Periodontally Accelerated Osteogenic Orthodontics (PAOO) or Wilckodontics - Rapid orthodontic treatment procedures can be achieved by performing Alveolar Corticotomies (ACS) shortly before the application of orthodontic forces. This method has been suggested to enhance tooth movement and reduce orthodontic treatment treatment time. WICKO BROTHERS (THOMAS WILCKO AND WILLIAM WILCKO) in 2001 introduced this technique. PAOO has expanded the arena of traditional orthodontic tooth movement protocols. This technique can be especially beneficial for adult patients seeking orthodontic tooth movement.

1. WILCKODONTICS
PRESENTED BY –
DR. SHRADDHA KODE

2. INTRODUCTION
– Search for improvements in orthodontic therapy is
shared by several dental specialities especially
periodontics.
– Rapid orthodontic treatment procedures can be achieved
by performing Alveolar Corticotomies (ACS) shortly
before the application of orthodontic forces.
– This method has been suggested to enhance tooth
movement and reduce orthodontic treatment time.

3. HISTORY
– Described in 1893 by L.C.BRYAN in textbook called
ORTHODONTIA – MALPOSITION OF HUMAN TEETH, ITS
PREVENTION AND REMEDY
– KOLE in 1959 – First to introduce rapid tooth movement
by alveolar corticotomy
“Bony Block Movement”
– DUKER in 1975 - Investigated the effect of rapid tooth
movement using corticotomy technique on the vitality of
the teeth and the marginal periodontium.

4. – SUYA in 1991 - Tooth movement was made by moving
blocks of bone using crowns of teeth as handles.
Completion of movement takes within 3-4 months.
– WICKO BROTHERS (THOMAS WILCKO AND WILLIAM
WILCKO) in 2001 – Introduced PERIODONTALLY
ACCELERATED OSTEOGENIC ORTHODONTICS (PAOO)
SELECTIVE CORTICOTOMY + ALVEOLAR GRAFTING
They patented this technique

5. RATIONALE
– Orthopedist HERALD FROST – Surgical wounding of
osseous tissues causes tissue reorganisation adjacent to
the site of injury
– This cascade of physiologic healing events is REGIONAL
ACCELERATORY PHENOMENON (RAP)

6. INDICATIONS
– Dehiscence and fenestrations over prominent root surfaces
– Anterior open bites and deviated midlines
– Cross bites and tooth size discrepancies
– Conservative alternative to orthognathic surgery
– Moderate to severe malocclusions in both adolescents and adults
– Accelerate canine retraction after premolar extraction
– Enhance post- orthodontic stability
– Facilitate eruption of impacted teeth

7. CONTRAINDICATIONS
– Patients with severe active periodontal disease.
– Patients with inadequately treated endodontic problems.
– Patients on long term medications which will slow down
bone metabolism, such as bisphosphanate and NSAIDs.
– Patients on long term steroid therapy

8. CASE SELECTION
– Patients of any age (as young as 11yrs to 70 yrs) as long
as they have healthy periodontium
– Used in most cases where traditional fixed orthodontic
therapy is used
– Effective in Class I malocclusion with moderate to severe
crowding and Class II malocclusion requiring expansion
or extraction

9. – Orthodontist – Ortho tooth movement plan, arch
segment to contract or expand and anchorage units
– Periodontist – Periodontal status, mucogingival
conditions and esthetic needs of the patient
– Orthodontic brackets and arch wire activation done 1
week before
– Within 2 weeks of surgery, active orthodontic treatment
to be initiated

10. SURGICAL TECHNIQUE
– STEP 1 – FLAP DESIGN
– Full thickness flap (most coronal aspect) + split thickness
flap(apical portion)
– Periosteal layer is removed – Access to alveolar bone
– Mesial and distal extension

12. – STEP 2 – DECORTICATION
– Under LA using low speed no.2 carbide bur Vertical
cortical incisions performed interproximally and
extending well beyond dental apices
– Subapical horizontal corticotomy given connecting
interdental cuts
– Done on both labial and lingual/palatal aspect of alveolar
bone

