The aim of the present randomized controlled clinical trial will compare Insignia orthodontic treatment to piezocision-assisted Insignia orthodontics in adult patients. The primary objective will be to determine the efficacy of piezocision-accelerated orthodontic treatment by measuring the treatment duration in both groups. The secondary objectives will be to compare periodontal health, alveolar crest changes, bone and gingival healing, analgesic intake and patient-centered outcomes between the 2 groups.

Inclusion Criteria:

• Patients requiring maxillary and mandible orthodontic treatment (both arches)
• Adult patients with completed growth based on the cervical vertebral maturation method as described by Baccetti et al. (Baccetti et al. 2002)
• Minimal to moderate maxillary and mandibular anterior crowding at baseline (irregularity index <6;(Little 1975));
• American Society of Anesthesiology I or II (I = nor- mal healthy patient; II = patient with mild systemic disease);
• Adequate dento-oral health (i.e., the absence of periodontal diseases, periapical infection, or untreated caries).

Exclusion Criteria:

• controlled periodontitis with a loss of alveolar support >10%
• gingival recession >2 mm
• smokers
• altered bone metabolism (e.g., due to antiresorptive drug, steroid, or immunosuppressant use)
• mental or motor disabilities; and 6) pregnancy.