Symposium orthodontics and periodontology Alfonso Caiazzo & Federico Brugnami: The clinical use of corticotomy and guided bone regeneration (Periodontally Accelerated Osteogenic Orthodontic)

This course  will be focused on clinical application of so called Periodontally Accelerated Orthodontic Movement ( aka Corticotomy ) beyond the mere acceleration:

When  corticotomy  and guided bone regeneration procedures  are added to orthodontic treatment we are looking at Periodontally Accelerated Osteogenic Orthodontics (PAOO ® ).

To consider corticotomy or PAOO ® as simply a means of accelerating orthodontic treatment is quite limitative.

Corticotomy wit Regenerative Procedure offers many clinical advantages :

1) Expand scope of orthodontics

- Reduce Orthodontic treatment time
- Improve range of movements
- Modify differential anchorage between groups of teeth
- Diminish risks of relapse.

2) Eliminates the need for dental extractions in many patients

3) Reduces risks of periodontal side effects of orthodontics treatment

- Less incidence of marginal bone resorption
- Expansion of alveolar basis and more bone support
- Shorter treatment time, therefore less plaque accumulation on orthodontic armamentarium

4) Improved post-surgical outcomes

- Less root resorption during active orthodontic movement due to decreased resistance of cortical bone
- Change of periodontal biotype due to the addition of bone graft

5) Modify lower third of face

6) Minimally invasive surgery (compared to Orthognathic or osteo-distraction, and applicable only when the skeletal discrepancy is less than 2-3 mm)

- Decreases postoperative discomfort
- Minimal complications
- Ability to perform surgery in an office-setting
- Improved efficiency
- Decrease costs
- No requirement for hospitalization

7) Working together with Oral Maxillo-Facial Surgeons in orthognathic cases.

This surgical technique has evolved and there are now several variations including the flapless approach ( Piezocision ) and the single flap approach ( SFC single Flap Corticotomy).

Both are easily employed by clinicians and likely to be more readily accepted by patients. The ability to use these techniques will facilitate the choice of the most efficient and least invasive approach.

The appropriate multidisciplinary approach allows clinicians to plan surgical procedures in sequential and/ or segmental fashion according to the progress of the orthodontic treatment.

At this point surgery becomes secondary to the orthodontic treatment which therefore becomes orthodontically driven and as a result minimally invasive.

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