Traditional surgical orthodontic therapy utilizes cell mediated orthodontic tooth movement to align teeth within the alveolar processes prior to orthognathic procedures. Orthognathic procedures are used to align the skeletal structures of the face and orient the alveolar arches so that the teeth are positioned in proper molar and cuspid relationships. Treatment planning relies heavily on clinical assessment of facial defects and cephalometric analysis to determine these discrepancies. Once these discrepancies have been identified, appropriate skeletal movements are completed by the surgeon with procedures such as the sagital split osteotomy and Le Fort osteotomy. While these procedures have experienced very favorable outcomes, there are many cases in which the facial deficit is not truly a skeletal problem, but is an alveolar bone discrepancy. The alveolar bone discrepancy may be either an intra-alveolar arch defect that does not allow enough room for the dentition, or it may be an alveolar-skeletal defect that does not align the alveolus properly with its associated skeletal structures. Dentoalveolar discrepancies are difficult to treat with cellular mediated orthodontic tooth movement alone. Arch deformities usually require the orthodontist to prolong orthodontic treatment time to obtain proper tooth alignment. Many times this requires the extraction of multiple teeth or the positioning of the teeth outside the confines of their underlying bone. Traditional surgical procedures that have been used to correct arch width discrepancies are: surgically assisted rapid palatal expansion and the mandibular midline distraction. While these surgical procedures have provided favorable results, they do not assist in the anterior-posterior discrepancies or vertical discrepancies. Many of the anterior-posterior dentoalveolar discrepancies are treated with orthognathic surgical procedures even though the underlying skeletal foundation is in a relatively normal position. One example of this, is mandibular advancement in patients with mandibular alveolar deficiency. Often this can necessitate a reduction genioplasty to prevent over projection of the mandible. In 1959, Heinrich Kole suggested that the greatest resistance to tooth movement is created by the cortical bone of the alveolus. He described the use of interdental corticotomies to facilitate accelerated orthodontic tooth repositioning in three dimensions. This procedure was described by many other authors but became less favorable due to advancements in orthognathic surgery. With the recent decline in the number of orthognathic surgical cases being treatment planned or accepted for a variety of reasons, there is tremendous need to assist the orthodontist with alternative options that can augment orthodontic outcomes. In this chapter, we would like to present a new concept which addresses dentoalveolar bony discrepancies with inter-dental osteotomies, distraction osteogenesis, and active orthodontics. This procedure is designed to change the dentoalveolar complex so that the teeth, dentoalveolar bone, and the jaws are appropriately addressed to maximize ideal functional and esthetic relationships.