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16. Delayed passive eruption of teeth can lead to excessive gingival attachment: normal attachment (left), moderate excess attachment (center), and severe excess attachment (right). Note that the tip of the periodontal probe rests at the gingival crest demonstrating that clinical crown length deceases as gingiva excess increases.

16. Delayed passive eruption of teeth can lead to excessive gingival attachment: normal attachment (left), moderate excess attachment (center), and severe excess attachment (right). Note that the tip of the periodontal probe rests at the gingival crest demonstrating that clinical crown length deceases as gingiva excess increases.

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Periodontally Accelerated Osteogenic Orthodontics(PAOO) Miniscrew Implants for Orthodontic Anchorage

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The aim of the study was to evaluate the stress distribution patterns in teeth and supporting structures of fixed prosthesis and design modifications in a fixed prosthesis with either normal or reduced bone support of an additional abutment. Study was also undertaken to disprove Ante's law. Main models and variations of main models (modification 1,...

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... However, the two previous studies indicated that the alveolar bone density increased significantly at the end of the follow-up period [17,32]. This may be explained by the incorporation of the bone graft with the cortical bone [29], and other studies have indicated that incorporation of the bone graft into the new bone layer has a beneficial effect in repairing the bone defect and increasing the volume of the alveolar bone [14,35]. Whereas one clinical trial [31] reported that bone density increased in the PAOO group as well as in the corticotomy-only group at three and six months following the onset of orthodontic treatment, which was explained by the high osteoinductive property of BMP-2 [31]. ...
Article
The current review aimed to critically and systematically evaluate the available evidence regarding the effectiveness of periodontally accelerated osteogenic orthodontics (PAOO) in accelerating orthodontic tooth movement and supporting the alveolar bone. Additionally, this review aimed to analyze the untoward effects of this procedure and the patient-reported outcome measures. A comprehensive electronic search was performed on 10 databases in addition to a manual search to retrieve all relevant studies. Randomized controlled trials (RCTs) were only included in this review. The interventional group was the PAOO procedure, whereas the control group was either a non-accelerated traditional fixed orthodontic treatment or an accelerated treatment using any other intervention. The Cochrane risk of bias tool for randomized controlled trials (RoB 2) was employed to estimate the risk of bias in the included studies. The current review included eight RCTs evaluating 175 participants (63 males and 112 females) with a mean age ranging from 18.8 to 29.6 years. Five of them assessed the effectiveness of PAOO versus traditional orthodontic treatment, i.e. without any adjuvant surgical intervention. At the same time, the remaining three studies evaluated the effectiveness of PAOO versus corticotomy-only as an adjunctive procedure. The PAOO accelerated the leveling and alignment stage from 39% to 47% and accelerated the retraction of the upper anterior teeth from 41% to 61% compared to conventional orthodontic treatment. One study only indicated that PAOO reduced treatment time by 30.3% versus a corticotomy-only as an adjunctive procedure. No significant side effects have been reported with the PAOO procedure. The PAOO procedure was effective in accelerating orthodontic movement and tended to increase the thickness of the alveolar bone. But most periodontal outcome measures regarding PAOO application were not comprehensively covered in the included trials.
... This finding confirmed the healthy gingival status following PAOO as similar to other studies. 5,25,26 The test site showed a statistically significant early postsurgical healing when compared to the control group in the 4th week (1 week after surgery) (Fig. 4). This could be explained by the wound healing properties induced by the PRF membrane, which is consistent with another study. ...
Article
Background The present study is aimed to compare the osteoblastic activity in periodontally accelerated osteogenic orthodontics (PAOO) with and without the platelet-rich fibrin (PRF) membrane by evaluating the gingival crevicular fluid (GCF), alkaline phosphate (ALP) levels and also to explore the efficiency of PRF membrane in terms of healing. Methods A split-mouth randomized controlled trial, which comprised 16 sites, was randomly treated with PAOO + PRF membrane and PAOO alone. The primary outcome was to analyze the GCF ALP levels at baseline, 3rd, week, 5th week (2 weeks after surgery, 1 h before and after activation), 7th week (4 weeks after surgery), and 9th week (6 weeks after surgery). The clinical parameters (plaque index [PI], gingival index [GI], bleeding index [BI]) were assessed at baseline, 3rd week, 15th week, and 27th week. Healing index was recorded at 4th week (1 week after surgery), 5th week (2 weeks after surgery), and 7th week (4 weeks after surgery). Results There was a statistically significant increase in GCF ALP levels (p < 0.05) in the test site (PAOO with PRF membrane) 2 weeks post-surgically compared to the control site. Improvement in the clinical measures (PI, GI, BI) was statistically significant at all time intervals. Adjunctive use of PRF resulted in statistically significant early healing in the first postoperative week compared to the control site (p < 0.05). Conclusions Within the limitations of this split-mouth study, PRF membrane showed significant osteoblastic activity in the 5th week (2 weeks after PAOO) with the increased GCF ALP levels and accelerated healing in the 1st week after PAOO. They also maintained post-orthodontic stability until 18 months.
