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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).