This document describes the periodontal accelerated osteogenic orthodontics (PAOO) technique.
PAOO combines selective alveolar corticotomy, particulate bone grafting, and orthodontic forces to shorten treatment time. It is based on the regional acceleratory phenomenon where corticotomy leads to temporary demineralization and remodeling of alveolar bone. The technique was developed from earlier corticotomy-facilitated orthodontics. It results in increased alveolar bone width and stability. The document then describes the surgical technique for PAOO, including flap design and corticotomy procedures to provide access for grafting and accelerate orthodontic tooth movement.
Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...Abu-Hussein Muhamad
Piezosurgery has been applied in dentistry for many years. This paper reviews specifically the treatment applications that have been used in surgically assisted orthodontic treatment since the last decade. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a surgical technique which results in an increase in alveolar bone width, shorter treatment time, increase post-treatment stability, and decrease amount of apical root resorption. The aim of this case report is to compare the use of micro-motor and piezoelectric surgery unit during decortication in Periodontally Accelerated Osteogenic Orthodontics technique.
Key words: Piezoelectric surgery, piezosurgery, Periodontal regeneration , accelerated tooth movement
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.
This document provides an overview of Periodontally Accelerated Osteogenic Orthodontics (PAOO). It discusses the history and development of PAOO, the biological mechanisms underlying rapid tooth movement using this technique, the surgical procedures involved, indications and contraindications for its use, advantages and disadvantages compared to traditional orthodontics, and case reports. PAOO combines selective alveolar corticotomy, particulate bone grafting, and orthodontic forces to accelerate tooth movement based on the regional acceleratory phenomenon response to the corticotomy injury.
This research paper examines the use of micro-osteoperforation (MOP) to accelerate orthodontic tooth movement. MOP is a minimally invasive procedure that involves creating controlled microtraumas in the bone using specialized devices. This stimulates an inflammatory response and increases the rate of alveolar bone remodeling compared to conventional orthodontics. Several clinical studies showed MOP resulted in 41-50% faster canine retraction and higher levels of inflammatory markers associated with bone remodeling. While MOP reduces treatment time, future research is still needed to further validate its efficacy.
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
This document describes a case study involving periodontally accelerated osteogenic orthodontics (PAOO) to accelerate orthodontic tooth movement. PAOO involves selective alveolar decortications and bone grafting to induce regional acceleratory phenomenon and reduce orthodontic treatment time. The case report describes performing corticotomy and bone grafting to close a 6.5mm space between teeth in a 27-year-old female patient, achieving the space closure in 4 months, which is significantly faster than conventional orthodontic treatment. PAOO provides benefits like reduced treatment time, increased bone volume, and improved post-treatment stability compared to traditional orthodontics.
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.
Article teixeira effects of micro-osteoperforationCentric Learning
1. The study examined the effect of micro-osteoperforations (MOPs) on the rate of tooth movement in 20 patients undergoing orthodontic treatment.
2. The experimental group received MOPs on one side of the maxilla prior to canine retraction, while the control group did not receive MOPs.
3. MOPs significantly increased the rate of tooth movement by 2.3-fold and increased inflammatory marker levels. Patients did not report significant pain from the procedure.
Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...Abu-Hussein Muhamad
Piezosurgery has been applied in dentistry for many years. This paper reviews specifically the treatment applications that have been used in surgically assisted orthodontic treatment since the last decade. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a surgical technique which results in an increase in alveolar bone width, shorter treatment time, increase post-treatment stability, and decrease amount of apical root resorption. The aim of this case report is to compare the use of micro-motor and piezoelectric surgery unit during decortication in Periodontally Accelerated Osteogenic Orthodontics technique.
Key words: Piezoelectric surgery, piezosurgery, Periodontal regeneration , accelerated tooth movement
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.
This document provides an overview of Periodontally Accelerated Osteogenic Orthodontics (PAOO). It discusses the history and development of PAOO, the biological mechanisms underlying rapid tooth movement using this technique, the surgical procedures involved, indications and contraindications for its use, advantages and disadvantages compared to traditional orthodontics, and case reports. PAOO combines selective alveolar corticotomy, particulate bone grafting, and orthodontic forces to accelerate tooth movement based on the regional acceleratory phenomenon response to the corticotomy injury.
This research paper examines the use of micro-osteoperforation (MOP) to accelerate orthodontic tooth movement. MOP is a minimally invasive procedure that involves creating controlled microtraumas in the bone using specialized devices. This stimulates an inflammatory response and increases the rate of alveolar bone remodeling compared to conventional orthodontics. Several clinical studies showed MOP resulted in 41-50% faster canine retraction and higher levels of inflammatory markers associated with bone remodeling. While MOP reduces treatment time, future research is still needed to further validate its efficacy.
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
This document describes a case study involving periodontally accelerated osteogenic orthodontics (PAOO) to accelerate orthodontic tooth movement. PAOO involves selective alveolar decortications and bone grafting to induce regional acceleratory phenomenon and reduce orthodontic treatment time. The case report describes performing corticotomy and bone grafting to close a 6.5mm space between teeth in a 27-year-old female patient, achieving the space closure in 4 months, which is significantly faster than conventional orthodontic treatment. PAOO provides benefits like reduced treatment time, increased bone volume, and improved post-treatment stability compared to traditional orthodontics.
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.
Article teixeira effects of micro-osteoperforationCentric Learning
1. The study examined the effect of micro-osteoperforations (MOPs) on the rate of tooth movement in 20 patients undergoing orthodontic treatment.
2. The experimental group received MOPs on one side of the maxilla prior to canine retraction, while the control group did not receive MOPs.
3. MOPs significantly increased the rate of tooth movement by 2.3-fold and increased inflammatory marker levels. Patients did not report significant pain from the procedure.
1. Corticotomy facilitates faster orthodontic tooth movement by reducing resistance in the cortical bone layer.
2. Selective alveolar decortication (SAD) is shown to create a transient demineralization-remineralization effect on the alveolar bone through the regional acceleratory phenomenon (RAP), allowing teeth to move 2-3 times faster.
3. The periodontally accelerated osteogenic orthodontics (PAOO) technique combines SAD with alveolar bone grafting to generate new bone, reducing relapse risk and extending treatment limits.
