M. Thomas Wilcko

Accelerated Osteogenic Orthodontics Technique: A 1-Stage Surgically Facilitated Rapid Orthodontic Technique With Alveolar Augmentation

PURPOSE Demineralization of a thin layer of bone over a root prominence after corticotomy surgery can optimize the response to applied orthodontic forces. This physiologic response is consistent with the regional acceleratory phenomenon process. When combined with alveolar augmentation, one is no longer strictly at the mercy of the original alveolar volume and osseous dehiscences, and fenestrations can be corrected over vital root surfaces. This is substantiated with computerized tomographic and histologic evaluations. Two case reports are presented that demonstrate the usefulness of the accelerated osteogenic orthodontics technique in de-crowding and space closing for the correction of dental malocclusions. MATERIALS AND METHODS Orthodontics is combined with full-thickness flap reflection, selective alveolar decortication, ostectomy, and bone grafting to accomplish complete orthodontic treatment. RESULTS Rapid tooth movement was demonstrated in both cases and stability up to 8 years of retention. CONCLUSION The accelerated osteogenic orthodontics technique provides for efficient and stable orthodontic tooth movement. Frequently, the teeth can be moved further in one third to one fourth the time required for traditional orthodontics alone. This is a physiologically based treatment consistent with a regional acceleratory phenomenon and maintaining an adequate blood supply is essential.

Periodontal Accelerated Osteogenic Orthodontics: A Description of the Surgical Technique

1 a z t g r b t w t t b e v p eriodontal accelerated osteogenic orthodontics PAOO) is a clinical procedure that combines selecive alveolar corticotomy, particulate bone grafting, nd the application of orthodontic forces. This proedure is theoretically based on the bone healing attern known as the regional acceleratory phenomnon (RAP). PAOO results in an increase in alveolar one width, shorter treatment time, increased postreatment stability, and decreased amount of apical oot resorption. The purpose of this article is to escribe the clinical surgical procedures that comrise the PAOO procedure.

Accelerating tooth movement: The case for corticotomy-induced orthodontics

4 Increased societal demands have led patients to request shorter orthodontic treatments, yet their expectations for outstanding final results remain high. One option for reducing treatment time is the dual-specialty in-office corticotomy-facilitated bone augmentation approach called the periodontally accelerated osteogenic orthodontics procedure. Periodontally accelerated osteogenic orthodontics treatment can often be completed in one third to one fourth of the time required for traditional orthodontic treatment. More importantly, a greater degree of movement can be achieved, reducing the need for extractions while providing increased periodontal support; this can provide orthodontists with a new population of adult and adolescent patients who otherwise might not seek needed orthodontic treatment. Periodontally accelerated osteogenic orthodontics treatment is appropriate for both adults and adolescents when most of the permanent teeth have erupted. Full treatment quickly resolves the entire scope of the patients treatment needs, including minor facial reshaping. In conjunction with traditional orthodontics, segmental issues such as forced eruptions of impacted teeth and molar intrusions can be rapidly corrected. Treatment decisions are based on considerations such as severity of the malocclusion, preexisting alveolar deficiencies, extraction vs nonextraction protocols, and patient expectations. Corticotomy surgery provides for a periodontal ligament-mediated acceleration in tooth movement as a result of a stimulated regional acceleratory phenomenon in conjunction with the proper morphologic situation of a thin layer of bone in the direction of movement. The induced increase in bone turnover

Mandibular irregularity index stability following alveolar corticotomy and grafting : a 10-year preliminary study

OBJECTIVE To evaluate mandibular irregularity index stability following orthodontic treatment facilitated by alveolar corticotomy and augmentation bone grafting (Cort+). MATERIALS AND METHODS The irregularity index of 121 orthodontically treated and 15 untreated patient study casts was analyzed at 5 years and 10 years. RESULTS Cort+ resulted in significantly lower mandibular irregularity index scores at both 5 years (1.5 mm vs 4.2 mm, P < .000) and 10 years (2.1 mm vs 4.1 mm, P < .000) compared with conventionally treated patients. CONCLUSIONS Unmatched samples advise caution with conclusions, but orthodontic therapy combined with Cort+ enhanced the stability of the postorthodontic mandibular irregularity index for at least 10 years in this preliminary study.

