Rapid Tooth Movement Research Articles

Effect of Injectable Platelet-Rich Fibrin and Micro-Osteoperforation on Accelerated Orthodontic Tooth Movement: Protocol for a Split-Mouth Randomised Clinical Trial

Introduction: Orthodontic treatment is often perceived as time-consuming by patients. Various techniques have been developed to accelerate treatment and reduce its duration, but there is limited literature supporting their efficacy and advantages. This study aims to compare the effectiveness and acceptability of two methods in accelerating orthodontic tooth movement, providing valuable insights for clinicians. Need for the study/Rationale: Injectable Platelet-Rich Fibrin (i-PRF) and Micro-Osteoperforation (MOP) are two modalities known to accelerate tooth movement. i-PRF is a chemical modality, while MOP is a minimally invasive mechanical procedure. Both stimulate osteoclastic inflammatory cytokines, facilitating rapid tooth movement. However, there is limited evidence comparing the efficacy of these two methods. By comparing the mechanical i.e. MOP and chemical i.e. i-PRF modes of accelerated orthodontics, this planned protocol will study to determine the most feasible treatment modality based on objective patient outcomes, rate of tooth movement, and advantages/disadvantages. Aim: To evaluate and compare the effects of i-PRF and MOP on accelerated orthodontic movement in a young adult population. Materials and Methods: This split-mouth prospective randomised study will involve 10 participants selected from the departmental Out Patient Department (OPD) based on inclusion and exclusion criteria. Informed consent will be obtained. The participants will be divided into two groups: Group A: Undergoing MOP Group B: Undergoing i-PRF Group allocation (left or right side) will be randomised. The rate of maxillary canine retraction will be measured after intervention in both study groups. Expected Results: Both i-PRF and MOP are expected to accelerate orthodontic tooth movement, with MOP being more effective in this regard.

Surgical Orthodontic Treatment of Class II Malocclusion with Facial Asymmetry

This case report describes a successful surgical orthodontic treatment of a Class II malocclusion with facial asymmetry. An 18-year-old female visited our dental clinic due to proclined anterior teeth and facial asymmetry. Straight facial profile and skeletal Class II was observed. The frontal cephalometric analysis showed that the left ramus length was longer and the left ramal angle was greater than the right. After extraction of the maxillary and mandibular second premolars, dental arch was decompensated. After presurgical orthodontic treatment, bilateral sagittal split ramus osteotomy (BSSRO) was performed. Facial asymmetry was improved, but posterior open bite on the right was occurred by insufficient dental decompensation. To prevent recurrence of the mandible, a bite stop was made by bonding resin on the lingual side of the right maxillary canine. This prevented the recurrence of the mandibular rolling and yawing with the use of bilateral intermaxillary elastics. The right mandibular posterior part with open bite was segmented from the main arch wire and was extruded with intermaxillary elastic. Fast occlusal stabilization was achieved by using the rapid tooth movement after surgery. Since intermaxillary elastic was used while applying an intrusion force with a micro-implant to the left posterior region, it was possible to stabilize the mandible while prevent tooth extrusion. After treatment, facial symmetry and good occlusal relationship were achieved.

6-Shogaol promotes bone resorption and accelerates orthodontic tooth movement through the JNK-NFATc1 signaling axis.

Corticotomy is widely used in clinical practice to accelerate tooth movement and shorten the duration of orthodontic treatment. It is effective, but an invasive surgery is needed to induce alveolar bone osteopenia that enable rapid tooth movement. In this study, we discovered the potential of 6-shogaol as a more patient-friendly non-invasive alternative to induce transient osteopenia and accelerate tooth movement. The effects of 6-shogaol on the bone marrow macrophages (BMM) proliferation and osteoclast differentiation, and bone resorption were determined in vitro. Sprague-Dawley rats were distributed into three groups: CON, IPinj or Localinj and euthanized at day 28. Micro-CT, histology, immunohistological, and TUNEL analysis were performed to evaluate the tooth movement acceleration effect of 6-shogaol. In vitro, 6-shogaol promotes osteoclast differentiation and functional demineralization of alveolar bone. RANKL-induced mRNA expression of osteoclastic-specific genes was significantly higher in the presence of 6-shogaol. A dose-dependent increase in the area of TRAP-positive cells was observed with 6-shogaol treatment. F-actin ring formation and increased bone resorption confirmed that osteoclasts treated with 6-shogaol were mature and functional. 6-shogaol stimulated JNK activation and NFATc1 expression during osteoclast differentiation. In vivo, 6-shogaol promotes alveolar bone transient osteopenia and accelerates orthodontic tooth movement. Alveolar bone mass was reduced, more osteoclasts were observed in bone resorption lacunae on the compression side, and the expression of RANKL and sclerostin were higher than the control group. In conclusion, our results suggest that 6-shogoal accelerates tooth movement by inducing osteopenia by a mechanism similar to surgically induced bone injury.

