Periodontally assisted osteogenic orthodontics: A review

Periodontally assisted osteogenic orthodontics ISSN: 2394-0026 (P)Review Article ISSN: 2394-0034 (O)Periodontally assisted osteogenic orthodontics: A review Neetha J Shetty*Associate Professor, Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Mangalore, India*Corresponding author email: [email protected] to cite this article: Neetha J Shetty. Periodontally assisted osteogenic orthodontics: A review.IAIM, 2015; 2(2): 165-168.Available online at www.iaimjournal.comReceived on: 08-01-2015 Accepted on: 19-01-2015AbstractThe periodontally accelerated osteogenic orthodontic (PAOO) technique combines selectivedecortication facilitated orthodontics with periodontal regeneration in order to create rapidorthodontic tooth movement (OTM). This reduces potential side effects like root resorption, toothdevitalization, relapse, inadequate basal bone and bacterial time-load factors like caries andperiodontal infection. Tooth movement can be achieved with increased alveolar volume providingfor a more intact periodontium, decreased need for extractions, degree of facial remodelling andincreased bone support for teeth and overlying soft tissues, thus, augmenting gingival and facialesthetics. With an increasing number of adults considering orthodontic treatment, with a propensityfor periodontal problems, PAOO technique can be a powerful and attractive treatment option indental treatment.Key wordsPAOO, Orthodontics, Periodontal regeneration, Corticotomy.Introduction also present with moderate to advanced periodontitis with gingival recession, requiringIdeal esthetic, restorative and reconstructive the need for periodontal plastic treatment.dental treatments are facilitated by favorably However, these patients have to undergopositioned teeth and an enhanced muco-gingival orthodontic treatment for 2-3 years which is ancomplex. Patients requiring comprehensive obstacle in undergoing ideal rehabilitativedental rehabilitation, correction of malocclusion dental care. By combining Periodontallyor mutilated occlusion, frequently require Accelerated Osteogenic Orthodontics (PAOO)orthodontic treatment in order to obtain a with orthodontic treatment the time requiredpredictable, esthetic and functional treatment for comprehensive orthodontic therapy isoutcome. Of these patients, few of them mayInternational Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 165Copy right © 2015, IAIM, All Rights Reserved.

Periodontally assisted osteogenic orthodontics ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)reduced by 60-75%. This emerging technology is osteotomy cut with a sub apical horizontalcalled Wilckodontics or PAOO. corticotomy cuts beyond the apices of the teeth, followed by fixed orthodontic appliances. TheHistorical background cases were completed in between 6 months andCorticotomy facilitated orthodontics have been twelve 12 months’ time. Outstanding results andemployed in various forms over the past to extreme patient satisfaction with corticotomyspeed up orthodontic treatment. Kole in 1959 procedures were reported. He believed that thewas the first to introduce this as a means for tooth movements were made by moving blocksrapid tooth movement [1, 2, 3]. The cortical of bone using the crowns of the teeth asplates of bone were believed to cause main handles. He recommended completion of toothresistance to tooth movement and by disrupting movement in 3–4 months, as the edges of theits continuity, orthodontics could be completed blocks of bone would begin to fuse togetherin much less time than normally expected. Kole’s after this time.procedure included the reflection of full Wilcko, et al. [6, 7, 8, 9] recently introduced athickness flaps to expose buccal and lingual more surgical orthodontic therapy whichalveolar bone, followed by interdental cuts included the innovative strategy of combiningthrough the cortical bone, barely penetrating corticotomy surgery with alveolar grafting in athe medullary bone. These vertical interdental technique referred to as Accelerated Osteogeniccuts were joined by subapical horizontal cuts Orthodontics (AOO) and more recently to aswhich followed osteotomy style, penetrating the Periodontally Accelerated Osteogenicfull thickness of the alveolus. According to him, Orthodontics (PAOO) [8] .The technique uses aas the blocks of bone was being moved rather comprehensive fixed orthodontic appliance inthan the individual teeth, the root resorption conjunction with full thickness flaps and labialwould not occur and retention time would be and lingual corticotomies around teeth to beminimized. But, because of the invasive nature moved. Teeth movement was initiated twoof thist echnique, it was never accepted. weeks after the surgery, thereafter every twoDuker in 1975 [4] using Kole’s basic technique weeks the orthodontic appliance was activated.investigated the effect of rapid tooth movement Wilcko, et al. [8] also reported that thisusing corticotomy technique on the vitality of technique reduces treatment time to one-thirdthe teeth and the marginal periodontium. He the time of conventional orthodontics. Theyconcluded that the health of the periodontium indicated the use of PAOO for treatment ofwas preserved by avoiding the marginal crest moderate to severely crowded Class I and Classbone during corticotomy cuts. Also, neither the II. Several reports indicated that this techniquepulp nor the periodontium were damaged after is safe, effective, and extremely predictable,corticotomy surgery followed by orthodontic associated with less root resorption and reducedtooth movement. The subsequent techniques treatment time, and can reduce the need fortook this into consideration and the interdental orthognathic surgery in certain situations. [5, 6,cuts were always left at least 2 mm short of the 7, 8, 9, 10, 11, 12, 13, 14]alveolar crestal bone level. Lee, et al. [14] conducted a study on 65 KoreanSuya in 1991 [5] reported corticotomy-assisted adult female patients with bimaxillary dento-orthodontic treatment of 395 adult Japanese alveolar protrusion in order to comparepatients. Here, he substituting the horizontal orthodontic treatment outcomes using anteriorInternational Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 166Copy right © 2015, IAIM, All Rights Reserved.

