Evaluation of Treatment Outcomes of En masse Retraction with Temporary Skeletal Anchorage Devices in Comparison with Two-step Retraction with Conventional Anchorage in Patients with Dentoalveolar Protrusion: A Systematic Review and Meta-analysis

Hanin Nizar Khlef, Mohammad Younis Hajeer, Mowaffak A Ajaj, Omar Heshmeh, Hanin Nizar Khlef, Mohammad Younis Hajeer, Mowaffak A Ajaj, Omar Heshmeh

Abstract

Objective: The main objective is to evaluate the effectiveness of en masse retraction with temporary skeletal anchorage devices (TSADs) versus two-step retraction with conventional anchorage (CA) in terms of the skeletal, dental, and soft-tissue variables, as well as the duration of retraction or overall orthodontic treatment.

Materials and methods: An electronic search of PubMed and nine other major databases for prospective, randomized controlled trials (RCTs) and clinical controlled trials (CCTs) was carried out between January 1990 and April 2018. The bibliography in each identified article was checked out. In addition, manual searching was performed in the same time frame in five major orthodontic journals. Adult patients undergoing fixed orthodontic treatment with extraction of maxillary premolars followed by an en masse retraction in the experimental group and two-step retraction of upper anterior teeth in the control group. Methodological index for nonrandomized studies for CCTs and Cochrane's risk of bias tool for RCTs were applied.

Results: Four articles (two RCTs and two CCTs) were included in this review and all articles were appropriate for the quantitative synthesis. There was no significant difference between the en masse retraction and two-step retraction groups in terms of SNA, SNB, ANB, and MP-SN angles. Using TSADs gave significantly better results in terms of posterior anchorage and incisors inclination, and greater anterior teeth retraction in comparison with CA (standardized mean difference [SMD] = -3.03 mm, P < 0.001; SMD = 0.74°, P = 0.003; SMD = -0.46 mm, P = 0.03, respectively). En masse/TSAD combination caused a significantly greater increase in nasolabial angle, higher decrease in facial convexity angle, and greater lower lip retraction in comparison with two-step/CA combination (weighted mean difference = 4.73°, P = 0.007; P = 0.0435; SMD = -0.95 mm, P = 0.01, respectively).

Conclusion: There is weak-to-moderate evidence that using either en masse/TSAD combination or two-step/CA combination would lead to similar skeletal improvement. There is a very weak-to-moderate evidence that using TSADs with en masse retraction would cause better posterior anchorage and incisors inclination, and greater anterior teeth retraction than using CA with two-step retraction. There is weak-to-moderate evidence that using en masse/TSAD combination would lead to a better improvement in the facial profile. According to the quality of evidence, we confirm the need for more well-conducted RCTs in the en masse retraction field.

Keywords: Anchorage; anterior teeth; en masse; extraction; meta-analysis; orthodontic; protrusion; retraction; systematic review; two-step.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2019 Contemporary Clinical Dentistry.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 flow diagram of the study selection process
Figure 2
Figure 2
The risk of bias in randomized controlled trials
Figure 3
Figure 3
The overall risk of bias for each domain
Figure 4
Figure 4
Forest plot showing the amount of horizontal movement of U6 in en masse/ temporary skeletal anchorage devices group versus two-step/conventional anchorage group
Figure 5
Figure 5
Forest plot showing the amount of horizontal movement of upper incisal edges in en massel temporary skeletal anchorage devices group versus two-step/conventional anchorage group
Figure 6
Figure 6
Forest plot showing the incisors’ inclination variable in en massel temporary skeletal anchorage devices group versus two-step/conventional anchorage group
Figure 7
Figure 7
Forest plot showing the amount of vertical movement of incisors in en massel temporary skeletal anchorage devices group versus two-step/conventional anchorage group
Figure 8
Figure 8
Forest plot showing the amount of vertical movement of U6 in en massel temporary skeletal anchorage devices group versus two-step/conventional anchorage group

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Source: PubMed

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