Changes in Periodontal Tissues With Periodontally Accelerated Orthodontics: A Systematic Review and Meta-Analysis

Periodontally accelerated orthodontic (PAO) therapy has been found to increase hard tissue, helping to decrease orthodontic relapse rates and improve retention capacity. The aim of this study was to synthesize available evidence on clinical and tomographic changes in periodontal tissues when using PAO techniques. A systematic review with meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered in the International Prospective Register of Systematic Reviews (PROSPERO). The search was carried out in PubMed, Embase, Cochrane, Web of Science, Scopus, and Google Scholar. Randomized and non-randomized clinical trials comparing PAO versus conventional orthodontics were included. Quality assessment was performed using the Downs & Black scale, and the risk of bias was assessed using the revised Cochrane risk-of-bias tool. Mean differences and 95% confidence intervals (CIs) were calculated, and the mean difference was divided by a t-test. During the initial search, 465 studies were identified. Five articles studying 130 patients were included, which assessed both clinical and tomographic changes, along with treatment duration. PAO was administered to patients with skeletal class III in three studies, to class II patients in one study, and to individuals with dental crowding in another study. Two studies showed a moderate risk of bias, and the rest showed a low risk. The meta-analysis revealed a vestibular bone thickness increase of 0.32 mm (0.56-008; P = 0.008), a reduction of 3.12 mm (2.15-4.08; P= 0.001) in gingival retraction, and a treatment duration that was 7.07 months (8.79-5.36; P = 0.001) shorter in patients subjected to PAO compared to those undergoing conventional orthodontic treatment. Considering the limitations of the study and acknowledging that definitive conclusions cannot be drawn, the findings suggest that treatment time decreased in patients undergoing PAO, with an increase in vestibular bone thickness and less gingival retraction observed in those undergoing this intervention.