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WHY SPEED?
Many orthodontic patients jeopardize their dental health and decline treatment, due to its long treatment times
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
Historical prospective
BONY BLOCK TECHNIQUE It was first introduced by DR KOLE in 1959(interradicular corticotomy and supra apical osteotomy) In 1979 DR DUKER by experimenting on beagle dogs concluded that neither the pulp nor the periodontium were damaged following CFOT(interdental cuts 2mm short of alveolar crestal bone level)
GANERSON ET AL in 1978 revised DR KOLE`s Technique without the supra apical osteotomy. DR KOLE`s EXPLANATION TO TOOTH MOVEMENT IDEA BEHIND HIS WORK Teeth move faster when the resistance exerted by the surrounding cortical bone is reduced POST SURGERY and APPLICATION OF ORTHODONTIC FORCE
DRAW BACKS
1. CORTICOTOMY and OSTEOTOMY Depending on the severity of injury to the trabecular bone
There were increased risk of postoperative tooth devitalization and even bone necrosis 2. CORTICOTOMY ALONE
DISCOVERY OF RAP
A distinguished orthopedist DR HAROLD FROST discovered that there was direct correlation between
which accelerates the healing of injuries that would affect survival i.e this phenomenon causes bone healing 10-50 times faster than normal bone turnover
Increased osteoblastic , osteoclastic activity and increased levels of local and systemic inflammation
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 by corticotomy over a range of 3-4months
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 perio complex surrounded by rigid bone but forces are concentrated on tooth perio complex surrounded by low density trabecular bone.
FURTHER REPORTS
Lee et al described that there were differences in bone regeneration after corticotomy and osteotomy The prolonged period of hyalinization is the reason to explain why there is some degree of root resorption in conventional orthodontic tooth movement , which is not observed in CAT A recent histological study showed that selective alveolar decortication induced increased turnover of alveolar spongiosa (SEBEON ET AL). Corticotomy was found to produce bone resorption around the moving teeth by day 21 after surgery and the area refilled with bone after 60 days.(WANG ET AL )
WILCKODONTICS
IN 1995 DRS WILCKO using their knowledge of corticotomy and RAP developed their Patented periodontally accelerated osteogenic orthodontics(PAOO) It is a combination of selective alveolar decortication and alveolar augmentation by grafting also reffered it as ACCELERATED OSTEOGENIC ORTHODONTICS
Technique
1. Administration of local anaesthesia 2. Crevicular incision is made buccaly and lingual extending two to three teeth beyond the area to be treated
3. FULL THICKNESS FLAP ELEVATED BEYOND THE APEX OF THE TOOTH IF POSSIBLE
4. The area is debrided and curettage is done to remove any inflammed tissue
1. Alveolar activation is done with selective alveolar decortications on both buccal and lingual sides using piezosurgery technique or routine burs 2. Vertical corticotomy cuts are made between the roots stopping just short of alveolar crest(usually 3mm). The cuts are connected beyond the apices of the teeth with scalloped horizontal cuts
3. Cortical perforation can be made at selective areas to increase blood supply to the graft material
To treat recession
1. Flaps are repositioned back allowing sufficient bone coverage 2. Interrupted loop sutures are made
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 movement
Contraindications
Bone loss Periodontal disease Rhematoid arthritis patients who require regular dose of NSAIDS Class 3 condition
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
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
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
CONCLUSION
Conventional orthodontics typically takes 18 and 24 months to achieve desired results PAOO also known as WILCKODONTICS can straighten most pateints teeth in 3-8 months This option is particularly appealing in adult patients who wants to shorten treatment time Thus, PAOO puts orthodontics on a fast track by incorporating changes in the structure of surrounding bone