... [51] Forced-eruption time can be significantly reduced using ostectomy-decortication [ Figure 6]. For a detailed description of the ostectomy-decortication technique see Wilcko et al. [52] and Ferguson et al. [53] In a study with 118 patients, 57 treated with ostectomy-decortication and 61 with open-closed surgical exposure, forced-eruption time was on average 6.6 months for the ostectomy-decortication group and 21.0 months for the open-closed surgical exposure group. [53] Forced-eruption time is the time between surgery date and date the canine which was tied into the orthodontic arch wire in a position similar to the adjacent teeth. ...
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The prevalence of impacted maxillary canines is 2–3%. In Caucasian populations, it is reported to be more palatally displaced than buccally, with the opposite trend seen in Asian populations. At the ages of 9–11 years, the position of the canine germ should be diagnosed, for most children through clinical supervision. In 7–10% of children, the clinical investigation must be supplemented with radiographic investigation, in most cases with intraoral radiographs. About 50% of impacted canines cause root resorption of the adjacent teeth. To detect the severity of resorption, cone-beam computed tomography is necessary. Root resorptions on incisor roots occur most often at 11–12 years of age. Early diagnosis of ectopically positioned maxillary canines is very important. In cases with palatally displaced canines and no root resorptions, extraction of the primary canines has been found in different studies to give good results. If the permanent canine has not started to normalize its position within 12 months, orthodontic treatment must be taken in consideration. Often, this is done by surgical exposure and orthodontic traction of the canine out into the dental arch.
... Advocates of alveolar decortication surgical procedures in combination with orthodontic therapy purport reduced palatally impacted canine forced-eruption times. 18 The ostectomy-decortication technique for palatally impacted canine exposure has been described as follows 19 ( Figure 1A-F): ...
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Objectives: To compare forced-eruption times for palatally impacted canines treated with and without the ostectomy-decortication technique and to assess the influence of palatally impacted canine pretreatment position and angle on forced-eruption time. Materials and methods: The sample was composed of 118 patient-subjects with 151 palatally impacted canines treated with the ostectomy-decortication technique (n = 72) and without (n = 79). The orthopantomogram radiographs (OPGs) were analyzed for palatally impacted canine angle and horizontal and vertical position. Recovery time was measured from the start of forced eruption until the canine was within ±1 mm of final dental arch position. Results: The time of forced canine eruption with ostectomy-decortication technique was significantly shorter than without (6.6 vs 21.0 months). Pretreatment canine position significantly increased forced-eruption time in the ostectomy-decortication group but not in the control sample. Conclusions: Forced-eruption time of palatally impacted canines using the ostectomy-decortication technique was 3.2 times more rapid than without. Forced-eruption time increased significantly as a function of pretreatment palatally impacted canine position severity in the ostectomy-decortication group but not in the control.
... 23,24 Un tratamiento ortodóncico de corto tiempo, es ventajosos o para los tejidos periodontales, lo cual reduce substancialmente el tiempo disponible para que los biofilms bacterianos relativamente benignos asuman cambios cualitativos y se conviertan en un potencial citotóxico destructivo, que a menudo se ve cuando la aparatología fija se ha tenido en los dientes por más de 2 o 3 años. 25 ...