Keratinized Gingiva Height Increases After Alveolar Corticotomy and Augmentation Bone Grafting

BACKGROUND The aim of the present study is to compare the keratinized gingival tissue (KT) height labial to the mandibular incisors after active orthodontic treatment (AOT) with and without alveolar corticotomy and bone grafting. METHODS Two orthodontically treated groups of 35 patients each, with (Cort) and without (Conv) alveolar decortication and augmentation bone grafting, are matched in this case-control study for sample size, sex, mandibular premolar extractions, pretreatment age, post-treatment observation period, and pretreatment KT height. Standardized digital frontal occlusion photographs taken before and at least 1 year after AOT were adjusted to 96 dots per inch and measured with image analysis software for vertical KT height labial to each mandibular incisor. RESULTS An average of 1.5 years after completion of AOT, KT height had increased significantly by 0.78 mm (P < 0.001) in the Cort group and decreased 0.38 mm (P = 0.002) in the Conv group; a 1.28-mm KT height gain was demonstrated in the subgroup representing the lowest half of Cort KT height at pretreatment. Mandibular incisor inclination and prominence explained neither the decrease in KT height in Conv nor the KT height gain in Cort. CONCLUSIONS Orthodontic therapy combined with alveolar decortication and augmentation bone grafting resulted in a significant increase in KT height. Although KT height surrounding the dentition has been devalued by evidence-based studies, the value-added protection of KT height increase after decortication and augmentation bone grafting offsets the concerns of orthodontic proclination or expanding mandibular incisors facially.

Tooth Movement Mechanobiology: Toward a Unifying Concept

Tooth movement, as it is generally visualized by orthodontist clinicians, is modeled as a biological event mediated by the cells of the periodontal ligament (PDL) whereby alveolar bone resorption is witnessed on the “pressure” side and bone apposition on the “tension” side. This “pressure-tension” image is burned so deeply into the orthodontic psyche after a century plus of scrutiny that the structural features, characteristics, and mechanisms involving the tooth, the PDL, and the alveolar bone are at the heart of the prevailing tooth movement paradigm and have dominated investigatory attention. Scholarship on tooth movement biology has focused on breaking down the cell-centric “pressure-tension” model into its component parts so as to tease out individual functions. Our understanding of the tissue, cellular, and molecular mechanisms involved in orthodontic tooth movement has created a segregated literature and knowledge base of part-processes that is indeed impressive. But these reductionist explanations of the physical body – this collection of parsed physiological processes – have not resulted in a cohesive understanding of clinically relevant tooth movement.

Root resorption following periodontally accelerated osteogenic orthodontics

Background: Literature evidence suggests that root resorption, an adverse side effect of orthodontic therapy, may be decreased under conditions of alveolar osteopenia, a condition characterized by diminished bone density and created secondary to alveolar corticotomy (Cort) surgery. Purpose: To compare root resorption of the maxillary central incisors following nonextraction orthodontic therapy with and without Cort surgery. Materials and Methods: The sample comprised two groups, with and without Cort and was matched by age and gender: Cort-facilitated nonextraction orthodontics with 27 subjects, 53 central incisors of mean age 24.8 ± 10.2 years, and conventional (Conv) nonextraction orthodontics with 27 subjects, 54 incisors with mean age of 19.6 ± 8.8 years. All periapical radiographs were taken with the paralleling technique; total tooth lengths of the right and left central incisors were measured by projecting and enlarging the periapical radiographs exactly 8 times. Results: t-tests revealed a significant decrease in treatment time in the Cort group (6.3 ± 8.0 vs. 17.4 ± 20.2 months, P = 0.000). Pretreatment root lengths were not significantly different (P = 0.11), but Conv had significantly shorter roots at posttreatment when compared with Cort (P = 0.03). Significant root resorption (P < 0.01) occurred in both Cort (0.3 mm) and Conv (0.7 mm), but the increment of change was significantly greater in Conv (P < 0.03). The variable SNA increased significantly in the Cort (P = 0.001) group and decreased significantly in the Conv group (P < 0.001). Conclusions: Based on the conditions of this study, it may be concluded that Cort-facilitated nonextraction orthodontic therapy results in less root resorption and enhanced alveolar support within a significantly reduced clinical service delivery time frame. Rapid orthodontic treatment and reduced apical root resorption are probably due to the transient osteopenia induced by the Cort surgery and inspired by regional acceleratory phenomenon.