OBJECTIVES The aim of this review was to systematically evaluate the failure rates of miniscrews related to their specific insertion site and explore the insertion site dependent risk factors contributing to their failure. SEARCH METHODS An electronic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Knowledge, Scopus, MEDLINE and PubMed up to October 2017. A comprehensive manual search was also performed. ELIGIBILITY CRITERIA Randomised clinical trials and prospective non-randomised studies, reporting a minimum of 20 inserted miniscrews in a specific insertion site and reporting the miniscrews' failure rate in that insertion site, were included. DATA COLLECTION AND ANALYSIS Study selection, data extraction and quality assessment were performed independently by two reviewers. Studies were sub-grouped according to the insertion site, and the failure rates for every individual insertion site were analysed using a random-effects model with corresponding 95% confidence interval. Sensitivity analyses were performed in order to test the robustness of the reported results. RESULTS Overall, 61 studies were included in the quantitative synthesis. Palatal sites had failure rates of 1.3% (95% CI 0.3-6), 4.8% (95% CI 1.6-13.4) and 5.5% (95% CI 2.8-10.7) for the midpalatal, paramedian and parapalatal insertion sites, respectively. The failure rates for the maxillary buccal sites were 9.2% (95% CI 7.4-11.4), 9.7% (95% CI 5.1-17.6) and 16.4% (95% CI 4.9-42.5) for the interradicular miniscrews inserted between maxillary first molars and second premolars and between maxillary canines and lateral incisors, and those inserted in the zygomatic buttress respectively. The failure rates for the mandibular buccal insertion sites were 13.5% (95% CI 7.3-23.6) and 9.9% (95% CI 4.9-19.1) for the interradicular miniscrews inserted between mandibular first molars and second premolars and between mandibular canines and first premolars, respectively. The risk of failure increased when the miniscrews contacted the roots, with a risk ratio of 8.7 (95% CI 5.1-14.7). CONCLUSIONS Orthodontic miniscrew implants provide acceptable success rates that vary among the explored insertion sites. Very low to low quality of evidence suggests that miniscrews inserted in midpalatal locations have a failure rate of 1.3% and those inserted in the zygomatic buttress have a failure rate of 16.4%. Moderate quality of evidence indicates that root contact significantly contributes to the failure of interradicular miniscrews placed between the first molars and second premolars. Results should be interpreted with caution due to methodological drawbacks in some of the included studies.

中文翻译：

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解剖部位和相关风险因素对正畸微螺钉种植体存活率的作用：系统评价和荟萃分析。

目的 本综述的目的是系统地评估与其特定插入部位相关的微型螺钉的失败率，并探讨导致其失败的插入部位相关风险因素。检索方法截至 2017 年 10 月，在 Cochrane 对照试验中央注册库 (CENTRAL)、Web of Knowledge、Scopus、MEDLINE 和 PubMed 中进行了电子检索。还进行了全面的手动检索。入选标准包括随机临床试验和前瞻性非随机研究，报告在特定插入部位至少插入 20 颗微型螺钉，并报告微型螺钉在该插入部位的失败率。数据收集和分析研究选择、数据提取和质量评估由两名审查员独立进行。根据插入部位对研究进行分组，并使用具有相应 95% 置信区间的随机效应模型分析每个单独插入部位的失败率。进行敏感性分析以测试报告结果的稳健性。结果 总体而言，61 项研究被纳入定量综合。腭中部、正中和腭旁插入部位的失败率分别为 1.3% (95% CI 0.3-6)、4.8% (95% CI 1.6-13.4) 和 5.5% (95% CI 2.8-10.7)。插入上颌第一磨牙之间的根间微型螺钉的上颌颊侧部位的失败率为 9.2% (95% CI 7.4-11.4)、9.7% (95% CI 5.1-17.6) 和 16.4% (95% CI 4.9-42.5)和第二前磨牙以及上颌尖牙和侧切牙之间，和分别插入颧骨的那些。下颌第一磨牙和第二前磨牙之间以及下颌尖牙和第一前磨牙之间的根间微螺钉的下颌颊侧插入部位的失败率分别为 13.5% (95% CI 7.3-23.6) 和 9.9% (95% CI 4.9-19.1) ， 分别。当微螺钉接触根部时，失败的风险增加，风险比为 8.7 (95% CI 5.1-14.7)。结论 正畸微螺钉植入物提供了可接受的成功率，这些成功率因所探索的插入部位而异。非常低到低质量的证据表明，插入中腭位置的微型螺钉的失败率为 1.3%，插入颧骨的微型螺钉的失败率为 16.4%。中等质量的证据表明，牙根接触会导致放置在第一磨牙和第二前磨牙之间的根间微型螺钉的失效。由于某些纳入研究的方法学缺陷，应谨慎解释结果。