Objectives: This study compared pain levels after using micro-osteoperforations versus no application during leveling and alignment of anterior maxillary crowding. Methods: A randomized parallel-arm clinical trial was conducted in the outpatient orthodontic clinic in the Faculty of Dental Medicine l Azhar University Cairo – Egypt, on 20 eligible participants, ages 13 to 19, undergoing orthodontic treatment for moderately crowded maxillary anterior teeth. Participants received bonded conventional fixed orthodontic appliances with NiTiarchwires for leveling and alignment and were randomly assigned into two equal groups of 10 each to receive micro-osteoperforations or none. Micro-osteoperforations were applied under local anesthesia with orthodontic mini-screws, 3 mm apart within the attached gingiva and 1 mm apical to mucogingival junction equidistant between the upper right and upper left canine at every interdental labial alveolar bone except at the midline to avoid injury to the labial frenum. Pain intensity was measured using a 10 cm visual analog scale at 24 hours, three days, and one week after insertion of the first leveling and alignment arch wires. Data were analyzed using an independent t-test for intergroup comparison and one-way repeated measure ANOVA for intragroup comparison. Results: Twenty patients were randomized and analyzed at the end of the study. Pain levels in the micro-osteoperforation group were higher than in the control group but with no statistically significant difference (P-value > 0.05). Pain levels were higher at 24 hours and significantly reduced till one week in each group. Conclusions:Micro-osteoperforations, a minimally invasive tool for accelerating orthodontic tooth movement, showed promising results with mild to moderate pain levels after aligning crowded maxillary anterior teeth.