title: Barriers and facilitators to the implementation of orthodontic mini-implants in clinical practice: a protocol for a systematic review and meta-analysis.
abstract: BACKGROUND
  Most orthodontic treatment plans need some form of anchorage to control the reciprocal forces of tooth movement. Orthodontic mini implants (OMIs) have been hailed for having revolutionized orthodontics, because they provide anchorage without depending on the collaboration of patients, they have a favorable effectiveness compared with conventional anchorage devices, and they can be used for a wide scale of treatment objectives. However, surveys have shown that many orthodontists never or rarely use them. To understand the rationale behind this knowledge-to-action gap, we will conduct a systematic review that will identify and quantify potential barriers and facilitators to the implementation of OMIs in clinical practice for all potential stakeholders, i.e., patients, family members, clinicians, office staff, clinic owners, policy makers, etc. The prevalence of clinicians that do not use OMIs will be our secondary outcome.
  
  
  METHODS
  The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 Statement was adopted as the framework for reporting this manuscript. We will apply broad-spectrum search strategies and will search MEDLINE and more than 40 other databases. We will conduct searches in the gray literature, screen reference lists, and hand-search 12 journals. All study designs, stakeholders, interventions, settings, and languages will be eligible. We will search studies that report on barriers or facilitators to the implementation of orthodontic mini implants (OMIs) in clinical practice. Implementation constructs and their prevalence among pertinent stakeholders will be our primary outcomes. All searching and data extraction procedures will be conducted by three experienced reviewers. We will also contact authors and investigators to obtain additional information on data items and unidentified studies. Risk of bias will be scored with tools designed for the specific study designs. We will assess heterogeneity, meta-biases, and the robustness of the overall evidence of outcomes. We will present findings in a systematic narrative synthesis and plan meta-analyses when pertinent criteria are met.
  
  
  CONCLUSIONS
  Knowledge creation on this research topic could identify and quantify both expected and unexpected implementation constructs and their stakeholders. Such knowledge can help develop strategies to address implementation issues and redirect future studies on OMIs towards knowledge translation. This could lead to improved patient-health experiences and a reduction in research waste.
authors: Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. reyndersmail@gmail.com.|Private practice of orthodontics, Via Matteo Bandello 15, 20123, Milan, Italy. reyndersmail@gmail.com.
authors: Reint
authors: R
authors: Meursinge Reynders
authors: Private practice of orthodontics, Via Matteo Bandello 15, 20123, Milan, Italy. lr.laura.ronchi@gmail.com.
authors: Laura
authors: L
authors: Ronchi
authors: Private practice of orthodontics, Via Matteo Bandello 15, 20123, Milan, Italy. sluppers@yahoo.com.
authors: Luisa
authors: L
authors: Ladu
authors: Department of Veterinary Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano dell'Emilia (BO), Italy. nicoladiggi@gmail.com.
authors: Nicola
authors: N
authors: Di Girolamo
authors: Department of Oral and Maxillofacial Surgery, Academic Medical Center and Academisch Centrum Tandheelkunde Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.delange@amc.uva.nl.
authors: Jan
authors: J
authors: de Lange
authors: Bodleian Health Care libraries, John Radcliffe Hospital, University of Oxford, Cairns Library Level 3, Oxford, OX3 9DU, UK. nia.roberts@bodleian.ox.ac.uk.
authors: Nia
authors: N
authors: Roberts
authors: Department of Allied Health, Clinical Governance, Education and Research, Gold Coast Health Griffith University, Executive Offices A Block Level 4. 1 Hospital Blvd, Southport, QLD, 4215, Australia. Sharon.Mickan@health.qld.gov.au.
authors: Sharon
authors: S
authors: Mickan
mesh_terms: D015921:Dental Implants; D006801:Humans; D052280:Orthodontic Anchorage Procedures / Q000295:instrumentation*; D000078202:Systematic Reviews as Topic; D057170:Translational Research, Biomedical; D015201:Meta-Analysis as Topic
chemical_list: D015921:Dental Implants