Effects of obesity on periodontal tissue remodeling during orthodontic movement

Orthodontic movement triggers a sequence of cellular and molecular events that may be affected by different systemic conditions. This study evaluated the effect of obesity on rat periodontal tissue remodeling induced by mechanical orthodontic force. Thirty-two Holtzman rats were distributed into 4 groups: control, obesity induction (O), orthodontic movement (M), and obesity induction and orthodontic movement (OM). Obesity was induced by a high-fat diet for 90days. After 15days of orthodontic movement, the animals were killed. Obesity induction was confirmed by animal body weight, adipose tissue weight, and serologic analysis. Periodontal tissue remodeling was evaluated using microcomputed tomography and histologic analysis. The gene expression of adipokines and cytokines in gingival tissues was evaluated. An increase in body and adipose tissue weight was observed in the obesity induction groups. The O group presented an increase in lipids and blood glucose. The OM group showed a decrease in bone volume fraction and bone mineral density compared with all other groups and a tendency for more rapid tooth movement than the M group. The OM group showed a higher quantity of inflammatory cells and higher Mmp1 expression than the O group. The O and OM groups showed higher Nampt expression than the control group and lower Nampt expression than the M group. Obesity modulates periodontal tissue remodeling during orthodontic movement and results in more inflammation and bone loss than in nonobese animals.

Comparison of the Efficiency and Treatment Outcome of Patients Treated with Corticotomy-Assisted En masse Orthodontic Retraction with the En masse Retraction without Corticotomy.

Background:Corticotomy in fixed orthodontic treatment gives a potential approach to reduce the treatment duration. Typically, this duration of rapid tooth movement lasts 4–6 months.Aim:The aim of this study was to compare the treatment outcome and effectiveness in en masse retraction with and without corticotomy.Materials and Methods:Thirty-two patients (male 16 and female 16) who opted to undergo surgery to reduce the orthodontic treatment time were chosen for the research, and the group consisted of 26 patients (male 13 and female 13) who did not opt for the corticotomy procedure were selected as the control. There was no blindness of the party distribution. It was focused on the patient's ability to opt for an additional minor surgical procedure that may affect orthodontic treatment length. The operation was conducted under local anesthesia (Lignox 2%). The same maxillofacial surgeon performed all the surgical operations.Results:The space present in the maxillary and mandibular arch at the time of retraction had no statistically significant difference in both the control and study groups (P > 0.05). In comparison, the mean amount of retraction space in the maxillary arch and maxillary arch was significant in the control and study groups at 1 month, 2 months, 3 months, and 4 months of the time interval.Conclusion:It can be concluded that corticotomy-assisted retraction significantly decreases the total length of orthodontic care. Effectively stationary anchorage segment was made, thereby removing the need for other anchorage boosters, instrumental in maximum anchorage cases using corticotomy technique.

Interleukin 17 (IL-17) and interleukin 23 (IL-23) levels are modulated by compressive orthodontic forces in humans

ObjectiveThe purpose of the investigation was to evaluate whether the application of compression forces exerted on the periodontal ligament during orthodontic movement is reflected at the level of interleukin (IL)-17 and IL-23. Materials and methodsThe gingival crevicular fluid (GCF) samples from the compression sites of 32 molars from 16 patients prescribed with modified Hyrax appliance were collected. The GCF were analyzed for IL-17, IL-23, and IL-1β (Control) at baseline and at 1, 7, and 14 days of active wear of the appliance. ResultsOrthodontic forces resulted in increased levels of IL-17 and IL-23 in the GCF, which were statistically significant at 7 days of force application at compression sites. At day 14, levels decreased to baseline; IL-1β levels (positive control) were more elevated at all times after force application. IL-17 and IL-23 levels were significantly lower than IL-1β, and undetectable in some samples. ConclusionUpregulation of IL-17 and IL-23 occurred in response to the force application in compression sites. Monitoring the levels of inflammatory mediators might be a clinically useful procedure, as they may help to define optimal forces to produce the most rapid tooth movement.

