Temporary anchorage devices in orthodontics: a bibliometric analysis of the 50 most-cited articles from 2012 to 2022
ABSTRACT
Objectives
To identify and analyze the 50 most cited articles on temporary anchorage devices (TADs) and investigate the achievement and development of scientific research about the topic through a bibliometric analysis.
Materials and Methods
On August 22, 2022, a computerized database search was performed to detect papers published in the scientific literature about TADs from 2012 to 2022. Metrics data were identified using the Incites Journal Citation Reports (Clarivate Analytics) data set. The Scopus database was used to obtain information on the authors’ affiliations, country of origin, and h-index. Key words were automatically harvested from the selected articles to implement the visualized analysis.
Results
From a total of 1858 papers screened by searching the database, a list of the top 50 most cited articles was created. The total number of citations collected by the 50 most cited articles in TADs was 2380. Among the 50 most cited articles on TADs, 38 were original research papers (76.0%) and 12 were reviews (24.0%). As shown by the key word–network analysis, Orthodontic anchorage procedure was identified as the larger node.
Conclusions
Findings of this bibliometric study showed an increasing number of citations for papers on TADs, accompanied by a simultaneous rise in scientific interest in this topic in the past decade. The present work identifies the most influential articles, emphasizing the journals, the authors, and the topics addressed.
INTRODUCTION
Anchorage, defined as resistance to unwanted tooth movement, is the cornerstone of the orthodontic force system, and strategies for its control should be considered a significant factor in planning and achieving successful treatment.1 Evolving from the work of Roberts et al.2 on tissue response to orthodontic forces applied to restorative implants, orthodontic bone anchorage has attained widespread use in recent years and has had a major impact on treatment to provide intraoral anchorage, adding an entirely new scope for orthodontic practice.3–5
Orthodontic bone anchorage can be obtained through mechanically retentive devices, such as miniscrews and miniplates.6 Since these temporary anchorage devices (TADs) use osseous physical engagement for stability, osseointegration is neither expected nor desired, although studies have shown that a limited and variable level (10–58%) of osseointegration could occur.6,7 Therefore, the effectiveness of miniscrews is related to primary stability, which has become a major issue to be investigated. Several factors could be related to their permanency, such as bone thickness, oral hygiene, smoking, insertion site, miniscrew design factors, type of mucosa (keratinized and nonkeratinized), and other patient-related factors.6,8
TADs have been widely used in the orthodontic field in recent years because of their capability to reduce the need for patient compliance and increase the number of treatment options to better match esthetic and occlusal treatment goals.3–5
As a result, a significant increase in research activity has been observed over the past decade, in line with the growing number of publications, on TADs.4,5 The large number of publications creates difficulties for researchers in obtaining high-quality information, and bibliometric analysis is a mathematical and statistical method that assesses the interrelationships and impact of published papers within a specific scientific research area.9,10
Thus, despite the variety of research topics on TADs,3–8 bibliometric and visual analysis could help to identify the hot topics in this research field and the direction of scientific development in this specific field. Therefore, the aim of this study was to perform a bibliometric analysis of the 50 most cited papers to provide a clearer scientific scenario for physicians that might improve the clinical research on this orthodontic device.
MATERIALS AND METHODS
On August 22, 2022, an independent database search was conducted to find papers published in the scientific literature about TADs during the past 10 years (from 2012 to 2022). The following research query was developed: ((“orthodontic*” OR “orthodontic treatment” OR “orthognatic*”) AND (“TAD*” OR “temporary anchorage device*” OR “miniimplant*” OR “skeletal anchorage” OR “miniscrew*” OR “microimplant”)), and the Scopus database was searched (Elsevier BV, Amsterdam, The Netherlands).
Two reviewers independently screened the papers according to titles, abstracts, and full text to determine study eligibility. In case of disagreement, consensus was achieved through a third reviewer.
Using the Incites Journal Citation Reports (Clarivate Analytics), the following journal-based bibliometric parameters were collected: 2021 Journal Impact Factor (JIF); quartile of the Category “Dentistry, Oral Surgery & Medicine,” according to Web of Science Core Collection (when it was available); Eigenfactor Score; Normalized Eigenfactor; article influence score; 5-Year Journal Impact Factor (5-JIF); Immediacy Index.
Key words were automatically retrieved from the data set based on bibliographic data and used to create a cooccurrence network. Key words were counted using full counting, meaning that each co-occurrence link received the same weight. To eliminate repetition, two authors carefully reviewed and amended all of the terms to construct a bespoke thesaurus. VOSviewer (Centre for Science and Technology Studies, Leiden University, Leiden, The Netherlands) was used to map key words. The nodes represented the key words, the edges represented the key word association, and the distance between nodes generally reflected relationships among the nodes.
RESULTS
From the research query, 1858 papers were identified. After applying a limitation filter to find papers from 2012 to 2022, 1274 papers were obtained, which are listed from the most cited to the least cited paper in Table 1,11–60 with the total number of citations collected being 2380. Thirty-eight were original research papers (76.0%), and 12 were reviews (24.0%). Ten of the reviews were systematic reviews (20.0%), of which 6 were with meta-analyses (12.0%). Among the original articles, 14 were prospective studies (28%), 8 were finite element analysis studies (16%), 5 were retrospective studies (10%), 4 were case reports (8%), 2 were in vitro studies (4%), 2 were randomized clinical trials (RCTs) (4%), and 3 were animal studies (6%). Figure 1 displays further details. The papers on TADs were published in 16 different scientific journals, and 9 (56.25%) were in the category “Dentistry, Oral Surgery & Medicine,” as depicted by Table 2.
