Periodontally Accelerated Osteogenic Orthodontics Research Articles

The Effect of Corticotomy-Assisted Orthodontic Therapy (CAOT) or Periodontally Accelerated Osteogenic Orthodontics (PAOO) on Bone Remodeling and the Health of Periodontium: A Systematic Review of Systematic Reviews.

Background: Orthodontic treatment involves moving teeth within the alveolar ridge. Bone remodeling is associated with the activity of osteoblasts and osteoclasts. Procedures such as corticotomy-assisted orthodontic therapy (CAOT) or periodontally accelerated osteogenic orthodontics (PAOO) are intended to reduce bone density and negative stress on the grip side and therefore limit bone resorption during orthodontic movement or add bone substitute material so that the tooth does not cross the vestibular plate. Methods: The study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The study design was defined in the PICO format-Population (P): patients with full permanent dentition, both adolescents and adults; Intervention (I): orthodontic treatment with fixed appliances using additional supportive treatments such as CAOT or PAOO; Comparison (C): assessment of the impact of additional treatments during orthodontic treatment on the remodeling of the alveolar bone and the condition of the periodontium; Result (O): statistically significant/non-significant differences in the condition of the alveolar bone before and after orthodontic treatment. Search filters include the time of publication of the article, systematic reviews from the last five years, and publications that appeared in English. The information provided in the abstracts of systematic reviews that describe the effects of additional procedures during orthodontic treatment such as CAOT or PAOO on the health of periodontium was analyzed. Articles unrelated to the subject of the planned study and those in which tooth movement acceleration was analyzed were excluded. Results: Eight articles were selected in which a total number of 835 subjects took part. The changes in bone density and effects on periodontium were different after CAOT and PAOO. Conclusions: The validity of CAOT and PAOO procedures remains controversial. Better results are obtained when combined with tissue augmentation or thickening of the gingival phenotype rather than as stand-alone procedures, as their uses to protect periodontal tissues are limited.

Dental and Periodontal Changes After Accelerated Correction of Lower Anterior Teeth Crowding With Periodontally Accelerated Osteogenic Orthodontics (PAOO) Procedure: A Randomized Controlled Trial.

Objective To evaluate the relative efficacy of periodontally accelerated osteogenic orthodontics (PAOO) compared to conventional fixed appliances in correcting lower anterior teeth crowding using a non-extraction treatment approach. Material and methods A single-center, two-arm, parallel-group randomized controlled trial was conducted on 38 patients (9 males, 29 females) with moderate crowding. These patients did not require premolar extraction and were randomly allocated into two treatment groups: the PAOO group and the conventional orthodontic treatment group. The Little Irregularity Index (LII) measured crowding intensity on pre-treatment study models. Changes in this index were recorded monthly in both treatment groups. The inter-canine width, inter-second-premolar width, plaque index (PI), gingival index (GI), and papillary bleeding index (PBI) were also measured before and after the leveling and alignment stage. Statistical analysis between the two groups was performed using Mann-Whitney U tests. Results For the LII, the average time for irregularity resolution was three months in the PAOO group, compared to five months in the conventional orthodontic treatment group. Regarding changes in inter-second-premolar width, the PAOO procedure led to a significant decrease in the increase of inter-second-premolar width, with an average increase of +1.52 mm compared to +2.71 mm in the control group. For the GI and PBI, it was found that their values significantly increased with PAOO application, averaging 0.18 and 0.17, respectively, compared to 0.05 and 0.07 in the control group. Conclusions The use of PAOO in orthodontic treatment accelerated the leveling and alignment process by 40%. Changes in the inter-canine width, the inter-second-premolar width, and the status of periodontal tissues were minimal and clinically negligible.

Exploration of key factors in Gingival Crevicular fluids from patients undergoing Periodontally Accelerated Osteogenic Orthodontics (PAOO) using proteome analysis