This study evaluated the clinical performance of tooth-supported overdentures compared to conventional dentures. 42 overdenture prostheses were constructed for 37 patients using remaining teeth as abutments. Most were lower complete overdentures retaining anterior teeth. The results showed that overdentures provided much better denture stability and retention, improved patient acceptance, higher chewing performance, fewer post-insertion sore spots, less alveolar bone loss, and a shorter adjustment period compared to conventional dentures. The overdenture technique was found to be suitable for treating patients planned for full lower extractions and conventional dentures.
This document discusses dental implants and immediate loading protocols. It provides background on the history and development of dental implants, including the concept of osseointegration. Primary stability and bone quality are important factors for implant success. Immediate loading was introduced as an alternative to delayed loading protocols, offering benefits of shortened treatment time and early rehabilitation. Research suggests immediate loading may stimulate bone formation through mechanical strain. The document then focuses on treatment of edentulism with implant overdentures, including benefits over conventional dentures. It describes different attachment systems and reviews evidence on immediate loading for mandibular overdentures, finding it is clinically well documented but not scientifically validated to the same degree as conventional loading.
This document provides an overview of implant surgery from basics to advanced concepts. It discusses the history of dental implants from early bamboo pegs in ancient China to the development of modern titanium implants. Key aspects covered include bone biology, osseointegration, implant components, principles of implant positioning, and the surgical procedure. Implant planning involves consideration of anatomy, available bone dimensions, and prosthetic goals to determine optimal implant placement and angulation. Patient selection involves evaluating medical history and indications versus contraindications for implant surgery.
Treatment planning for implant :- force factor related to patient conditionsMayank Aggarwal
- Bite force during mastication ranges from 5-44 lbs and occurs for short periods each day. Parafunctional forces from bruxism, clenching, and tongue thrust can exceed normal bite forces and damage implants over time.
- Treatment planning for patients with risk factors like bruxism, excessive crown-to-implant length, or strong bite forces focus on decreasing stress by adding implants, widening implant diameter, eliminating cantilevers, and designing prosthetics to better distribute forces.
- Diagnosis of parafunctions considers tooth wear patterns, muscle tenderness, and jaw issues. Occlusal guards can help determine the impact of occlusion and protect implants and prosthetics at night.
The document discusses the clinical evaluation of implant patients, including case types and indications, risk factors and contraindications, and the pre-treatment evaluation process. A comprehensive evaluation is needed to determine if implant therapy is possible, practical, and indicated for the patient. The evaluation should assess the patient's medical history, medications, habits, motivations, and oral examination to analyze the dentoalveolar condition and feasibility of implant placement. The patient's goals and expectations must also be evaluated to ensure realistic outcomes.
This document contains a presentation on short dental implants given by Dr. Mohammed Alshehri at the ITI Congress Middle East in Abu Dhabi, UAE in December 2012. The presentation defines short implants, reviews the available evidence on their success rates compared to longer implants or bone augmentation procedures, and identifies factors that can affect the success of short implants such as surgical protocol, implant design, surface characteristics, crown-to-implant ratio and occlusal forces. Studies show short implants have high success rates, especially when placed in the mandible, and may be preferable to more complex augmentation procedures.
Atrophied Edentulous Mandible with Implant-Supported Overdenture; A 10-year f...Abu-Hussein Muhamad
Abstract: Severe atrophy of the inferior alveolar process and underlying basal bone often results in problems with a lower denture. These problems include insufficient retention of the lower denture, intolerance to loading by the mucosa, pain, difficulties with eating and speech, loss of soft-tissue support, and altered facial appearance. These problems are a challenge for the prosthodontist and surgeon. In this case report, patient with resorbed edentulous mandible was successfully rehabilitated using two dental implants placed in the interforaminal region with ball abutments opposing conventional maxillary complete denture. Key Words: dental implants; dental prosthesis, implant-supported; resorption,
Abstract: Corticotomy-assisted orthodontic treatment is an established and efficient orthodontic technique that has recently been studied in a number of publications. Corticotomy facilitated orthodontics have been employed in various forms over speed up orthodontic treatment It involves selective alveolar decortication in the form of decortication lines and dots performed around the teeth that are to be moved. It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement. This technique has several advantages, including faster tooth movement, shorter treatment time, safer expansion of constricted arches, enhanced post-orthodontic treatment stability and extended envelope of tooth movement. The aim of this article is to present a comprehensive review of the literature, including historical background, contemporary clinical techniques, indications, contraindications, complications and side effects. Keywords: Corticotomy, decortication, review, orthodontic treatment
This presentation reviews common functional and esthetic problems associated with extraction of teeth and current methods and surgical techniques to minimize loss of bone and soft tissue
This presentation has videos and more surgical aspects of recent advances in Implant dentistry.This is different from other presentations in this platform since it is stuffed with most recent articles and informations
The document discusses temporary anchorage devices (TADs) used in orthodontic treatment. It defines TADs as devices that are temporarily fixed to bone to enhance orthodontic anchorage and are later removed. The document covers the history of TADs, classifications based on materials and design, indications for use, surgical procedures for placement, and factors involved in success and failure. It provides examples of different TAD systems and discusses considerations for biomechanics, long-term stability and failure of implants.
This document discusses ridge augmentation procedures for alveolar bone regeneration prior to dental implant placement. It covers principles of guided bone regeneration using barrier membranes and bone grafts/substitutes to promote new bone growth. Diagnostic factors and classification systems for bone defects are presented. Techniques for horizontal and vertical ridge augmentation are described, including ridge preservation, socket grafting, ridge splitting, and onlay block grafts. Emerging technologies using growth factors, cell therapies, advanced scaffold materials and computer-guided designs are also mentioned. The goal of these procedures is to generate sufficient bone volume and quality for safe, long-term stable implant therapy.
A technique for immediate occlusal implant loading of a completely edentulo...jackabcdental
This document describes a technique for immediate loading of implants in the completely edentulous mandible using a custom-fabricated interim implant-supported prosthesis. Four implants were placed between the mental foramina and immediately loaded with an interim acrylic resin prosthesis. Transparent surgical guides and templates were used to identify implant positions, which allowed for minimal denture modification and improved structural integrity and esthetics of the interim prosthesis. At 3 months, a definitive implant-supported prosthesis was fabricated. This technique aims to reduce treatment time and postoperative discomfort through immediate loading of implants in the mandible.
This document summarizes distraction osteogenesis (DO), which is a process where new bone is formed between bone segments that are gradually separated. DO involves three phases: a latency phase, distraction phase where the bone is gradually separated, and consolidation phase where the new bone mineralizes. It discusses the history and applications of DO, including for lengthening of long bones and the mandible. Key advantages are that it allows for larger movements than traditional bone grafts and avoids prolonged fixation. Potential complications include non-compliance, pain, premature consolidation, and neurological damage.
