Periodontally accelerated osteogenic orthodontics (PAOO) is an adjunctive technique in orthodontic treatment, based on the principle of the regional acceleratory phenomenon (RAP). It aims to shorten orthodontic treatment duration by enhancing osteoclast activity. In recent years, the surgical approach of PAOO has been gradually optimized with the development of techniques such as piezosurgical corticotomy and alveolar micro-osteoperforations. The materials used have also improved, including novel grafting materials such as bioactive glass and new barrier membranes like platelet-rich fibrin. Thanks to these clinical innovations, PAOO is evolving toward a trend of minimal pain, low invasiveness, and high efficacy. However, clinical research on PAOO remains limited, large-sample, multicenter randomized controlled trials are still needed to evaluate the clinical effectiveness of different surgical techniques and grafting materials in PAOO.