A Clinical Evaluation of Effect of Positional Change of Mini Implant on Intrusion of Maxillary Incisors - A Randomized Clinical Trial

Introduction: A true maxillary intrusion is always a challenge for orthodontists. There are number of methods of incisor intrusion. Mini Implant assisted incisor intrusion is gaining popularity in recent years. We conducted this research to evaluate and compare the effect of different implant positioning on amount and rate of intrusion, axial and labiolingual inclination of incisors, amount of external apical root resorption of incisors.
 Materials & Method: A prospective, double-blind, randomized clinical study was designed consisting of 30 adult or-thodontic patients, aged 25 and above. The subjects were divided into two groups (Group A-15 patients where mini-implant was placed between two maxillary central incisors below ANS, Group B -15 patients where mini- implant was placed distal to maxillary lateral incisor). Amount of intrusion and change in axial inclination was measured on OPG, labiolingual inclination was measured on Lateral cephalogram, IOPA was taken to observe EARR. The intragroup comparison of pre treatment and post treatment changes were done using Wil-coxon signed rank test, where as the intergroup comparison between Group A and Group B were compared using Mann Whitney U test.
 Result: Statistically significant 3D changes of both central and lateral incisors were seen when continuous intrusion forces were applied from implant placed distal to lateral incisors. Whereas true intrusion with minimal (non significant) axial and labiolingual inclination changes were seen with forces applied through implant placed in the midline. 80 grams of light continuous forces brought about rapid tooth movement with no side effects such as tissue irritation and EARR.
 Conclusion: Mini implant placed below ANS leads to true en-mass intrusion of four maxillary incisors while intrusion carried out with implant placed distal to lateral incisors bilaterally have 3D changes on all four maxillary incisors.

Periodontally Accelerated Osteogenic Orthodontics (PAOO) Using Platelet‐Rich Fibrin Alone: A Modified Approach With a 3‐Year Follow‐Up

IntroductionOrthodontists are reportedly seeing more adult patients in their practices. Hence, it becomes increasingly important to evaluate the periodontium for any existing problems or potential issues that could be caused by orthodontic treatment. Periodontally accelerated osteogenic orthodontics (PAOO) is a method of surgically assisted tooth movement achieved through a combination of corticotomy and bone grafting allowing rapid tooth movement and decreased treatment time. Platelet‐rich fibrin (PRF) is shown to have osteoinductive effects along with enhanced soft and hard tissue healing outcomes. The aim of this case report is to describe a variation of the PAOO technique using PRF membranes alone and provide a proof of concept for the effect of PRF on soft and hard tissue healing outcomes when used with PAOO.Case PresentationA 43‐year‐old female expressed displeasure over her malaligned lower anterior teeth and difficulty performing oral hygiene in that area. Clinical examination showed inadequate keratinized tissue, and cone‐beam computed tomography (CBCT) images revealed extensive loss of buccal bone. Ultrasonic buccal corticotomies were made using a piezoelectric device from the alveolar crest extending past the tooth apices in the lower anterior region. Five PRF membranes were placed over the teeth and secured with sutures.ConclusionsThree‐year follow‐up showed exceptional improvement in soft tissue appearance and keratinized tissue width. CBCT images revealed no further loss of buccal bone. This is the first case to demonstrate that PAOO using PRF can be a viable option for orthodontic movement of periodontally compromised teeth.

Acceleration of Orthodontic Tooth Movement: An Overview

The purpose of orthodontic treatment is to enhance patients’ life quality by improving their dentofacial functions and aesthetics. Minimal histological damage and pain, rapid tooth movement, short treatment duration, and stability of results are the major criteria for successful treatment. In recent years, the demand for orthodontic treatment has been increasing gradually. Prolonged duration of orthodontic treatment affects the psychological motivation of the patients and leads to several undesirable situations, such as caries, gingival recession, and root resorption. Thus, in recent years, related research has investigated the acceleration of orthodontic tooth movement. However, despite the various laboratory and clinical interventions designed to achieve faster tooth movement, uncertainties and unanswered questions about these techniques persist and warrant further investigation. Several surgical techniques as well as physical and chemical applications have been reported by previous studies to accelerate orthodontic tooth movement, most of which have been conducted on animals, with debatable applicability on humans. However, as tooth movement is a multifactorial phenomenon, further research is needed in the future. In this review, we describe the orthodontic tooth movement acceleration methods reported thus far.

