Buccal bone regeneration combined with piezocision in adult orthodontic patients: Clinical, 3D radiographic, and patient-reported outcomes

Objective: Assess the clinical effects, 3D radiographic results and patient-reported outcome measures
(PROMs) of buccal bone regeneration combined with piezocision.
Methods: Ten patients presenting roots prominence with a thin buccal bone thickness or buccal bone
dehiscence in the lower front region were enrolled. Patients received orthodontic treatment assisted by piezocison which was combined with a buccal alveolar bone regeneration using a tunneling approach. A comparison between pre- and post-treatment alveolar bone measurements based on CBCT was performed. Periodontal parameters such as recession scores and root resorption were recorded before and after treatment. The PROMs were also investigated.
Results: An overall significant buccal bone gain of 2.7 2.7% was found after the treatment. The apical region reached the highest gain of 8.9 5.5% whereas the most coronal region showed no significant increase of the bone envelope (1.2 2.7%). No adverse event such as the appearance of recession or root resorption were observed. However, in 2 patients, the biomaterial was not properly integrated and seemed to be encapsulated. The pain level and the paracetamol consumption were equivalent to those after the placement of the orthodontic appliance except on the day of the surgery.
Conclusions: Within the limitation of this study, piezocision combined with buccal bone regeneration
using a tunneling technique seems to be effective to augment bone and did not lead to gingival recession. However, in 2 cases the biomaterial seemed encapsulated, and therefore the predictability of the integration of the material can be questioned.