... Algunas de las ventajas evidenciadas : Tratamientos de mucho menos tiempo a diferencia de los convencionales , ?, 23, 25, 32, 33 no altera la vitalidad pulpar o existencia de sensibilidad en piezas dentales tratadas con esta técnica 23,24 ,mejora el movimiento dental y reduce la necesidad de extracciones , 7, 23, 25 evitando la recidiva posterior a la finalización del tratamiento convencional, 7 menor tiempo en el tratamiento , la flora bacteriana no es afectada por cambios citotóxicos 7, 25 , el volumen alveolar aumenta y mejora la estructura del periodonto complejo reduce el tiempo y la carga bacterial, evitando posibles infecciones gracias al injerto óseo que se coloca, el cual previamente fue embebido en una sustancia antibacterial, 7 no hay formación de bolsas periodontales en las piezas dentarias después del tratamiento ortodóncico con esta técnica,23 disminuye el riesgo de reabsorción radicular. 23,25,34,35 ...
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An alternative that has provided benefits in orthodontic treatment to reduce root resorption and provide better stability after treatment is periodontally advanced orthodontic therapy, to achieve success in treatment there must be strict cooperation between the orthodontist and periodontist during the planning of the case . In this therapy it is necessary to perform a surgical approach called corticotomy consisting of access to the cortical bone, this process activates a physiological cascade responsible for producing accelerated orthodontic movement. There are promising clinical and histological results, as evidenced by scientific evidence. PAOO increases orthodontic movement after alveolar decortication and bone augmentation contributes to bone union providing long-term treatment stability; increase the alveolar volume and strengthen the periodontium. Key words: orthodontics, bone matrix, tooth movement, acceleration.
... En relación a la frecuencia de las características clínicas el estudio de Plazas y cols, 24 mostró una mayor prevalencia del perfil convexo (58,3 %); en el estudio de Palacios y cols, 25 se observó un alto porcentaje de relación canina Clase I derecha (55 %) e izquierda (58 %); el estudio de Urrego y cols, 21 presentó un 68,6 % de overjet normal de 1-3 mm; en el estudio de Urrego y cols, 21 el 48,6 % presentó overbite normal de 1-3 mm; en el estudio de Burgos solo el 3,8 % presentó mordida abierta al igual que el estudio de Chumi y et al., 16 el 5 % presentó mordida abierta anterior; en el estudio de Urrego y cols, 21 se presentó un 11 % de mordida cruzada anterior o posterior de los cuales 10,6 % es uni lateral y un 3.7 % es bilateral; en el estudio de Mendoza y cols, 20 se muestra un 46 % de apiñamiento y en relación a los diastemas dentarios el estudio de Urrego y cols, 21 nos muestra solo un 11,3 % de diastemas. ...
... Para este último año, se crea el actual Sistema Nacional Coordinado y Descentralizado de Salud (SNCDS), el cual de la misma forma no ha tenido una sostenibilidad por parte del gobierno y ha entrado en un proceso de reforma a partir del año 2013. 25 Es bastante llamativa la inestabilidad y la discontinuidad del sistema peruano a lo largo de la historia, esto hace referencia a la gran inequidad y el retraso de políticas en salud en relación con otros países del continente, queda claro que si no se continúa con un consolidado sistema, no podrá existir desarrollo ni equidad. 26 A causa de todo este desequilibrio, los recursos humanos también se ven alterados: remuneraciones bajas, conflictos permanentes, insuficiencia de personal de salud en los hospitales, incluso un alto número de migración de médicos y enfermeros al extranjero. ...
... 23,24 Un tratamiento ortodóncico de corto tiempo, es ventajosos o para los tejidos periodontales, lo cual reduce substancialmente el tiempo disponible para que los biofilms bacterianos relativamente benignos asuman cambios cualitativos y se conviertan en un potencial citotóxico destructivo, que a menudo se ve cuando la aparatología fija se ha tenido en los dientes por más de 2 o 3 años. 25 ...
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El sistema tipogr�a�co empleado para componer la revista es LATEX, software libre utilizado para la comunicaci�on y publicaci�on de documentos cient���cos de alta calidad. Odontolog��a Activa emplea la clase Oactiva.cls, desarrollada especialmente para la revista y disponible para los autores en la p�agina web http://www.oactiva.ucacue.edu.ec
... This transient, reversible osteopenia of the thin layer of bone permits the root of the tooth to carry the demineralized collagenous matrix of the bone with it and a reactionary bone formation. [6,7] This results in net increased alveolar volume which can provide for a more intact periodontium, a decreased need for extraction, a degree of facial reshaping, and an increase in bony support for both the teeth and overlying soft tissue. ...
