Speedy orthodontics –A case report

IntroductionComplex malocclusions like severe

rotation has always possessed a serious setback to orthodontic treatment in terms of prolonged treatment time. But with the development of corticotomy assisted orthodontics various new vistas have been opened up for enhancing orthodontic treatment. Reduced treatment time, increased alveolar volume and reduced root resorption have weighed in over conventional non surgical procedures.

What is accelarated

osteogenic orthodontics?

• Accelerated osteogenic orthodontics is a brain child of an orthodontist and a periodontist, Dr.Willian Wilcko and Dr.Thomas Wilcko.

William Wilcko Thomas Wilcko

• Corticotomy assisted orthodontics is a unique blend of orthodontic mechanics with alveolar decortication and alveolar augmentation procedure. This technique is 3-4 times faster than conventional methods thereby bringing down the treatment duration. These are surgical interventions limited to cortical portion of alveolar bone.

What is regional acceleratory

phenomenon?• Introduced by Frost in 1983.

• Regional – demineralisation occurs at both the cut site as well as adjacent bone.

• Acceleratory - exagerated or intensified bone response in cuts that extends to the bone marrow.

• Regional acceleratory phenomenon is a local response to noxious stimulus which describes a process by which tissue forms faster than normal regional regeneration process.

• Following surgical insult to cortical bone, regional acceleratory phenomenon increases the tissue reorganization and healing by transient burst of localized hard and soft tissue remodelling.

• Initial phase results in increased cortical bone porosity because of increased osteoclastic activity.

• Calcium depletion and diminished bone densities result in rapid tooth movement.

Accelerated osteogenic orthodontics surgical technique.

• AOO is an interdisciplinary technique which requires the expertise of an orthodontist and oral surgeon/periodontist.

• Brackets and arch wires are placed at least one week prior to surgery.

• Surgery is performed under local anaesthesia.

•Full thickness flap was raised labially and lingually.

•Flaps are raised beyond the apices of the teeth to avoid damaging the neurovascular complex.

Buccal and lingual corticotomy cuts and cortical bone perforations are made near the malpositioned teeth using low speed round burs.

After bone activation,bone grafting material layered over the activated bone.

•Graft material can be bovine powder or 100% demineralised freeze dried bone graft .•Quantity of bone graft depends on the quality of pre existing bone.•Graft is wet with clindamycin phosphate/ bacteriostatic water/ platelet rich plasma of 5 mg/ml. this provides an antibiotic effect as well as medium for placement.

Flap is repositioned using non resorbable suture material.

• Soon after flap repositioning orthodontic force should be applied.

• Orthodontic adjustments should be made every 2 weeks interval.

• The tooth movement that occurs at this stage is purely physiological and not by repositioning the segments of bone.

• Osteoclastic activity increases, temporary intrabony osteopenia occurs as well as at the same time decortication induces this state.

Case report

Patients age : 15 yrs.Sex : male.Patients chief complaint : patient complaints of forwardly placed upper front teeth.

Pre treatment

Front

Right Left

Occlusion

Upper Lower

• Diagnosis : Angles Class I malocclusion on a Class I skeletal base with orthognathic maxilla and mandible, with bimaxillary dento alveolar proclination and protrusion, with single tooth cross bite in relation to 43, midline diastema of 2 mm and disto buccal rotation of 33, overjet of 8 mm and overbite of 5 mm.

Treatment plan : Extraction of all first premolars.

• Patient was bonded with 0.018 Roth preadjusted edgewise appliance.

• 0.016 coaxial wire was placed in both upper and lower arches for initial levelling and aligning.

• Over a period of 8 months we tried most of the conventional techniques to derotate canine.

• Unfortunately non of them could give a proper result.

• At that juncture we strated thinking about

Partial decortication Bone graftingSuture placement

•0.016 x 0.022 NiTi piggy back wire was fully engaged into the canine bracket using ligature tie on the day of surgery to apply a light and continous force.

• Elastic chain was also placed from the button

placed on the distal surface of canine to the

rigid 0.017x0.025 stain less steel base arch

wire with gingival off set.

• Orthodontic adjustment was done in every 2 weeks interval.

After 2 weeks of derotation.

After 4 weeks

After space closure

IOPABEFORE DEROTATION AFTER DEROTATION

Conclusion• Corticotomy assisted orthodontics is an effective and reliable technique to treat severe malocllusions to reduce the treatment time and increase the treatment quality.

• Reduced root resorption, increased alveolar volume, reduced chair side time are the basic advantages of this technique. However this should be carefully performed over the teeth and surrounding tissues to avoid the risk of devitalization of the teeth and periodontal damage.

• A long term follow up studies have to be performed to evaluate the effects of corticotomy assisted orthodontics on retention and stability.