Histological response in dental pulp of accelerate tooth movement using periodontal ligament distraction osteogenesis in dogs

PurposeThis study compared initial histological change in dental pulp in response to periodontal ligament distraction osteogenesis (PLDO) with that to conventional orthodontic treatment to determine the effectiveness of PLDO. Materials and methodsPLDO was performed on the right side (PLDO group) and conventional orthodontic treatment on the left side (CCS group) in 6 male beagle dogs. Untreated teeth served as a control group. Radiographs were obtained after appliance activation. Change in pulpal blood flow was measured using a Doppler blood flow meter. The sections were stained with hematoxylin-eosin and Masson’s trichrome for morphological observation. Cell response was observed by immunohistochemistry using proliferating cell nuclear antigen (PCNA) and the TUNEL method. ResultsThe total movement distance of the premolar was significantly greater in the PLDO group than in the CCS group. A decrease in pulpal blood flow and the number of odontoblast cells was observed together with dental pulp capillary dilation at 5 and 12 days after appliance attachment in both groups. While many TUNEL-positive cells were observed on the 5th day in both experimental groups, they showed a decrease at 12 days. More PCNA-positive cells were observed on the 12th day than on the 5th day in both groups. There was no difference in invasiveness between the pulpal reaction to PLDO and that to conventional orthodontic treatment, suggesting that the level of recovery is similar. ConclusionPLDO enabled rapid tooth movement and initial histological change in the dental pulp was similar to that in response to conventional orthodontic treatment.

Periodontally accelerated osteogenic orthodontics

The orthodontic treatment is perhaps in terms of duration, the longest performed dental procedure. To accelerate tooth movement, orthodontists and periodontists together have worked out a successful technique termed as Wilckodontics, commonly known as periodontally accelerated osteogenic orthodontics. It is an emerging technology in the field of dentistry. Wilckodontics has solved the dilemma of rapid tooth movement by exploiting the dynamics of bone physiology and redirecting the emphasis in tooth movement to the manner in which the supporting bone responds to orthodontic forces. In this article, a 27-year-old male, with a Class I moderately crowded malocclusion, elected to undergo this new treatment option, due to the estimated reduction in treatment time. This case report shows one case of lower anterior crowding done using this technique. The total orthodontic treatment, from bracketing to debracketing, required exactly 6 months, with 12 orthodontic adjustments.

Osseous outgrowth on the buccal maxilla associated with piezosurgery-assisted en-masse retraction: A case series

Piezoelectric surgery is a novel surgical approach used in orthodontic treatment for rapid tooth movement. This paper presents a case series wherein osseous outgrowths were observed in response to piezosurgery-assisted en-masse retraction. Sixteen patients requiring upper premolar extractions were treated with miniscrew-supported en-masse retraction and received minimally invasive decortication via piezosurgery. Computed tomography (CT) of the maxillary anterior region was performed to investigate the nature of the outgrowths. In 8 of the 16 patients, hemispheric or disc-shaped osseous outgrowths were observed on the sites where piezosurgery was performed during retraction. CT images revealed that these outgrowths were alveolar bone. This case series presents a previously unreported osseous response to piezosurgery-assisted tooth movement during orthodontic treatment. The response is mostly transient and is observed in 50% of the treated patients, suggesting a bone turnover that can be assessed clinically and radiographically.

Effect of flapless osteoperforation-assisted tooth movement on atrophic alveolar ridge: Histomorphometric and gene-enrichment analysis.

To investigate the effect of flapless osteoperforation on the tissue response of the atrophic alveolar ridge affected by orthodontic tooth movement (OTM). An atrophic alveolar ridge model was established in the mandibular quadrants of eight beagle dogs. As a split-mouth design, the quadrants were randomly divided into group C (OTM only) and group OP (OTM with flapless osteoperforation). The rate of OTM for 10 weeks was compared between groups, and micro-CT-based histomorphometric analysis and RNA-sequencing-based gene-enrichment analysis were performed targeting the atrophic ridge. Group OP displayed more rapid tooth movement with lower bone mineral density and higher trabecular fraction in the atrophic ridge than did group C, showing no intergroup difference of total ridge volume. As contributing biological functional pathways in group OP, the genes related to osteoclast differentiation and TNF signaling pathway were up-regulated and those associated with Wnt signaling pathway and AMPK signaling pathway were down-regulated. Flapless osteoperforation facilitated the rate of OTM toward the atrophic ridge, maintaining low bone density, whereas it did not increase the volume of the atrophic ridge.

