Does periodontally accelerated osteogenic orthodontics improve orthodontic treatment outcome? A systematic review and meta-analysis.
Periodontally accelerated osteogenic orthodontics (PAOO) can be used to improve periodontal conditions and accelerate tooth movement. The aim of this systematic review and meta-analysis was to compare periodontal outcome and treatment duration of patients undergoing PAOO to accelerate orthodontic treatment. An electronic search was performed in four electronic databases including Pubmed, EBSCO Cochrane library, CINAHL Complete for randomized clinical trials till November 2017. A hand search was performed on clinicaltrials.gov and Google scholar. Randomized controlled trials reporting periodontal outcomes and treatment duration of PAOO in adult patients by evaluating treatment duration, root resorption, bone density and pocket depths were included. Two authors conducted searches, data extraction and bias assessment with conflict resolution with a third author. Cochrane's tool for risk of bias assessment was used for evaluation. A manual search was conducted for additional studies. A quantitative synthesis of the pooled results was conducted. Five studies were included in the qualitative synthesis and two in the quantitative synthesis. A total of 56 patients underwent the PAOO technique; the effects of this therapy were compared with 21 patients who underwent corticotomy, 9 underwent non-extraction comprehensive orthodontic treatment and 15 underwent fixed mechanotherapy with extractions of first premolars. A random effect model was used for pocket depths and showed a non-significant difference between bioactive glass augmented corticotomy and corticotomy alone (weighted mean difference, -0.03; 95% CI, -0.16, 0.09). Bone density elucidated a non-significant difference between bioactive glass augmented corticotomy and corticotomy alone (weighted mean difference, 27.69; 95% CI, -2.29, 57.67). Fixed effect model was used for root length which revealed a non-significant difference between bioactive glass augmented corticotomy and corticotomy alone (weighted mean difference, 0.01; 95% CI, -0.00, 0.02). Studies showed significant improvements in periodontal health. Treatment duration was reduced in patients who underwent PAOO. Root resorption was not sufficiently evaluated by current literature.