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Abstract Objective The aim of the present systematic review and network meta-analysis (NMA) is to analyze the accuracy of image-guided-based orthodontic mini-implants placement techniques in the inter-radicular space. Methods The study was conducted under the PRISMA recommendations. Three databases were searched up to July 2022. In vitro randomized experimental trials (RETs) including static computer-aided implant surgery (s-CAIS), mixed reality (MR), soft tissue static computer-aided implant surgery (ST s-CAIS) and conventional free-hand technique (FHT) for the orthodontic mini-implants placement in the inter-radicular space were selected. The risk of bias was assessed using the Current Research Information System scale. A random effects model was used in the NMA. Direct comparisons were combined with a random effects model in a frequentist NMA to estimate indirect comparisons, and the estimated effect size of the comparisons between techniques were analyzed by difference of means. Inconsistency was assessed with the Q test, with a significance level of p

Objective: The aim of the present systematic review and network meta-analysis (NMA) is to analyze the accuracy of image-guided-based orthodontic mini-implants placement techniques in the inter-radicular space. Methods: The study was conducted under the PRISMA recommendations. Three databases were searched up to July 2022. In vitro randomized experimental trials (RETs) including static computer-aided implant surgery (s-CAIS), mixed reality (MR), soft tissue static computer-aided implant surgery (ST s-CAIS) and conventional free-hand technique (FHT) for the orthodontic mini-implants placement in the inter-radicular space were selected. The risk of bias was assessed using the Current Research Information System scale. A random effects model was used in the NMA. Direct comparisons were combined with a random effects model in a frequentist NMA to estimate indirect comparisons, and the estimated effect size of the comparisons between techniques were analyzed by difference of means. Inconsistency was assessed with the Q test, with a significance level of p < 0.05, and a net heat plot. Results: A total of 92 articles was identified, and 8 RETs (8 direct comparisons of 4 techniques) were included in the NMA, which examined 4 orthodontic mini-implants placement techniques: s-CAIS, MR, ST s-CAIS, and FHT. Taking FHT as reference, s-CAIS and ST s-CAIS showed statistically significant coronal and apical deviation. In addition, s-CAIS showed statistically significant angular deviation. However, MR did not show statistically significant differences with respect to FHT, which presented the highest p-score. At the coronal deviation, ST s-CAIS presented the highest P-score (0.862), followed by s-CAIS (0.721). At the apical deviation, s-CAIS presented the highest P-score (0.844), followed by ST s-CAIS (0.791). Finally, at the angular deviation s-CAIS presented again the highest P-score (0.851). Conclusions: Within the limitations of this study, it was found that the image-guided-based orthodontic mini-implants placement techniques showed more accuracy than the free-hand conventional placement technique; specially the computer-aided static navigation techniques for the orthodontic mini-implants placed in the inter-radicular space. [ABSTRACT FROM AUTHOR]

To analyze the influence of the operator experience on the accuracy of orthodontic self-tapping micro-screws placement, a total of 60 orthodontic self-tapping micro-screws were randomly distributed into two study groups: Group A. Orthodontic micro-screws placement by an orthodontist with 10 years of experience (n = 30); and B. Orthodontic micro-screws placement by an orthodontist student without experience (n = 30). Cone-beam computed tomography scans and intraoral scans were performed before and after the orthodontic self-tapping micro-screws placement and uploaded in 3D implant-planning software to analyze the deviation angle and the horizontal deviation measured at the coronal entry point and apical endpoint between orthodontic micro-screws planned and performed. In addition, intraoperative complications such as root perforations after orthodontic self-tapping micro-screws placement and fracture of the orthodontic self-tapping micro-screws during their placement were also analyzed. The paired t-test revealed statistically significant differences at the apical endpoint (p = 0.004) of planned and performed orthodontic self-tapping micro-screws between the orthodontist with 10 years of experience and the orthodontist student without experience. However, the paired t-test revealed no statistically significant differences at the coronal entry point (p = 0.220) and angular deviations (p = 0.602) of planned and performed orthodontic self-tapping micro-screws between the orthodontist with 10 years of experience and the orthodontic student without experience. Furthermore, five root perforations were observed in the no experience study group and three orthodontic self-tapping micro-screws were fractured in each study group. In conclusion, the results show that the greater experience of the operator influences the accuracy of orthodontic micro-screws placement, resulting in less intraoperative complications. [ABSTRACT FROM AUTHOR]

