Orthodontics

With an increasing number of adult patients visiting orthodontic clinic, the orthodontist cons¬tantly looking for accelerated tooth movement options. Surgical intervention to affect the alveolar bone and tooth movement has been described in various forms for over many years. However, it is the spirit of interdiscipli¬nary collaboration in orthodontics has expanded the realm of traditional orthodontic tooth movement protocols. Periodontal accelerated osteogenic orthodontics (PAOO) is a clinical procedure that combines selective alveolar corticotomy, particulate bone grafting, and the application of orthodontic forces. This procedure is theoretically based on the bone healing pattern known as the regional acceleratory phenomenon (RAP). Tooth

Most of conventional orthodontic treatments require more than one year to complete. Unfortunately many potential orthodontic patients jeopardize their dental health and decline treatment, due to this long treatment times. The development of corticotomy-assisted orthodontic treatment (CAOT) opened doors and offered solutions to many limitations in the orthodontic treatment of adults. It was first introduced in 1959 by Kole [1] as a mean for rapid tooth movement. It was believed that the main resistance to tooth movement was the cortical plates of bone and by disrupting its continuity, orthodon¬tics could be completed in much less time than normally expected. Kole’s procedure involves the reflection of full thickness flaps to expose buccal and lingual alveolar bone, followed by interdental cuts through the cortical bone and barely penetrating the medullary bone (corti¬cotomy style). The subapical horizontal cuts connecting the interdental cuts were osteotomy style, penetrating the full thickness of the alveolus. Because of the inva¬sive nature of Kole’s technique, it was never widely ac¬cepted. From Koles work arose the term “Bony block” to describe the suspected movement after corticotomy surgery. Koles interpretation of bony block concept prevailed until 2001 publication of Wilcko et al [2]. Wilcko et al introduced a novel surgical orthodontic therapy referred to as Periodontally accelerated osteogenic

It can be successfully combined with gingival augmentation procedures too. In addition it should not be considered as an alternative for surgically assisted palatal expansion in case of severe posterior cross-bite and bimaxillary protrusion.

Surgical technique for PAOO consists of several steps (Table 1) viz flap reflection, decortications, particulate grafting, closure and orthodontic force application. The placement of orthodontic brackets and activation of arch wires are done one week before the surgery. However, bracketing can also be done up to 1-2 weeks post surgery. If delayed, the advantage of RAP could fail to occur. The orthodontist has 4-6 months as window period for rapid movement. After which finishing movements occur with normal speed.

Nowzari et al (2008) [4] reported for the first time use of particulate autogenous bone grafts with coticotomy assisted rapid orthodontic procedure. They concluded PAOO with autogenous bone graft as effective treatment approach for orthodontic treatment in