|Year : 2019 | Volume
| Issue : 6 | Page : 97-106
Periodontal accelerated osteogenic orthodontics technique for rapid orthodontic tooth movement: A systematic review
Venkataramana Vannala1, Anilkumar Katta2, Manchala S Reddy3, Shishir R Shetty4, Raghavendra M Shetty5, Shakeel S Khazi6
1 Department of Orthodontics, College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
2 Consultant Orthodontist, Smile 4 All Dental Clinic, Guntur, Andhra Pradesh, India
3 Department of Periodontics, College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
4 Department of Oral Medicine and Radiology, College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
5 Department of Pediatric Dentistry, College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
6 Department of Prosthodontics, College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
|Date of Web Publication||28-May-2019|
Dr. Venkataramana Vannala
Department of Orthodontics, College of Dentistry, Gulf Medical University, Ajman 4184
United Arab Emirates
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: The aim of this review was to analyze the data in the available literature regarding aspects of periodontally accelerated orthodontic therapy such as reduction in treatment time, variation in surgical techniques, and patient satisfaction. Materials and Methods: An internet-based search was performed for the articles published between January 2008 and August 2018 using keywords periodontal accelerated orthodontic tooth movement, corticotomy, bone grafting, tooth movement, and treatment duration. A total of 84 articles were obtained from MEDLINE and Embase search engines, of which 31 articles were eligible to be included for the systematic review. Results: On analysis, it was observed that the earlier studies were predominantly pertaining to case reports. In the later part of the decade considered in this review, it was observed that the emphasis was given to clinical and animal studies. Conclusions: Most of the studies included in the review concluded that there was a significant reduction in orthodontic treatment duration using periodontal accelerated techniques compared to conventional orthodontic treatment.
Keywords: Bone grafting, corticotomy, periodontal accelerated orthodontic tooth movement (PAOO), tooth movement, treatment duration
|How to cite this article:|
Vannala V, Katta A, Reddy MS, Shetty SR, Shetty RM, Khazi SS. Periodontal accelerated osteogenic orthodontics technique for rapid orthodontic tooth movement: A systematic review. J Pharm Bioall Sci 2019;11, Suppl S2:97-106
|How to cite this URL:|
Vannala V, Katta A, Reddy MS, Shetty SR, Shetty RM, Khazi SS. Periodontal accelerated osteogenic orthodontics technique for rapid orthodontic tooth movement: A systematic review. J Pharm Bioall Sci [serial online] 2019 [cited 2019 Sep 15];11, Suppl S2:97-106. Available from: http://www.jpbsonline.org/text.asp?2019/11/6/97/258841
| Introduction|| |
To achieve the orthodontic objectives of a functional and esthetic dentition, which most patients and clinicians desire for, orthodontic treatment must be performed. Orthodontic tooth movement can be brought by use of either fixed or removable appliances by applying different forces. Force when applied on to a tooth in a particular direction results in physiological tooth movement. Factors that play an important role in tooth movement are quality and quantity of force and treatment time. Along with this, knowledge about growth and development of dentofacial complex is essential. In today’s time, dental appearance is considered as an important feature while defining the facial appeal as it plays an important role in human social interactions.,,, Recent reports have stated that there is a relationship between dental malocclusion, psychosocial well-being, and self-esteem. In addition, current trend is that we have more of adult patients seeking ortho treatment in order to improve their facial appearance.,,, It is estimated that the approximately 12–24 months is the time needed for comprehensive orthodontic treatment, which in turn depends upon severity, treatment plan, and individual characteristics. Prolonged treatment time means this can be an added risk factor for other dental problems such as root resorption, caries, and periodontal disease due to poor oral hygiene.,,
To reduce orthodontic treatment time due to patient demand, orthodontists have tried to accelerate tooth movement using various methods such as photobiomodulation, pharmacological approaches, and low-intensity laser irradiation. Among all these procedures, surgical procedure, i.e., periodontally accelerated osteogenic orthodontics technique (PAOO), has widely been popularized as it significantly reduced orthodontic treatment time.,
What is periodontally accelerated osteogenic orthodontics?
It is a combination of periodontal and orthodontic treatment, which included surgical alveolar decortication followed by bone grafting and orthodontic treatment. The end results of this procedure lead to long-term improvement of the periodontium with reduction in orthodontic treatment time. Name it decortication or corticotomy in simple terms, it means intentional cutting or injury of cortical bone.
Regional accelerating phenomenon (RAP) is the main biological mechanism behind the acceleration of orthodontic tooth movement, which was proven by most of the animal studies. RAP has been defined as a re-organization activity and physiologic event that happened next to the site of injury, resulting in regional reduction in bone density in the healthy tissue.
