The effect of micro‑osteoperforation on root resorption, pulp vitality, and biological changes of teeth subjected to orthodontic tooth movement: A systematic review study

Abstract

Background: These days minimally invasive micro‑osteoperforation (MOPs) has accelerated
orthodontic tooth movement (OTM). However, there are some conflicting reports about their
various impacts; hence, the present systematic review study aimed to evaluate the effect of MOP
on root resorption, pulp vitality, and the biological changes of teeth subjected to OTM.
Materials and Methods: Search in electronic databases of English literature including PubMed,
Scopus, Web of sciences, Cochrane, and Google scholar as well as a manual search was performed
from 2013 to 2022. Most of the studies included in this article were randomized controlled trials.
Results: From the total number of 321 found articles, 31 duplicated and 268 irrelevant articles
were excluded regarding the defined inclusion and exclusion criteria. Consequently, 22 articles were
subjected to the quality assessment process, and finally, 18 articles were selected for the review
phase. Root resorption during tooth movement using the MOP approach was reported only in
one study. Besides, except for two animal studies, all of the relevant included articles showed that
MOPs significantly increased the expression of some inflammatory biomarkers known to recruit
osteoclast precursors and increase the number of osteoclast cells. On the other hand, two animal
studies showed no differences in osteoclast counts by using MOPs in comparison to their control
groups, which was consequently the result of biologic variability between animal and human and
also probably the small sample sizes of these two studies.
Conclusion: In this systematic review, according to the adverse effects of MOP on root resorption,
one study showed higher levels of root resorption among patients undergoing MOP. However, this
outcome was due to the different methods used to evaluate the effect of MOPs on root resorption.
Moreover, a high certainty of evidence supports that MOP causes biological changes and an elevation
in cytokines, chemokines, and other biomarkers that stimulates osteoclasts differentiation which
in turn accelerate OTM. There was no change in pulp vitality status based on available evidence.
Key Words: Biomarkers, flapless‑osteoperforation, orthodontic tooth movement, pulp vitality,root resorption