|Year : 2012 | Volume
| Issue : 1 | Page : 2-4
A Bhagyalakshmi1, BS Avinash2, Nitin V Muralidhar1
1 Department of Orthodontics, JSS Dental College and Hospital, Mysore, Karnataka, India
2 Department of Periodontology, JSS Dental College and Hospital, Mysore, Karnataka, India
|Date of Web Publication||21-May-2012|
Department of Orthodontics, JSS Dental College and Hospital, Mysore, Karnataka 570 015
Source of Support: None, Conflict of Interest: None
Every orthodontic patient requires that the treatment be completed in a short duration. During orthodontic treatment, wearing of orthodontic braces, besides being unaesthetic will also restrict patients from eating certain food; it would also make it difficult for patient to maintain good oral hygiene. Because of these reasons many patients decline for orthodontic treatment. But recently there are many techniques in orthodontics like distraction osteogenesis, corticotomy, etc. where treatment can be completed in a very short duration when compared to conventional treatment. This article discusses one of such technique known as "Wilkodontics" which helps in faster orthodontic tooth movement, thus helping the clinician to complete the treatment at the earliest.
Keywords: Corticotomy, regional acceleratory phenomenon, wilkodontics
|How to cite this article:|
Bhagyalakshmi A, Avinash B S, Muralidhar NV. Rapid orthodontics. Int J Health Allied Sci 2012;1:2-4
| Introduction|| |
One of the most important reasons why patients are reluctant to wear orthodontic appliance is its longer duration of treatment. Wearing braces can be a nuisance and many potential patients decline needed orthodontic work just because of the lengthy treatment times and choose to have the multitude of appointments that are required. While new wire and bracket technologies have reduced treatment times, yet many patients require that treatment be still faster.
This article will discuss on a treatment approach that drastically reduces orthodontic treatment duration.
| Corticotomy-Assisted Orthodontics|| |
Corticotomy has been used in many of the orthodontic treatment or orthognathic surgery. Kole reported combining orthodontics with corticotomy surgery and completed the active tooth movement in adult orthodontic cases in 6--12 weeks.  This faster tooth movement was believed to be due to the reduced resistance of the cortical bone by surgical procedure.
Orthopaedist Harold Frost termed this as the regional acceleratory phenomenon (RAP). , In RAP there is temporary burst of localized soft and hard tissue remodeling (i.e., regeneration) which rebuilds the bone back to its normal state. 
As early as the 1950s, periodontists began using a corticotomy technique to increase the rate of tooth movement. The inclusion of grafting procedure makes it possible to simultaneously augment and reshape the supporting alveolar bone. 
Recent animal studies have added more evidence to the effect of corticotomy-assisted orthodontic tooth movement (CAOT). Ren et al, evaluated the effects of alveolar interseptal corticotomy and extraction on orthodontic tooth movement in beagles. The tooth on the experimental side moved more rapidly than the tooth on the control side, without any associated root resorption or irreversible pulp injury. In addition, active and extensive bone remodeling around the moved tooth was shown. Mostafa et al, reported a doubled rate of tooth movement after corticotomy in dogs and attributed this to the observed increase in bone turnover and the regional acceleratory phenomenon. In another animal study using corticotomy-assisted orthodontic treatment, the third premolar was mesialized significantly faster than the control side in 12 dogs. Corticotomy was found to increase tooth movement for at least 2 weeks after the surgery and to limit the hyalinization of the periodontal ligaments on the alveolar wall to the first week after corticotomy. This was also attributed to a rapid alveolar bone reaction. 
Two recent histological studies were conducted to evaluate tissue response to decortication. , Sebaoun et al, evaluated the response of alveolar bone to a selective alveolar decortication in a rat model in terms of time and proximity to the site of decortication without attempting any type of tooth movement. This study demonstrated an increased turnover of alveolar spongiosa as a response to alveolar decortication. Three weeks after surgery, the catabolic activity (osteoclast count) and anabolic activity (apposition rate) were three times greater, calcified spongiosa decreased by twofold and PDL surface increased by twofold. This dramatic increase in bone turnover decreased to a steady state by the 11th week after surgery. The observed effect of corticotomy was localized to the area immediately adjacent to the decortication cuts.
In the other histological study, Wang et al, explained the sequence of events occurring after corticotomy in rats. CAOT was compared to osteotomy-assisted tooth movement and to controls. Corticotomy was found to produce bone resorption around the moving teeth by day 21 after surgery and the area refilled with bone after 60 days. This confirms the occurrence of reversible osteopenia during CAOT.
This combination of corticotomy facilitated orthodontic treatment and periodontal alveolar augmentation has been termed as the accelerated osteogenic orthodontics (AOO) procedure. (The AOO appliances and the method of the accelerated osteogenic orthodontics procedure are patented by Wilkodontics, Erie, PA, USA.)
| Wilkodontics|| |
Wilkodontics TM - also known as accelerated osteogenic orthodontics (AOO) TM - is a relatively new treatment in the orthodontic realm. This technique has roots in orthopedics, dating back to the early 1900s. Only recently was it modified to assist in orthodontic tooth movement.