BackgroundThe aims of this study are to explore protein changes in gingival crevicular fluid at different time points after PAOO by proteomics method and to select significant bone metabolization-related biomarkers.MethodsThis study included 10 adult patients experiencing PAOO. After orthodontic alignment and leveling, the maxillary anterior teeth were treated with PAOO, which is classified as the experimental area. The traditional orthodontic treatment was performed in the mandibular dentition as the control. Gingival crevicular fluid samples were collected at the following time points: the day before the PAOO (T1) and at 1 week, 2 weeks, 1 month, 2 months and 6 months after PAOO (T2, T3, T4, T5 and T6, respectively). The label-free quantitative proteomic assay was used to evaluate the gingival crevicular fluid in PAOO and control areas at time point T1, T2, and T4. Bioinformatics analysis was carried out to categorize proteins based on biological processes, cellular component and molecular function, which is in compliance with gene ontology (GO) standards. The changes of proteins were confirmed by ELISA.ResultsA total of 134 proteins were selected by keywords (Osteoblast markers, Osteoclast markers, Osteoclastogenesis regulating genes and inflammatory marker). 33 of them were statistically different between groups, and 12 were related to bone metabolism. 5 proteins selected by label-free quantitative proteomics were KLF10, SYT7, APOA1, FBN1 and NOTCH1. KLF10 decreased after PAOO, hitting a trough at T4, and then leveled off. SYT7 increased after PAOO, reaching a peak at T3, and then stabilized until T6. APOA1 ascended to a peak at T4 after PAOO, and then remained stable until T6. The FBN1 rose after PAOO, reaching a peak at T4, and then went down slowly. NOTCH1 ascended rapidly in the first two weeks after PAOO and continued its slow growth trend.ConclusionIn this study, protein changes in gingival crevicular fluid were detected by proteomics method, and significant bone metabolization-related proteins were selected. It is speculated that APOA1, FBN1, NOTCH1, SYT7 and KLF10 played key roles in regulating bone metabolic balance and in reversible osteopenia after PAOO, which might be involved in the accelerated tooth movement.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (Clinical trial registration number: ChiCTR-ONRC-13,004,129) (26/04/2013).

A Comparative Evaluation Of Canine Retraction Using Periodontally Accelerated Osteogenic Orthodontics (PAOO) And Conventional Mechanotherapy As Assessed By CBCT

A Comparative Evaluation Of Canine Retraction Using Periodontally Accelerated Osteogenic Orthodontics (PAOO) And Conventional Mechanotherapy As Assessed By CBCT

PAOO Technique for The Bimaxillary Protrusion: A Case Report

Background: Bimaxillary protrusion is a common malocclusion that can lead to functional and aesthetic issues. Conventional orthodontic treatment may not always be effective, and surgical approaches can be invasive. The Periodontally Accelerated Osteogenic Orthodontics (PAOO) technique is a minimally invasive alternative that involves corticotomy and orthodontic treatment. Objective: This case report aimed to evaluate the effectiveness of the PAOO technique for the correction of bimaxillary protrusion in a 16-year-old female patient. Methods: The PAOO technique involved corticotomy and piezocision on a 16-year-old female patient undergoing orthodontic treatment with a fixed appliance. The patient was being followed up for 18 months after orthodontic appliance placement with premolars extractions but did not get any favorable result and was referred by the Department of Orthodontics to undergo corticotomy procedure. The effectiveness of the treatment was evaluated using cephalometric and occlusal analyses. Results: The PAOO technique significantly improved the patient’s skeletal and dental parameters. The maxillary and mandibular incisors were retracted, resulting in a significant improvement in the patient’s profile. The occlusal analysis showed good intercuspation and a stable occlusion. Conclusion: The PAOO technique is a viable option for the correction of bimaxillary protrusion, as it can achieve significant improvements in skeletal and dental parameters with minimal invasiveness. Further studies are needed to validate these findings and compare the PAOO technique with conventional surgical and orthodontic approaches.

The clinical efficacy of periodontally accelerated osteogenic orthodontics in patients with bone fenestration and dehiscence: a retrospective study

