EFFECT OF PIEZOCISION ON MANDIBULAR ANTERIOR ALIGNMENT DURING FIXED ORTHODONTIC TREATMENT: A SYSTEMATIC REVIEW AND META ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

Introduction: Piezocision is a minimally invasive surgical technique proposed to accelerate orthodontic tooth movement. However, evidence regarding its effect on the alignment of mandibular anterior teeth remains inconsistent. Objective: To evaluate the effect of piezocision on the time required to achieve mandibular anterior alignment during fixed orthodontic treatment compared with orthodontic treatment without piezocision. Materials and Methods: A systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines. PubMed/MEDLINE, Cochrane CENTRAL, ScienceDirect, Embase/Ovid, and Google Scholar were searched from inception to January 30, 2026. Randomized controlled trials evaluating piezocision assisted fixed orthodontic treatment for mandibular anterior crowding were considered eligible. Two reviewers independently performed study selection and data extraction, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Where sufficiently comparable data were available, continuous outcomes were synthesized using mean differences with 95% confidence intervals (CIs) under an inverse-variance random-effects model. Results: Six randomized controlled trials were included in the systematic review. Four studies contributed to the meta-analysis of time required to achieve mandibular anterior alignment. The pooled analysis suggested a reduction in alignment time favouring piezocision (MD −46.29 days, 95% CI −76.12 to −16.45; P = 0.002); however, substantial heterogeneity was observed (I² = 93%), limiting confidence in the consistency and generalizability of this estimate. Conclusion: Piezocision may accelerate the alignment of mandibular anterior teeth during fixed orthodontic treatment. However, substantial heterogeneity among studies indicates considerable uncertainty regarding the magnitude and consistency of this effect.