Evaluation of the Levels of Pain, Discomfort, Functional Impairments and Satisfaction With the Periodontally Accelerated Osteogenic Orthodontics (PAOO) When Leveling and Aligning Crowded Teeth: A Prospective Cohort Study

Abstract

Background Only a few studies have reported levels of pain, discomfort, functional impairments, and patients' satisfaction after undergoing periodontally accelerated osteogenic orthodontics (PAOO). Therefore, the objectives were to evaluate postoperative pain, discomfort, functional impairments, and satisfaction following this surgical intervention. Methods A prospective cohort study was undertaken at the Department of Orthodontics, University of Damascus Dental School, between August 2018 and November 2020. The sample consisted of 16 patients (4 males, 12 females, mean age: 21±3.05 years) with moderately crowded lower anterior teeth who underwent full-thickness vestibular flap elevation followed by cortical cuts using piezosurgery. Then a bovine xenograft was applied before reflecting the flap and suturing. Fixed orthodontic therapy was then initiated. Questionnaires were administered to assess the levels of pain, discomfort, and oral functional problems using a visual analog scale (VAS) at one day, seven days, 14 days, and 28 days after surgery. The level of satisfaction was also assessed at 28 days postoperatively. Friedman's test was employed, and Wilcoxon signed-rank tests were used for post-hoc tests with an adjusted alpha level. Results On the first day following the PAOO, the mean values of perceived pain, discomfort, swelling, mastication difficulties, swallowing problems, limitation in jaw movements were 80.00, 80.63, 68.13, 78.13, 55.00, and 64.38, respectively. These mean values dropped significantly in the following assessment times (P<0.001). At 28 days following the PAOO, the mean satisfaction score was 84.94±22.46. All patients mentioned that they took painkillers after the surgical intervention. Conclusions On the first day following surgery, patients perceived high levels of pain and discomfort, moderate to severe levels of swelling and chewing difficulties, and suffered from restricted jaw movement. These levels decreased significantly in the following assessment times. Patients' satisfaction with the PAOO procedure was high.

Keywords: crowded lower anterior teeth; discomfort; functional impairment; pain; periodontally accelerated osteogenic orthodontics (paoo); piezosurgery; satisfaction; visual analog scale (vas); xenograft.

Figure 1. Surgical intervention procedures: Local anesthesia (lidocaine HCL 2% - epinephrine 1:80000) (A). The full-thickness flap was raised labially only (B). The selective cortical cut was performed according to vertical cutting lines between the roots and ended with a horizontal cutting line using a piezosurgery (C). The xenograft (Bone-D®, MedPark Co, Busan, Korea, the particle size of 0.2 mm–1.0 mm) was placed (D). The wound was sutured using a 2 metric nylon 3/0 suture on a reverse cutter needle (Shandong, China) (E).

Figure 2. This questionnaire was administered at one day, seven days, and 14 days following the surgical intervention.

Figure 3. The questionnaire administered to patients at 28 days following the surgical intervention