PurposeThe objective of the study was to explore the effect of periodontally accelerated osteogenic orthodontics (PAOO) in orthodontic patients with bone dehiscence and fenestration in the anterior alveolar region of the mandible.MethodsA retrospective study was performed in 42 patients with bone dehiscence and fenestrations in the anterior alveolar region of the mandible who underwent the PAOO technique. The bleeding index (BI), probing depth (PD), keratinized gingiva width (KGW), gingival recession level (GRL), and gingival phenotype were recorded and assessed at baseline and 6 and 12 months postoperatively. Cone-beam computerized tomography was used to measure bone volume in terms of root length (RL), horizontal bone thickness at different levels, and vertical bone height at baseline and 6 months and 12 months after surgery.ResultsThe sample was composed of 42 patients (22 males and 20 females; mean age, aged 25.6 ± 4.8 years) with 81 teeth showing dehiscence/fenestrations and 36 sites presenting gingival recessions. There was no significant difference in BI, PD, or KGW (between baseline and 6 or 12 months postoperatively) based on the clinical evaluations (P > 0.05). Gingival recession sites demonstrated a significant reduction in the GRL after surgery (P < 0.05). Furthermore, the proportion of teeth with a thick gingival phenotype increased from 33.61% at baseline to 53.13% at the end of the follow-up. In addition, the bone thickness measurements at the mid-root and crestal levels were markedly increased compared with the baseline values (P < 0.05), although the increase in thickness at the apical level was not statistically significant (P > 0.05).ConclusionsWithin the limitations of the study, the results show that the PAOO technique is beneficial to periodontal conditions in terms of soft and hard tissue augmentation. The PAOO procedure may represent a safe and efficient treatment for orthodontic patients with bone dehiscence and fenestration.Trial registrationThis study was approved by the ethics committee of the stomatological hospital affiliated with Xi'an Jiaotong University (xjkqll [2019] No. 016) and registered in the Chinese Clinical Trial Registry (ChiCTR2100053092).

Periodontal soft tissue increase induced by periodontally accelerated osteogenic orthodontics surgery

ObjectivesTo quantitatively assess periodontal soft tissue changes, including gingival thickness and keratinized gingiva width after periodontally accelerated osteogenic orthodontics (PAOO) surgery by digital measurements. MethodsThis study enrolled 15 maxillaries with 89 anterior teeth and 16 mandibles with 94 anterior teeth from Chinese adult patients with skeletal Angle Class III malocclusion for whom PAOO surgery was proposed during orthodontic treatment. Intraoral scanning and cone beam computed tomography (CBCT) examinations were performed before PAOO surgery and 6 months after the surgery. Keratinized gingiva width was measured on the digital model acquired by intraoral scanning. The gingival thickness was measured using a digital three-dimensional (3D) model based on the combination of digital intraoral scanning and CBCT data.ResultsThe mean gingival thickness before surgery was 0.91 ± 0.32 mm and 1.21 ± 0.38 mm at 6-month after PAOO. Patients showed periodontal soft tissue increase with a mean gingival tissue gain of 0.30 ± 0.33 mm. At 1 mm, 2 and 3 mm apical to cemento-enamel junction (CEJ) levels, the gingival thickness increase of the mandible was higher than that of the maxilla (0.38 ± 0.30 mm vs. 0.24 ± 0.31 mm, 0.43 ± 0.35 mm vs. 0.26 ± 0.41 mm, 0.36 ± 0.27 vs. 0.25 ± 0.32 mm, respectively, all P < 0.05). Moreover, the sites of gingival thickness ≤ 1 mm before surgery showed more tissue gain than the sites > 1 mm (0.36 ± 0.32 mm vs. 0.18 ± 0.31 mm, P < 0.001). The mean keratinized gingiva width at T0 was 3.88 ± 1.22 mm, and increased 1.05 ± 1.24 mm 6 months after PAOO surgery. Moreover, a digital 3D model for gingival thickness measurement based on the combination of digital intraoral scanning and CBCT displayed high reliability and accuracy with an intra-class correlation coefficient (ICC) of 0.897.ConclusionPAOO could improve an insufficient quantity of periodontal soft and hard tissues in patients with skeletal Angle Class III malocclusion, including the gingival thickness and keratinized gingiva width. A digital 3D model based on the combination of digital intraoral scanning and CBCT data could provide a new digital measurement of gingival thickness with high accuracy and reliability.

Osteoclast-Driven Osteogenesis, Bone Remodeling and Biomaterial Resorption: A New Profile of BMP2-CPC-Induced Alveolar Bone Regeneration.