This document provides information on dental implants including:
1. It defines a dental implant as an artificial titanium fixture surgically placed into the jawbone to replace a missing tooth and root.
2. Implant dentistry/implantology is concerned with replacing missing teeth and supporting structures with prostheses anchored to the jawbone.
3. Common implant designs include parallel or tapered, threaded screw-shaped implants which are the most commonly used type today.
This case report describes immediate placement of a dental implant in the socket of an extracted fractured maxillary incisor tooth. The tooth was extracted atraumatically without flap reflection and the implant was immediately placed, achieving primary stability. A provisional restoration was placed for temporization. At the 4 month follow-up, an impression was made and a definitive restoration placed. The patient exhibited no clinical or radiographic complications after 1 year of follow-up, demonstrating that immediate implant placement can preserve hard and soft tissues while providing immediate esthetics, function, and comfort.
The document discusses various approaches to accelerate orthodontic tooth movement including biomechanical, physiological/mechanical, pharmacological, surgical-assisted, and surgery-simulated approaches. The biomechanical approach examines self-ligating bracket systems. The physiological/mechanical approach explores direct electric current stimulation, enzymatic micro batteries, piezoelectric stimulation, low-level laser therapy, and photobiomodulation. The pharmacological approach investigates prostaglandins, corticosteroids, growth hormone, parathyroid hormone, vitamin D, and relaxin. The surgical-assisted approach examines rapid canine retraction through distraction of the periodontal ligament and dentoalveolar distraction. The surgery-simulated
The document discusses four techniques for corticotomy:
1. Percutaneous corticotomy involves making small incisions to cut cortices with an osteotome and completing the cut through rotational osteoclasis.
2. Drilling of the posterior cortex uses drill holes to perforate the posterior cortex followed by rotational osteoclasis.
3. The Gigli saw method passes a needle or tape around the posterior cortex to allow cutting with a Gigli saw through an anterior incision.
4. Oblique osteotomy provides some cortical support and decreases risk of axial deviation compared to other techniques.
1. Corticotomy facilitates faster orthodontic tooth movement by reducing resistance in the cortical bone layer.
2. Selective alveolar decortication (SAD) is shown to create a transient demineralization-remineralization effect on the alveolar bone through the regional acceleratory phenomenon (RAP), allowing teeth to move 2-3 times faster.
3. The periodontally accelerated osteogenic orthodontics (PAOO) technique combines SAD with alveolar bone grafting to generate new bone, reducing relapse risk and extending treatment limits.
This study evaluated the clinical performance of tooth-supported overdentures compared to conventional dentures. 42 overdenture prostheses were constructed for 37 patients using remaining teeth as abutments. Most were lower complete overdentures retaining anterior teeth. The results showed that overdentures provided much better denture stability and retention, improved patient acceptance, higher chewing performance, fewer post-insertion sore spots, less alveolar bone loss, and a shorter adjustment period compared to conventional dentures. The overdenture technique was found to be suitable for treating patients planned for full lower extractions and conventional dentures.
This document discusses dental implants and immediate loading protocols. It provides background on the history and development of dental implants, including the concept of osseointegration. Primary stability and bone quality are important factors for implant success. Immediate loading was introduced as an alternative to delayed loading protocols, offering benefits of shortened treatment time and early rehabilitation. Research suggests immediate loading may stimulate bone formation through mechanical strain. The document then focuses on treatment of edentulism with implant overdentures, including benefits over conventional dentures. It describes different attachment systems and reviews evidence on immediate loading for mandibular overdentures, finding it is clinically well documented but not scientifically validated to the same degree as conventional loading.
This document provides an overview of implant surgery from basics to advanced concepts. It discusses the history of dental implants from early bamboo pegs in ancient China to the development of modern titanium implants. Key aspects covered include bone biology, osseointegration, implant components, principles of implant positioning, and the surgical procedure. Implant planning involves consideration of anatomy, available bone dimensions, and prosthetic goals to determine optimal implant placement and angulation. Patient selection involves evaluating medical history and indications versus contraindications for implant surgery.
Treatment planning for implant :- force factor related to patient conditionsMayank Aggarwal
- Bite force during mastication ranges from 5-44 lbs and occurs for short periods each day. Parafunctional forces from bruxism, clenching, and tongue thrust can exceed normal bite forces and damage implants over time.
- Treatment planning for patients with risk factors like bruxism, excessive crown-to-implant length, or strong bite forces focus on decreasing stress by adding implants, widening implant diameter, eliminating cantilevers, and designing prosthetics to better distribute forces.
- Diagnosis of parafunctions considers tooth wear patterns, muscle tenderness, and jaw issues. Occlusal guards can help determine the impact of occlusion and protect implants and prosthetics at night.
The document discusses the clinical evaluation of implant patients, including case types and indications, risk factors and contraindications, and the pre-treatment evaluation process. A comprehensive evaluation is needed to determine if implant therapy is possible, practical, and indicated for the patient. The evaluation should assess the patient's medical history, medications, habits, motivations, and oral examination to analyze the dentoalveolar condition and feasibility of implant placement. The patient's goals and expectations must also be evaluated to ensure realistic outcomes.
This document contains a presentation on short dental implants given by Dr. Mohammed Alshehri at the ITI Congress Middle East in Abu Dhabi, UAE in December 2012. The presentation defines short implants, reviews the available evidence on their success rates compared to longer implants or bone augmentation procedures, and identifies factors that can affect the success of short implants such as surgical protocol, implant design, surface characteristics, crown-to-implant ratio and occlusal forces. Studies show short implants have high success rates, especially when placed in the mandible, and may be preferable to more complex augmentation procedures.