The rationale behind this particular method comprises careful alveolar decortication, which is a form of periodontal tissue engineering causing transient osteopenia and high turnover adjacent to the injury site. Alveolar decortication initiates a healing response, the amount of which is directly related to the intensity and proximity of the surgical insult.
Historic view: L. C. Bryan (1892) was the first to treat malocclusion cases with the help of corticotomy procedure; later Heinrich Kole reintroduced this procedure to correct malocclusion. Of late, Wilcko et al. termed selective alveolar decortication combined with grafting and orthodontic treatment. They coined the term PAOO. Authors reported that 6–8 months were the time required to treat orthodontic cases with the help of PAOO surgery, which was quite faster than the conventional orthodontic treatment.
It enhances alveolar bone volume and periodontium (i.e., correction of dehiscences and fenestrations).
Reduces treatment time (i.e., 3–4 times more rapid active orthodontic treatment).
Better posttreatment stability and a lesser amount of relapse.
Malocclusion treatment scope can be enhanced of (i.e., avoiding orthognathic surgery and extractions in selected cases).
Patient’s profile can be improved if needed.
Rapid recovery of impacted teeth (i.e., canines).
Thinner mandibular cortices
Patients with active periodontal disease or gingival recession
In the treatment of severe posterior cross-bite
Bimaxillary protrusion when accompanied with a gummy smile
This systematic review was conducted in the College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates, between January 2008 and August 2018. A literature survey was conducted to identify all aspects of the studies that examined the effect, indications, and the biology of corticotomy. MEDLINE in process and other nonindexed citation, PubMed, and Embase reviews were searched. Keywords used included Periodontally Accelerated Orthodontic Tooth movement (PAOO), Corticotomy, Bone grafting, tooth movement, and treatment duration. Articles in the form of case reports, case series, and research studies were included in the review. Review articles were excluded. Only English language full-text articles were used as data source.
Randomized controlled trials (RCTs), prospective controlled studies, and retrospective controlled trials were considered eligible to be included in the systematic review. The studies had to be in English language only, addressing at least some aspect of PAOO in both human and animals. Eligibility of potential studies was determined by reading the title and abstract of each article identified by the search, and then full texts of the articles were retrieved from the selected abstracts/titles. Two reviewers were assigned to review the full text of articles and were calibrated to use the review process adopted in this review. The data were categorized and tabulated into clinical studies [Table 1] and animal studies [Table 2].,
| Conclusions|| |
Due to the swift outcome of the treatment, adults shifting toward orthodontic treatment are more in number and forgo their taboos concerning the duration of treatment. PAOO is a technique that has many applications in the orthodontic treatment for adults because it helps to overcome many of the current limitations of conventional treatment, including lengthy duration, potential for periodontal complications, lack of growth, and the limited envelope of tooth movement. Further, randomized testing in humans is still necessary to confirm the claimed advantages of this technique and to evaluate the long-term effects of it. Interdisciplinary communication and proper coordination are essential for apt treatment planning and satisfying outcome.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wilcko TM, Wilcko WM. Accelerated osteogenic orthodontics technique A-1 stage surgically facilitated rapid orthodontic technique with alveolar augmentation. J Oral Maxillofac Surg 2009;67:2149-59.
Lee W, Karapetyan G, Moats R, Yamashita DD, Moon HB, Ferguson DJ, et al
. Corticotomy-/osteotomy-assisted tooth movement microcts differ. J Dent Res 2008;87:861-7.
Nowzari H, Yorita FK, Chang H-C. Periodontally accelerated osteogenic orthodontics combined with autogenous bone grafting. Compendium 2008:29:200-6.
Sebaoun JD, Kantarci A, Turner JW, Carvalho RS, Van Dyke TE, Ferguson DJ. Modeling of trabecular bone and lamina dura following selective alveolar decortication in rats. J Periodontol 2008;79:1679-88.
Wang L, Lee W, Lei DL, Liu YP, Yamashita DD, Yen SL. Tissue responses in corticotomy- and osteotomy-assisted tooth movements in rats: Histology and immunostaining. Am J Orthod Dentofacial Orthop 2009;136:770.e1-11; discussion 770-1.
Seifi M, Younessian F, Ameli N. The innovated laser assisted flapless corticotomy to enhance orthodontic tooth movement. J Lasers Med Sci 2012;3:20-5.
Hernández-Alfaro F, Guijarro-Martínez R. Endoscopically assisted tunnel approach for minimally invasive corticotomies. J Periodont 2012;83:574-80.