This bedside-to-bench study aimed to systematically investigate the value of applying BMP2-loaded calcium phosphate cement (BMP2-CPC) in the restoration of large-scale alveolar bone defects. Compared to deproteinized bovine bone (DBB), BMP2-CPC was shown to be capable of inducing a favorable pattern of bone regeneration and bone remodeling accompanied by active osteoclastogenesis and optimized biomaterial resorption when applied in reconstructive periodontally accelerated osteogenic orthodontics (PAOO) surgery. To verify the regulatory role of osteoclasts in the BMP2-CPC-induced pattern of bone regeneration, in vitro and in vivo studies were designed to elucidate the underlying mechanism. Our results revealed that osteoclasts played a multifaceted role (facilitating osteogenesis, bone remodeling and biomaterial resorption) in the BMP2-CPC-induced bone regeneration. Osteoclasts contributed to the osteogenic differentiation of mesenchymal stem cells (MSCs) by secreting calcium ions, CTHRC1 and PDGF-B. Moreover, the increased osteoclasts promoted the remodeling of new bone and BMP2-CPC resorption, leading to a harmonized replacement of biomaterials with mature bone. In conclusion, the in vitro and in vivo experimental results corresponded with the clinical results and showed the optimized properties of BMP2-CPC in activating osteoclast-driven bone regeneration and remodeling, thus indicating the highly promising prospects of BMP2-CPC as an ideal therapeutic for alveolar bone defects.

A new subgingival sling suture technique for periodontally accelerated osteogenic orthodontics.

This study aimed to design a modified subgingival sling suture for periodontally accelerated osteogenic orthodontics (PAOO) as well as evaluate postoperative effects including gingival recession (GR), alveolar bone crest resorption, dental plague accumulation on sutures and alveolar bone augmentation. Twelve patients with bone defects in the anterior alveolar region of the mandible were included in this study. Subgingival sling suture, developed from traditional sling suture, was applied in modified PAOO operation. Probing depth, bleeding index, and GR were assessed, and cone-beam computerized tomography and laser microscope for thread surface were evaluated at baseline, postoperative 1 and 3 months to analyze the effects. Alveolar bone thickness on the labial side at the midpoint of the middle third of the root increased from 0.96 ± 0.28 mm to 3.38 ± 0.61 mm (P < .01), and that of the apical third advanced from 1.26 ± 0.33 mm to 3.61 ± 1.02 mm (P < .01), both exhibiting significant increase. No significant alveolar bone crest loss, probing depth increase, GR, and attachment loss was observed. This modified PAOO operation, associated with novel subgingival sling suture, productively augments alveolar bone volume and addresses problems in terms of GR and vertical loss of alveolar bone.

The Effectiveness of Periodontally Accelerated Osteogenic Orthodontics (PAOO) in Accelerating Tooth Movement and Supporting Alveolar Bone Thickness During Orthodontic Treatment: A Systematic Review.

The current review aimed to critically and systematically evaluate the available evidence regarding the effectiveness of periodontally accelerated osteogenic orthodontics (PAOO) in accelerating orthodontic tooth movement and supporting the alveolar bone. Additionally, this review aimed to analyze the untoward effects of this procedure and the patient-reported outcome measures.A comprehensive electronic search was performed on 10 databases in addition to a manual search to retrieve all relevant studies. Randomized controlled trials (RCTs) were only included in this review. The interventional group was the PAOO procedure, whereas the control group was either a non-accelerated traditional fixed orthodontic treatment or an accelerated treatment using any other intervention. The Cochrane risk of bias tool for randomized controlled trials (RoB 2) was employed to estimate the risk of bias in the included studies.The current review included eight RCTs evaluating 175 participants (63 males and 112 females) with a mean age ranging from 18.8 to 29.6 years. Five of them assessed the effectiveness of PAOO versus traditional orthodontic treatment, i.e. without any adjuvant surgical intervention. At the same time, the remaining three studies evaluated the effectiveness of PAOO versus corticotomy-only as an adjunctive procedure. The PAOO accelerated the leveling and alignment stage from 39% to 47% and accelerated the retraction of the upper anterior teeth from 41% to 61% compared to conventional orthodontic treatment. One study only indicated that PAOO reduced treatment time by 30.3% versus a corticotomy-only as an adjunctive procedure. No significant side effects have been reported with the PAOO procedure.The PAOO procedure was effective in accelerating orthodontic movement and tended to increase the thickness of the alveolar bone. But most periodontal outcome measures regarding PAOO application were not comprehensively covered in the included trials.

Maxillary Expansion: A Comparison of Damon Self-Ligating Bracket Therapy with MARPE and PAOO.