Atrophied Edentulous Mandible with Implant-Supported Overdenture; A 10-year f...Abu-Hussein Muhamad
Abstract: Severe atrophy of the inferior alveolar process and underlying basal bone often results in problems with a lower denture. These problems include insufficient retention of the lower denture, intolerance to loading by the mucosa, pain, difficulties with eating and speech, loss of soft-tissue support, and altered facial appearance. These problems are a challenge for the prosthodontist and surgeon. In this case report, patient with resorbed edentulous mandible was successfully rehabilitated using two dental implants placed in the interforaminal region with ball abutments opposing conventional maxillary complete denture. Key Words: dental implants; dental prosthesis, implant-supported; resorption,
Abstract: Corticotomy-assisted orthodontic treatment is an established and efficient orthodontic technique that has recently been studied in a number of publications. Corticotomy facilitated orthodontics have been employed in various forms over speed up orthodontic treatment It involves selective alveolar decortication in the form of decortication lines and dots performed around the teeth that are to be moved. It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement. This technique has several advantages, including faster tooth movement, shorter treatment time, safer expansion of constricted arches, enhanced post-orthodontic treatment stability and extended envelope of tooth movement. The aim of this article is to present a comprehensive review of the literature, including historical background, contemporary clinical techniques, indications, contraindications, complications and side effects. Keywords: Corticotomy, decortication, review, orthodontic treatment
This presentation reviews common functional and esthetic problems associated with extraction of teeth and current methods and surgical techniques to minimize loss of bone and soft tissue
This presentation has videos and more surgical aspects of recent advances in Implant dentistry.This is different from other presentations in this platform since it is stuffed with most recent articles and informations
The document discusses temporary anchorage devices (TADs) used in orthodontic treatment. It defines TADs as devices that are temporarily fixed to bone to enhance orthodontic anchorage and are later removed. The document covers the history of TADs, classifications based on materials and design, indications for use, surgical procedures for placement, and factors involved in success and failure. It provides examples of different TAD systems and discusses considerations for biomechanics, long-term stability and failure of implants.
This document discusses ridge augmentation procedures for alveolar bone regeneration prior to dental implant placement. It covers principles of guided bone regeneration using barrier membranes and bone grafts/substitutes to promote new bone growth. Diagnostic factors and classification systems for bone defects are presented. Techniques for horizontal and vertical ridge augmentation are described, including ridge preservation, socket grafting, ridge splitting, and onlay block grafts. Emerging technologies using growth factors, cell therapies, advanced scaffold materials and computer-guided designs are also mentioned. The goal of these procedures is to generate sufficient bone volume and quality for safe, long-term stable implant therapy.
A technique for immediate occlusal implant loading of a completely edentulo...jackabcdental
This document describes a technique for immediate loading of implants in the completely edentulous mandible using a custom-fabricated interim implant-supported prosthesis. Four implants were placed between the mental foramina and immediately loaded with an interim acrylic resin prosthesis. Transparent surgical guides and templates were used to identify implant positions, which allowed for minimal denture modification and improved structural integrity and esthetics of the interim prosthesis. At 3 months, a definitive implant-supported prosthesis was fabricated. This technique aims to reduce treatment time and postoperative discomfort through immediate loading of implants in the mandible.
This document summarizes distraction osteogenesis (DO), which is a process where new bone is formed between bone segments that are gradually separated. DO involves three phases: a latency phase, distraction phase where the bone is gradually separated, and consolidation phase where the new bone mineralizes. It discusses the history and applications of DO, including for lengthening of long bones and the mandible. Key advantages are that it allows for larger movements than traditional bone grafts and avoids prolonged fixation. Potential complications include non-compliance, pain, premature consolidation, and neurological damage.
This document provides information on dental implants including:
1. It defines a dental implant as an artificial titanium fixture surgically placed into the jawbone to replace a missing tooth and root.
2. Implant dentistry/implantology is concerned with replacing missing teeth and supporting structures with prostheses anchored to the jawbone.
3. Common implant designs include parallel or tapered, threaded screw-shaped implants which are the most commonly used type today.
This case report describes immediate placement of a dental implant in the socket of an extracted fractured maxillary incisor tooth. The tooth was extracted atraumatically without flap reflection and the implant was immediately placed, achieving primary stability. A provisional restoration was placed for temporization. At the 4 month follow-up, an impression was made and a definitive restoration placed. The patient exhibited no clinical or radiographic complications after 1 year of follow-up, demonstrating that immediate implant placement can preserve hard and soft tissues while providing immediate esthetics, function, and comfort.
The document discusses various approaches to accelerate orthodontic tooth movement including biomechanical, physiological/mechanical, pharmacological, surgical-assisted, and surgery-simulated approaches. The biomechanical approach examines self-ligating bracket systems. The physiological/mechanical approach explores direct electric current stimulation, enzymatic micro batteries, piezoelectric stimulation, low-level laser therapy, and photobiomodulation. The pharmacological approach investigates prostaglandins, corticosteroids, growth hormone, parathyroid hormone, vitamin D, and relaxin. The surgical-assisted approach examines rapid canine retraction through distraction of the periodontal ligament and dentoalveolar distraction. The surgery-simulated
The document discusses four techniques for corticotomy:
1. Percutaneous corticotomy involves making small incisions to cut cortices with an osteotome and completing the cut through rotational osteoclasis.
2. Drilling of the posterior cortex uses drill holes to perforate the posterior cortex followed by rotational osteoclasis.
3. The Gigli saw method passes a needle or tape around the posterior cortex to allow cutting with a Gigli saw through an anterior incision.
4. Oblique osteotomy provides some cortical support and decreases risk of axial deviation compared to other techniques.
Este documento describe diferentes técnicas quirúrgicas como la corticotomía, piezocisión y osteotomía microquirúrgica diseñadas para acelerar el movimiento dental durante el tratamiento ortodóncico. Explica los conceptos subyacentes como el fenómeno acelerador regional y cómo estas técnicas pueden reducir significativamente el tiempo de tratamiento, mejorar la estabilidad de los resultados y expandir las posibilidades del tratamiento ortodóncico.
Relapse in orthodontics /certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Advances in orthodontics /certified fixed orthodontic courses by Indian dent...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Corticotomías alveolares en el tratamiento ortodóntico
Tratamiento eficiente en un marco biológico y seguro ( variaciones individuales de cada paciente). Se trata de un procedimiento quirúrgico que afecta mecánicamente el hueso cortical y medular en su totalidad creando segmentos óseos.
En esta presentación encontrara:
- Introducción
- Mecanismo biológico
-Técnicas
- Estudios en animales
- Indicaciones - Casos clínicos
- Contraindicaciones
- Conclusiones
En Clínica Birbe somos una clínica con dedicación exclusiva a la cirugía maxilofacial e implantología. Disponemos de un equipo humano a la vanguardia de nuestra especialidad y de unas instalaciones biotecnológicas de última generación.
www.birbe.org
A scissor bite, also known as a Brodie bite, is a malocclusion where the maxillary molars are positioned outward or the mandibular molars are positioned inward, causing the molars to overlap without contact when the mouth is closed. It is characterized by labial eruption of the upper molars or lingual tipping of the lower molars due to an arch length discrepancy in the posterior region. Treatment involves using elastic forces or orthodontic appliances to correct the positioning of the molars, and recently miniplates or mini screws placed in the bone have provided skeletal anchorage for tooth movements without undesirable side effects.
