Summary Objective The aim of this study was to investigate the effects of piezocision (surgical protocol with sutures) in orthodontic treatment using CAD/CAM (computer-aided design and computer-aided manufacturing) customized orthodontic appliances. Design The study is designed as a parallel group, randomized controlled trial (RCT). Setting University Hospital. Ethical approval The study was approved by the ethic committee of the University Hospital Liege, Belgium. Subjects and methods This RCT was conducted on 24 adult patients requiring orthodontic treatment to release mild overcrowding. Patients were all treated with a customized appliance and randomly assigned by means of sealed envelopes containing group codes to either a test group treated with piezocision or a control group without any further treatment. A blinded orthodontist validated appliance removal or further adjustments based on the model study. Outcome measures The overall treatment time and the time between archwire changes were recorded. Moreover, clinical and radiological features such as tooth resorption, gingival recessions, and the presence of scars were evaluated. Results A total of 24 patients (12 control and 12 test) completed the study. The overall treatment time was significantly shorter in the test group than the control group. Likewise, the time difference between all arch changes was significantly lower when piezocision was performed, except for the first arch at the mandible and the last arches at both maxillae. During the fine-tuning phase, no significant difference was found between the two groups. All periodontal and radiographic parameters remained stable from the start to the end of treatment in both the groups. However, minor scars were found in 66 per cent cases. Limitations This trial was a single-centre trial. Conclusions Piezocision seems to be an effective method to accelerate orthodontic treatment in cases of mild overcrowding. However, the effect was only observed during the alignment phase and a greater efficiency was found in the maxilla. The technique may be contraindicated in patients with a high smile line since the risk of slight scarring exists. Registration ClinicalTrails.gov (Identifier: NCT03406130)

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Objective To compare treatment duration and quality between standard vs computer-aided design/computer-aided manufacturing (CAD/CAM) customized self-ligating systems using indirect bonding with both. Materials and Methods This comparative trial included 24 patients: 12 treated with a CAD/CAM custom indirect bonding self-ligating system (CAD/CAM) and 12 others treated with an indirect bonding self-ligating standard system (I-STD). For each group, overall orthodontic treatment (OT) time was calculated and included the time needed to place each arch as well as the duration of the alignment and fine-tuning phases. The quality of the final result was analyzed using the American Board of Orthodontics Cast-Radiograph Evaluation. Patient-reported outcome measures (PROMs) were also evaluated. Results Patient characteristics were similar between the 2 groups except for age, which was slightly lower in the I-SDT group. Overall OT time was increased by 26% in the I-STD group compared with the CAD/CAM group (497 ± 40 days vs 393 ± 55 days, P = 0.0002) due to a shorter fine-tuning phase in the latter group (P<0.01). No difference was found between the groups for alignment phase. Quality of the final result was similar (I-STD, 25.7 ± 6.1; CAD/CAM, 21.6 ± 6.3) among the groups. Finally, no difference was found in the PROMs variables. Conclusions Despite a 26% longer OT time when compared with the CAD/CAM customized bracket system, the indirect bonding self-ligating bracket system demonstrated the same quality of treatment. PROMs demonstrated a high level of acceptance and satisfaction for both techniques.