Efficiency of piezosurgery technique in miniscrew supported en-masse retraction: a single-centre, randomized controlled trial.

Piezoelectric surgery is a newly introduced technique for rapid tooth movement. However, the efficiency of this technique has not been investigated on en-masse retraction cases yet. To investigate the efficiency of piezosurgery technique in accelerating miniscrew supported en-masse retraction and study the biological tissue response. In addition, to show if this technique induces a difference in dental, skeletal and soft tissue changes on lateral cephalograms, and in canine and molar rotations, besides intercanine and intermolar widths on dental casts. We conducted a randomized, single-centred, parallel-group, controlled trial, requiring upper right and left first premolar extractions on 30 patients above the minimum age of 14 years at the beginning of retraction. Piezosurgery-assisted versus conventional en-masse retraction anchored from miniscrews placed between second premolars and first molars, bilaterally. The main outcome was the en-masse retraction rate. Secondary outcomes were gingival crevicular fluid (GCF) volume and GCF content of receptor activator of nuclear factor κβ ligand (RANKL), changes regarding cephalometric and dental cast variables, and miniscrew success rates. Accomplished with opaque, sealed envelopes. Applicable for data assessment only. Commenced in February 2013 and ended in October 2014. Thirty-one patients were included in the study and divided into 2 groups of piezosurgery (n = 16) and control (n = 15). After 9.3 months of follow-up, no statistically significant difference was observed between groups for neither retraction rates (P = 0.958) nor GCF parameters (P > 0.05). Changes in lateral cephalometric and dental cast variables, and miniscrew success rates did not show significant differences either. Based on the results of this study, piezosurgery technique was found to be ineffective in accelerating en-masse retraction, and promoting a difference in the studied GCF parameters, skeletal and dental variables. The trial was not registered. The full protocol of this PhD thesis study can be accessed from tez.yok.gov.tr. This work was supported by Başkent University Research Fund. No conflict of interest was declared.

Accelerating Tooth Movement: What Options We Have?

With a better understanding of the molecular and cellular basis of orthodontic tooth movement now the focus is on surgically assisted rapid tooth movement This requires the collective effort of orthodontists and periodontists Clinically corticotomies and osteotomies have been devised to fasten the orthodontic tooth movement OTM Besides these this article highlights various newer methods of enhancing the rate of tooth movement like low level laser therapy use of electric current periodontal tissue activation by vibration photobiomodulation Pulsed electromagnetic fields etc Recent research has shown that these methods effectively increase the rate of OTM

A Single Stage Surgically Facilitated Rapid Orthodontic Technique with Alveolar Bone Augmentation in the Treatment of Various Dental Malocclusions: Case Series

Background: Corticotomy when done on the bone over a root prominence can cause its demineralization, optimizing the response to applied orthodontic forces. This, when combined with augmentation of the alveolar bone can increase its volume and can also correct osseous dehiscences, and fenestrations over root surfaces. Here are cases that demonstrate the usefulness of periodontally accelerated orthodontic procedure in orthodontic treatment for the correction of various dental malocclusions. Materials and methods: Orthodontic tooth movement combined with elevation of full-thickness flap, selective decortication, and ostectomy of alveolar bone, followed by bone grafting to accomplish the desired complete orthodontic treatment. Results: The desired outcome of the PAOO as demonstrated by rapid tooth movement was observed in all the cases. Conclusion: An efficient and stable orthodontic tooth movement can be achieved with the periodotally accelerated osteogenic orthodontics technique. With this technique, the teeth can be moved in one third to one fourth the time required for traditional orthodontics alone. Maintaining an adequate blood supply is an essential element in this technique as this is a physiologically based treatment consistent with a regional acceleratory phenomenon.