This document provides an overview of orthodontics and orthodontic tooth movement. It defines orthodontics as the specialty concerned with treatment and management of malocclusion. Orthodontic tooth movement results from forces delivered by fixed or removable appliances and occurs through the periodontal ligament in response to these mechanical forces. Proper application of biomechanical principles can improve treatment efficiency. Different types of tooth movement like tipping, translation, and rotation are discussed along with optimal force levels and durations. Factors like wire properties, bracket size and material are also covered.
This document summarizes a study on using bone grafts and immediate implant placement in areas of high aesthetic value. It describes using block bone grafts taken from the mandible to augment alveolar ridge deficiencies in the maxilla before placing implants. The goals were to assess success rates of implants placed in grafted bone and determine if this technique is suitable for aesthetic areas. The methodology involved using SPI implants and placing immediate provisional restorations on the implants after grafting and implantation to condition the soft tissues during healing. Success was based on radiographic and clinical assessments during outpatient follow-ups.
This document summarizes a study on using bone grafts and immediate implant placement in areas of high aesthetic value. It describes using block bone grafts taken from the mandible to augment alveolar ridge deficiencies in the maxilla before placing implants. The goals were to assess success rates of implants placed in grafted bone and determine if this technique is suitable for aesthetic areas. The protocol involved using SPI implants and placing immediate provisional restorations on the implants after graft integration to condition the soft tissues during healing. The study aims to evaluate if this technique can provide rigid fixation and osseointegration of implants in grafted bone for functional loading.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses secondary pre-prosthetic surgical procedures. It describes ideal ridge form for denture wearing and secondary procedures to modify ridges through augmentation or altering relationships. Ridge augmentation aims to recreate ridges compatible with dentures through autografts, homografts, or alloplastic materials. Ridge relationship procedures correct arch discrepancies through maxillary advancement or mandibular advancement surgeries. Secondary soft tissue procedures further modify ridges after hard tissue alterations.
1) Understanding the mechanisms of peri-implant bone healing is important as dental implants are increasingly used in more challenging situations.
2) There are differences in how cortical and trabecular bone heal, with trabecular bone healing more rapidly through new bone formation versus cortical bone healing through slower remodeling.
3) Classifying bone as "poor quality" based on its trabecular nature is a misnomer, as trabecular bone is well suited for rapid healing due to its vascular and cellular composition.
This document discusses dental implants and the importance of soft tissue and bone health for implant success. It covers topics like osseointegration between implants and bone, gingival shrinkage during healing, the peri-implant soft tissue seal, the need for keratinized gingiva, and maintaining the biological width of peri-implant soft tissues. Patient factors like age, smoking, and diseases as well as local bone quality can influence implant success. Proper implant placement and surgical technique are important to support the overlying soft tissues long-term.
This study analyzed the position and angulation of 300 maxillary central incisors using cone beam imaging to provide data to help clinicians achieve good esthetic results for immediate dental implants. The thickness of buccal and palatal bone and apical bone height were measured. Incisors were classified according to their position (buccal, midline, palatal) and angulation (toward buccal, anterior to A point, parallel to alveolus). Most incisors were positioned buccally. Recommendations for implant placement based on tooth classification aim to maintain adequate buccal bone thickness and prevent complications.
Clinical Replacement Therapy and the Immediate Post-extraction Dental ImplantAbu-Hussein Muhamad
Immediate dental implants have greatly reduced the treatment time and the number of surgical intervene tions. Recently it has been noted that this treatment modality can be used in aesthetically demanding cases especially the anterior maxilla. The aim of this article is to describe a clinical case in which a fractured maxillary canine was replaced by an osseointegrated implant using a simplified technique in a patient who was a smoker and presented poor oral hygiene. The technique adopted permits a reduction of the number of implant components and consequently a lower cost of treatment, while at the same time maintaining acceptable aesthetic and functional outcomes.
Resective osseous surgery involves removing tooth-supporting alveolar bone to reshape it and eliminate periodontal pockets. It is indicated for inconsistent bone margins, reverse bone architecture, one-wall defects, and other bone irregularities. The surgery involves using burs and chisels to perform vertical grooving of thick bone, blending any bone ledges on tooth roots, flattening interproximal bone in narrow areas, and gradualizing marginal bone. Flaps are closed to cover the new bony margins. Post-operative maintenance like cleaning and antibiotics is needed to allow healing over 2-3 weeks.
Corticotomy facilitated orthodontics
Although the art and science of orthodontics have progressed significantly over the past 100 years, relatively little has been done to enhance the rate at which tooth movement occur. Many methods have been done to enhance the rate of tooth movement. These methods include the injection of biologically active peptides, the use of magnets and even the application of electric current and corticotomy.
Corticotomy: is slight penetration through the cortical bone and did not be confused with the osteotomy. Or defined as incision made into the cortical bone.
This penetration or incision leads to decrease the resistance of the alveolar and diminish physical alveolar bone contact that accelerates the rate of tooth movement.
Several authors have described rapid tooth in conjunction with corticotomy surgery as movement by bony (Block). Kole6 was the first describe the corticotomy as a surgical procedure in which one tooth or group of teeth with the adjacent bone is repositioned in one step. But others prefer to call this osteo-corticotomy or intra alveolar segmental osteotomy, reserving the term corticotomy for a technique in which cuts are made in the buccal cortical plate of bone. So that the segment to be moved orthodontically is held only by cancellous trabeculea and palatal cortical bone.
Kole in 19596 reported combining orthodontics with corticotomy surgery and complete the active tooth movement in adult orthodontic cases in 6 to 12 weeks.
The inter-proximal corticotomy cuts were extended through the entire thickness of the cortical layer, just barely penetrating the medullary bone.
The vertical cuts were connected beyond the apices of the teeth with horizontal osteotomy cut extending through the entire thickness of the alveolus, essentially creating blocks of bone in which one or more teeth were embedded, using the crowns of the teeth as a handles. Kole believed that he was able to move the blocks of bone some what independly of each other because they were only connected by less-dense medullary bone. He found no incidence of root resorption, no loss of tooth vitality and no pocket formation.
