Micro-osteoperforations for accelerating orthodontic tooth movement: a systematic review and meta-analysis

Background Prolonged orthodontic treatment increases the risk of enamel demineralization, caries, periodontal inflammation, and root resorption. Micro-osteoperforations (MOPs) may accelerate orthodontic tooth movement by inducing localized bone remodelling through the regional acceleratory phenomenon.Objective To evaluate the efficacy, safety, and biological mechanisms of MOPs in accelerating orthodontic tooth movement using evidence exclusively from randomized controlled trials (RCTs).Methods PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched from inception to October 2025. RCTs comparing MOPs with conventional orthodontic treatment were included. Primary outcome was the rate of tooth movement; secondary outcomes included biomarkers, root resorption, adverse events, and patient-reported outcomes. Risk of bias and certainty of evidence were assessed using Cochrane Risk of Bias 2.0 and GRADE, respectively. Random-effects meta-analysis was performed.Results Sixteen RCTs involving 748 participants were included. MOPs significantly increased the rate of tooth movement (mean difference [MD] 0.42 mm/month; 95% CI, 0.31–0.53; p < 0.001; I2 = 45%). Repeated MOPs produced greater acceleration than single MOPs (MD 0.58 vs 0.24 mm/month; p = 0.002). Biomarker studies demonstrated transient increases in interleukin-1β, RANKL, and matrix metalloproteinases during the first month. Adverse effects included moderate pain and swelling, while root resorption did not differ significantly from controls. Conclusions MOPs accelerate orthodontic tooth movement in short-term RCTs, but evidence remains insufficient to quantify overall treatment-time reduction or long-term stability. Standardized protocols and larger multicenter trials are warranted.