Effect of Micro-Osteoperforations on Orthodontic Tooth Movement: A Systematic Review and Meta-Analysis

While micro-osteoperforations (MOPs) have been proposed as a potential solution for the slow pace of orthodontic treatment, their effectiveness is widely debated. This meta-analysis was designed to assess whether MOPs are a clinically effective and safe tool, and to explore how they might be best applied. Based on the protocol registered prospectively in PROSPERO (CRD42025633088), a systematic search was conducted in PubMed, Embase, Scopus, Cochrane CENTRAL and key grey literature. Randomized controlled trials were synthesized using random-effects meta-analysis; extensive subgroup and meta-regression analyses were conducted to explore heterogeneity. The certainty of evidences was rated with the GRADE framework. Thirty-nine trials encompassing 1025 participants suggested a substantial acceleratory effect (SMD = 1.66; 95% CI: 1.27-2.05). Meta-regression suggested that the standardized effect may decrease with longer follow-up (β = −0.168 SMD units per week) and protocols that repeated MOPs approximately every 4 weeks were associated with ∼0.54 mm of cumulative movement (study-level association). In metric-specific analyses, MOPs appeared to improve anterior alignment measured by Little’s Irregularity Index by 1.24 mm during the first month with no statistical heterogeneity (I² = 0%). No clear evidence of increased root resorption or clinically important periodontal deterioration was observed. Pain was minimal overall, though it was associated with the number of perforations performed. Moderate-certainty of evidence suggests that a protocol-driven approach-specifically, repeating a trio of shallow buccal perforations every 4 weeks is associated with accelerated tooth movement. However, substantial heterogeneity warrants cautious interpretation of the precise magnitude of this effect.