Methods of incisor inclination control during the non-accelerated retraction of upper anterior teeth with fixed orthodontic appliances: a systematic review and meta-analysis
Abstract
Background: Protrusion of the maxillary incisors represents a frequent clinical challenge in orthodontic treatment. Current systematic reviews are limited in range and methods employed, while individual trials lack consensus on the most effective mechanics for retraction.
Objective: This systematic review aimed to evaluate the effectiveness of various approaches used to control anterior tooth inclination during non‑accelerated retraction with buccal fixed appliances.
Methods: A search of databases was conducted in September (2025) to identify randomized controlled trials using various methods and techniques to retract the upper anterior teeth. Eligible RCTs enrolling patients aged 12-35 years who underwent extraction of upper first premolars were included. Meta‑analyses used random‑effects models (RevMan 5.3). Certainty of evidence was appraised with GRADE.
Results: Twenty RCTs with 568 patients in total were included. Risk‑of‑bias was low in 11 trials, some concerns in 4, and high in 5. Pooled analyses showed that retraction produced clinically and statistically significant palatal crown inclination of the upper incisors across techniques: sliding en‑masse (MD ≈ - 9.8°; moderate certainty), loop‑based en‑masse (MD ≈ - 13.3°; moderate certainty), and two‑step retraction (MD ≈ - 8.9°; moderate certainty). Loop‑based mechanics were associated with slightly greater retroclination than sliding (MD = 2.49°; statistically significant but not clinically meaningful; moderate…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 568 participants or records.
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