Expression of collagen I, collagen III and MMP-1 on the tension side of distracted tooth using periodontal ligament distraction osteogenesis in beagle dogs

ObjectiveTo investigate the expression changes of collagen types I and III (Coll I and III) and matrix metalloproteinase-1 (MMP-1) in the periodontal ligament on the tension side of the distracted tooth using periodontal ligament distraction osteogenesis in beagle dogs. MethodsTwenty Beagle dogs were randomly divided into five groups of four dogs each according to their experimental periods. Dogs in each group were subjected to five days (T1), 10 days (T2), or 15 days (T3) of force loading, or 15 days of force loading with 10 days (T4) or 90 days (T5) of retention. For dogs in each group, the first premolar movement was achieved in the lower arch on one side (Exp) using periodontal distraction osteogenesis and on the other side (Con) using the conventional orthodontic method. The orthodontic movements of the first and third premolars in each group were measured at indicated time. Coll I and III expressions were determined by Picrosirius red staining and HE staining while MMP-1 expression was examined by immuno-histochemical staining. ResultsFifteen days of force loading resulted in faster movement of the first premolar on the Exp side, but no difference in the third premolar movements between the Exp and Con sides. Periodontal ligament tissue on the tension side was remodelled faster on the Exp side than on the Con side. The quality of the newly formed bone was acceptable. Coll III and MMP-1 in the periodontal ligament tissue reached a higher expression peak at an earlier time point on the Exp side than on the Con side. Significant difference also existed in the Coll I expression between the Exp and Con sides (P<0.05). During force loading, the Coll I expression first decreased and then increased on the Exp side, but increased continuously on the Con side. After 90 days’ retention, collagen expressions showed no significant difference between the two sides (P>0.05) and the expression level of MMP-1 returned to normal on the two sides. ConclusionRapid tooth movement accompanied with local upregulation of Coll I, Coll III, and MMP-1 was achieved in the early stage of periodontal distraction osteogenesis. The rapid tooth movement is in accordance with the physiological remodelling process.

Role of Periodontal Therapy in Rapid Tooth Movement

Periodontally accelerated osteogenic orthodontics (PAOO) or Wilckodontics is a clinical procedure that combines selective alveolar corticotomy, particulate bone grafting and the application of orthodontic forces. The most important factor in the success of PAOO is proper case selection and careful surgical and orthodontic treatment. An increasing amount of orthodontic patients seeking orthodontic treatment, make them prone to periodontal complications since their teeth are confined to the nonflexible alveolar bone. Interdisciplinary orthodontic treatment along with tissue engineering principles can create rapid orthodontic tooth movement as well as reducing side effects such as root resorption, relapse, inadequate basal bone and infection. Many of these challenging aspects facilitate the necessities of special concepts where PAOO technique opened doors and offered solutions to many limitation in orthodontic treatment. The aim of this article was to provide an overview of the literature including the historical background, indications, contraindication, the biological aspect of PAOO and the surgical technique and modifications of the same.

Rapid maxillary canine retraction by dental distraction: A clinical study.

Aim:The aim of this clinical study was to perform rapid maxillary canine retraction through distraction of the periodontal ligament and investigate the rate and amount of canine retraction, amount of anchor loss, the nature of tooth movement achieved, and radiographic changes in the periodontal ligament region during and after canine distraction.Materials and Methods:This study was conducted on 10 distractions ranging in age from 14 years to 25 years who needed canine retraction and first premolar extraction in the maxillary arch. Ten canine distractions were carried out with custom-made, tooth-borne intra-oral distraction device.Results:The results indicate that the periodontal ligament can be distracted just like the mid-palatal suture in rapid palatal expansion and the maxillary canines are retracted rapidly into the first premolar extraction space at the rate of about 2.53 mm/week.Conclusion:Though this study indicates that the periodontal ligament can be distracted to elicit rapid tooth movement, the long-term effects of canine distraction are not well known and need close monitoring.

Periodontally Assisted Osteogenic Orthodontic: Journey from Past to Present- a review

Now a days increasing number of adult patient come for Orthodontic treatment who wants their braces off as early as possible. Adults are more concerned about their aesthetics even with braces. To overcome this kind of psychological or psychosocial problem, new Orthodontic techniques have emerged to reduce treatment duration without compromising stability. There have been theories suggested by various authors for rapid tooth movement. One of such theories is periodontically accelerated osteogenic Orthodontics (PAOO) which is patented by Wilckodontics, which is said to harness the regional acceleratory phenomenon (RAP). PAOO technique definitely reduces treatment time than conventional orthodontic treatment. Studies also shows that, it increases alveolar bone thickness due to bone grafting, enhancing post orthodontic stability with lesser chances of root resorption.