To determine whether augmentation-containing periodontally accelerated osteogenic orthodontics (PAOO), considered within the broader surgically facilitated orthodontic therapy (SFOT) framework, changes alveolar housing or periodontal phenotype compared with conventional orthodontics, while evaluating longitudinal evidence separately.

This review was prospectively registered in PROSPERO (CRD420261415748) and reported according to PRISMA 2020. PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, CENTRAL, CNKI, Wanfang Data, SinoMed/CBM and ClinicalTrials.gov were searched from inception to 24 July 2026 without language restrictions. Comparative studies of graft-containing PAOO versus conventional orthodontics formed the primary synthesis; longitudinal and within-PAOO studies were analysed separately. Risk of bias was assessed using RoB 2 or ROBINS-I, uncontrolled longitudinal reports with the JBI case-series checklist, certainty with GRADE, and synthesis without meta-analysis followed SWiM.

The searches identified 4,577 records. After removal of 2,417 duplicate or overlapping records, 2,160 were screened; 65 full-text reports were assessed and 24 excluded. Forty-one reports representing 39 study families were retained: 32 reports from 30 comparative families and nine contextual reports. Some studies reported favourable short-term facial/labial alveolar changes, but landmarks, follow-up and analytical units varied substantially. Several keratinized-gingiva results were inconsistent, irreproducible or potentially non-independent. No outcome domain met criteria for meta-analysis, and certainty was very low throughout.

Augmentation-containing PAOO may produce favourable short-term facial/labial alveolar changes in selected anatomically compromised regions, but effect magnitude, causality, retention-period durability, periodontal or root protection, and comprehensive procedural safety remain uncertain.