Periodontally Accelerated Osteogenic Orthodonticsorthodontics. These cases repre-sent extreme com-plications, but are inserted to make a point . ... Root proximity problems, and thus

Periodontally Accelerated Osteogenic Orthodontics.

Female, 35yrs; 9 months appliances, Bicuspid extraction. Note integrity of recession sites post treatment. Pre-treatment, generalized of Periodontitis, in posterior segments.

wit

Teenager, less than 6 months in appliances

bel

Above: Pre treatment Below: Post treatment Note: dehiscences fenestrations Treatment time: 7-8 months.

thu

Indications for PAOO!Pre-treatment, above, soft tissues look great. After flap reflection, look closely! A disaster waiting to happen!!!

ros

odo

Pre-treatment on the left, Post-treatment on the right 6 months of treatment time Note dehiscences pre-grafting.

Above: #8/9 Ankylosed. Patient in appliances for 3 years. Below: 3 months foll0wing PAOO treatment

dav

Note the risk of completing orthodontic treatment in these sites with deep dehiscences. Bone grafting, achieved through the use of the PAO technique reduces the risk of future severe recession problems.

Risk factors associated with

conventional orthodontics.

These cases repre-sent extreme com-plications, but are inserted to make a

point

Gingival Recession

Apical Root Resorption Plus

Gingival Recession

2006 2007 2008

??EtiologyEtiology

Relapse, Decalcification,

Frenum, Local Recession.

Example of a high risk patient both wanting and needing orthodontic treatment. Risk factors include: Gingival recession Crowded mandibular anterior teeth. Root proximity problems, and thus thin interdental bone Periodontitis in all posterior teeth (6-8mm probing )

1

1

“Why PAOO (Wilckodontics) should be a routine part of

Periodontal/Orthodontic practice!”

Colin Richman DMD Periodontics and Dental Implants

cr27@drcolinrichman.com - 404/784-7272;

2

2

Colin Richman DMD Periodontics and Dental Implants

cr27@drcolinrichman.com - 404/784-7272;

Pre-treatment narrative Note the quality and quantity of attached tissue in this crowded, class 1 case, suggesting adequate facial alveolar bone. However, at the time of PAO surgery, I was surprised to note the extent of facial dehiscences/fenestrations present. These lesions where treated according to classic PAO principles, including cortical perforations and hard and soft tissue grafting.

Legend Page 1. Upper left/right images: Pre-orthodontic, pre PAOO treatment. Middle left and right images: PAO surgery, with simultaneous initiation of Orthodontic treatment. Page 2. Left side: Pre-treatment images. Right side: 2 weeks post surgery with 2 weeks concurrent post-initiation of orthodontic forces. Note the amount of mandibular tooth movement, and arch unraveling in the upper images, Note the amount of space closure of the maxillary molar-bicuspid site, (lower images). The benefits of PAO treatment for this patient will include: (a) Less Risk of Post Orthodontic gingival recession and subsequent

Cervical Abrasion (NCCL) (b) Greater Post Orthodontic Stability and Retention (c) Accelerated treatment time - 60-70% (d) Less Risk of Root resorption and less risk of an unfavorable crown to root ratio.

3

3

Colin Richman DMD Periodontics and Dental Implants

cr27@drcolinrichman.com - 404/784-7272;

4

4

Above: Root surface and bone preparation with perioosteal fenestrations. Middle: Grafting with Bio-Oss and DFDBA. Below: Two weeks Post-surgery.