Evaluation of patient-centered outcomes associated with the acceleration of canine retraction by using minimally invasive surgical procedures: A randomized clinical controlled trial

Abstract

Background: Only a few studies in the literature have reported patient-centered outcomes associated with minimally invasive corticotomy, and thus, related scientific evidence is limited.

Objectives: The objective of this study was to evaluate patient-centered outcomes associated with upper canine retraction assisted with piezocision or laser-assisted flapless corticotomy (LAFC).

Material and methods: Thirty-two patients (19 females, 13 males) at a mean age of 18.25 ±3.05 years were randomly divided into 2 equal groups: the LAFC group (LG; n = 16) and the piezocision group (PG; n = 16). In each group, the surgical procedure was randomly assigned to one side of the maxillary arch, and the other side served as the control. Standardized questionnaires using the numerical rating scale (NRS) were distributed to all patients during the 1st month after the surgical procedure at 4 time points: 24 h (T1); 3 days (T2); 7 days (T3); and 14 days (T4). The patients' responses were obtained, regarding their feelings of pain, discomfort, swelling, eating difficulty, jaw movement restriction, analgesic consumption, and satisfaction.

Results: The levels of pain, discomfort, swelling, and difficulty in chewing were significantly greater at the experimental sides as compared to the control sides only at T1 in both groups (p < 0.05). The levels of pain and discomfort in LG were significantly lower than those in PG only at T1 (p = 0.013 and p = 0.009, respectively) whereas there were no significant differences between the groups regarding swelling, eating difficulty, jaw movement restriction, and analgesic consumption. The patients in both groups reported high levels of satisfaction, with no significant differences. The levels of pain, discomfort, swelling, eating difficulty, and jaw movement restriction were dramatically decreased 1 day after flapless corticotomy treatment in both groups (p < 0.05).

Conclusions: Both LAFC and piezocision were associated with high levels of pain, discomfort, swelling, and difficulty in chewing at T1. Laser-assisted flapless corticotomy caused less pain and discomfort than piezocision.

Keywords: minimally invasive surgical procedures; orthodontic tooth movement; patient-centered care; piezosurgery.