Citation: The Angle Orthodontist 93, 5; 10.2319/010923-18.1
DISCUSSION
This was the first bibliometric analysis of the 50 most cited articles on TADs. According to other comparable publications, the size of 50 articles was selected to have a sample size large enough to extract significant information and to graph with significant trendline data. The last 10 years were selected to increase clinical interest in looking at articles with newer protocols, with recognition of the rapid and recent evolution of this technique.61,62
The popularity of TADs has grown in recent years, supported by clinicians and researchers, confirming TADs as valuable tools. Despite the importance of reviews in supporting evidence about a specific topic, only 20% of the articles listed in the present work belong to that category. Secondary studies represent the apex of the research hierarchy, and consequently, they should be the best source for understanding a topic.63 Studies at the bottom of the evidence hierarchy (case reports, animal studies, in vitro studies, finite element analysis) can be found in the list, probably because the topic is relatively young and more time is required to improve the quality of the literature supporting it. Only 3 were RCTs, although this study design could provide the highest quality evidence, probably due to the cost and time required to carry out these types of scientific work.63
Number of Citations
The rate of citations per year has increased during the past decade. This trend in the total number of articles regarding the topic is depicted by Figure 2. It might be relevant to note that the use of citations per year as an indicator might reduce the bias caused by the time frame needed to collect citations related to older articles, considering that time could influence the ranking of article citations. Consequentially, dominant items on the list may be old studies, whereas high-quality, meaningful, and original papers published in recent years could be undervalued. In addition, the use of citations per year as an indicator may indicate that many high-quality articles were published during the decade 2012–2022 and that the quality of these papers has been increasing over the years. On the other hand, the phenomenon of obliteration by incorporation9,10,61,62 should be taken into consideration, which implies that historical scientific research is rarely cited, as the information provided becomes an integral part of clinical medical activity, and researchers may no longer feel the need to cite those studies.
Citation: The Angle Orthodontist 93, 5; 10.2319/010923-18.1
Journals
The 50 most cited articles were published in 17 different journals, indicating heterogeneity in the source of scientific information regarding the topic. It is relevant to notice that 2 journals (American Journal of Orthodontics and Dentofacial Orthopedics and The Angle Orthodontist) collected the majority of the citations (n = 1478, 62.10% of the total amount of citations). This was in line with Bradford’s law, according to which, despite the large number of journals, most of the citations were collected by a few of them.9,10,61,62 This could have been due to many factors. First, multidisciplinary journals, such as medical and engineering journals, have often been awarded with higher journal metrics. Second, journals with a higher JIF often have a rate of publications extremely low and with very strict selection. In addition, some journals are renowned by clinicians and have a larger audience despite their measured scientific impact. Last, some of the journals are open access and promote distribution of published articles and their citations. Despite the higher publication fees often requested by open access journals, researchers are motivated to send their work to these journals due to the larger audience and wider dissemination of articles. Indeed, as reported by Hua et al.,64 open access papers should accelerate research, improve education, and benefit all researchers and practitioners, particularly those in low-income countries and resource-poor institutions.
Key Word Network Analysis
A key word map was built using the terms from the 50 most referenced articles about TADs (Figure 3). Key words are used to express the research field of hotspots; in addition, directions can be reflected in key word co-occurrence. The key word map showed Orthodontic anchorage procedure as the larger node, because this term has been the most used among articles, collecting 39 occurrences and 758 total link strengths. The clinical protocols for using TADs are undoubtedly one of the most relevant matters of focus by clinicians, considering the relatively recent introduction of skeletal anchorage in daily clinical practice.
Citation: The Angle Orthodontist 93, 5; 10.2319/010923-18.1
One of the most recurrent words was palatal expansion. Indeed, seven papers among the 50 most cited articles on TADs discussed miniscrew-supported rapid maxillary expansion, and one paper was on maxillary protraction using a hybrid hyrax-facemask combination. Scientific literature showed that bone-borne expanders increased the skeletal separation of the midpalatal suture, with a more parallel sutural opening and reduced buccal tipping of the maxillary first molars.15,39 In addition, the use of bone-borne palatal expanders has enabled midpalatal suture disjunction, even in the latter stages of suture maturation, reducing undesired dental effects related to these procedures in adolescents and adults.15,39
Looking at the co-occurrence maps, another recurrent word was palate, which is often selected as an extra-alveolar site for TAD insertion because of excellent bone quality and less possibility of root damage to the adjacent teeth. Considering the keratinized soft tissue and sufficient cortical bone, TAD placement in the paramedian palatal area has been recommended. However, it was reported that there was thinner bone in the early mixed dentition, compared with the late mixed and permanent dentition groups.20
Limitations
This study was not free from limitations. First, even if the number of total citations is an important indicator of the quality and attractiveness of an article, a certain amount of time is needed for a paper to accumulate citations. Therefore, using only the number of citations is not sufficient to determine the value of a paper. Indeed, high-quality but more recent articles may not have been identified. Second, there may have been a bias related to the presence of self-citations and the potential preference of some authors to cite articles from a specific journal. Third, the articles were identified only from Scopus. Last, the total citations of an article could have been affected by the journal level, and an article published in a journal with a high impact factor may have been more likely to receive more citations.
CONCLUSIONS
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Taken together, findings of this bibliometric study showed an increasing number of citations for papers on TADs, highlighting an increasing interest in scientific research in the past decade on this topic in orthodontics.
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Among the 50 most cited articles on TADs, 10 were systematic reviews, of which 6 had meta-analyses.
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Starting from the analysis of the most cited articles on TADs in this field, researchers might improve the clinical research on this orthodontic device.
Study design of the 50 most cited papers on temporary anchorage devices.
Number of citations per year received by the 50 most cited papers on temporary anchorage devices.
Key word network analysis of the 50 most cited papers on temporary anchorage devices.
Contributor Notes