*3.3.7. Piezocision*

In 2009, Dibart et al. [43] introduced a minimally invasive technique that can be applied by piezosurgical tools, the piezoincision method, which can be carried out without any flap surgery as in corticision method but it allows hard or soft tissue grafting differently. In this method, small piezoelectric incisions are placed in the area from the targeted corticotomy area to periost. Piezoincisions of 3 mm length and depth are applied with the piezosaw without removing mucoperiosteal flap. In this stage, mucoperiosteal flap can be removed as a tunnel and a bone graft in pad form can be replaced if necessary. Sutures are required if grafting is applied, otherwise there is no need for sutures. It was reported that no significant difference was found in terms of tooth movement speed and root resorption in the studies which compare corticotomy-assisted methods with piezoincision method [44].

Piezoincision is a practical, minimally invasive, and effective method. Additionally, ultrasonic vibrations which occur during the procedure in piezoincision method also contribute to accelerate tooth movement [3]. Required precautions must be taken before the procedure with patients in high-risk group due to possibility of temporary bacteremia formation risk following the procedure.

#### *3.3.8. Piezopuncture*

"Piezopuncture" method, which is applied by using an ultrasonic piezosurgical tool, "piezotome" without gingival incisions in piezoincision method was developed by Kim et al. [45]. In their study on 10 dogs, the researchers created several cortical punctures both buccally and lingually on the mesial and distal sides of the teeth which will be moved and reported that anabolic activity and tooth movement were accelerated at the end of the procedure. Omidkhoda et al. who carried out piezopuncture technique on human reported that tooth movement was accelerated but they observed distal tilt in the canine teeth crowns in their case reports which consist of two cases [46].

"Piezopuncture" method also takes part in literature as a method with promising positive results but it must be evaluated by further clinical studies.
