Evaluation Of The Effectiveness And Potential Harm Of PAOO:An Evidence Based Systematic Review

Objective:The objective of this study is to make a systematic assessment of PAOO with scientific evidence about the effectiveness and potential harm in clinical results.Method:Electronic search was mainly conducted in following databases:PubMed,Embase,Web of Science,Cochrane library,CENTRAL,with an additional search in Geen Medical,Google Scholar when full text was not available,last updated in October 1st 2020.Unpublishing and ongoing trials were also valuated through ICTRP.Population of including trials incorporated fixed-appliance orthodontic patients with PAOO surgery or not.Cochrane Risk of Bias Tool was taken to assess risk of bias.Included trials were identified according to PRISMA flow and risk of bias was evaluated with Cochrane risk of bias tool.Then researchers took an extraction of basic information and relevant data.Quantitative analysis was conducted with pooled data by Review manager 5.4(Revman 5.4),whose result was graded by GRADEpro GDT while descriptive analysis was carried out when statistics can’t be calculated together.Result:(1)A total of 12 studies were involved in this review,including 4 randomized controlled trials(RCT),4 clinical controlled trials(CCT),4 retrospective cohort studies.Most of the results were descriptive analysis due to a high heterogeneity among included trials and main outcomes are as follows.(2)Descriptive analysis indicated that1)It can be concluded that PAOO worked no significant difference for periodontal soft tissues by observing probing depth(PD),and gingival recession(GR)despite the fact that PAOO improved KGW in one trial;2)PAOO changed alveolar bone dramatically by increasing bone volume and bone density;3)PAOO made a significantly reduced treatment time possible while contributed to tooth movement to a limited extent.4)PAOO worked no difference on root resorption during orthodontic treatment.(3)PD was also quantitatively analyzed and Moderate evidence supported that PAOO took insignificant role in PD change(P>0.05).Conclusion:(1)Current evidence supports that PAOO can effectively modify the phenotype of dental hard tissue by increasing bone volume and bone density while produces no significant effect on soft tissue.(2)At the same time,PAOO can boost the speed of orthodontic tooth movement and enlarged the scope of tooth movement to a limited extent with n o adverse effect detected.(3)To get a full understanding of PAOO in orthodontics,more elaborately designed trials and standardized criterion for relevant parameters are necessary.Registration:This review was registered in PROSPERO,protocol number CRD42021230438.