The efficacy and accuracy of 3D-guided orthodontic piezocision: a randomized controlled trial.

BACKGROUND: No randomized controlled trial (RCT) has studied the accuracy of surgical guides used in terms of orthodontic treatment acceleration. Therefore the aim of this trial was to assess computer-guided piezocision-based orthodontic. MATERIALS AND METHODS: Thirty-two patients with severely crowded upper anterior teeth were enrolled and randomly allocated to either the experimental group (ExpG) or the control one. Subjects of the ExpG received three-dimensional (3D) guided piezoelectric corticotomies on the buccal alveolar bone of the anterior region. Five piezocision cuts were properly performed between each anterior teeth and the adjacent in virtual models. Surgical guides were designed and 3D-printed with preplanned slots that guide gingival and then piezoelectric incisions. The patients underwent Cone-Beam Computed Tomography CBCT before and immediately after surgery. Thus, Predesigned piezocisions were compared to the actual ones in attempt to measure three dimensional deviations of the applied peizocisions. RESULTS: Ninety-six severe maxillary dental crowding were assigned for eligibility, 40 of them met the inclusion criteria. Thirty-two participants were randomly allocated to the trial`s groups. No patient was lost to follow-up neither from the control nor the experimental group. Overall alignment time (OAT) was reduced by 53% in the experimental group compared to the control group. The mean of the 3D deviation of the surgical guide was 0.23 mm (standard deviation 0.19 mm). CONCLUSION: The values of the surgical guide deviation was nearly null, which confirms that this innovative technique is clinically applicable. Furthermore, this technique was impressively effective in accelerating orthodontic tooth movement. TRIAL REGISTRATION: This trial was registered at The ISRCTN registry (ID: ISRCTN65498676 Registration date: 07/04/2021).

Evaluation of the levels of pain and discomfort of piezocision-assisted flapless corticotomy when treating severely crowded lower anterior teeth: a single-center, randomized controlled clinical trial.

BACKGROUND: No randomized controlled trial (RCT) has compared flapless piezocision-assisted corticotomy in the extraction-based orthodontic decrowding of lower anterior teeth with the conventional treatment in terms of pain, discomfort and acceptability. Therefore, the aim of this trial was to compare piezocision-based orthodontic decrowding of lower anterior teeth following premolar-extraction with the conventional orthodontic treatment regarding levels of pain, discomfort, and patients' satisfaction. METHODS: A parallel-group RCT was conducted on 34 patients with severely crowded lower anterior teeth. Subjects were randomly allocated to either the experimental (ExpG) or the control group. Piezoelectric corticotomies were performed on the labial surfaces of the alveolar bone in the anterior region in the ExpG. Levels of pain, discomfort, swelling, difficulties of mastication, swallowing and jaws movement limitation were recorded on a Visual Analog Scale (VAS) at 1, 7, 14 and 28 days. In the ExpG, patients were also asked to rate their level of satisfaction following acceleration. Two-sample t tests were employed to detect significant differences. RESULTS: No statistically significant differences were found between the two groups at one day following treatment commencement regarding pain, discomfort, difficulties of mastication, swallowing and limitation in jaws movement (P = 0.082, 0.367, 0.062, 0.446, 0.359; respectively). However, a statistically significant difference was found between the two groups regarding the perception of swelling at the first-day assessment (P = 0.011). No statistically significant differences were detected between the two groups at 7 days regarding the five previously mentioned variables. There was a drop down to zero level at two weeks and four weeks following treatment onset for all variables. The level of satisfaction in the ExpG had a mean value of 86.47 (±22.47) and all patients were positive towards recommending the surgical intervention to a friend. CONCLUSIONS: No significant differences in the levels of pain and discomfort were found between the ExpG and the control group for all variables except for the perception of swelling at one day following intervention. Patient-centered outcomes revealed a high level of acceptance and satisfaction with this technique. TRIAL REGISTRATION: This trial was registered at Clinical Trials.gov (Identifier NCT02975765 ).

Efficacy of piezocision-based flapless corticotomy in the orthodontic correction of severely crowded lower anterior teeth: a randomized controlled trial.

BACKGROUND: No randomized controlled trial (RCT) has compared flapless piezocision-assisted corticotomy in the extraction-based orthodontic decrowding of lower anterior teeth with the conventional treatment. OBJECTIVE: To evaluate the effectiveness of flapless piezocision-assisted corticotomies in accelerating lower anterior teeth alignment. TRIAL DESIGN: A parallel-group RCT was conducted. MATERIALS AND METHODS: Thirty-six patients (mean age 20.32 ± 1.96 years) in need of orthodontic treatment with a fixed orthodontic appliance were enrolled and randomly allocated to either the experimental or the control group. Following first premolar extraction, five radiographic-guided micro incisions and localized piezoelectric corticotomies were performed on the labial surfaces of the alveolar bone between the six anterior teeth in order to accelerate alignment for patients in the experimental group, whereas those in the control group received traditional orthodontic treatment. The overall alignment time (OAT) required to complete anterior alignment of the mandibular dental arch (OAT) was measured. Little's Irregularity Index (LII) was also calculated at monthly intervals. Randomization was performed using a software-generated list of random numbers; the recruited patients were divided into two parallel groups with a 1:1 allocation ratio. Assessor blinding was employed. RESULTS: One hundred and eight severe dental crowding patients were evaluated for eligibility, 40 of them fulfilled the inclusion criteria. Thirty-six participants were allocated to the treatment groups randomly. One female patient was lost to follow-up from the control group, and another female patient was excluded from analysis for the experimental group. Accordingly, the results of 34 patients were statistically analyzed. OAT was reduced by 59% in the experimental group compared to the control group, with a statistically significant difference between the two groups (P < 0.001). No harms were encountered. CONCLUSION: Flapless piezocision technique was very effective in accelerating orthodontic tooth movement. TRIAL REGISTRATION: This trial was registered at Clinical Trials.gov (Identifier: NCT02977221).