Summary: Background: With the widespread of surgically-assisted orthodontic acceleration, the analysis of patient-reported outcome measures (PROMs) has become very important to assure patient acceptance and satisfaction before adopting any acceleration procedure. Objective: This review aimed to critically appraise the available evidence regarding the levels of pain, discomfort, functional impairments, and other patient-reported outcome measures during surgically-assisted acceleration of orthodontic treatment compared with the traditional non-accelerated treatment. Search methods: Eight electronic bibliographic databases were searched from January 1990 till May 2022. A manual search of the selected orthodontic journals was also undertaken. Selection criteria: Randomized controlled trials (RCTs) were included in this systematic review on patients undergoing orthodontic treatment with one group subjected to an acceleration procedure. Data collection and analysis: Cochrane’s risk of bias tool (RoB2 tool) was used to assess the risk of bias of the included RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence. Results: Thirteen RCTs were included in this review (333 patients), and only minimally invasive surgically-assisted acceleration studies were included. Two RCTs were included in the quantitative synthesis of data. After the first day of surgical intervention, the levels of pain and discomfort ranged from mild to moderate in the surgical groups (mean values ranged from 0.8 to 6.8), while it was mild in the control groups. However, on the seventh day after the surgical intervention, the levels of pain, discomfort, swelling, and functional impairments were almost similar between groups. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low. Conclusions: All surgical interventions were minimally invasive. There was very low to low evidence that acceleration caused mild to moderate pain and discomfort on the first day after the surgical intervention and disappeared completely at one week following surgery. Functional impairments were found within acceptable limits immediately and in the short-term follow-up. More high-quality randomized controlled clinical trials are needed to establish good evidence in this field. Registration: The protocol of this systematic review was registered in PROSPERO database (CRD42021274481) during the first stages of this review.

(1) Background: This study aimed to compare patient-reported outcome measures when accelerating en masse retraction between the piezocision procedure and the subsequent application of low-level laser therapy (FC+LLLT), with the piezocision alone (FC), and in a control group. (2) Methods: A three-arm randomized controlled trial (RCT) was conducted involving 60 patients (41 females and 19 males) with Class II division I malocclusion. The en masse retraction was performed using NiTi closed coil springs attached to miniscrews. The LLLT was performed using an 808 nm Ga-Al-As diode laser. Patient responses regarding pain, discomfort, swelling, and chewing difficulties were reported at ten assessment points. (3) Results: The greatest pain levels were observed 24 h after the application of force during the first and third months of retraction. The mean pain, discomfort, swelling, and chewing difficulties were significantly smaller in the control group than in the FC and FC+LLLT groups. High satisfaction levels were reported in all three groups (p < 0.05). (4) Conclusions: The accelerated en masse retraction via piezocision, followed by a small course of LLLT, was accompanied by significantly fewer pain, discomfort, and chewing difficulties than the control group. LLLT is a valuable addition to piezocision, with an improved patient experience.

Background: Orthodontic treatment involving tooth extractions typically spans 25–35 months in adult patients. While various methods have been explored to accelerate this process, the outcomes remain inconsistent. This study focuses on evaluating the efficacy of these methods specifically in adult populations. Objectives: This study aimed to evaluate the effects of flapless piezocision combined with low-level laser therapy (LLLT) on the rate of en-masse retraction, comparing it to piezocision alone and conventional. Materials and methods: This single-center, three-arm, parallel-group randomized controlled trial involved adult patients with Class II Division 1 malocclusion who required upper premolar extractions. The study included healthy males and females aged 17–28. Participants were randomly assigned to one of three groups in a 1:1:1 ratio through seven blocks of nine participants each: (1) Piezocision-assisted en-masse retraction with low-level laser therapy (FC + LLLT), (2) Piezocision-assisted en-masse retraction (FC), and (3) Conventional en-masse retraction (CONV). After completing the leveling and alignment phase, piezocision procedures were performed using buccal and palatal vertical incisions made with a piezosurgery microsaw in FC and FC + LLLT groups. Six weeks later, in the FC + LLLT group, low-level laser therapy (LLLT) utilizing a GaAlAs diode laser was administered regularly until en-masse retraction. The primary outcome was the rate of en-masse retraction; secondary outcomes included changes in first molar positions and inter-molar and inter-canine widths. Results: In this RCT of 80 patients, 63 (16 males and 47 females, mean age: 21.46 ± 3.16 years) were recruited. The FC + LLLT group had the greatest retraction rate at 1.32 ± 0.19 mm/month, significantly greater than the FC (1.09 ± 0.13 mm/month) and CONV groups (0.75 ± 0.06 mm/month). No significant differences were found in first molar distal movement or inter-molar width changes. Conclusion: Combining LLLT with flapless piezocision significantly boosts upper anterior teeth retraction by 43.8%, compared to 31.8% with piezocision alone. This approach remains effective throughout the retraction period, while piezocision benefits were mainly seen in the initial two months. All methods cause slight distal movement of first molars and minor increases in inter-canine and intermolar widths, with no significant differences. Harms: No harms were reported. Trial registration number: This trial protocol was registered in the Clinical Trials database (NCT05655169).