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Periodontally Accelerated Osteogenic Orthodontics : A Mini Review

11 Periodontally Accelerated Osteogenic Orthodontics : A Mini Review Janvi Mody1, Dishani Jain1, Shrey Mehta2, Divya Bhat2, Anjali Nagrik3, Gabriela Fernandes4 1 Y.M.T. Dental College and Hospital, Kharghar, Navi Mumbai, Maharashtra, India 2 Private Dental Practice, India 3 Bharati Vidyapeeth Dental College, Navi Mumbai, Maharashtra, India 4 Department of Oral Biology, School of dental medicine, SUNY Buffalo, Buffalo, New York, USA Correspondence: Dr. Gabriela Fernandes, Department of Oral Biology, School of dental medicine, SUNY Buffalo, Buffalo, New York, USA. Email: gfernand@buffalo.edu ABSTRACT


I. INTRODUCTION
The constant need for perfection is widely increasing in these recent days. Everyone wants that 'million dollar smile' and this desire has amplified in great amounts in the adult population 1 . Hence, they resort to orthodontic treatment. With the growing demand for this perfect smile, people simultaneously also pursue faster results 1 . Not only is the process of orthodontics time consuming but it also gives rise to various periodontal complications like alveolar bone resorption while uprighting 2,3 . It must be understood that orthodontic treatment is different for adults and adolescents. Growth factors, increased hyalinization and complications are some of the attributes to be taken into consideration.
Since there is always a solution for every problem, the hassle of adult orthodontics can also be made easier. With the help of corticotomy-assisted orthodontic treatment, more commonly known as Wilkodontics 4,5 , the gap between orthognathic surgery and conventional orthodontics has been successfully bridged. The technique combines the use of selective alveolar corticotomy, bone grafting and orthodontic forces 6 . The 'regional accelatory phenomenon' as given by Harold Frost, are a sequence of events where the osseous hard tissue is surgically wounded and this results in the reorganization of bone in the site adjacent to the injury site 7 . Periodontally accelerated osteogenic orthodontics works on this same phenomena.
Periodontally accelerated osteogenic orthodontics enhances the response of the periodontium to applied orthodontic forces, increases expansion, differential tooth movement, traction of teeth which are impacted and also the stability 8 . With that, it also leaves a more stable periodontal tissue with increased alveolar bulk to support the teeth, in turn leading to greater retention. The main attraction of PAOO 7 is the enormous amount of time difference that it shows.
On an average, where a normal orthodontic procedure would take 18-27 months, PAOO accelerates the process to a 6-9 month one 6 . Orthodontic braces are observed in patients undergone surgery for 3-9 months. This review paper compiles and overlooks the information regarding PAOO including its history, the mechanism behind it, its procedure, advantages, disadvantages, indications, contraindications and its technique.

History
Over these many years, there have been many studies showing the relation between selective alveolar decortication and accelerated orthodontic movement. L. C. Bryan in 1983 first described the corticotomy-facilitated tooth movement in a textbook which was introduced by Kole in 1959 9 as a pathway for rapid tooth movement. Their basic principle behind this was that tooth movement is mainly resisted by cortical plates. If the continuity of the cortical plates is disrupted, the orthodontic treatment time could be reduced. As mentioned earlier, the regional acceleratory phenomenon given by Frost was one of the first findings of the osseous insult seen in long bones. A similar phenomenon was also described by Yaffe et al. 10  To elaborately explain it, the technique includes the surgical scaring by making vertical grooves on the labial and lingual cortical plates. On a regular basis of recall of two weeks, the patient shows significant tooth rapid tooth movement as compared to the periodontal ligament the cell mediated tooth movement. Regional Acceleratory Phenomenon, which is a part of healing event is responsible for the rapid tooth movement after which Periodontally Accelerated Osteogenic Orthodontics 6,7,11 is carried out. Regional Acceleratory Phenomenon shows two chief features which facilitates orthodontic tooth movement. They are namely, decreased regional bone density and accelerated bone turnover.
The various indications of PAOO are: • Crowding • Repairing bone dehiscence and fenestrations as alveolar grafting is carried out.
• In the last 10 years, excellent results were seen in patients where Periodontally Accelerated Osteogenic Orthodontics was carried out.
The disadvantages are: • Expensive procedure to carry out • Mild surgical procedure, hence cannot be carried out in medically compromised individuals.
• Mild to moderate pain and swelling is experienced