# Complications Arising Due to Orthodontic Treatment--A Systematic Review and Meta-Analysis
## 4 Discussion  
The significance of this study lies in its systematic approach to reviewing the literature on the metallurgical characteristics of metals and alloys used in orthodontic treatment, and the associated complications. By synthesizing the findings of 14 studies, this review provides a comprehensive overview of the difficulties related to orthodontic treatment and highlights the need for more long-term studies to confirm the involvement of an orthodontic component in these issues. The review's implications are threefold. Firstly, our findings identified gingival mucosa and root resorption as the most commonly reported periodontal problems associated with orthodontic treatment. Orthodontists can use this information to monitor patients for these complications and take preventive measures to minimize their occurrence. Additionally, this investigation highlights the need for more long-termstudies to confirm the involvement of orthodontic treatment in the identified complications. Future studies can build on the findings of this review to investigate the mechanisms underlying these complications and develop strategies to mitigate them. Moreover, this review can inform the education and training of orthodontic professionals by providing a comprehensive overview of the complications associated with orthodontic treatment. Educators can use this information to develop curricula that emphasize the importance of monitoring patients for these complications and taking preventive measures to minimize their occurrence. Overall, this systematic review contributes to our understanding of the metallurgical characteristics of metals and alloys used in orthodontic treatment and the associated complications, providing a foundation for future research, clinical practice, and education in this field. The duration of orthodontic treatment, the level of pain and discomfort, and the use of retention appliances, in contrast, were all linked to patient dissatisfaction. This was revealed by a systematic analysis of 18 studies [9] that looked at patient satisfaction with orthodontic treatment. The evaluation showed a wide range in terms of research design, setting, demographics, and measurement methods. According to a qualitative study [10], adult patients' satisfaction with their orthodontic care was correlated with communication, staff, the physical surroundings, appointments, and the impact of appliance therapy. Orthodontic treatment aims to move teeth to their desired positions, but this movement can result in some undesirable consequences, such as root resorption [31]. Root resorption occurs when the cells responsible for breaking down and rebuilding bone, known as osteoclasts and osteoblasts, respectively, become overactive and remove more tooth structure than necessary, leading to shorter roots [32; 33; 34; 35]. Intrusion, retraction, and torque movements are common orthodontic tooth movements that have been investigated regarding their potential to cause root resorption [36; 37; 38; 39; 40]. While these movements alone may not increase the risk of root resorption, factors such as the amount of force applied, stress distribution region, and total apical displacement can make them more potent [41; 42; 43]. First, the amount of force applied is critical in determining the extent of root resorption. Studies have shown that higher forces lead to increased root resorption, with force levels above 2 N associated with a greater risk of resorption [44; 45; 46; 35; 47]. This is because high forces cause an imbalance between the forces applied to the tooth and the ability of the surrounding tissues to support them. As a result, the tooth moves faster than the surrounding bone can remodel, leading to hyalinization (death of cells) and resorption of the root [48; 49; 50; 51]. Second, the stress distribution region can also affect the risk of root resorption [52; 53; 54; 55; 56; 57]. When orthodontic forces are applied, they create stresses within the tooth and the surrounding bone.