Barriers and facilitators to the implementation of orthodontic mini implants in clinical practice: a systematic review.
Numerous surveys have shown that orthodontic mini implants (OMIs) are underused in clinical practice. To investigate this implementation issue, we conducted a systematic review to (1) identify barriers and facilitators to the implementation of OMIs for all potential stakeholders and (2) quantify these implementation constructs, i.e., record their prevalence. We also recorded the prevalence of clinicians in the eligible studies that do not use OMIs.



Methods were based on our published protocol. Broad-spectrum eligibility criteria were defined. A barrier was defined as any variable that impedes or obstructs the use of OMIs and a facilitator as any variable that eases and promotes their use. Over 30 databases including gray literature were searched until 15 January 2016. The Joanna Briggs Institute tool for studies reporting prevalence and incidence data was used to critically appraise the included studies. Outcomes were qualitatively synthesized, and meta-analyses were only conducted when pre-set criteria were fulfilled. Three reviewers conducted all research procedures independently. We also contacted authors of eligible studies to obtain additional information.



Three surveys fulfilled the eligibility criteria. Seventeen implementation constructs were identified in these studies and were extracted from a total of 165 patients and 1391 clinicians. Eight of the 17 constructs were scored by more than 50 % of the pertinent stakeholders. Three of these constructs overlapped between studies. Contacting of authors clarified various uncertainties but was not always successful. Limitations of the eligible studies included (1) the small number of studies; (2) not defining the research questions, i.e., the primary outcomes; (3) the research design (surveys) of the studies and the exclusive use of closed-ended questions; (4) not consulting standards for identifying implementation constructs; (5) the lack of pilot testing; (6) high heterogeneity; (7) the risk of reporting bias; and (8) additional shortcomings. Meta-analyses were not possible because of these limitations. Two eligible studies found that respectively 56.3 % (952/1691) and 40.16 % (439/1093) of clinicians do not use OMIs.



