Donald J Ferguson
European University College, UAE
Title: Augmented Corticotomy with Orthodontics for Accelerated Tooth Movement
Biography
Biography: Donald J Ferguson
Abstract
Periodontally Accelerated Osteogenic Orthodontics (PAOO) combines alveolar decortication plus augmentation grafting technique to accelerated orthodontic tooth movement. Fixed orthodontic appliances are placed followed within 1 week by full thickness flap surgery and scaring of facial-lingual alveolar cortices. The patient is seen every 2 weeks following the procedure. Rapid tooth movement results from the transient demineralization-remineralization (osteopenia) produced within the alveolus, i.e. increased bone turnover. Benefits of PAOO therapy include: 1) active orthodontic treatment times averaging 6 months, 2) greater scope of malocclusion treatment, 2) greater stability of clinical outcomes and less relapse, and 3) increased alveolar volume and enhanced periodontal health.
Tensional integrity or “prestress” keeps hydrostatically contained dento-alveolar tissues sensitive to and prepared for changes in the biomechanical environment. Sustained orthodontic forces translated at nano-level in the multiple microenvironments involved in tooth movement are reflected at all length scales including the organ-level. The biomechanical stresses introduced by intentional wounding in PAOO technique “tricks” the body by signaling local micro-fracture level microstrain and regional acceleratory phenomena (increased turnover and demineralization, i.e. transient osteopenia) is initiated. In other words, PAOO patient tissues go into hyper-activity in order to bring excessive microstrain back to steady state homeostatic levels which provide the orthodontist with the golden opportunity to accelerated tooth movement. The lesson learned from wound healing is that tensional readiness and the remarkable ability for maxillofacial tissue to accommodate to changes in tissue tension can be used to accelerate tooth movement. The host response is remarkably local and so PAOO surgery is used strategically to move certain teeth or tooth groups. Applying tensional integrity concept explains all variations in individual patient response to treatment and all experimental data from accelerated tooth movement investigations. The prevailing pressure-tension concept does not clearly explain the tooth movement phenomena and a PDL cell-mediated focus needs revisiting.