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

OBJECTIVE: This meta-analysis aimed at critically assessing currently available evidence regarding the overall effectiveness of Piezocision in accelerating orthodontic tooth movement, as well as the adverse effects of this intervention in orthodontic patients. SEARCH METHODS: Electronic search of 6 databases and additional manual searches up to April 2019 without restrictions, also update the search was done by 20(th) November. SELECTION CRITERIA: Randomized controlled trials (RCT) and controlled clinical trials (CCT) reporting piezocision-assisted orthodontics versus conventional orthodontics were included in the review. DATA COLLECTION AND ANALYSIS: The data are expressed by mean differences (MD), 95% confidence intervals, fixed-effect model or random-effect model in the meta-analysis in regard to statistical heterogeneity analyses (tau(2), and I(2)). Included randomized studies were assessed for risk of bias using the new Cochrane Risk of Bias tool (ROB.2) and the non-randomized studies were assessed using (ROBINS I) tool. The studies were graded according to the GRADE approach. RESULTS: Fourteen papers for 13 unique trials were included in this systematic review and eight studies were included in the meta-analysis. The meta-analysis showed that the mean difference of the canine retraction rate in the first and second month after piezocision was 0.66 mm/month and 0.48mm/month, respectively. A total canine retraction rate in the first two months after piezocision was statistically significant (0.57 mm/month, p<0.00001), favoring the piezocision group with a high heterogeneity between studies I(2) = 69%. For the total treatment time outcome measure, there was a statistically significant difference in the overall treatment time (MD 101.64 Days, 95% CI, 59.24–144.06) favoring the piezocision group. CONCLUSIONS: Low quality evidence suggests that piezocision is an effective surgical procedure in accelerating the rate of canine retraction in the first two months and reducing the treatment duration. However, this effect appears to be clinically insignificant. SYSTEMATIC REVIEW REGISTRATION: CRD42019136303.