|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 2020 Nov 26];11, Suppl S2:97-106. Available from: https://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.
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[Table 1], [Table 2]