Owen AH. Accelerated invisalign treatment. JCO 2001;35: 381-5.
Hassan AH, Fraidi AA. Corticotomy assisted orthodontic treatment. Open Dent J 2010;4:159-64.
Thomas MB. An evidence-based analysis of periodontally accelerated orthodontic and osteogenic techniques. Sem Orthodont 2008;14:305-16.
Kole H. Surgical operations on the alveolar ridge to correct occlusal abnormalities. Oral Surg Oral Med Oral Pathol 1959;12:515-29 concl.
Düker J. Experimental animal research into segmental alveolar movement after corticotomy. J Maxillofac Surg 1975;3:81-4.
Kau CH, Kantarci A, Shaughnessy T, Vachiramon A, Santiwong P, de la Fuente A, et al
. Photobiomodulation accelerates orthodontic alignment in the early phase of treatment. Prog Orthod 2013;14:30.
McGorray SP, Dolce C, Kramer S, Stewart D, Wheeler TT. A randomized, placebo-controlled clinical trial on the effects of recombinant human relaxin on tooth movement and short-term stability. Am J Orthod Dentofacial Orthop 2012;141:196-203.
Cruz DR, Kohara EK, Ribeiro MS, Wetter NU. Effects of low-intensity laser therapy on the orthodontic movement velocity of human teeth: A preliminary study. Lasers Surg Med 2004;35:117-20.
Nimeri G, Kau CH, Abou-Kheir NS, Corona R. Acceleration of tooth movement during orthodontic treatment—a frontier in orthodontics. Prog Orthod 2013;14:42.
Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid orthodontics with alveolar reshaping: Two case reports of decrowding. Int J Periodontics Restorative Dent 2001;21:9-19.
Wilcko MT, Wilcko WM, Bissada NF. An evidence-based analysis of periodontally accelerated orthodontic and osteogenic techniques: A synthesis of scientific perspectives. Semin Orthod 2008;14:305-16.
Wilcko WM, Ferguson DJ, Bouquot JE, Wilcko MT. Rapid orthodontic decrowding with alveolar augmentation: case report. World J Orthod 2003;4:197-205.
Hassan AH, Al-Saeed SH, Al-Maghlouth BA, Bahammam MA, Linjawi AI, El-Bialy TH. Corticotomy-assisted orthodontic treatment. A systematic review of the biological basis and clinical effectiveness. Saudi Med J 2015;36:794-801.
Thind SK, Chatterjee A, Arshad F, Sandhu PS, Thind MS, Nahin J. A clinical comparative evaluation of periodontally accelerated osteogenic orthodontics with piezo and surgical bur: An interdisciplinary approach. J Indian Soc Periodontol 2018;22:328-33.
] [Full text]
Brugnami F, Caiazzo A, Mehra P. Can corticotomy (with or without bone grafting) expand the limits of safe orthodontic therapy? J Oral Biol Craniofac Res 2018;8:1-6.
Addanki P, Gooty JR, Palaparthy R. Clinical and radiographic comparative evaluation of buccal and palatal corticotomy with buccal corticotomy in periodontally accelerated osteogenic orthodontics with surgical bur. Contemp Clin Dent 2017;8:321-6.
] [Full text]
Mahantesha S, Yashi P, Karan P, Ashwini S, Prashanth GS. Wilckodontics. A novel synergy in time to save time: A case report. Int J Appl Dent Sci 2017;3:5-7.
Bahammam MA. Effectiveness of bovine-derived xenograft versus bioactive glass with periodontally accelerated osteogenic orthodontics in adults: A randomized, controlled clinical trial. BMC Oral Health 2016;16:126.
Awasthi E, Sanjay K, Bhongade ML, Shrivastav S. Alveolar bone housing—A modified wilkodontics approach- A case report. J Clin Diagn Res 2016;10:ZD12-5.
Charavet C, Lecloux G, Bruwier A, Rompen E, Maes N, Limme M, et al
. Localized piezoelectric alveolar decortication for orthodontic treatment in adults: A randomized controlled trial. J Dent Res 2016;95:1003-9.
Ahn HW, Seo DH, Kim SH, Park YG, Chung KR, Nelson G. Morphologic evaluation of dentoalveolar structures of mandibular anterior teeth during augmented corticotomy-assisted decompensation. Am J Orthod Dentofacial Orthop 2016;150:659-69.
Jahanbakhshi MR, Motamedi AM, Feizbakhsh M, Mogharehabed A. The effect of buccal corticotomy on accelerating orthodontic tooth movement of maxillary canine. Dent Res J (Isfahan) 2016;13:303-8.
