Efficacy of reticulated surgical guide vs. dynamic navigation to prevent periodontal tissue overheating during piezocision using thermography: a randomized pilot clinical trial

Objectives: This split‑mouth randomized pilot trial compared two innovative piezocision techniques-reticulated static computer‑guided surgery and dynamic computer‑guided surgery-to assess their effectiveness in preventing tissue overheating. Methods: Ten adult patients undergoing accelerated orthodontic treatment received both interventions in different quadrants. Preoperative planning combined cone‑beam computed tomography (CBCT) and optical scanning to align DICOM and STL data. The static technique employed a digitally designed reticulated surgical guide with a plurality of openings, forming a net-like structure, whereas the dynamic technique used a real‑time navigation system. Tissue temperatures were recorded preoperatively, intraoperatively, and immediately postoperatively via an infrared smartphone camera. The Wilcoxon signed-rank test was used to evaluated thermographic differences. A post-hoc power calculation yielded 82.6%. Results: Pre-operative temperatures were similar in both groups (p > 0.05). The lowest intraoperative temperature (23 °C) occurred in the upper premolar region with dynamic guidance, while the highest (50 °C) was observed in the lower molar region using the static guide. Descriptive analysis revealed a maximal postoperative temperature disparity of approximately 10 °C between techniques. Conclusions: Dynamic computer‑guided piezocision significantly reduces surface tissue overheating compared to the reticulated static guide by enabling unobstructed irrigation and real‑time feedback, suggesting an alternative associated with lower surface temperature under our protocol forpiezocision procedures. Clinical relevance: Dynamic navigation provides an alternative to static guides in corticotomy procedures, in terms of the prevention of tissue burns, by mitigating tissue overheating. This advancement has the potential to enhance patient safety, optimize protocols in accelerated orthodontics, and promote the integration of smartphone‑based thermography in dental procedures.