Non-Cochrane · intervention · PM41816269
Assessing the efficacy and safety of minimally invasive surgical techniques in enhancing orthodontic tooth movement: A systematic review and meta-analysis of randomized controlled trials.
AlShammery Deema, Alshafai Narjes W, Alshahrani Lina A, et al. · Journal of orthodontic science · 2026 · PubMed · doi:10.4103/jos.jos_129_25
Findings
Population Patients receiving fixed orthodontic appliance treatment
13 findings
| Minimally invasive surgery without flap elevation (micro-osteoperforation, piezocision, flapless corticotomy/corticision, laser-assisted flapless corticotomy, interseptal bone reduction) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | En-masse retraction of anterior teeth Not specified | MD 1.55 [-0.65, 3.76] GRADE not reported 2 studies · 53 participants |
| Minimally invasive surgery without flap elevation (micro-osteoperforation, piezocision, flapless corticotomy/corticision, laser-assisted flapless corticotomy, interseptal bone reduction) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 2 months | MD 0.55 [0.35, 0.75] GRADE not reported 11 studies · 550 participants |
| Minimally invasive surgery without flap elevation (micro-osteoperforation, piezocision, flapless corticotomy/corticision, laser-assisted flapless corticotomy, interseptal bone reduction) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 3 months | MD 0.52 [0.26, 0.78] GRADE not reported 8 studies · 426 participants |
| Minimally invasive surgery without flap elevation (micro-osteoperforation, piezocision, flapless corticotomy/corticision, laser-assisted flapless corticotomy, interseptal bone reduction) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 1 month | MD 0.42 [0.26, 0.58] GRADE not reported 15 studies · 718 participants |
| Minimally invasive surgery without flap elevation (micro-osteoperforation, piezocision, flapless corticotomy/corticision, laser-assisted flapless corticotomy, interseptal bone reduction) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Overall orthodontic treatment time (crowding correction), days Until alignment | MD -42.3 [-68.31, -16.3] GRADE not reported 6 studies · 190 participants |
| Micro-osteoperforation (MOPs) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 2 months · Micro-osteoperforation subgroup | MD 0.47 [0.28, 0.66] GRADE not reported 7 studies · 376 participants |
| Micro-osteoperforation (MOPs) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 1 month · Micro-osteoperforation subgroup | MD 0.39 [0.19, 0.59] GRADE not reported 9 studies · 452 participants |
| Micro-osteoperforation (MOPs) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 1, 2 and 3 months combined · Micro-osteoperforation subgroup | MD 0.42 [0.31, 0.52] GRADE not reported 9 studies · 1100 participants |
| Micro-osteoperforation (MOPs) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 3 months · Micro-osteoperforation subgroup | MD 0.41 [0.2, 0.61] GRADE not reported 5 studies · 272 participants |
| Flapless corticotomy (piezocision or laser-assisted flapless corticotomy) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 3 months · Flapless corticotomy subgroup | MD 0.25 [-0.73, 1.23] GRADE not reported 3 studies · 118 participants |
| Flapless corticotomy (piezocision or laser-assisted flapless corticotomy) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 1, 2 and 3 months combined · Flapless corticotomy subgroup | MD 0.44 [0.18, 0.7] GRADE not reported 6 studies · 486 participants |
| Flapless corticotomy (piezocision or laser-assisted flapless corticotomy) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 2 months · Flapless corticotomy subgroup | MD 0.53 [-0.1, 1.16] GRADE not reported 4 studies · 138 participants |
| Flapless corticotomy (piezocision or laser-assisted flapless corticotomy) plus orthodontic treatment | Conventional fixed orthodontic treatment alone | Rate of canine movement (RCM), distance moved, mm 1 month · Flapless corticotomy subgroup | MD 0.42 [0.09, 0.74] GRADE not reported 6 studies · 230 participants |
Included primary studies 53
