Accelerated orthodontic tooth movement: surgical techniques and the regional acceleratory phenomenon

Background Techniques to accelerate tooth movement have been a topic of interest in orthodontics over the past decade. As orthodontic treatment time is linked to potential detrimental effects, such as increased decalcification, dental caries, root resorption, and gingival inflammation, the possibility of reducing treatment time in orthodontics may provide multiple benefits to the patient. Another reason for the surge in interest in accelerated tooth movement has been the increased interest in adult orthodontics. Review This review summarizes the different methods for surgical acceleration of orthodontic tooth movement. It also describes the advantages and limitations of these techniques, including guidance for future investigations. Conclusions Optimization of the described techniques is still required, but some of the techniques appear to offer the potential for accelerating orthodontic tooth movement and improving outcomes in well-selected cases.

Periodontally Accelerated Osteogenic Orthodontics (PAOO) vs Osteoperforations (A Review on Periodontal Reactions to Orthodontic Tooth Movement)

A high number of adult patients are undertaking orthodontic treatment now because of the newer methods, technology, and innovations available in the market. Orthodontic profession is continually looking for new ways to perform treatment effectively for such patients, as there are many differences in the biology, motivation, and treatment objectives between adults and children. Aligner therapy and mini-implants are some of the ways of managing orthodontic treatment for adult patients. Treatment time is a concern for adult patients and methods to accelerate the orthodontic tooth movement have been a focus in the orthodontic field. Periodontal accelerated osteogenic orthodontics (PAOO) is a surgical procedure that is performed with a combination of alveolar corticotomy, bone grafting, followed by orthodontic treatment. This procedure uses the principle of regional acceleratory phenomenon (RAP). Another procedure commonly used for accelerated orthodontic tooth movement is osteoperforations. This is a minimally invasive procedure, which does not include a flap surgery. The purpose of this article is to describe the differences between adult and children periodontal tissues, the use of different appliances for adult treatment, how orthodontic treatment has been modified for adult patients, and the detailed explanation of procedures for accelerating orthodontic tooth movement such as PAOO and osteoperforations and the potential complications

Corticotomy depth and regional acceleratory phenomenon intensity:

ABSTRACT Objectives To determine if the depth of corticotomy done with the piezoelectric knife could play a role in the intensity of the regional acceleratory phenomenon (RAP). Materials and Methods Eighteen Sprague-Dawley rats were divided into two groups: untreated (3 rats) and treatment (15 rats). In the treatment group, a split-model design was used. The right tibia received transcortical (deep) penetrations with the piezoelectric knife, while intracortical (shallow) penetrations were performed on the left tibia of the same animal. The rats were euthanized at day 1, 3, 7, 14, and 28. Cone-beam computed tomography scans were taken for each sample and then assessed by histological analysis. Results Higher amounts of osteoclastic activity and new collagen formation were observed in the deep penetration group when compared with the shallow penetration group. The former peaked at day 14 for both groups (1.53% ± 0.01% vs 0.03% ± 0.0004%, respectively), and the latter peaked at day 28 (0.65 × 106 ± 0.01 vs 0.08 × 106 ± 0.0008, respectively). Conclusions Within the limitations of this study, it appears that the intensity of the RAP in the rat is corticotomy depth dependent. This is to be kept in mind when decorticating the bone during surgically facilitated orthodontic procedures.

Micro-osteoperforations and Its Effect on the Rate of Tooth Movement: A Systematic Review

Prolonged orthodontic treatments have inconvenienced patients and clinicians alike. Surgically assisted techniques for accelerating orthodontic tooth movement have shown promising results in the literature over the years. The minimally invasive nature of micro-osteoperforations (MOPs), however, for enhanced orthodontic tooth movement has recently gained momentum, with many clinical trials conducted on both animals and humans. An electronic search was performed to extract papers using PubMed, Google Scholar, Scopus, and Web of Science. The keywords that were used included “MOP,” “accelerating tooth movement,” “orthodontic tooth movement,” and “regional acceleratory phenomenon.” The studies that met our inclusion criteria were extracted and evaluated in this review. MOPs have been proven time and again, in animal and human studies alike, to increase the rate of orthodontic tooth movement. The application of perforations to cortical bone present in the pathway of teeth, which are specifically to be moved creates transient osteopenia. This reduces the density of the cortical bone, hence speeding up the rate of orthodontic tooth movement. Many techniques have been implemented and perfected to enhance orthodontic tooth movement and shorten the treatment time in the literature. MOPs have proven to be a universally applied, nontechnical, repeatable, and minimally invasive method of accelerating tooth movement, with extremely minimal consequences.

Facial asymmetry correction: From conventional orthognathic treatment to surgery-first approach

The surgery-first approach (SFA), which proceeds without presurgical orthodontic treatment, is assumed to shorten the treatment course because the direction of post-surgical orthodontic tooth movement conforms to the normal muscular forces. Moreover, the regional acceleratory phenomenon (RAP), evoked by surgery, helps in tooth alignment and compensation in a faster way. Although SFA has definite advantages, especially in class III individuals, there is a lack of data about its indications in patients with facial asymmetry. In this article, we reviewed recently published articles on the treatment of asymmetric patients using the SFA. Different aspects, including the three-dimensional assessment of stability in different planes, approaches for fabrication of a surgical splint, predictability of the results, skills needed for bimaxillary surgery, indications as the treatment of choice for condylar hyperplasia, and combination with distraction osteogenesis in candidates with severe asymmetries were found to be the main topics discussed for patients presenting with facial asymmetry

Regional Acceleratory Phenomenon after Orthodontic Force Exertion in Ovariectomized Rats

The application of orthodontic forces may be one of the factors that produce a regional acceleratory phenomenon (RAP) in mandibular and maxillary bones. The effect of exerted forces on bone tissue ahead of their point of application has not been extensively studied. Moreover, limited information exists regarding this phenomenon on osteoporotic bone. The study aim was to examine the role of orthodontic forces on the expression of RAP in normal and osteoporotic mature rats. Thirty-six eight-month-old skeletally mature female Wistar rats, half of which had been previously ovariectomized (OVX) at the age of 6 months, were subjected to orthodontic movement of the upper right first molar. An orthodontic force of 60 gr* was generated through a closed coil spring for 14 days. The maxillae were then removed and the area ahead of the first molar was examined histologically. On the side of orthodontic force application, distortion of bone structure and woven bone formation were observed in non-OVX rats, whereas in the OVX rats, extensive remodeling was apparent. In conclusion, the application of orthodontic forces on both normal and osteoporotic mature rats in the present study created a RAP ahead of the loaded teeth demonstrated histologically, indicating increased bone resorption and formation in the OVX rats.

Other interesting effects of alveolar corticotomies in orthodontics apart from the acceleration of tooth movement

The acceleration of orthodontic tooth movement due to alveolar corticotomies has been well documented in the literature. It is defined by a phenomenon of transient osteopenia named “the regional acceleratory phenomenon” by Frost. This biological mechanism has been described in studies on both humans and animals. However, other interesting effects in orthodontics are associated with alveolar corticotomies: higher amplitude of tooth movements, a decrease of the root resorptions and an increase of stability after orthodontic treatment.