Improper dentition can affect the quality of life by impacting function, appearance, and the psychological well-being of the patient, which is why orthodontic therapy is necessary. However, most patients are reluctant to undergo fixed orthodontic therapy due to the longer treatment duration. The modern era of interdisciplinary dentistry has introduced new alternatives to traditional treatment, such as Periodontal Accelerated Osteogenic Orthodontics (PAOO). The PAOO technique combines orthodontic techniques facilitated by selective decortication with alveolar augmentation. With this technique, a tooth can be moved 2-3 times further in one-third or one-quarter of the time required for traditional orthodontic therapy.

Bryan (1893) described the first tooth movement facilitated by corticotomy in the textbook Orthodontia: Or Malposition of the Human Teeth, Its Prevention and Remedy. In 1959, Heinrick Köle described a combined technique of radicular corticotomy/supra-apical osteotomy, which was adopted or modified by most clinicians for current corticotomy procedures. Over time, the supra-apical connecting osteotomy cuts used by Köle were replaced by corticotomy cuts.

Gantes et al. reported minimal changes in periodontal attachment in corticotomy-assisted orthodontics in five adult patients, with about a 50% reduction in average treatment time compared to traditional orthodontics. Wilcko et al. modified the corticotomy-assisted approach, patented as Accelerated Osteogenic Orthodontics (AOO) or PAOO, proposing additional alveolar augmentation using a combination of demineralized freeze-dried bone allograft and xenograft or bioabsorbable alloplastic grafts.

 The role of periodontists and surgeons in PAOO is becoming increasingly important. It is essential that the periodontist or surgeon understands the biology of the procedure to meet the patient’s needs and thus help the orthodontist achieve faster and more stable results. Therefore, a joint consultation with both the orthodontist and surgeon is necessary when planning this procedure.

Indications and Contraindications for PAOO:

 Indications

 Crossbites and discrepancies in tooth size and arch length

 PAOO can, in some cases, be used as an alternative to orthognathic surgery

 Contraindications

 Active periodontal disease

 As an alternative to surgically assisted palatal expansion in treating severe posterior crossbites

Moderate to severe malocclusions, such as significant bimaxillary protrusion, Class I malocclusion with moderate to severe crowding, Class II.

It should not be attempted in cases where bimaxillary protrusion is accompanied by a gummy smile.

Corticotomy-assisted orthodontics has been used in the past in various forms to accelerate orthodontic treatment. It was believed that the main resistance to tooth movement was due to the cortical bone plates, and by interrupting their continuity, orthodontics could be completed much faster than traditionally expected. Köle’s original technique involved a combination of interradicular corticotomy and supra-apical osteotomy. Although the procedure’s results were stable, pulp necrosis was not uncommon.

Surgical intervention results in significant alveolar demineralization, leading to transient osteopenia, which allows for rapid tooth movement since the teeth are supported by trabecular bone and move through it. Once the orthodontic tooth movement is completed, an environment is created that promotes alveolar remineralization.

The time required for tooth alignment after corticotomy can be 1.5 to 3 months or less.  

Medications that slow bone turnover and increase calcium absorption can potentially be problematic for such procedures. Bisphosphonates, and even some calcium supplements, fall into this category. Additionally, the osteopenia that facilitates tooth movement is a sterile inflammatory process, and certain medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), could inhibit this movement. Therefore, postoperative pain management with opioid analgesics is recommended.  

The effectiveness and efficiency of corticotomy lie in reducing orthodontic treatment time and facilitating orthodontics to accelerate tooth movement in adult patients.

Conclusion

Over the past two decades, the refinement of attempts to engineer an “optimal response” of alveolar bone to the applied “optimal force” has pushed both periodontology and orthodontics directly into the field of surgical dentofacial orthopedics. Compared to traditional orthodontics, corticotomy-assisted orthodontics (PAOO) has been key in achieving the desired results in a shorter period.