Amalgamation of alveolar decortication and augmentation procedures – the path towards accelerated orthodontics
Dr. A. Arif Yezdani, Professor and Director
Dept. of Orthodontics and Dentofacial Orthopedics, Bharat Institute of Higher Education and Research, India
Aim : Amalgamation of alveolar decortication and augmentation in conjunction with efficient orthodontic bio-mechanics accelerates orthodontic tooth movement with shortened treatment duration.
Accelerated Osteogenic Orthodontics (AOO) is a procedure wherein selective decortication of alveolar bone is done which in turn induces an increase in hard and soft tissue turnover by a process known as RAP (Regional Acceleratory Phenomenon) that potentiates tissue organization and healing.
The cancellous portion of the alveolar bone is induced into a more pliable, transient demineralized state called osteopenia, a catabolic process wherein there is a decrease in bone density but no change in bone volume. This is followed by an anabolic process wherein new bone is formed and the osteoid matrix begins to mineralize. This demineralization-remineralization phenomena facilitates rapid tooth movement. The RAP, commences a few days after surgery, peaks between 1-2 months when catabolic and anabolic responses are 3-fold higher, dissipates to a normal steady state by 11 weeks after surgery, and takes about 6-24 months to resolve completely.
The periodontal alveolar augmentation with a bone graft improves the structural integrity of the periodontium as it augments, reshapes, and provides additional bone support. It causes an increase in thickness of the alveolar bone at the cephalometric landmarks, points A and B which in certain situations provides a degree of improvement in lip posture. Pre-existing alveolar fenestrations over root prominences are also effectively eliminated thus reducing the probability of bony dehiscence formation.
The advantages of AOO are that there is good presence of interdental papillae and adequate zone of gingival attachment with no gingival recession. There is no apical root resorption, no loss of tooth vitality nor significant reduction in radiographic height of crestal bone. Relapse is minimized and the reduction in bacterial time-load factors also reduces the incidence of infection and caries.
A couple of cases are discussed to highlight the AOO procedure with different types of bone grafts.