Purpose The aim of this study was to investigate arch parameters and dentoalveolar changes from pretreatment to posttreatment by comparing the Miniscrew Assisted Rapid Palatal Expansion (MARPE), Periodontally Accelerated Osteogenic Orthodontics (PAOO), and Damon self-ligating bracket therapies. Materials and Methods Seventy-nine patients underwent maxillary expansion followed by or in conjunction with Damon (n = 23), PAOO (n = 28), and MARPE (n = 28) therapies. Nine maxillary dental arch parameters were compared at pretreatment, posttreatment as well as, increments of treatment change. Measurements were made on STL study casts using 3Shape Ortho Analyzer 3D scanner software. Results All groups showed significant posterior width increase in the molar area. The mean increase in inter-molar distance was more than 8X greater in MARPE group compared to Damon and more than 4X greater compared to PAOO. MARPE showed significantly greater increments of change in inter-molar width and palatal vault area Conclusions All groups showed a significant width increase in the canine and molar area. MARPE showed the greatest increase in inter-molar width, followed by PAOO and Damon. MARPE was the only group to show a significant increase in palatal vault area.

Evaluation of the Levels of Pain, Discomfort, Functional Impairments and Satisfaction With the Periodontally Accelerated Osteogenic Orthodontics (PAOO) When Leveling and Aligning Crowded Teeth: A Prospective Cohort Study.

BackgroundOnly a few studies have reported levels of pain, discomfort, functional impairments, and patients' satisfaction after undergoing periodontally accelerated osteogenic orthodontics (PAOO). Therefore, the objectives were to evaluate postoperative pain, discomfort, functional impairments, and satisfaction following this surgical intervention.MethodsA prospective cohort study was undertaken at the Department of Orthodontics, University of Damascus Dental School, between August 2018 and November 2020. The sample consisted of 16 patients (4 males, 12 females, mean age: 21±3.05 years) with moderately crowded lower anterior teeth who underwent full-thickness vestibular flap elevation followed by cortical cuts using piezosurgery. Then a bovine xenograft was applied before reflecting the flap and suturing. Fixed orthodontic therapy was then initiated. Questionnaires were administered to assess the levels of pain, discomfort, and oral functional problems using a visual analog scale (VAS) at one day, seven days, 14 days, and 28 days after surgery. The level of satisfaction was also assessed at 28 days postoperatively. Friedman's test was employed, and Wilcoxon signed-rank tests were used for post-hoc tests with an adjusted alpha level.ResultsOn the first day following the PAOO, the mean values of perceived pain, discomfort, swelling, mastication difficulties, swallowing problems, limitation in jaw movements were 80.00, 80.63, 68.13, 78.13, 55.00, and 64.38, respectively. These mean values dropped significantly in the following assessment times (P<0.001). At 28 days following the PAOO, the mean satisfaction score was 84.94±22.46. All patients mentioned that they took painkillers after the surgical intervention.ConclusionsOn the first day following surgery, patients perceived high levels of pain and discomfort, moderate to severe levels of swelling and chewing difficulties, and suffered from restricted jaw movement. These levels decreased significantly in the following assessment times. Patients' satisfaction with the PAOO procedure was high.

Evaluation and comparison of periodontal and orthodontic parameters in patients managed with periodontally accelerated osteogenic orthodontics versus conventional orthodontic treatment

Introduction: Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a clinical procedure which is gaining popularity due to its claims to increase in alveolar bone width, shorter treatment time, increased post treatment stability, and decreased amount of apical root resorption. However, there is paucity of literature available on changes in periodontal and orthodontic parameters following (PAOO).Aims and Objective: The aims of the current study were to evaluate the efficacy of orthodontic treatment with PAOO and compare the treatment duration between the PAOO based fixed orthodontic treatment and the conventional fixed orthodontics in patients with bi-maxillary dentoalveolar protrusion. Materials and Methods: Group A consisted of 12 bimaxillary dentoalveolar protrusion patients who underwent PAOO during orthodontic treatment and Group B consisted of 12 Bimaxillary dentoalveolar protrusion patients who underwent conventional orthodontic treatment without PAOO. Statistical analysis was performed using the Wilcoxon test for a paired group comparison. Pre- and posttreatment measurements of each parameter were averaged (mean – SD), and all tests were performed at the 5% significance level. P values ≥0.05 were regarded as statistically significant. Results: No significant changes were seen in values probing depth, clinical attachment loss, width of keratinized attached gingiva, plaque index and gingival index between the two groups. However, statistically significant difference was seen in the orthodontic treatment duration between the two groups. Conclusion: It can be concluded that PAOO is a safe and reliable procedure which decreases the total orthodontic treatment duration significantly with stable periodontal results as achieved with conventional orthodontic treatment.