Munoz F, Jiménez C, Espinoza D, Vervelle A, Beugnet J, Haidar Z. Use of leukocyte and platelet-rich fibrin (L-PRF) in periodontally accelerated osteogenic orthodontics (PAOO): Clinical effects on edema and pain. J Clin Exp Dent 2016;8:e119-24.
Abbas NH, Sabet NE, Hassan IT. Evaluation of corticotomy-facilitated orthodontics and piezocision in rapid canine retraction. Am J Orthod Dentofacial Orthop 2016;149:473-80.
Wu J, Xu L, Liang C, Jiang J. Class III orthognathic surgical cases facilitated by accelerated osteogenic orthodontics: A preliminary report. Aust Orthod J 2015;31:226-35.
Sakthi SV, Vikraman B, Shobana VR, Iyer SK, Krishnaswamy NR. Corticotomy-assisted retraction: An outcome assessment. Indian J Dent Res 2014;25:748-54.
] [Full text]
Bhattacharya P, Bhattacharya H, Anjum A, Bhandari R, Agarwal DK, Gupta A, et al
. Assessment of corticotomy facilitated tooth movement and changes in alveolar bone thickness—A CT scan study. J Clin Diagn Res 2014;8:ZC26-30.
Al-Naoum F, Hajeer MY, Al-Jundi A. Does alveolar corticotomy accelerate orthodontic tooth movement when retracting upper canines? A split-mouth design randomized controlled trial. J Oral Maxillofac Surg 2014;72:1880-9.
Krishnan P, Shetty S, Husain A. An adjunctive minor surgical procedure for increased rate of retraction. J Pharm Bioallied Sci 2013;5:S39-42.
Coscia G, Coscia V, Peluso V, Addabbo F. Augmented corticotomy combined with accelerated orthodontic forces in class III orthognathic patients: Morphologic aspects of the mandibular anterior ridge with cone-beam computed tomography. J Oral Maxillofac Surg 2013;71:1760.e1-9.
Yezdani AA. Accelerated orthodontics with alveolar decortication and augmentation: A case report. Orthodontics (Chic) 2012;13:146-55.
Shoreibah EA, Salama AE, Attia MS, Abu-Seida SM. Corticotomy-facilitated orthodontics in adults using a further modified technique. J Int Acad Periodontol 2012;14:97-104.
Choo H, Heo HA, Yoon HJ, Chung KR, Kim SH. Treatment outcome analysis of speedy surgical orthodontics for adults with maxillary protrusion. Am J Orthod Dentofacial Orthop 2011;140:e251-62.
Nowzari H, Yorita FK, Chang HC. Periodontally accelerated osteogenic orthodontics combined with autogenous bone grafting. Compend Contin Educ Dent 2008;29:200-6; quiz 207, 218.
Lee JK, Chung KR, Baek SH. Treatment outcomes of orthodontic treatment, corticotomy-assisted orthodontic treatment, and anterior segmental osteotomy for bimaxillary dentoalveolar protrusion. Plast Reconstr Surg 2007;120:1027-36.
Chen YW, Wang HC, Gao LH, Liu C, Jiang YX, Qu H, et al
. Osteoclastogenesis in local alveolar bone in early decortication-facilitated orthodontic tooth movement. PLoS One 2016;11:e0153937.
Lee KB, Lee DY, Ahn HW, Kim SH, Kim EC, Roitman I. Tooth movement out of the bony wall using augmented corticotomy with nonautogenous graft materials for bone regeneration. Biomed Res Int 2014;2014:347508.
Ahn HW, Ohe JY, Lee SH, Park YG, Kim SJ. Timing of force application affects the rate of tooth movement into surgical alveolar defects with grafts in beagles. Am J Orthod Dentofacial Orthop 2014;145:486-95.
Yuan H, Zhu X, Lu J, Dai J, Fang B, Shen SG. Accelerated orthodontic tooth movement following le fort I osteotomy in a rodent model. J Oral Maxillofac Surg 2014;72:764-72.
Kim YS, Kim SJ, Yoon HJ, Lee PJ, Moon W, Park YG. Effect of piezopuncture on tooth movement and bone remodeling in dogs. Am J Orthod Dentofacial Orthop 2013;144:23-31.
Baloul SS, Gerstenfeld LC, Morgan EF, Carvalho RS, Van Dyke TE, Kantarci A. Mechanism of action and morphologic changes in the alveolar bone in response to selective alveolar decortication-facilitated tooth movement. Am J Orthod Dentofacial Orthop 2011;139:S83-101.
[Table 1], [Table 2]