Kole used this surgical technique for correction of some of dento-alveolar problems as:
Protruding of lower incisors: this procedure is indicated in most of cases but should be determined whether a mandibular or dento-alveolar retrusion. Buccally the cortiocotomy is performed between the incisors and canine then horizontal cut is made 1cm. below the incisors, lingual two vertical and one horizontal cut is made fig(1).
Distal displacement of a single tooth or group of teeth: correction necessitates a long period of treatment in adult patients fig(2) .
The retrusion of all six lower anterior teeth: after buccal and ligual corticotomy is perefrmed.
Alignment of rotated teeth.
Correction of spaced teeth: in maxillary and mandibular protrusion with diastemas between the t
This document discusses preprosthetic surgery, which involves surgical procedures done prior to the construction of dentures to improve the denture foundation and ensure successful denture therapy. Some reasons for preprosthetic surgery include removing retained teeth/roots, smoothing uneven ridges, reducing tori or exostoses that could interfere with denture placement, and adjusting the mental foramen if resorption has caused sharp edges that could cause pain. Both non-surgical and surgical methods are discussed, including alveoloplasty to reshape ridges and remove undercuts or projections, as well as the importance of a thorough examination and developing a treatment plan with the patient.
It restore alveolar bone to the level existing at the time of surgery or slightly more apical to this level. Aim is to achieve positive bony architecture.
STEPS INCLUDE:
1.VERTICAL GROOVING
2. RADICULAR BLENDING
3. FLATTENING INTERPROXIMAL BONE
4. GRADUALIZING MARGINAL BONE
PREFERRED TREATMENT FOR ONE WALLED PERIODONTAL BONE DEFECTS (HEMISEPTUM)
A 58-year-old patient visited the clinic seeking treatment for removable dentures. An examination found she was missing teeth in the upper anterior region and had a protruding ridge that could cause discomfort. She also had a fused labial frenulum. The general dentist referred her to oral surgery for preprosthetic surgery. Her general health was normal with no systemic issues.
Periodontally Accelerated Osteogenic Orthodontics: A Surgical Technique and C...iosrjce
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The document describes an abstract book for a poster presentation at the Osteology Foundation on regenerative dentistry and dental tissue engineering. It provides details on the invited poster abstract committee members and categories. It announced that the best 5 abstracts in clinical and basic research categories will present to the committee. Prize awards for the best posters will be given. The accepted poster abstracts are numbered and organized by topic and presentation times are provided.
Orthodontics has been developing greatly in achieving the desired results both clinically and technically.
Today, it is still very challenging to reduce the duration of orthodontic treatments.
It is one of the common deterents that the orthodontist faces and it causes irritation among adults plus increasing risks of caries, gingival recession, and root resorption.
A number of attempts have been made to create different approaches both preclinically and clinically in order to achieve quicker results, but still there are a lot of uncertainties and unanswered questions towards most of these techniques.
Resective osseous surgery involves reshaping the alveolar bone through additive or subtractive techniques to correct deformities caused by periodontal disease. The goal is to reshape the marginal bone to resemble healthy bone. Key steps include vertical grooving, radicular blending, flattening interproximal bone, and gradualizing marginal bone using instruments like chisels and curettes. This technique is best for early to moderate bone loss up to 3mm and can provide reduced pocket depths and stable tissue contours for long-term maintenance when performed with apically positioned flaps.
Atrophied Edentulous Mandible with Implant-Supported Overdenture; A 10-year f...iosrjce
This document summarizes a case report of a patient with a severely resorbed edentulous mandible who was successfully rehabilitated with two dental implants placed in the interforaminal region with ball attachments supporting an overdenture. After 10 years of follow-up, the patient was highly satisfied with the retention, comfort and function provided by the implant-retained overdenture. The case report also reviews literature on the use of implant-supported overdentures for treating resorbed edentulous ridges, finding they provide better function and retention compared to conventional dentures and reduce further bone loss.
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2. MURPHY ET AL 2161
over the root surfaces, a soft tissue matrix of the after surgery. If complex mucogingival procedures
bone, which could be carried with the root and are combined with the PAOO surgery, the lack of
later remineralize, occurred after the completion of fixed orthodontic appliances may enable easier flap
the orthodontic treatment. In an effort to enhance manipulation and suturing. In all cases initiation of
bony volumes after the application of orthodontic orthodontic force should not be delayed more than 2
forces, they also suggested the use of particulate weeks after surgery. A longer delay will fail to take full
bone grafting in combination with the decortica- advantage of the limited time period that the RAP is
tion procedures. The Wilckos combined the refined occurring.
corticotomy-facilitated orthodontic technique with The orthodontist has a limited amount of time to
alveolar augmentation and named the orthodontic accomplish accelerated tooth movement. This period
and periodontal aspects of this procedure the ac- is usually 4 to 6 months, after which finishing move-
celerated osteogenic orthodontics (AOO) tech- ments occur with a normal speed. Given this limited
nique and, more recently, the PAOO surgical tech- “window” of rapid movement, the orthodontist will
nique, respectively. need to advance arch wire sizes rapidly, initially en-
gaging the largest arch wire possible.
Case Selection
PAOO can be used in most cases in which tradi-
tional fixed orthodontic therapy is used. PAOO has
Surgical Technique
been shown to be efficacious in the treatment of Class FLAP DESIGN
I malocclusions with moderate to severe crowding, The objectives of the flap design are to 1) provide
Class II malocclusions requiring expansion or extrac- access to the alveolar bone wherein corticotomies
tions, and mild Class III malocclusions. The orthodon- are to be performed, 2) provide for coverage of the
tic therapist determines the plan for the movement, particulate graft, 3) maintain the height and volume
identifying the teeth that will provide anchorage and
of the interdental tissues, and 4) enhance the es-
those portions of the arch that will be expanded or
thetic appearance of the gingival form where nec-
contracted. From this plan, a prescription for areas
essary.
requiring corticotomies is developed. Careful coordi-
The basic flap design is a combination of a full-
nation between the surgeon and orthodontist is re-
thickness flap in the most coronal aspect of the flap
quired for successful outcomes. It is suggested that
with a split-thickness dissection performed in the
both the surgeon and orthodontist be trained to-
apical portions. The purpose of the split-thickness
gether in the use of this technique to ensure a com-
dissection is to provide mobility of the flap so that
mon basis of knowledge.
