Evaluation of the effectiveness of piezocision-assisted flapless corticotomy in the retraction of four upper incisors: A randomized controlled clinical trial

Abstract

Background. Comprehensive orthodontic treatment may last for 20-24 months. Reducing the treatment time has become a common demand from both patients and orthodontists. Minimally invasive piezocision is one of the suggested approaches to accelerate the orthodontic tooth movement. Objectives. The aim of this randomized controlled clinical trial was to assess the effectiveness of the flapless piezocision procedure in accelerating the retraction of upper incisors. Material and methods. A single-blinded, parallel-group randomized controlled clinical trial was conducted at the Department of Orthodontics at the University of Damascus Dental School, Syria. The study involved 42 patients (11 males, 31 females) at the age of 16-31 years (mean age: 19.15 years). The patients had class II division I malocclusion and were treated with fixed appliances using the two-step retraction technique. With an allocation ratio of 1:1, the participants were randomly assigned to either the experimental group (n = 21) or the control group (n = 21) using a computer-generated list of random numbers. Allocation was concealed due to the use of sequentially numbered, opaque, sealed envelopes. The primary outcomes were the rate of incisor retraction (RIR) and the time required for retraction. The outcome assessor was blinded. Results. The data analysis included 20 patients in each group. The rate of incisor retraction significantly increased in the experimental group by 53%, with a significant shortening of the retraction time in the experimental group by 27% (p < 0.001). The rate of anchorage loss was significantly lesser in the experimental group (p < 0.001). Regarding the cephalometric assessment, incisor tipping was significantly greater in the control group than in the experimental group. Skeletal measurements showed insignificant changes following retraction between the 2 groups. Conclusions. The piezocision procedure was found to be effective in accelerating the retraction of 4 upper incisors, reducing the retraction time, preserving anchorage and enhancing root torque control during retraction.

Is Piezocision effective in accelerating orthodontic tooth movement: A systematic review and meta-analysis

“…This is statistically significant, but we cannot say if it would be clinically significant, as the mean treatment duration varies between 19-34 months. [2] For maxillary incisors' retraction, Al-Imam et al [40] found a statistically significant increase in the rate of retraction. According to this study [40] palatal and labial piezocision decreased the time of incisors' retraction by 3 weeks when compared to incisors' retraction without piezocision.…”

“…The summary findings are presented in Fig 2, Table 2, and S3 Table. Most of the RCTs were classified as having a high risk of bias. Only one study [32] was judged as having a low risk of bias, and three studies [33][34][35] were judged in the "some concerns" category. The two CCTs were having a serious risk of bias because of a lack of information regarding missing data.…”

“…Some studies [36,37] failed to treat the missing data, and other studies [15,31,33,35,[38][39][40]had some concerns in treating missing data. The randomization process was in some concern in five studies [29,31,[35][36][37] and at low risk of bias for other studies [15,32,33,[38][39][40][41].…”

“…Incisors' retraction. Only one study [40] reported the acceleration of incisors' retraction with assistance of piezocision cuts from the palatal and labial aspects. The authors concluded that the piezocision accelerated the incisors' retraction and decreased the time of retraction by 27% when compared to incisors' retraction without piezocision procedure.…”

“…[31,32,41] Also, Raj et al [37] concluded that the probing depth and the relative attachment level (RAL) increased gradually in both sides without statistical differences between the piezocision and control side. Moreover, Al-Imam et al [34]reported that they excluded one patient who had acute postsurgical inflammation between the upper central incisors from the palatal aspect. Pain in patients reported outcome measures.…”