Wilkodontics or the AOO procedure was developed by Drs Thomas and William Wilko, of Erie, PA in 1995. Thomas Wilko is a periodontist in practice for more than 25 years, and his brother William Wilko, is an orthodontist in practice for more than 18 years. Both were interested in methods of growing bone called distraction osteogenesis and regional accelerated phenomenon (RAP), and modified these methods to work orthodontically with limited trauma to the surgical site.
| Clinical Procedure|| |
A week before the AOO procedure maxillary and mandibular bands and brackets with nickel titanium (Niti) wires are placed. Sulcular incisions are placed both labially and lingually using 12B Bard Parker blade all around the maxillary and mandibular teeth except palatally between maxillary central incisors. Vertical releasing incisions are generally not required but if a thick layer of grafting material is required it may be given. A full thickness flap is elevated both lingually and labially beyond the apices of the teeth taking care not to disturb the neurovascular bundles.
Selective partial decortication is done on the labial and lingual aspects of maxillary and mandibular anterior teeth and premolars. Decortication is not done on molars as it would be used as anchorage units. The decorticaton is accomplished with circumscribing corticotomy cuts outlining the roots of the teeth and small round corticotomy perforations where possible. The corticotomy cuts and perforations are made with No. 2 round long shank round bur in a high speed handpiece with copious water irrigation and extended only barely into the medullary bone. The interradicualar vertical corticotomy cuts should be 2 mm apical to the alveolar crest and extended 2-3 mm beyond the apices of the teeth, where they are connected with a scalloped horizontal connecting corticotomy cut. Once this is done bone grafting is followed. An established resorbable grafting mixture for osseous augmentation consisting of approximately equal amounts by volume of demineralized freezed dried bone allograft (DFDBA) and bovine bone can be used. The DFDBA and bovine bone are mixed dry and then wet with clindamycin phosphate/sterile water solution just prior to placement. The mixture is then spread over the partially decorticated bone both labially and lingually. On an average the layer of graft material should 2--3 mm thick. The full thickness flap are then returned to their original position and sutured into place with interrupted loop suture. Postsurgically the patient is prescribed antibiotics and analgesics. Analgesics should be stopped as soon as possible and NSAIDs should not be taken until the orthodontic treatment is completed.
Scaling will be done 1 month following the surgery and the importance of good oral hygiene should be reinforced.
The first orthodontic adjustment will be performed approximately 2 weeks following the surgery. Thereafter every 2 weeks interval orthodontic adjustment is done until the treatment is completed.
| How does it work?|| |
Following decorticomy, RAP potentiates tissue reorganization and healing by way of a transient burst of localized hard and soft tissue remodeling.  The bone goes through a phase known as osteopenia, where its mineral content is temporarily decreased. The tissues of the alveolar bone release rich deposits of calcium, and a new bone begins to mineralize in about 20-55 days. While the alveolar bone is in this transient state, the tooth movement will be faster as the bone is softer and there is less resistance to the orthodontic forces. This accelerated remodeling is influenced by bone density and the hyalinization of the periodontal ligament. ,
Yaffe et al, found that in the initial phases of RAP, there will be an increase in cortical bone porosity because of increased osteoclastic activity and speculated that bone dehiscence might occur after periodontal surgery in an area where cortical bone is initially thin. Pfeifer  also found increased osteoclastic activity along the PDL surface following surgery. There is strong indirect evidence that the physiologic events associated with RAP following surgery, i.e., calcium depletion and diminished bone densities, result in rapid tooth movement. Ostoclasts are capable of demineralizing bone via a proton pump. 
Research has shown that once the alveolar bone heals additional alveolar bone forms. So after AOO, the alveolar bone is apparently not only as strong as it was before the procedure but there is actually more of it which is advantageous if the profile of the patient needs to be built up to improve the facial esthetics.
| Advantages of Aoo|| |
- Duration of orthodontic treatment is reduced.
- Less likelihood of root resorption.
- Comparable tooth movements are accomplished in 2 weeks as compared to 6- to 8- week intervals of conventional orthodontics. 
- AOO procedure can be used to cover preexisting bony fenestrations over the root prominences.
- An increase in cephalometric point A and point B area. ,
- In certain situations, the additional alveolar bone can also provide improved lip posture.
- An improvement in the structural integrity of the periodontium.
| Disadvantages of Aoo|| |
- Expensive procedure.
- It is mildly invasive procedure and like all surgeries, it has its risks.
- Pain and swelling with possible infection.
| Conclusion|| |
By combining the talents of the periodontist and the orthodontist, a viable and a safe orthodontic treatment can be completed in a fraction of the time required for conventional orthodontics. However, the orthodontic clinician must be aware that dental anchorage changes as a consequence of alveolar osteopenia.
| References|| |
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