maxillary first molars and fixed appliance treatment.
Intervention: MOPs caused by the Propel device under LA. They repeated this every month until the completion of alignment.
Control: No MOPs
Outcomes: The primary outcome was the overall time to complete alignment of the maxillary teeth. Secondary outcomes were the alignment improvement percentage of the teeth using Little’s Index.
They did a nice sample size calculation powered to detect a difference of 28 days in the time to alignment.
They used pre-prepared blocked randomisation, and they concealed the allocation in sealed envelopes. It was not possible to blind the participants and operators, but they recorded all data analysed blind. Their statistical analysis was relevant.
What did they find?
Twenty-eight patients (14 in each group) completed the trial. There were no differences between the groups at the start of treatment.
The mean time to alignment for the MOPs group was 139 days (95% CI=115.32-161.83), and for the control, this was 143days (95% CI=107.12-179.74). When they looked at the secondary outcomes, they did not detect any statistical or clinically significant differences between the groups.
Their overall conclusion was:
“The application of MOPs is not more effective than conventional methods in accelerating the initial orthodontic alignment of maxillary teeth”.
What did I think?
I thought that this was a nicely done, small trial. The authors followed trial methodology well. It was also nice to see a team look at the overall alignment of teeth rather than retraction of canines etc.
If I am critical, I am a little concerned about the small sample size, even though they had sufficient power. Nevertheless, when we look at the effect size, it is minimal. However, the 95% confidence intervals are wide. This is a reflection of the small sample size.
When I looked at the findings, I agreed with their conclusions. They put these very clearly. In short, it appears that there is a lack of evidence for the claimed effects of MOPSs. In other words, they do not work.
Final thoughts
Once again, it appears that a widely promoted intervention does not live up to the early promise as promoted by the developers and the clinical salespeople. This links to the Propel website, and you can see the “usual suspects” who are perhaps blind to science, or maybe they do not understand the research?
Emeritus Professor of Orthodontics, University of Manchester, UK.
I wonder what the KOLs at CTOR would have to say about this…they are rather quick to fire off letters to the editor about any study that shows the lack of effectiveness of MOPs (as it pertains to the rate of tooth movement). The one RCT that showed Propel to be significantly faster, was severely flawed and should never have been accepted into the AJO. This is just yet another product where claims were made in advance of the data, and it was left to others to evaluate those claims
One could ask whether full page advertisements have any influence on what is is published in the AJO?
One could ask whether full page advertisements have any influence on what is is published in the AJO?
Interesting article in the July issue (AJO-DO 160:77-83) in relation to advertisements in orthodontic journals. They conclude “less than 2% of advertisements supported by high-level evidence “.
When will the reality finally be accepted on this and the book closed? Is it really necessary to still research this? Can resources not be better used for other aspects that require research?
yeah, great a have a fresh look at it, if only to rule it out. I can’t see a larger sample size or a more heterogeneous sample improving on the confidence interval. A good example of how the KOB blog works well.