Meta-analysis shows micro-osteoperforation accelerates orthodontic tooth movement safely across sixteen randomized controlled trials involving patients undergoing treatment

Prolonged orthodontic treatment is associated with adverse clinical outcomes such as enamel white spot lesions and root resorption, and micro-osteoperforation (MOPs) is a minimally invasive intervention for accelerating orthodontic tooth movement (OTM). This meta-analysis aimed to evaluate the efficacy of MOPs in accelerating OTM, assess its potential adverse effects on periodontal tissues, root structure and anchorage, and summarize the optimal application parameters of MOPs for clinical practice. A systematic literature search was conducted in PubMed, Web of Science, EMBASE, Scopus, Cochrane Library, LILACS, and Google Scholar, with 16 randomized controlled trials (RCTs) included after screening 1,175 records. This study was registered in the PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD420251149503). The Cochrane ROB 2 tool was used to assess the risk of bias of included studies, and the GRADE approach was applied to evaluate the certainty of the cumulative evidence. Compared with traditional orthodontic treatment, the MOPs group achieved an increase of 0.67 mm (95% CI: 0.45–0.88) in the total OTM distance and a monthly increase of 0.20 mm (95% CI: 0.13–0.26) in the OTM rate. Multiple MOPs significantly increased the total OTM distance (1.17 mm, 95% CI: 0.21–2.13) compared with single MOPs (0.61 mm, 95% CI: 0.45–0.77), while the monthly OTM rate remained stable at approximately 0.2 mm. For secondary outcomes, MOPs was associated with a non-clinically significant increase in root resorption (mean difference: 0.19 mm, 95% CI: −0.14 to 0.51), no significant anchorage loss, and mild, transient adverse effects on periodontal parameters (e.g., slight increase in probing depth). Postoperative pain in the MOPs group was significantly higher on the surgery day but diminished rapidly, with no long-term impact on patients’ quality of life. Subgroup analyses showed that mandibular MOPs, repeated MOPs application, and the use of the Propel device were associated with enhanced acceleration effects. The included studies had an overall low risk of bias in randomization, incomplete outcome data and selective reporting domains. Moderate risks of performance and detection bias were present across all studies due to the inherent inability to blind participants and operators for surgical interventions such as MOPs. MOPs appears to be an effective adjunctive approach for accelerating orthodontic tooth movement without causing clinically significant damage to root structure, anchorage, or periodontal tissues. Meanwhile, long-term outcomes and optimal application parameters—such as the number, depth, and frequency of perforations—require further investigation. Clinical implementation should be individualized based on patient characteristics and treatment objectives. https://www.crd.york.ac.uk/PROSPERO/recorddashboard, PROSPERO CRD420251149503.