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Hatrom 2020 Effect of piezocision corticotomy on en-masse retraction. PMID:33378476 | 2020 | 2 other reviews | not stated | not extracted yet |
| Singh 2023 Effect of Mini-implant assisted Micro-osteoperforation on the rate of orthodontic tooth movement-A randomized clinical trial. PMID:38234639 | 2023 | 2 other reviews | not stated | not extracted yet |
| Thomas 2021 Evaluation of physiodispenser assisted micro-osteoperforation on the rate of tooth movement and associated periodontal tissue status… PMID:34112627 | 2021 | 2 other reviews | not stated | not extracted yet |
| Aboalnaga 2019 Effect of micro-osteoperforation on the rate of canine retraction: a split-mouth randomized controlled trial. PMID:31155698 | 2019 | 1 other review | not stated | not extracted yet |
| Alfawal 2018 Evaluation of piezocision and laser-assisted flapless corticotomy in the acceleration of canine retraction: a randomized controlled trial. PMID:29454369 | 2018 | 1 other review | not stated | not extracted yet |
| Alikhani 2013 Effect of micro-osteoperforations on the rate of tooth movement. PMID:24182579 | 2013 | 1 other review | not stated | not extracted yet |
| Alkebsi 2018 Three-dimensional assessment of the effect of micro-osteoperforations on the rate of tooth movement during canine retraction in adults… PMID:29853235 | 2018 | 1 other review | not stated | not extracted yet |
| Alqadasi 2021 Three-dimensional assessment of accelerating orthodontic tooth movement-micro-osteoperforations vs piezocision: A randomized,… PMID:33124098 | 2021 | 1 other review | not stated | not extracted yet |
| Attri 2018 Comparison of rate of tooth movement and pain perception during accelerated tooth movement associated with conventional fixed appliances… PMID:30281397 | 2018 | 1 other review | not stated | not extracted yet |
| Bakr 2023 Effects of Flapless Laser Corticotomy in Upper and Lower Canine Retraction: A Split-mouth, Randomized Controlled Trial. PMID:37159786 | 2023 | 1 other review | not stated | not extracted yet |
| Bansal 2019 Effects of mini-implant facilitated micro-osteoperforations in alleviating mandibular anterior crowding: A randomized controlled clinical… PMID:31649899 | 2019 | 1 other review | not stated | not extracted yet |
| Charavet 2019 Piezocision-assisted orthodontic treatment using CAD/CAM customized orthodontic appliances: a randomized controlled trial in adults DOI:10.1093/ejo/cjy082 | 2019 | 1 other review | not stated | not extracted yet |
| Gibreal 2019a Efficacy of piezocision-based flapless corticotomy in the orthodontic correction of severely crowded lower anterior teeth: a randomized… DOI:10.1093/ejo/cjy042 | 2018 | 1 other review | not stated | not extracted yet |
| Gibreal 2019b Evaluation of the levels of pain and discomfort of piezocision-assisted flapless corticotomy when treating severely crowded lower anterior… PMID:30991984 | 2019 | 1 other review | not stated | not extracted yet |
| Jaber 2022 Evaluation of the efficacy of laser-assisted flapless corticotomy in accelerating canine retraction: a split-mouth randomized controlled… PMID:33876339 | 2022 | 1 other review | not stated | not extracted yet |
| Mahmoudzadeh 2020 Efficacy of Er,Cr Laser incision Corticotomy in Rapid Maxillary Canine Retraction: A Split-Mouth Randomized Clinical Trial. PMID:33425295 | 2020 | 1 other review | not stated | not extracted yet |
| Raghav 2022 Effect of micro-osteoperforations on the rate of orthodontic tooth movement and expression of biomarkers: a randomized controlled clinical… PMID:35674571 | 2022 | 1 other review | not stated | not extracted yet |
| Shahrin 2021 Effect of micro-osteoperforations on external apical root resorption: A randomized controlled trial. PMID:33678624 | 2021 | 1 other review | not stated | not extracted yet |
| Sultana 2022 Effect of piezocision procedure in levelling and alignment stage of fixed orthodontic treatment: a randomized clinical trial DOI:10.1038/s41598-022-09851-0 | 2022 | 1 other review | not stated | not extracted yet |
| Tunçer 2017 Efficiency of piezosurgery technique in miniscrew supported en-masse retraction: a single-centre, randomized controlled trial. PMID:28402521 | 2017 | 1 other review | not stated | not extracted yet |
