Assessing the efficacy and safety of minimally invasive surgical techniques in enhancing orthodontic tooth movement: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis evaluated the efficacy and safety of minimally invasive surgical techniques (MIS) to accelerate orthodontic tooth movement. A comprehensive search of PubMed, Web of Science, Cochrane CENTRAL, ProQuest, ScienceDirect, and OVID, along with manual reference screening, was conducted up to January 2024. Randomized controlled trials comparing MIS methods (including micro-osteoperforation, piezocision, flapless corticotomy/corticision, interseptal bone reduction, discision, and laser-assisted flapless corticotomy) with conventional orthodontic treatment were included. Thirty trials (809 participants) met eligibility criteria. Meta-analysis demonstrated significantly faster canine movement with MIS at one month (WMD 0.42 mm; 95% CI 0.26-0.58; <i>P</i> < 0.00001), two months (WMD 0.55 mm; 95% CI 0.35-0.75; <i>P</i> < 0.00001), and three months (WMD 0.52 mm; 95% CI 0.26-0.78; <i>P</i> = 0.0001). Subgroup analyses indicated micro-osteoperforation significantly accelerated movement (<i>P</i> < 0.05), while flapless corticotomy was not effective beyond two months (<i>P</i> > 0.05). Overall treatment time was reduced (WMD -42.30 days; 95% CI -68.31 to -16.30; <i>P</i> = 0.001), while no significant difference was found for en-masse retraction (WMD 1.55; 95% CI -0.65 to 3.76; <i>P</i> = 0.17). Reported adverse effects were minimal, with rare unintended tooth movements. MIS appears effective in accelerating orthodontic tooth movement and reducing treatment duration, particularly early in treatment, but heterogeneity highlights the need for standardized protocols and long-term multicenter trials.