Wilkodontics: A Meteoric Rise to Faster Orthodontic Treatments

A tremendous amount of advances has been made in the field of dentistry in the past few decades. In spite of these advances, the average orthodontic treatment lasts 1.5 to 3 years. "Wilkodontics," often called Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a procedure that helps in accelerating tooth movement as well as in providing an increase for rendering extensive dental services and care to the patients in bone activation through selective decortication and osteotomies as well as alveolar augmentation using a particulate bone graft. Thus, thisThis article attempts to review the main indications, contraindications, and modifications of wilkodontics.

Periodontally Accelerated Osteogenic Orthodontics (PAOO) vs Osteoperforations (A Review on Periodontal Reactions to Orthodontic Tooth Movement)

A high number of adult patients are undertaking orthodontic treatment now because of the newer methods, technology, and innovations available in the market. Orthodontic profession is continually looking for new ways to perform treatment effectively for such patients, as there are many differences in the biology, motivation, and treatment objectives between adults and children. Aligner therapy and mini-implants are some of the ways of managing orthodontic treatment for adult patients. Treatment time is a concern for adult patients and methods to accelerate the orthodontic tooth movement have been a focus in the orthodontic field. Periodontal accelerated osteogenic orthodontics (PAOO) is a surgical procedure that is performed with a combination of alveolar corticotomy, bone grafting, followed by orthodontic treatment. This procedure uses the principle of regional acceleratory phenomenon (RAP). Another procedure commonly used for accelerated orthodontic tooth movement is osteoperforations. This is a minimally invasive procedure, which does not include a flap surgery. The purpose of this article is to describe the differences between adult and children periodontal tissues, the use of different appliances for adult treatment, how orthodontic treatment has been modified for adult patients, and the detailed explanation of procedures for accelerating orthodontic tooth movement such as PAOO and osteoperforations and the potential complications

Effectiveness of platelet rich fibrin versus demineralized bone xenograft in periodontally accelerated osteogenic orthodontics.

To compare the rate of extraction space closure between periodontally accelerated osteogenic orthodontics (PAOO) using platelet-rich fibrin (PRF) (Group 1) and PAOO using demineralized bone xenograft (DMBM) (Group 2) and to compare the level of wound healing between the PRF group vs the DMBM group after PAOO. A two-arm prospective single blind pilot study with a split-mouth design was used in which 14 patients requiring premolar extraction were divided into two groups: PRF and DMBM. En-masse space closure was carried out with using mini implants after the PAOO procedure. The amount of space closure was measured at five time points with 2-week intervals within 2 months. The gingival healing levels were assessed using early wound healing scores on the first postoperative day. The rate of extraction space closure was faster in the experimental quadrant at all time points (T1-T4) in the PRF group and at time points (T3, T4) in the DMBM group. Comparison between experimental quadrants showed a significant increase in the rate of space closure in the PRF group T1 to T3 (P < .05). The PRF group showed higher total early healing scores than the DMBM group. PRF, when used in the PAOO procedure, produces a faster rate of space closure with better early wound healing than DMBM.

Periodontally accelerated osteogenic orthodontics in clinical treatment

Orthodontic tooth movement inevitably affects adjacent periodontal tissue. The labiobuccal alveolar bone is generally thin, and patients with dental crowding often present alveolar dehiscence and fenestration. These may lead to prolonged treatment time, even gingival atrophy, tooth loosening and other complications in the orthodontic tooth movement. Periodontally accelerated osteogenic orthodontics (PAOO) could accelerate the orthodontic tooth movement and promote the formation of new bone by using corticotomy and bone grafting. This article, starting from the influence of orthodontic treatment on periodontal hard tissue, describes the application of PAOO in orthodontic treatment.

