This case report describes using corticotomy-assisted orthodontics to rapidly derotate a maxillary canine tooth. The patient had a Class I malocclusion with bimaxillary dentoalveolar protrusion and a distobuccally rotated upper right canine. Conventional orthodontics failed to derotate the canine over 8 months. Corticotomy, bone grafting, and accelerated orthodontic forces successfully derotated the canine within 4 weeks while reducing overall treatment time. Corticotomy-assisted orthodontics is an effective technique to treat complex malocclusions faster with less root resorption and increased alveolar bone volume compared to conventional orthodontics.

1. Speedy orthodontics –
A case report

2. Introduction
Complex malocclusions like severe rotation
has always possessed a serious setback to
orthodontic treatment in terms of prolonged
treatment time. But with the development of
corticotomy assisted orthodontics various new
vistas have been opened up for enhancing
orthodontic treatment. Reduced treatment
time, increased alveolar volume and reduced
root resorption have weighed in over
conventional non surgical procedures.

3. What is accelarated osteogenic orthodontics?
• Accelerated osteogenic orthodontics is a
brain child of an orthodontist and a
periodontist, Dr.Willian Wilcko and
Dr.Thomas Wilcko.
William Wilcko Thomas Wilcko

4. • Corticotomy assisted orthodontics is a unique
blend of orthodontic mechanics with alveolar
decortication and alveolar augmentation
procedure. This technique is 3-4 times faster
than conventional methods thereby bringing
down the treatment duration. These are
surgical interventions limited to cortical
portion of alveolar bone.

5. What is regional acceleratory phenomenon?
• Introduced by Frost in 1983.
• Regional – demineralisation occurs at both the cut
site as well as adjacent bone.
• Acceleratory - exagerated or intensified bone
response in cuts that extends to the bone marrow.
• Regional acceleratory phenomenon is a local
response to noxious stimulus which describes a
process by which tissue forms faster than normal
regional regeneration process.

6. • Following surgical insult to cortical bone,
regional acceleratory phenomenon increases
the tissue reorganization and healing by
transient burst of localized hard and soft
tissue remodelling.
• Initial phase results in increased cortical bone
porosity because of increased osteoclastic
activity.
• Calcium depletion and diminished bone
densities result in rapid tooth movement.

7. Accelerated osteogenic orthodontics surgical
technique.
• AOO is an interdisciplinary technique which
requires the expertise of an orthodontist and
oral surgeon/periodontist.
• Brackets and arch wires are placed at least
one week prior to surgery.
• Surgery is performed under local anaesthesia.

8. •Full thickness flap was
raised labially and lingually.
•Flaps are raised beyond the
apices of the teeth to avoid
damaging the neurovascular
complex.

9. Buccal and lingual corticotomy cuts and
cortical bone perforations are made
near the malpositioned teeth using low
speed round burs.

10. After bone activation,bone grafting material
layered over the activated bone.

11. •Graft material can be bovine powder or 100% demineralised freeze
dried bone graft .
•Quantity of bone graft depends on the quality of pre existing bone.
•Graft is wet with clindamycin phosphate/ bacteriostatic water/
platelet rich plasma of 5 mg/ml. this provides an antibiotic effect
as well as medium for placement.

12. Flap is repositioned using non resorbable
suture material.

13. • Soon after flap repositioning orthodontic force
should be applied.
• Orthodontic adjustments should be made
every 2 weeks interval.
• The tooth movement that occurs at this stage
is purely physiological and not by
repositioning the segments of bone.
• Osteoclastic activity increases, temporary
intrabony osteopenia occurs as well as at the
same time decortication induces this state.

14. Case report
Patients age : 15 yrs.
Sex : male.
Patients chief complaint : patient complaints of
forwardly placed upper front teeth.

15. Pre treatment
Front
Right
Left

16. Occlusion
Upper Lower

17. • Diagnosis : Angles Class I malocclusion
on a Class I skeletal base with
orthognathic maxilla and mandible, with
bimaxillary dento alveolar proclination
and protrusion, with single tooth cross
bite in relation to 43, midline diastema
of 2 mm and disto buccal rotation of 33,
overjet of 8 mm and overbite of 5 mm.

18. Treatment plan : Extraction of all first
premolars.
• Patient was bonded with 0.018 Roth
preadjusted edgewise appliance.
• 0.016 coaxial wire was placed in both upper
and lower arches for initial levelling and
aligning.

19. •Over a period of 8 months we tried most of the
conventional techniques to derotate canine.
•Unfortunately non of them could give a proper result.
•At that juncture we strated thinking about

20. Partial decorticationBone graftingSuture placement

21. •0.016 x 0.022 NiTi piggy back wire was fully
engaged into the canine bracket using ligature
tie on the day of surgery to apply a light and
continous force.

22. • Elastic chain was also placed from the button
placed on the distal surface of canine to the
rigid 0.017x0.025 stain less steel base arch
wire with gingival off set.
• Orthodontic adjustment was done in every 2
weeks interval.

23. After 2 weeks of derotation.

24. After 4 weeks

25. After space closure

26. IOPA
BEFORE DEROTATION AFTER DEROTATION

27. Conclusion
• Corticotomy assisted orthodontics is an
effective and reliable technique to treat severe
malocllusions to reduce the treatment time and
increase the treatment quality.
• Reduced root resorption, increased alveolar
volume, reduced chair side time are the basic
advantages of this technique. However this
should be carefully performed over the teeth
and surrounding tissues to avoid the risk of
devitalization of the teeth and periodontal
damage.

28. • A long term follow up studies have to be
performed to evaluate the effects of
corticotomy assisted orthodontics on
retention and stability.