Periodontally assisted osteogenic orthodontics ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)segmental osteotomy and corticotomy-assisted Advantagesorthodontic treatment. It was concluded that • PAOO allows 3-4 times faster orthodonticorthodontic treatment and corticotomy-assisted movements compared to conventionalorthodontic treatment are indicated for patients treatment. This results in better patientwith severe incisor proclination with normal compliance and also, less of bacterialbasal bone position, with corticotomy-assisted induced periodontal damage.orthodontic treatment having the advantage of • It causes 2-3 fold increase in envelope ofshorter treatment duration. Anterior segmental tooth movement providing for an expandedosteotomy is recommended for bimaxillary alveolar bone base and increased alveolardento-alveolar protrusion patients with gummy volume to support the straightened teeth.smile, basal bone prognathism, relatively normal Hence, it ensures greater stability and lessincisor inclination, and relatively under chances of relapse.developed chin position. • There are lesser chances of occurrence ofRationale of PAOO root fenestration and dehiscence owing to increased alveolar volume.Unlike a usual corticotomy, PAOO cuts into the • PAOO causes reduced complications likebone and decorticates it, thereby removing devitalization and root resorption [6, 7, 8, 9].some of the bone’s external surface. The bonethen goes through a phase of osteopenia, where Disadvantagesits mineral content is temporarily reduced. Now,the tissues of the alveolar bone release rich Compared to conventional procedures, PAOO isdeposits of calcium, and soon, new bone begins quite expensive. Also it is an invasive procedure;to mineralize in about 20 to 55 days. As the there are quite a few risks. It takes usually abone is still in a transient state with the bone week or two for recovery after surgery duringbeing softer and less resistance to forces, braces which the patient would have to skip work orcan move the teeth very quickly. Studies have school [6].shown that the results of PAOO are as stable Conclusionand long-lasting as conventional orthodonticbraces [6, 7, 8, 9]. PAOO has expanded the realm of traditional orthodontic tooth movement (OTM) protocols.Indications The spirit of interdisciplinary collaboration in orthodontics incorporates periodontal tissue• Dehiscence and fenestrations over engineering and regenerative surgery to prominent root surfaces expedite orthodontic tooth movement with reduced side-effects like root resorption, tooth• Anterior open bites and deviated midlines. devitalization, relapse, inadequate basal bone• Cross bites and tooth size-arch length and bacterial time load factors like caries and infection. This technique can be a \"WIN-WIN discrepancies: situation” with an increasing number of adults• Conservative alternative to orthognathic considering orthodontic treatment. surgery:• Where buccolingual width of alveolar ridge is less and extraction is contraindicated dueto facial profile.• Moderate to severe malocclusions in bothadolescents and adults [6, 7].International Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 167Copy right © 2015, IAIM, All Rights Reserved.

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