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The orthodontic treatment is perhaps in terms of duration, the longest performed dental procedure. To accelerate tooth movement, orthodontists and periodontists together have worked out a successful technique termed as Wilckodontics, commonly known as periodontally accelerated osteogenic orthodontics. It is an emerging technology in the field of dentistry. Wilckodontics has solved the dilemma of rapid tooth movement by exploiting the dynamics of bone physiology and redirecting the emphasis in tooth movement to the manner in which the supporting bone responds to orthodontic forces. In this article, a 27‑year‑old male, with a Class I moderately crowded malocclusion, elected to undergo this new treatment option, due to the estimated reduction in treatment time. This case report shows one case of lower anterior crowding done using this technique. The total orthodontic treatment, from bracketing to debracketing, required exactly 6 months, with 12 orthodontic adjustments
... One study has shown CAO without bone grafting resulted in complete healing in adolescents without any net tissue loss. 34 In contrast, it demonstrated incomplete healing accompanied by a small amount of tissue loss in adults. In addition, a controlled study showed bone density decreased after treatm ent and was back to normal after 6 months of retention in the control group (CAO without bone graft). ...
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Of all the modalities reported to decrease orthodontic treatment time, corticotomy-accelerated orthodontics (CAO) is the only evidence-based approach. The aim of this article is to critically review the available evidence and to summarize the pros and cons of CAO. Articles published in the last 15 years related to CAO were screened and critically assessed. Based on the literature, CAO results in acceleration of the orthodontic treatment rate as much as three times on average, in addition to many benefits not commonly recognized by the profession or reported in the literature. CAO is effective and safe for shortening the orthodontic treatment time, as well as for enhancing interdisciplinary outcomes beyond what conventional treatment alone is able to yield. More investigations are needed to validate and verify, as well as understand, the long-term implications to treatment from both a periodontal and orthodontic outcome standpoint.
... However, during the retention phase, the clinical result for the PAOO patients is better, without the presence of relapse. 7,12 In summary, we believe that the main advantage of this technique is the avoidance of maxillary segmentation, making this a safe and reliable technique. Furthermore, the decrease in postsurgical orthodontic treatment time, single step corticotomy, and the adequate aesthetic and functional balance given by the orthognathic surgery assisted by corticotomies make this technique a relevant innovation worth researching more. ...
Article
The aim of this study was to describe a surgical technique that can be used to solve dentofacial deformities associated with narrow interradicular spaces of the anterior teeth of the maxilla and inadequate overbite/overjet seen in hand-articulated models. This is presented here as an alternative to segmentation of the maxilla in Le Fort I osteotomy. Six patients with dentofacial deformities (classes II and III malocclusions) had Le Fort I osteotomy accompanied by buccal alveolar corticotomies of the maxilla. During the immediate postoperative period, elastic forces were applied to mobilize the anterior dentoalveolar segments until the planned overjet/overbite was observed. All patients reached the desired occlusion approximately 1 month after the surgical procedure. Pulp vitality of the teeth adjacent to the corticotomies was not compromised. The clinical results obtained confirm the technique as a safe and reliable alternative to segmentation of the maxilla in orthognathic surgery.
... The result of this interdisciplinary amalgamation has been rapid orthodontic tooth movement with drastically shortened treatment times and also an increased scope of treatment with reduced side-effects such as root alveolar bone, [19] relapse, [26] inadequate alveolar bone [27] and bacterial factors like caries and infection. ...
... This technique can be used to treat cases of borderline dental Class-III occlusion; however, severe skeletal Class-III situations cannot be adequately addressed with this technique. [26] The movement brought about with the PAOO technique is dentoalveolar in nature and as such the surrounding periodontium must be healthy. Therefore, reduced alveolar vitality can be caused from the use of bisphosphonates or from a prolonged corticosteroid therapy, which precludes the use of this technique. ...
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Periodontally accelerated osteogenic orthodontics is a relatively new procedure designed to minimize the time taken for orthodontic treatment. The orthodontist avails of the aid of a periodontist to perform decortication of the bone and places bone graft for rapid orthodontic correction of malocclusion. A PubMed search was carried out to identify papers describing the procedure, and the data were organized in the current format.