speedy orthodontics

8/13/2019 Speedy Orthodontics

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SPEEDYORTHODONTICS

By

K SARAVANAN

First year PG : Department of Orthodontics and Dentofacial

orthopedics


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WHY SPEED?

Many orthodontic patients jeopardize their dental health

and decline treatment, due to its long treatment times

Corticotomy facilitated orthodontics emerged to

speed up orthodontic treatment


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INTRODUCTION

What is Corticotomy?

A corticotomy is defined as a

surgical procedure whereby only

the cortical plate is cut ,perforated

or mechanically altered

This is in contrast to osteotomy

which is surgical cut through both

cortical bone and medullary bone


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Historical prospective

BONY BLOCK TECHNIQUE

It was first introduced by DRKOLE in 1959(interradicularcorticotomy and supra apicalosteotomy)

In 1979 DR DUKER byexperimenting on beagle dogsconcluded that neither thepulp nor the periodontium

were damaged followingCFOT(interdental cuts 2mmshort of alveolar crestal bonelevel)

COMBINED CORTICOTOMY AND

OSTEOTOMY


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GANERSON ET AL in 1978 revised DR KOLE`s Techniquewithout the supra apical osteotomy.

DR KOLE`s EXPLANATION TO TOOTH MOVEMENTIDEA BEHIND HIS WORK

Teeth move faster when the resistance exerted by thesurrounding cortical bone is reduced

POST SURGERY and APPLICATION OF ORTHODONTICFORCE

Movement of the entire alveolar cortical block

FOR EXAMPLE :MOVING BLOCKS OF BONE WITH CROWNS

OF TEETH AS HANDLES


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DRAW BACKS

1. CORTICOTOMY and OSTEOTOMY

Depending on the severity of injury to the trabecular bone

There were increased risk of postoperative toothdevitalization and even bone necrosis

2. CORTICOTOMY ALONE

Less injury and also prevention of post operative devitalization


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DISCOVERY OF RAP

A distinguished orthopedist DR HAROLD FROST discoveredthat there was direct correlation between

Degree of injuring of bone and its intensity of healingresponse

He called it the RAPID ACCELERATORY PHENOMENON


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Rapid acceleratory

phenomenon

Such healing response can be considered as a

physiological emergency mechanism

which accelerates the healing of injuries that would

affect survival i.e this phenomenon causes bone

healing 10-50 times faster than normal boneturnover

Increased osteoblastic , osteoclastic activity and

increased levels of local and systemic inflammation


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Sequence of events

Cortical activation

Transient osteopenia in alveolar bone

Reduction of biomechanical resistance

Rapid tooth movement through trabecular bone

Spatial window : RAP to the teeth surrounded bycorticotomy over a range of 3-4months


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Amount of force

1. Initial report

Heavier forces are required in cases of bone block

movement after corticotomy to move the tooth bone block

2. Confirmed report

Conventional forces are sufficient

REASON : Forces are not concentrated on tooth periocomplex surrounded by rigid bone but forces areconcentrated on tooth perio complex surrounded by lowdensity trabecular bone.


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Force and Hyalinization

Sequence of events

Tissue necrosis caused by excessive compression of the

pdl(see notes)

Vascular access of osteoclasts to PDL- lamina dura interfaceis limited

Extensive ,prolonged hyalinization causes slow tooth

movement

Thus as stated earlier , better mechanical loading is thereason why CAT shows a less period of hyalinization

Thus decreased necrosis leads to direct bone resorption andfaster tooth movement


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FURTHER REPORTS

Lee et al described that there were differences in boneregeneration after corticotomy and osteotomy

The prolonged period of hyalinization is the reason toexplain why there is some degree of root resorption inconventional orthodontic tooth movement , which is notobserved in CAT

A recent histological study showed that selective alveolar

decortication induced increased turnover of alveolarspongiosa (SEBEON ET AL).

Corticotomy was found to produce bone resorption aroundthe moving teeth by day 21 after surgery and the arearefilled with bone after 60 days.(WANG ET AL )


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WILCKODONTICS

IN 1995 DRS WILCKO using their knowledge of

corticotomy and RAP developed their Patented

periodontally accelerated osteogenicorthodontics(PAOO)

It is a combination of selective alveolar

decortication and alveolar augmentation by

grafting also reffered it as ACCELERATEDOSTEOGENIC ORTHODONTICS


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Technique

1. Administration of localanaesthesia

2. Crevicular incision is madebuccaly and lingual extending twoto three teeth beyond the area tobe treated

3. FULL THICKNESS FLAP

ELEVATED BEYOND THE APEXOF THE TOOTH IF POSSIBLE

4. The area is debrided andcurettage is done to remove anyinflammed tissue


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1. Alveolar activation is done with selective alveolardecortications on both buccal and lingual sides usingpiezosurgery technique or routine burs

2. Vertical corticotomy cuts are made between the rootsstopping just short of alveolar crest(usually 3mm). The cutsare connected beyond the apices of the teeth with scallopedhorizontal cuts

3. Cortical perforation can be made at selective areas toincrease blood supply to the graft material


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Placement of bone grafts

1. Use of mix of

demineralized freeze-

dried bone and bovinebone with clindamycin.

2. Care should be taken

not to place an

excessive amount ofbone graft which might

interfere with flap

placement


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To treat recession


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1. Flaps are repositioned back allowing sufficient

bone coverage

2. Interrupted loop sutures are made

3. Periodontal dressing is made for eventful healing


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Recovery from PAOO

surgery

Total recovery from the procedure usually takes 7-

10 days

There might be mild swelling and it might require

use of ice packs.

Clhorhexidine mouth wash may be used


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Orthodontic adjustments post

PAOO

Two weeks, post surgery orthodontic treatment

are resumed

The intervals for orthodontic adjustmentsaveraged two weeks

Depending on the case the braces are put for 3-9

months After braces removal ,a retainer for atleast 6

months is usually recommended


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Patient Qualification

Dr Wilcko says PAOO Technique can correct most of

the orthodontic problems that are treated with

traditional braces . It is to overcome short comings of conventional

method such as a) long treatment time,

b)limited encelope of tooth movementc)difficulty of producing movement in certain

direction


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Certain Clinical indications

1. Resolve crowding

2. Accelerate canine retraction after premolar

extraction

3. Facilitate eruption of impacted teeth

4. Facilitate slow orthodontic expansion

5. Molar intrusion and open bite correction

6. Manipulation of anchorage


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Contraindications

Bone loss

Periodontal disease

Rhematoid arthritis patients who require regular

dose of NSAIDS

Class 3 condition


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Side effects

Slight interdental dental bone loss in few cases

Loss of attached gingiva

Subcutaneous haematomas have been reported

in face and neck after intensive corticotomies.

No effect on vitality of the pulps are seen


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Advantages

Less time than traditional orthodontics

less likelihood of root resorption

History of relapse has been very low

Prevent devitalization of teeth

Prevent periodontal damage


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Disadvantages

Expensive procedure

Mildly invasive surgical procedure

Patients who take NSAIDS on a regular basis or

have chronic health problems cannot be treated

It does not lend itself to class 3 malocclusion

cases


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CONCLUSION

Conventional orthodontics typically takes 18 and24 months to achieve desired results

PAOO also known as WILCKODONTICS canstraighten most pateints teeth in 3-8 months

This option is particularly appealing in adultpatients who wants to shorten treatment time

Thus, PAOO puts orthodontics on a fast track byincorporating changes in the structure ofsurrounding bone

speedy orthodontics

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