| Uribe 2017 Efficiency of piezotome-corticision assisted orthodontics in alleviating mandibular anterior crowding—a randomized clinical trial DOI:10.1093/ejo/cjw091 | 2017 | 1 other review | not stated | not extracted yet |
| Venkatachalapathy 2022 Effect of Frequency of Micro-osteoperforation on Miniscrew- supported Canine Retraction: A Single-centered, Split-mouth Randomized… PMID:37283011 | 2022 | 1 other review | not stated | not extracted yet |
| Aboalnaga 2019 Effect of micro-osteoperforation on the rate of canine retraction: a split-mouth randomized controlled trial DOI:10.1186/s40510-019-0274-0 | 2019 | this review only | not stated | not extracted yet |
| Aksakalli 2016 Accelerated tooth movement with piezocision and its periodontal-transversal effects in patients with Class II malocclusion DOI:10.2319/012215-49.1 | 2016 | this review only | not stated | not extracted yet |
| Aksakalli 2016 Accelerated tooth movement with piezocision and its periodontal-transversal effects in patients with Class II malocclusion. PMID:25989211 | 2016 | this review only | not stated | not extracted yet |
| Alfawal 2018 Evaluation of piezocision and laser-assisted flapless corticotomy in the acceleration of canine retraction: a randomized controlled trial DOI:10.1186/s13005-018-0161-9 | 2018 | this review only | not stated | not extracted yet |
| Alfawal 2020 Evaluation of patient-centered outcomes associated with the acceleration of canine retraction by using minimally invasive surgical… DOI:10.17219/dmp/120181 | 2020 | this review only | not stated | not extracted yet |
| Alfawal 2020 Evaluation of patient-centered outcomes associated with the acceleration of canine retraction by using minimally invasive surgical… PMID:32909702 | 2020 | this review only | not stated | not extracted yet |
| Alikhani 2013 Effect of micro-osteoperforations on the rate of tooth movement DOI:10.1016/j.ajodo.2013.06.017 | 2013 | this review only | not stated | not extracted yet |
| Alkebsi 2018 Three-dimensional assessment of the effect of micro-osteoperforations on the rate of tooth movement during canine retraction in adults… DOI:10.1016/j.ajodo.2017.11.026 | 2018 | this review only | not stated | not extracted yet |
| Alqadasi 2021 Three‐dimensional assessment of accelerating orthodontic tooth movement—micro‐osteoperforations vs piezocision: A randomized,… DOI:10.1111/ocr.12437 | 2020 | this review only | not stated | not extracted yet |
| Alshammery 2020 Evaluation and Comparison of Periodontal Status and Rate of Canine Retraction With and Without Piezocision-Facilitated Orthodontics: A… DOI:10.11607/prd.3968 | 2020 | this review only | not stated | not extracted yet |
| Alshammery 2020 Retraction With and Without Piezocision-Facilitated Orthodontics: A Randomized Controlled Trial. PMID:31815981 | 2020 | this review only | not stated | not extracted yet |
| Asif 2020 Osseous evidence behind micro-osteoperforation technique in accelerating orthodontic tooth movement: A 3-month study DOI:10.1016/j.ajodo.2019.09.022 | 2020 | this review only | not stated | not extracted yet |
| Asif 2020 Osseous evidence behind micro-osteoperforation technique in accelerating orthodontic tooth movement: A 3-month study. PMID:32826123 | 2020 | this review only | not stated | not extracted yet |
| Attri 2018 Comparison of rate of tooth movement and pain perception during accelerated tooth movement associated with conventional fixed appliances… DOI:10.1080/14653125.2018.1528746 | 2018 | this review only | not stated | not extracted yet |
| Charavet 2019 Piezocision-assisted orthodontic treatment using CAD/CAM customized orthodontic appliances: a randomized controlled trial in adults. PMID:30649257 | 2019 | this review only | not stated | not extracted yet |
| Gibreal 2019a Efficacy of piezocision-based flapless corticotomy in the orthodontic correction of severely crowded lower anterior teeth: a randomized… PMID:29931294 | 2019 | this review only | not stated | not extracted yet |
| Gibreal 2019b Evaluation of the levels of pain and discomfort of piezocision-assisted flapless corticotomy when treating severely crowded lower anterior… DOI:10.1186/s12903-019-0758-9 | 2019 | this review only | not stated | not extracted yet |
