Comparison between conventional and piezocision-assisted orthodontics in relieving anterior crowding: a systematic review and meta-analysis

BACKGROUND: Prolonged duration of orthodontic treatment is of great concern and poses risks to the teeth and surrounding tissues. Orthodontic tooth movement can be accelerated by introducing regional insult. Evidence suggests piezocision to be minimally invasive and clinically effective. OBJECTIVE: The aim of the present study was to compare the effectiveness of conventional and piezocision-assisted orthodontics in relieving anterior crowding. SEARCH METHODS: Electronic and manual searches were conducted in databases including PubMed, Dental and Oral Science, CINAHL, and Cochrane Central Register of Controlled Trials until April 2019. SELECTION CRITERIA: Randomized and non-randomized controlled trials were included. DATA COLLECTION AND ANALYSIS: Data were extracted independently by two authors from the studies that fulfilled inclusion criteria. The primary outcome assessed was time required for the alleviation of crowding. The secondary outcomes evaluated were pain, root resorption, and periodontal health. The risk of bias in the clinical trials was evaluated according to the Cochrane Collaboration's tool. Studies having homogenous data were included in the meta-analysis using the RevMan software. RESULTS: Initial search yielded 3018 studies with eight articles meeting the inclusion criteria, six were randomized controlled trials and two were non-randomized controlled trials. Significant differences were found in alignment time between conventional and piezocision-assisted orthodontic treatment. However, gingival health, pain experienced by the patient, and root resorption showed non-significant differences. The forest plot of meta-analysis depicted significant mean difference of -46.44; 95 per cent confidence interval (CI) -87.95, -4.93; P ≤ 0.03 in the alignment time. Difference in pain levels was found to be non-significant (P = 0.78). LIMITATIONS: There is a shortage of high-quality randomized controlled trials with a limited sample size and lack of standardization of piezocision protocol. CONCLUSIONS AND IMPLICATIONS: According to the existing evidence, piezocision is effective in reducing tooth alignment time and alleviating crowding when compared to conventional therapy. Pain levels showed insignificant differences revealed in meta-analysis. Weak evidence suggests that there are no negative effects on periodontal health and root resorption after performing piezocision. REGISTRATION: PROSPERO (CRD42019134398).