Notwithstanding the limitations of the eligible studies, their findings were important because (1) 17 implementation constructs were identified of which 8 were scored by more than 50 % of the stakeholders; (2) the various shortcomings showed how to improve on future implementation studies; and (3) the underuse of OMIs in the selected studies and in the literature demonstrated the need to identify, quantify, and address implementation constructs. Prioritizing of future research questions on OMIs with all pertinent stakeholders is an important first step and could redirect research studies on OMIs towards implementation issues. Patients, clinicians, researchers, policymakers, insurance companies, implant companies, and research sponsors will all be beneficiaries.
Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. reyndersmail@gmail.com.|, Via Matteo Bandello 15, 20123, Milan, Italy. reyndersmail@gmail.com.
Reint
R
Meursinge Reynders
, Via Matteo Bandello 15, 20123, Milan, Italy.
Laura
L
Ronchi
, Via Matteo Bandello 15, 20123, Milan, Italy.
Luisa
L
Ladu
Department of Veterinary Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, BO, Italy.
Nicola
N
Di Girolamo
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.
Jan
J
de Lange
Bodleian Health Care libraries, Cairns Library Level 3, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK.
Nia
N
Roberts
Department of Allied Health, Gold Coast Health and Griffith University, Queensland, QLD, 4222, Australia.
Sharon
S
Mickan
D003729:Dental Care; D015921:Dental Implants; D006801:Humans
D015921:Dental Implants
Barriers; Contacting authors; Facilitators; Implementation; Knowledge translation; Mini implant; Orthodontics; Screw; Systematic review
Syst Rev. 2015 Apr 23;4:54
25900086
Implement Sci. 2006 Aug 09;1:16
16899124
BMJ Open. 2012 Sep 01;2(5):null
22942232
J Dent Res. 2011 Aug;90(8):969-76
21593250
Evid Based Dent. 2014 Dec;15(4):108-9
25522941
JAMA. 1999 Oct 20;282(15):1458-65
10535437
Med Care. 2001 Aug;39(8 Suppl 2):II46-54
11583121
Implement Sci. 2013 Feb 17;8:22
23414420
Patient Prefer Adherence. 2014 Jun 30;8:933-7
25061281
JAMA. 2012 Mar 28;307(12):1257-8
22453564
Syst Rev. 2015 Jan 01;4:1
25554246
Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259
22696318
Odontology. 2011 Jan;99(1):88-91
21271332
Control Clin Trials. 1986 Sep;7(3):177-88
3802833
J Orthod Sci. 2012 Apr;1(2):46-50
24987625
Implement Sci. 2009 Aug 07;4:50
19664226
Proc Inst Mech Eng H. 2013 Nov;227(11):1181-202
23917623
Prog Orthod. 2014 Apr 01;15(1):29
24935644
Biometrics. 2000 Jun;56(2):455-63
10877304
Cochrane Database Syst Rev. 2007 Jul 18;(3):CD005098
17636785
Clin Implant Dent Relat Res. 2008 Sep;10 (3):174-80
18384412
Am J Orthod Dentofacial Orthop. 2009 May;135(5):564.e1-19; discussion 564-5
19409331
BMJ. 2003 Sep 6;327(7414):557-60
12958120
N Engl J Med. 2003 Jun 26;348(26):2635-45
12826639
PLoS Med. 2009 Jul 21;6(7):e1000100
19621070
BMC Public Health. 2012 Sep 07;12:751
22958371
J Clin Orthod. 2010 Aug;44(8):481-6
21105585
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000409
17943742
Ann Intern Med. 1992 Jan 1;116(1):78-84
1530753
BMJ. 2015 Jan 02;349:g7647
25555855
Syst Rev. 2015 Apr 02;4:39
25875916
Bull World Health Organ. 2004 Oct;82(10):724-31; discussion 732
15643791
Am J Orthod Dentofacial Orthop. 2012 Nov;142(5):596-614.e5
23116501
Evid Based Dent. 2013 Sep;14(3):78-80
24071675
Am J Orthod Dentofacial Orthop. 2012 Nov;142(5):577-595.e7
23116500
Nature. 2015 Jul 30;523(7562):516-8
26223609
J Clin Orthod. 1997 Nov;31(11):763-7
9511584
J Orofac Orthop. 2015 Mar;76(2):113-24, 126-8
25744091
Implement Sci. 2015 May 22;10:71
25998148
J Orthod. 2006 Dec;33(4):288-307
17142335
BMJ. 1997 Sep 13;315(7109):629-34
9310563
Am J Orthod Dentofacial Orthop. 2010 Sep;138(3):250.e1-250.e10; discussion 250-1
20816284
PLoS One. 2014 Oct 10;9(10):e108150
25303241
Cochrane Database Syst Rev. 2011 Aug 10;(8):CD000125
21833939
J Clin Orthod. 2008 Nov;42(11):625-40
19075377
J Clin Epidemiol. 2011 Apr;64(4):383-94
21195583
Angle Orthod. 2008 Mar;78(2):228-33
18251610
BMC Med Res Methodol. 2007 Sep 10;7:40
17845719
Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005470
20238340
BMC Med Res Methodol. 2012 Nov 27;12:181
23185978
Syst Rev. 2016 Feb 05;5:22
26846440
J Orthod. 2010 Mar;37(1):43-55
20439926
Lancet. 2009 Jul 4;374(9683):86-9
19525005
J Contin Educ Health Prof. 2006 Winter;26(1):13-24
16557505
J Clin Orthod. 2008 Sep;42(9):513-8
18974458
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD000259
16625533
Int J Epidemiol. 2008 Oct;37(5):1158-60
18832388
Cochrane Database Syst Rev. 2014 Aug 19;(8):CD005098
25135678
Am J Orthod Dentofacial Orthop. 2009 Mar;135(3):284-91
19268825
Am J Orthod Dentofacial Orthop. 2008 May;133(5):642-53
18456137
J Clin Orthod. 2014 Oct;48(10):607-30
25416338
BMC Health Serv Res. 2014 Jan 03;14:2
24383766
Int J Health Policy Manag. 2014 Aug 13;3(3):123-8
25197676
Lancet. 2003 Oct 11;362(9391):1225-30
14568747
Implement Sci. 2012 May 31;7:50
22651257
PLoS Med. 2009 Jul 21;6(7):e1000097
19621072