Effect of platelet-rich fibrin membrane on gingival crevicular fluid alkaline phosphatase levels in patients undergoing periodontally accelerated osteogenic orthodontics

BackgroundThe present study is aimed to compare the osteoblastic activity in periodontally accelerated osteogenic orthodontics (PAOO) with and without the platelet-rich fibrin (PRF) membrane by evaluating the gingival crevicular fluid (GCF), alkaline phosphate (ALP) levels and also to explore the efficiency of PRF membrane in terms of healing. MethodsA split-mouth randomized controlled trial, which comprised 16 sites, was randomly treated with PAOO + PRF membrane and PAOO alone. The primary outcome was to analyze the GCF ALP levels at baseline, 3rd, week, 5th week (2 weeks after surgery, 1 h before and after activation), 7th week (4 weeks after surgery), and 9th week (6 weeks after surgery). The clinical parameters (plaque index [PI], gingival index [GI], bleeding index [BI]) were assessed at baseline, 3rd week, 15th week, and 27th week. Healing index was recorded at 4th week (1 week after surgery), 5th week (2 weeks after surgery), and 7th week (4 weeks after surgery). ResultsThere was a statistically significant increase in GCF ALP levels (p < 0.05) in the test site (PAOO with PRF membrane) 2 weeks post-surgically compared to the control site. Improvement in the clinical measures (PI, GI, BI) was statistically significant at all time intervals. Adjunctive use of PRF resulted in statistically significant early healing in the first postoperative week compared to the control site (p < 0.05). ConclusionsWithin the limitations of this split-mouth study, PRF membrane showed significant osteoblastic activity in the 5th week (2 weeks after PAOO) with the increased GCF ALP levels and accelerated healing in the 1st week after PAOO. They also maintained post-orthodontic stability until 18 months.

Effect of surgically facilitated accelerated orthodontics on treatment duration, root resorption and bone density

Introduction: The use of orthodontic treatment in adult patients for the treatment of malocclusion is becoming more common. But the major disadvantages of conventional orthodontic technique are the time consumed for the treatment (18 – 24 months), root resorption and formation of fenestrations and dehiscence. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a surgical technique which results in an increase in alveolar bone width, shorter treatment time, increase post-treatment stability, and decrease in the amount of apical root resorption. Objectives: The objective of the study was to evaluate the effect of Periodontally Accelerated osteogenic Orthodontics (PAOO) with surgical bur and piezicision on: Duration of orthodontic space closure, amount of root resorption, and the bone density. Materials and Methods: Forty subjects who needed orthodontic treatment were randomly selected and divided into two groups. Group I consists of 20 subjects who were selected for Periodontally Accelerated Osteogenic Orthodontics (PAOO) with surgical bur Group II: consists of 20 subjects who were selected for Periodontally Accelerated Osteogenic Orthodontics (PAOO) with peizocision. Patients were recalled at baseline, 3, 6, 9 and 12 months and were evaluated for amount of retraction, bone density, root resorption and detection of fenestration and dehiscence. Cone Beam Computerised Tomography (CBCT) was used to evaluate the bone density, root resorption and for the detection of fenestration and dehiscence. Results: In subjects where corticotomy was carried out with surgical bur the treatment time was less as compared to PAOO with peizocision. Group I had a mean retraction of 5.99 ± 0.5 mm after 3 months (p Conclusion: PAOO with surgical bur (Group I) decreases the treatment time as compared to piezocision (Group II). Amount of root resorption in Group I which was around 0.34 mm and that of Group II was around 0.51mm which is very minimal and increase in the bone density wa

Periodontally Accelerated Osteogenic Orthodontics (PAOO) technique in cleft patients: A complement to orthognathic surgery in dentoalveolar expansion. A case series report

The aim of this study was to describe a surgical technique that can be used to solve dentofacial deformities in cleft palate patients with maxillary hypoplasia in order to increase maxillary alveolar bone width, without modifying the skeletal base, and therefore, keeping the velopharyngeal function unaltered. Four patients with a history of cleft palate not associated with syndrome and treated under conventional surgical protocol during their childhood, underwent PAOO surgery incorporating L-PRF, followed by an accelerated orthodontic treatment with checkups every two weeks. All patients reached the desired occlusion without modifying their skeletal bases and velopharyngeal function. Orthodontic treatments were finished between 10 and 14 months after surgery without complications. There were no observed complications in the velopharyngeal postsurgical function and an increase in the arch width was achieved in all cases, along with a reduced orthodontic treatment time.The clinical results obtained confirm that PAOO technique is a safe and reliable complement to orthognathic surgery in the surgical treatment of cleft patients. By increasing the perimeter of the maxillary dentoalveolar ridge, the segmentation of the maxilla could be avoided, increasing the post operatory stability of these patients.