Han Xu, Kaile Sheng, Yan Wang, Mengyao Ding, Kun Wang, Xiaohang Xu, Chris Tat Chuen Fok, Qinzi Xie, Yunnan Jin, Chuyi Jin, Yifan Xie, Lipei Liu, Xing Chen, Cheng Ding
PAOO may shorten treatment and increase buccal bone thickness, but evidence of lingual bone gain was restricted to selected measurement sites. Keratinized gingival width and root length did not differ significantly between groups. Because all included studies were non-randomized and the certainty of evidence ranged from very low to low, these findings should be interpreted cautiously. Well-designed randomized trials with longer follow-up are needed.
OBJECTIVES: This review examined whether periodontally accelerated osteogenic orthodontics (PAOO) reduces orthodontic treatment time and whether it alters periodontal outcomes, including alveolar bone thickness, root length, and soft-tissue measures.
MATERIALS AND METHODS: PubMed, Embase, Web of Science, Google Scholar, the Cochrane Library, and ClinicalTrials.gov were searched through June 3, 2026. Studies comparing PAOO with conventional unassisted orthodontic treatments with relevant clinical or radiographic outcomes were included. Two reviewers independently extracted data and assessed risk of bias using ROBINS-I, while the certainty of evidence was rated with GRADE. Comparable continuous outcomes were pooled as mean differences.
RESULTS: Eleven non-randomized studies were included. PAOO was associated with a shorter treatment duration (MD = -7.51 months, 95% CI = -10.42 to -4.59, p < 0.001), albeit with high heterogeneity (I2 = 90%). Buccal bone thickness increased significantly across all vertical levels (MD range: 0.60 to 1.10 mm, all p < 0.05). Lingual bone thickness was significantly greater only at 4 mm (MD = 0.23 mm, 95% CI = 0.05 to 0.40, p = 0.01) and 6 mm (MD = 0.34 mm, 95% CI = 0.04 to 0.64, p = 0.03) apical to the cementoenamel junction. Neither keratinized gingival width nor root length differed significantly between groups.
CONCLUSIONS: PAOO may shorten treatment and increase buccal bone thickness, but evidence of lingual bone gain was restricted to selected measurement sites. Keratinized gingival width and root length did not differ significantly between groups. Because all included studies were non-randomized and the certainty of evidence ranged from very low to low, these findings should be interpreted cautiously. Well-designed randomized trials with longer follow-up are needed.
CLINICAL RELEVANCE: PAOO may represent a potential treatment option for selected adult patients, particularly those undergoing anterior decompensation or camouflage treatment with thin buccal bone, but the evidence remains limited.