To analyze the influence of the operator experience on the accuracy of orthodontic self-tapping micro-screws placement, a total of 60 orthodontic self-tapping micro-screws were randomly distributed into two study groups: Group A. Orthodontic micro-screws placement by an orthodontist with 10 years of experience (n = 30); and B. Orthodontic micro-screws placement by an orthodontist student without experience (n = 30). Cone-beam computed tomography scans and intraoral scans were performed before and after the orthodontic self-tapping micro-screws placement and uploaded in 3D implant-planning software to analyze the deviation angle and the horizontal deviation measured at the coronal entry point and apical endpoint between orthodontic micro-screws planned and performed. In addition, intraoperative complications such as root perforations after orthodontic self-tapping micro-screws placement and fracture of the orthodontic self-tapping micro-screws during their placement were also analyzed. The paired t-test revealed statistically significant differences at the apical endpoint (p = 0.004) of planned and performed orthodontic self-tapping micro-screws between the orthodontist with 10 years of experience and the orthodontist student without experience. However, the paired t-test revealed no statistically significant differences at the coronal entry point (p = 0.220) and angular deviations (p = 0.602) of planned and performed orthodontic self-tapping micro-screws between the orthodontist with 10 years of experience and the orthodontic student without experience. Furthermore, five root perforations were observed in the no experience study group and three orthodontic self-tapping micro-screws were fractured in each study group. In conclusion, the results show that the greater experience of the operator influences the accuracy of orthodontic micro-screws placement, resulting in less intraoperative complications.

Mini-implant loss is often associated with physical and mechanical aspects that result from choosing an inappropriate placement site. It is worth highlighting that: a) Interdental alveolar bone crests are flexible and deformable. For this reason, they may not offer the ideal absolute anchorage. The more cervical the structures, the more delicate they are, thus offering less physical support for mini-implant placement; b) Alveolar bone crests of triangular shape are more deformable, whereas those of rectangular shape are more flexible; c) The bases of the alveolar processes of the maxilla and the mandible are not flexible, for this reason, they are more likely to receive mini-implants; d) The more cervical a mini-implant is placed, the higher the risk of loss; the more apical a mini- implant is placed, the better its prognosis will be; e) 3D evaluations play a major role in planning the use of mini-implants. Based on the aforementioned considerations, the hypotheses about mini-implant loss are as follows: 1) Deflection of maxillary and mandibular alveolar processes when mini-implants are more cervically placed; 2) Mini-implants placed too near the periodontal ligament, with normal intra-alveolar tooth movement; 3) Low bone density, low thickness and low alveolar bone volume; 4) Low alveolar cortical bone thickness; 5) Excessive pressure inducing trabecular bone microfracture; 6) Sites of higher anatomical weakness in the mandible and the maxilla; 7) Thicker gingival tissue not considered when choosing the mini-implant. [ABSTRACT FROM AUTHOR]

To analyze the effect of a computer-aided static navigation technique and mixed reality technology on the accuracy of orthodontic micro-screw placement. Material and methods: Two hundred and seven orthodontic micro-screws were placed using either a computer-aided static navigation technique (NAV), a mixed reality device (MR), or a conventional freehand technique (FHT). Accuracy across different dental sectors was also analyzed. CBCT and intraoral scans were taken both prior to and following orthodontic micro-screw placement. The deviation angle and horizontal deviation were then analyzed; these measurements were taken at the coronal entry point and apical endpoint between the planned and performed orthodontic micro-screws. In addition, any complications resulting from micro-screw placement, such as spot perforations, were also analyzed across all dental sectors. Results: The statistical analysis showed significant differences between study groups with regard to the coronal entry-point (p < 0.001). The NAV study group showed statistically significant differences from the FHT (p < 0.001) and MR study groups (p < 0.001) at the apical end-point (p < 0.001), and the FHT group found significant differences from the angular deviations of the NAV (p < 0.001) and MR study groups deviations (p = 0.0011). Different dental sectors also differed significantly. (p < 0.001) Additionally, twelve root perforations were observed in the FHT group, while there were no root perforations in the NAV group. Conclusions: Computer-aided static navigation technique enable more accurate orthodontic micro-screw placement and fewer intraoperative complications when compared with the mixed reality technology and conventional freehand techniques. [ABSTRACT FROM AUTHOR]

To analyze the influence of the computer-aided static navigation technique on the accuracy of placement of orthodontic micro-screws. One hundred and thirty-eight orthodontic micro-screws were randomly assigned to the following study groups: Group A. orthodontic micro-screw placement using a computer-aided static navigation technique (n = 69); B. orthodontic micro-screw placement using the conventional freehand technique (n = 69). In addition, the accuracy in the canine–premolar, premolar and molar sectors was analyzed in each study group. Cone-beam computed tomography and intraoral scans were taken both prior and subsequent to orthodontic micro-screw placement. The images were then uploaded using a 3D implant planning software, where the deviation and horizontal angles were analyzed using a multivariate linear model. These measurements were taken at the coronal entry point and apical endpoint between the planned orthodontic micro-screws. In addition, any complications resulting from micro-screw placement, such as spot perforations, were also analyzed in all dental sectors. The statistical analysis showed significant differences between the two study groups with regard to the coronal entry-point, apical end-point (p < 0.001) and angular deviations (p < 0.001) between the computer-aided static navigation technique and freehand technique study groups. Moreover, statistically significant differences were showed between the different dental sectors (p < 0.001). Additionally, twelve root perforations were observed at the conventional free hand technique study group while there were no root perforations in the computer-aided static navigation technique study group. The results showed that the computer-aided static navigation technique enables a more accurate orthodontic micro-screw placement with less intraoperative complications when compared with the conventional freehand technique. [ABSTRACT FROM AUTHOR]