it may be sutured with minimal tension. After the
The surgical specialist must also evaluate the es-
thetic needs of the patient and incorporate these split-thickness dissection is performed, the perios-
requirements into the surgical treatment plan. For teal layer is carefully elevated from the alveolar
example, if a patient presents with gingival recession bone, providing access to the alveolar bone surface
in an area requiring corticotomy, a subepithelial con- and facilitating identification of critical neurovascu-
nective tissue graft can be placed in conjunction with lar structures. Mesial and distal extension of the flap
the PAOO surgery. beyond the corticotomy areas is suggested to re-
In some cases anchorage must be established be- duce the need for vertical releasing incisions. The
fore the PAOO procedure is initiated. This is most initial incision is carried out on both surfaces of the
commonly seen in Class II malocclusions requiring alveolus.
retraction. Both dental arches may present with dif- Preservation of the interdental gingival tissues is
ferent degrees of desired movement. For example, critical for a successful esthetic outcome. Numerous
mild anterior crowding may present in the mandibu- different papillae preservation techniques are fre-
lar anterior region and yet significant expansion is quently used. If possible, the papillae between the
required in the maxillary arch. In this scenario PAOO maxillary central incisors should not be elevated. Ac-
may be performed in the maxillary arch while tradi- cess to the labial alveolar bone in this area is achieved
tional orthodontic therapy is used to treat the man- by “tunneling” from the distal aspect (Fig 1). In almost
dibular arch. Having both arches corrected in a similar all cases the papilla is not reflected from the palatal
time frame is ideal. aspect between the central incisors. Retention of a
The placement of orthodontic brackets and activa- palatal or lingual gingival collar of tissue, not reflected
tion of the arch wires are typically done the week from the underlying alveolar bone, is frequently used
before the surgical aspect of PAOO is performed. to provide a collateral blood supply to the papillary
However, bracketing can occur up to 1 to 2 weeks tissue (Fig 2).
3. 2162 PERIODONTAL ACCELERATED OSTEOGENIC ORTHODONTICS
FIGURE 1. A, In esthetically sensitive areas such as the papillae between the central incisors, the initial incision is not carried through the
papillae. Access to the interproximal bone is achieved by tunneling under the flap. B, Healing at 7 days after use of microsurgical closure
techniques. C, Completed tooth movement at 6 months. (Orthodontic therapy was performed by Dr Nancy Ward, Baltimore, MD.)
Murphy et al. Periodontal Accelerated Osteogenic Orthodontics. J Oral Maxillofac Surg 2009.
DECORTICATION mies may also be achieved with a piezoelectric knife.
The purpose of the decortication is to initiate the At this time, there are no objective data to suggest
RAP response and not to create movable bone seg- that any specific pattern, depth, and extent of the
ments. By use of a No. 1 or No. 2 round bur in either corticotomy are superior. The corticotomies are
a high-speed handpiece or dental implant drill, decor- placed on both the labial and lingual (palatal) aspects
tications are made in the alveolar bone. The corticoto- of the alveolar bone.
4. MURPHY ET AL 2163
FIGURE 2. Typical palatal incision leaving collar of gingival FIGURE 4. Particulate bone graft layered over decorticated alve-
tissue, decreasing likelihood of sloughing of interproximal tissue. olar bone. Demineralized freeze-dried bone allograft was bound
Murphy et al. Periodontal Accelerated Osteogenic Orthodontics. with activated platelet-rich plasma resulting in a gelatinous consis-
J Oral Maxillofac Surg 2009. tency. This combination facilitates easier graft handling and phys-
ical stability.
Murphy et al. Periodontal Accelerated Osteogenic Orthodontics.
Typically, a vertical groove is placed in the inter- J Oral Maxillofac Surg 2009.
radicular space, midway between the root promi-
nences in the alveolar bone. This groove extends
from a point 2 to 3 mm below the crest of the bone the alveolar bone, and the need for labial support by
to a point 2 mm beyond the apices of the roots. These the alveolar bone. No objective data exist comparing
vertical corticotomies are then connected with a cir- one grafting material with another in terms of supe-
cular-shaped corticotomy. Care is taken not to extend riority. The most commonly used materials are depro-
the cuts near any neurovascular structures. If the teinized bovine bone, autogenous bone, decalcified
alveolar bone is of sufficient thickness, solitary perfo- freeze-dried bone allograft, or a combination thereof.
rations may be placed in the alveolar bone over the The use of a barrier membrane is not suggested (Figs
radicular surface. However, if this bone is estimated 4, 5).
to be less than 1 to 2 mm in thickness, these perfo- The grafting material is placed with an effort not to
rations are omitted to ensure no damage to the radic- place an excess amount. A typical volume used is 0.25
ular surface (Fig 3). to 0.5 mL of graft material per tooth. The decorticated
bone acts to retain the graft material. However,
PARTICULATE GRAFTING slumping of the graft can occur. The use of platelet-
Grafting is done in most areas that have undergone rich plasma or calcium sulfate has been reported to
corticotomies. The volume of the graft material used increase the stability of the graft material.
is dictated by the direction and amount of tooth
CLOSURE TECHNIQUES
movement predicted, the pretreatment thickness of
Primary closure of the gingival flaps without exces-
sive tension and graft containment are the therapeutic
endpoints of suturing. These are typically achieved
with nonresorbable interrupted sutures. The specific
suture used is determined by the thickness of the
tissue. The sutures that approximate the tissues at the
midline are placed first to ensure the proper align-
ment of the papillae. The remaining interproximal
sutures are placed next, followed by the closure of
any vertical incisions. No packing is required. The
sutures are usually left in place for 1 to 2 weeks.
PATIENT MANAGEMENT
The PAOO surgical procedure can take several
hours to complete when treating both dental arches.
FIGURE 3. Common decortication scheme. Because of the length of this procedure, sedation of
Murphy et al. Periodontal Accelerated Osteogenic Orthodontics. the patient is suggested. The use of short-term ste-
J Oral Maxillofac Surg 2009. roids, given either intravenously or orally, also en-
5. 2164 PERIODONTAL ACCELERATED OSTEOGENIC ORTHODONTICS
FIGURE 5. A, Pretreatment of patient with severe Class II malocclusion. B, PAOO corticotomies performed. C, Four-year retention.
(Orthodontic therapy was performed by Dr Nancy Ward, Baltimore, MD.)