14. – STEP 3 – PARTICULATE BONE GRAFTING
– Material – Deproteinised bovine bone, autogenous bone,
DFDBA
– Use of Platelet Rich Plasma/Calcium sulfate - Increases
stability of graft
– 0.25 to 0.5ml of graft material required per tooth

16. – STEP 4 – CLOSURE OF FLAP
– Sutures in the midline at interproximal areas followed by
other areas by interrupted sutures

18. – STEP 5 – PATIENT MANAGEMENT
– Post surgical complications – Pain, edema and
ecchymosis
– Antibiotics and analgesics and ice packs – For patient
comfort and clinical healing enhancement

19. ADVANTAGES
– 3 to 4 times faster orthodontic tooth movement
– 1/3rd to 1/4th conventional treatment time
– Less likelihood of root resorption and devitalisation
– Low chances of relapse
– Alveolar reshaping enhances patient’s profile

20. DISADVANTAGES
– Expensive procedure
– Mildly invasive procedure and like all surgeries it has risk
of some pain, swelling, and the possibility of infection.

21. MODIFICATIONS
– COMPRESSION OSTEOGENESIS – Required in cases of
molar intrusion
– CO similar to CAO except corticotectomy
– Corticotectomy + Anchor plates & elastic traction
– CAO – Movement of teeth in weakened alveolar bone
CO – Movement of bony block along with teeth

22. – PIEZOELECTRIC VERICAL CORTICOTOMIES + TUNNEL
APPROACH (To place bone graft)

23. NOVEL APPROACH
– LASER
– Flapless laser assisted corticotomy
– Decreases treatment time and damage to the
periodontium
– Er.Cr : YSGG laser irradiation

24. CASE REPORT
(Journal of Interdisciplinary Dentistry / Sep-Dec 2012 / Vol-2 / Issue-3)
– A 38-year-old female patient had a complaint of forwardly
placed upper and lower front teeth with spacing between the
teeth
– DIAGNOSIS - Angles Class I malocclusion with proclination
and spacing of upper and lower anterior teeth
– The patient consented to the PAOO
– Prior to surgical and orthodontic treatment, periodontal
health of the patient was restored by phase I periodontal
therapy including plaque control measures and scaling and
root planing.

28. CONCLUSION
– PAOO has expanded the realm of traditional orthodontic
tooth movement (OTM) protocols.
– The spirit of interdisciplinary collaboration in
orthodontics incorporates periodontal tissue engineering
and regenerative surgery to expedite orthodontic tooth
movement
– This technique can be a "WIN situation” with an
increasing number of adults considering orthodontic
treatment.

29. REFRENCES
– WilliamWilckoetal;RapidOrthodonticswithAlveolarReshaping:TwoCaseReportsof
Decrowding;TheInternationalJournalofPeriodontics&RestorativeDentistry;Volume21,
Number1,2001
– Neethaetal;Periodontallyassistedosteogenicorthodontics:Areview;IAIM,2015;2(2):165-168
– Satinderetal;Wilckodontics-BridgingOrthodonticsandPeriodontics;Volume-4,Issue-7,July-
2015;ISSNNo2277–8160
– Swyetaetal;WILCKODONTICS:ANINNOVATIVEACCELERATEDAPPROACHING
INTERDISCIPLINARYTREATMENTSTRATEGY;ejpmr,2016,3(9),534-539
– Sirishaetal;Wilckodontics- ANovelSynergyinTimetoSaveTime;JournalofClinicaland
DiagnosticResearch.2014Jan,Vol-8(1):322-325
– Sharathetal;Periodontallyacceleratedosteogenicorthodontics:Reviewonasurgicaltechnique
andacasereport;JournalofInterdisciplinaryDentistry/Sep-Dec2012/Vol-2/Issue-3