The effect of non-invasive physical interventions for accelerating tooth movement on orthodontically induced inflammatory root resorption: a systematic review and network meta-analysis

Root resorption is one of the most common complications following orthodontic treatment, and severe cases may compromise tooth stability and function. Over the past decades, pharmacological, surgical, and non-invasive physical interventions have been explored to mitigate orthodontically induced root resorption. Among these approaches, non-invasive physical interventions have attracted increasing attention because of their favorable safety profile and clinical convenience. Therefore, this study aimed to evaluate the effects of non-invasive physical interventions on orthodontically induced inflammatory root resorption (OIIRR) using a network meta-analysis, and to identify the most effective intervention in order to provide evidence-based recommendations for clinical practice. A systematic search was conducted across seven electronic databases from their inception to identify studies investigating the effects of representative physical interventions on OIIRR. Study selection was performed in accordance with the Cochrane System Evaluator’s Manual for Systematic Reviews. Following the PRISMA guidelines, statistical heterogeneity among studies was evaluated using the I² statistic. A random-effects model was applied when I² > 50%. Network meta-analysis was performed using Stata 16.0. Forest plots were generated using RevMan 5.4. A total of 1,135 records were screened, focusing on interventions including low-level laser therapy (LLLT), light-emitting diode (LED) therapy, and vibration. Twelve studies reporting OIIRR as an outcome measure were ultimately included. The results demonstrated that LED therapy significantly reduced OIIRR following orthodontic treatment (MD = − 0.14 mm3, 95% CI [− 0.18, − 0.10], p < 0.00001). Although LLLT (SMD = − 0.31, 95% CI [− 0.77, 0.14], p = 0.17) and vibration (SMD = − 1.67, 95% CI [− 3.54, 0.20], p = 0.08) showed a tendency toward reduced root resorption, these effects were not statistically significant. According to the SUCRA ranking, LED achieved a SUCRA value of 75.9 and a mean rank of 1.7, indicating a relative advantage over the other interventions in reducing OIIRR. LED therapy appears to be effective in alleviating orthodontically induced inflammatory root resorption. However, although the reduction in OIIRR was statistically significant, whether the magnitude of this effect translates into clinically meaningful benefits remains uncertain. Further well-designed studies are warranted to determine optimal device parameters and application protocols to maximize therapeutic efficacy.