Murphy et al. Periodontal Accelerated Osteogenic Orthodontics. J Oral Maxillofac Surg 2009.
hances patient comfort and clinical healing. Antibiot- evaluation and gentle prophylaxis every week for the
ics and pain medications are administered at the first month and then monthly thereafter.
clinician’s preference. However, long-term postoper-
ative administration of nonsteroidal anti-inflammatory
TECHNIQUE MODIFICATIONS
agents is discouraged, because they may theoretically
interfere with the regional acceleratory process. The PAOO can be successfully combined with gingival
application of icepacks to the affected areas also is augmentation procedures.13 This is particularly im-
suggested to decrease the severity of any possible portant to the adult patient who presents with signif-
postoperative swelling or edema. icant gingival recession. In these situations a subepi-
The most commonly reported postsurgical compli- thelial connective tissue graft is placed over the
cations are edema and ecchymosis, both of which are denuded root surface in addition to particulate graft
self-limiting. The patient will return for postsurgical placement. The graft is harvested by removing a 1- to
6. MURPHY ET AL 2165
FIGURE 6. A, Pretreatment view of patient undergoing PAOO procedure presenting with severe gingival recession on tooth 6. B, Composite
restoration removed and corticotomies performed. C, Subepithelial connective tissue graft placed under coronally advanced flap. D,
Two-year postsurgical result. (Orthodontic therapy was performed by Dr Marty Lang, Lutherville, MD.)
Murphy et al. Periodontal Accelerated Osteogenic Orthodontics. J Oral Maxillofac Surg 2009.
2-mm thickness of gingival connective tissue from the No objective data exist that describe the severity of
elevated palatal flap (Fig 6). postoperative pain with PAOO. However, case reports
claim there is surprisingly little postoperative pain.
Patients report more discomfort with arch wire acti-
Discussion
vation than with the surgical procedure. For the pa-
PAOO can play an important role in the compre- tient who presents with the need for gingival augmen-
hensive treatment of a patient’s occlusal and esthetic tation, this disadvantage of introducing a surgical
needs. This technique has been shown to increase procedure, as well as the associated costs, may not be
alveolar bone thickness, decrease treatment time, and relevant because surgical correction of the gingival
enhance post-treatment orthodontic stability. PAOO deficiency would be required regardless of the need
is an extension of previously described techniques for the PAOO procedure.
that surgically alter the alveolar bone to decrease On the basis of case reports, surgical complications
treatment time. It differs from prior techniques by the appear to be minimal with PAOO. Unfortunately, con-
additional step of alveolar bone grafting. It is this trolled multicenter data are not available at this time
additional step that is believed to be responsible for and objective assessment is not possible. The inci-
the increased post-treatment alveolar bone width. dence of root resorption by use of PAOO is decreased
Likewise, the additional alveolar bone width may be when compared with conventional treatment. The
responsible for enhanced long-term orthodontic sta- frequency of other possible complications, such as
bility. ankylosis and devitalization, is unknown, but such
A distinct disadvantage of this procedure is the complications have not been reported.
additional cost and morbidity associated with surgery. Because PAOO is a relatively new clinical proce-
Conversely, the true increase in treatment cost may dure, long-term data ( 5 years) regarding occlusal
be offset by the decreased treatment time or, in some stability are not available. However, 2-year data sug-
cases, the need for orthognathic surgical procedures. gest that PAOO can effectively, and with increased
7. 2166 PERIODONTAL ACCELERATED OSTEOGENIC ORTHODONTICS
efficiency, facilitate the orthodontic treatment of pa- 2. Pham-Nguyen K: Micro-CT analysis of osteopenia following
selective alveolar decortication and tooth movement [master’s
tients. A key component to this increased efficiency
thesis]. Boston, MA, Boston University, 2006
and these significantly decreased treatment times is 3. Twaddle BA, Ferguson DJ, Wilcko WM, et al: Dento-alveolar
the successful coordination of the orthodontic and bone density changes following corticotomy-facilitated orth-
surgical specialists. Without this coordination of the odontics [abstract]. J Dent Res 80:301, 2002
4. Hajji SS: The influence of the accelerated osteogenic response
treatment plan and therapy, chances for a successful on mandibular decrowding [abstract]. J Dent Res 30:180, 2001
treatment outcome are decreased. 5. Nazarov AD, Ferguson DJ, Wilcko WM, et al: Improved orth-
PAOO does result in significantly decreased treatment odontic retention following corticotomy using ABO Objective
time. We assume that a decrease in the length of treat- Grading System [abstract]. J Dent Res 83:2644, 2004
6. Machado IM, Ferguson DJ, Wilcko WM, et al: Reabsorcion
ment would probably increase the likelihood that pa- radicular despues del tratamiento ortodoncico con o sin corti-
tients, especially adults, would elect to pursue orthodon- cotomia alveolar. Rev Venez Ortod 19:647, 2002
tic therapy when they would otherwise decline 7. Köle H: Surgical operations of the alveolar ridge to correct
treatment. By decreasing treatment times, PAOO effec- occlusal abnormalities. Oral Surg Oral Med Oral Pathol 12:515,
1959
tively increases a patient’s access to orthodontic therapy 8. Generson RM, Porter JM, Zell A, et al: Combined surgical and
by decreasing an obstacle to treatment. Conversely, the orthodontic management of anterior open bite using corti-
introduction of a surgical phase to the orthodontic ther- cotomy. J Oral Surg 34:216, 1978
apy may prevent a patient from considering PAOO as a 9. Anholm M, Crites D, Hoff R, et al: Corticotomy-facilitated orth-
odontics. Calif Dent Assoc J 7:8, 1986
treatment option. Only after careful consultation and 10. Gantes B, Rathbun E, Anholm M: Effects on the periodontium
communication with an orthodontic therapist, peri- following corticotomy-facilitated orthodontics. Case reports. J
odontal therapist, and oral and maxillofacial surgeon will Periodontol 61:234, 1990
11. Suya H: Corticotomy in orthodontics, in Hösl E, Baldauf A
the patient be able to understand the advantages and
(eds): Mechanical and Biological Basics in Orthodontic Ther-
disadvantages of treatment. apy. Heidelberg, Hütlig Buch, 1991, pp 207-226
12. Frost HA: The regional acceleratory phenomena; a review.
Henry Ford Hosp Med J 31:3, 1983
References 13. Wilcko MT, Wilcko MW, Murphy KG, et al: Full-thickness
1. Wilcko WM, Wilcko MT, Bouquot JE, et al: Rapid orthodontics flap/subepithelial connective tissue grafting with intramarrow
with alveolar reshaping: Two case reports of decrowding. Int J penetrations: Three case reports of lingual root coverage. Int J
Periodontics Restorative Dent 21:9, 2001 Periodontics Restorative Dent 25:561, 2005