Effectiveness of platelet concentrates, corticotomy, and piezocision as adjuncts for accelerating maxillary canine retraction: a systematic review of randomized controlled trials.

BACKGROUND

Maxillary canine retraction following premolar extraction is a time-consuming phase of orthodontic treatment. Various adjunctive methods, including platelet concentrates, corticotomy, and piezocision, have been proposed to accelerate tooth movement; however, their relative effectiveness and safety remain unclear.

OBJECTIVE

To evaluate the effectiveness and safety of platelet concentrates, corticotomy, and piezocision as adjuncts to maxillary canine retraction after premolar extraction.

METHODS

PubMed/MEDLINE, Scopus, and Cochrane CENTRAL were searched from inception to April 30, 2026. Randomized controlled trials comparing platelet-rich plasma, injectable platelet-rich fibrin, leukocyte and platelet-rich fibrin, corticotomy, or piezocision with conventional maxillary canine retraction were included. Study selection, data extraction, and risk-of-bias assessment using RoB 2 were performed independently. Findings were synthesized narratively.

RESULTS

Twenty-five randomized studies were included. Corticotomy and piezocision generally increased canine retraction during the early postoperative period, although the effect decreased over time in several trials. Platelet concentrates produced inconsistent findings, ranging from no significant effect to small or temporary increases in movement. Evidence that these interventions shortened the complete duration of canine retraction was limited. Anchorage loss and periodontal outcomes were generally similar between groups, while findings for tipping, root resorption, pain, and adverse effects varied. Four studies had a low risk of bias, 21 raised some concerns.

CONCLUSION

Corticotomy and piezocision may increase rate of early maxillary canine retraction, while the effects of platelet concentrates are less consistent. Current evidence does not establish a reliable reduction in total retraction duration or support a clear ranking of the interventions. Better standardized randomized trials are required.

SYSTEMATIC REVIEW REGISTRATION: identifier CRD420261287411.