| Haliloglu-Ozkan 2018 In-vivo effects of flapless osteopuncture-facilitated tooth movement in the maxilla and the mandible. PMID:30305873 | 2018 | this review only | not stated | not extracted yet |
| Hatrom 2020 Effect of piezocision corticotomy on en-masse retraction: DOI:10.2319/092719-615.1 | 2020 | this review only | not stated | not extracted yet |
| Jaber 2022 Evaluation of the efficacy of laser-assisted flapless corticotomy in accelerating canine retraction: a split-mouth randomized controlled… DOI:10.1007/s10006-021-00963-x | 2021 | this review only | not stated | not extracted yet |
| Leethanakul 2014 Interseptal bone reduction on the rate of maxillary canine retraction DOI:10.2319/100613-737.1 | 2014 | this review only | not stated | not extracted yet |
| Leethanakul 2014 Interseptal bone reduction on the rate of maxillary canine retraction. PMID:24592904 | 2014 | this review only | not stated | not extracted yet |
| Raghav 2022 Effect of micro-osteoperforations on the rate of orthodontic tooth movement and expression of biomarkers: a randomized controlled clinical… DOI:10.1590/2177-6709.27.1.e2219403.oar | 2022 | this review only | not stated | not extracted yet |
| Sirri 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sivarajan 2019 Mini-implant supported canine retraction with micro-osteoperforation: A split-mouth randomized clinical trial DOI:10.2319/011518-47.1 | 2019 | this review only | not stated | not extracted yet |
| Sivarajan 2019 Mini-implant supported canine retraction with micro-osteoperforation: A split-mouth randomized clinical trial. PMID:30372126 | 2019 | this review only | not stated | not extracted yet |
| Sultana 2022 Effect of piezocision procedure in levelling and alignment stage of fixed orthodontic treatment: a randomized clinical trial. PMID:35422071 | 2022 | this review only | not stated | not extracted yet |
| Thomas 2021 Evaluation of physiodispenser assisted micro-osteoperforation on the rate of tooth movement and associated periodontal tissue status… DOI:10.1016/j.ejwf.2021.05.001 | 2021 | this review only | not stated | not extracted yet |
| Tuncer 2017 Efficiency of piezosurgery technique in miniscrew supported en-masse retraction: a single-centre, randomized controlled trial DOI:10.1093/ejo/cjx015 | 2017 | this review only | not stated | not extracted yet |
| Uribe 2017 Efficiency of piezotome-corticision assisted orthodontics in alleviating mandibular anterior crowding-a randomized clinical trial. PMID:28371882 | 2017 | this review only | not stated | not extracted yet |
| Venkatachalapathy 2022 Effect of Frequency of Micro-osteoperforation on Miniscrew- supported Canine Retraction: A Single-centered, Split-mouth Randomized… DOI:10.5005/jp-journals-10024-3385 | 2022 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients receiving orthodontic treatment with fixed appliances | Patients with fixed appliances, mean age 15.6 to 29.7 years (n=809 participants, 30 trials) |
| Intervention | Minimally invasive surgery without flap elevation (micro-osteoperforation, piezocision, flapless corticision, interseptal bone reduction, discision, laser-assisted flapless corticotomy) | MOP (14 studies), piezocision (12), laser-assisted flapless corticotomy (5), flapless corticision (1), interseptal bone reduction (1) |
| Comparison | Traditional fixed orthodontic therapy or alternative acceleration methods | Conventional orthodontic treatment; some trials compared two MIS techniques |
| Outcomes | Rate of tooth displacement and length of orthodontic treatment; secondary: pain, discomfort, periodontal complications, root resorption, anchorage loss, undesirable tooth movement, alveolar bone loss, pulp vitality | Canine movement at 1, 2 and 3 months; overall treatment time; en-masse retraction; qualitative secondary outcomes |
| Study designs | Two-arm and multi-arm RCTs with at least 10 participants | RCTs: 13 split-mouth, 12 parallel-group, 5 compound (n=30); 23 in meta-analysis |
| Timing | Follow-up not restricted | Follow-up up to 6 months or until alignment |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |