We won’t get fooled again? A new trial on speeding up tooth movement
This post is about a new study looking at micro-osteoperforation. This is an invasive way of trying to make teeth move faster.
Over the past few years several investigators have studied new methods that aim to reduce the duration of orthodontic treatment. One of these is micro-osteoperforation or MOPS. This is a relatively invasive technique and orthodontists make small holes in the gingivae and alveolar bone to cause localised trauma. I have posted about this before and I pointed out that there are no high quality trials that have looked at the rate of individual tooth movement. Therefore, I was very interested to see this new trial.
A team from Jordan did this trial and the AJO-DDO published it.
Three-dimensional assessment of the effect of micro-osteoperforations on the rate of tooth movement during canine retraction in adults with Class II malocclusion: A randomized controlled clinical trial.
Amal Alkebsi et al
I would like to thank the authors for providing these links:
This is a link to the author discussing their paper
The paper can also be accessed here until July 18.
What did they do?
They did a split mouth RCT with a 1:1 allocation of interventions to each side of the mouth.
The PICO was
Participants: Orthodontic patients who were older than 16 years with Class II Div 1 malocclusion requiring extraction of maxillary first premolars.
Intervention: They fitted MBT fixed appliances to level and align. Then they extracted the first premolars and placed miniscrews. When in 0.19×025 ss archwires they did Micro-osteoperforation with miniscrews 1.5 mm wide and 3-4mm deep to a set protocol. A retraction force was applied from a TAD to the canines. This was done 6 months after they extracted the first premolars.
Control: No MOPS but identical mechanics to the MOPs side of the mouth.
Outcome: The rate of canine tooth retraction per month. They measured this from 3D scans superimposed on the palate.
Importantly, they generated a blocked randomisation, concealment was done in sealed envelopes that were opened by the participants. They collected data blind.
They did a sample size calculation to ensure that the study had sufficient power.
What did they find?
They enrolled 35 patients and three dropped out.
Interestingly, there were no differences in the rate of tooth movement between the MOP and the control sides. This is the relevant data table.
Mean (mm) +/-SD
|p||Mean difference (mm) (95% CI)|
|1 month||0.67 (0.34)||0.65 (0.26)||0.77||0.02 (-0.13,0.18)|
|2 months||1.28 (0.5)||1.36 (0.49)||0.5||-0.08 (-0.33,0.16)|
|3 months||1.88 (0.67)||1.93 (0.74)||0.76||-0.05 (-0.4,0.29)|
As a result, they concluded that MOPs did not have an effect on the rate of tooth movement.
What did I think?
I thought that this was a good trial. The authors did this well and reported it concisely. They did not have a commercial interest in the technique.
They used a split mouth technique. This was relevant to study an intervention with no cross over effects. I thought that randomisation, concealment and blinding were adequate. Their method of measurement was accurate and has been used in other studies of tooth movement.
Interestingly, they applied the MOP with mini-screws. However, I was not sure how this differs from using the Propel device. I think that both methods seem to cause the same amount of localised trauma. Perhaps a Propel advocate or Key Opinion Leader could help us here?
My only concern with this paper was that they measured the short term effect of the intervention. I would be more certain about the “absence of evidence” if they had measured tooth movement over a longer period of time. However, the findings are relevant to the canine retraction phase of treatment.
I’ll take a bow for the new revolution
I feel that this paper adds to our knowledge on the absence of evidence on the effects of MOPs. Perhaps, this is another method of speeding up tooth movement that does not seem to have an effect?
Emeritus Professor of Orthodontics, University of Manchester, UK.