Un commentaire sur : le mouvement orthodontique accéléré par stimulation ostéogénique du parodonte – une alternative clinique (original) (raw)
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Tissue reaction to orthodontic tooth movement--a new paradigm
The European Journal of Orthodontics, 2001
Direct or indirect resorption are both perceived as a reaction to an applied force. This is in contrast to orthopaedic surgeons who describe apposition as 'the reaction to loading of bone'. The article reviews the literature on intrusion of teeth with periodontal breakdown, and on the basis of clinical and experimental studies. The conclusion is reached that intrusion can lead to an improved attachment level, and that forces have to be to low and continuous. The tissue reaction to a force system generating translation of premolars and molars in the five Macaca fascicularis monkeys is described. Three force levels, 100, 200, and 300 cN were applied for a period of 11 weeks. Undecalcified serial sections were cut parallel to the occlusal plane and a grid consisting of three concentric outlines of the root intersected by six radii was placed on each section so that areas anticipated to be subject to differing stress/strain distributions were isolated. A posteriori tests were utilized in order to separate areas that differed with regard to parameters reflecting bone turnover. Based on these results and a finite element model simulating the loading, a new hypothesis regarding tissue reaction to change in the stress strain distribution generated by orthodontic forces is suggested. The direct resorption could be perceived as a result of lowering of the normal strain from the functioning periodontal ligament (PDL) and as such as a start of remodelling, in the bone biological sense of the word. Indirect remodelling could be perceived as sterile inflammation attempting to remove ischaemic bone under the hyalinized tissue. At a distance from the alveolus, dense woven bone was observed as a sign of a regional acceleratory phenomena (RAP). The results of the intrusion could, according to the new hypothesis, be perceived as bending of the alveolar wall produced by the pull from Sharpey's fibres.
Seminars in Orthodontics, 2008
Interdisciplinary orthodontic tooth movement (OTM) can synthesize tissue engineering principles with periodontal regenerative surgery to create rapid orthodontic tooth movement and reduce side effects like root resorption, relapse, inadequate basal bone, and bacterial time-load factors (ie, infection). Normal metabolism seen in a natural healing response is accelerated resulting in a more stable clinical outcome. Specifically, modern computed tomographic imaging suggests what were thought be "bony blocks" undergo demineralization both on the surface and within the alveolar bone proper (reversible osteopenia). Periodontal analysis shows that with demineralization the remaining collagenous soft tissue matrix of the bone is transported with the root in the direction of the movement. When retained in the desired position the matrix remineralizes demonstrating malleability of the alveolus previously thought to be unattainable. This natural demineralization-remineralization phenomenon appears fairly complete in adolescents albeit benignly less complete in adults. The new interpretation of the rapid movement as "bone matrix transportation" has made it possible to design a surgical approach, which permits extraction space closure in 3 to 4 weeks. This protocol allows conventional OTM 300% to 400% faster, increases the envelope of movement 2-to 3-fold and alveolar augmentation (periodontally accelerated osteogenic orthodontics or PAOO), and increases alveolar volume providing an alternative to bicuspid extraction. (Semin Orthod 2008;14:305-316.)
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.
Biology of the Alveolar Bone: Orthodontic Tissue Regeneration (OTR)
Today the treatment of adult patients with complex dental problems often requires an interdisciplinary collaboration between different specialties of dental medicine among them frequently orthodontics: interdisciplinary orthodontics. The advancements in material science, biomechanics and in understanding the biology of the alveolar bone led to improved treatments of cases that once seem to be hopeless. The orthodontist, the surgeon and the periodontist work on the same biological substrate: the alveolar bone. Lack of alveolar bone support is probably the most common and challenging dilemma confronting this interdisciplinary team. The paper will discuss and evaluate periodontal lesions like bone dehiscence or fenestration, age-related changes of the bone, the lag time, special biomechanical considerations and the effect of intrusion and extrusion of teeth in patients with periodontal disease. The orthodontic tooth movement, even in vertical or horizontal plane, has a great osteogenic...
Australian orthodontic journal
There has been a revival of interest in the acceleration of orthodontic tooth movement (OTM) by inducing injury to dentoalveolar cortical bone. Termed corticotomy, the procedure offers an advantage to adult patients whose bone metabolism is such that any reduction in treatment time would be welcomed. The procedure has been refined for over 100 years and recent research indicates treatment duration may be reduced often by as much as a third, but it is not clear how widely the method is applied in practice. For the procedure to be successful, careful interdisciplinary management by orthodontists and periodontists is required. However, information regarding the attitude and knowledge of practitioners and the frequency of the procedure performed in Australia and New Zealand is lacking. A questionnaire was formulated and tested in a pilot study on postgraduate orthodontic and periodontic students at The University of Adelaide. As a consequence of the responses, the wording of several que...
European Journal of Oral Sciences, 2010
Norway 8 ALP Alkaline phosphatase Bax Bcl-2-associated X protein (a pro-apoptotic regulator) Bcl-2 B-cell lymphoma 2 (an apoptotic inhibitor) BMP Bone morphogenic protein BMU Bone multi-cellular units BSA Bovine serum albumin BSP Bone sialoprotein Cbfa1 Core-binding factor alpha 1 CD Cluster of differentiation CF Continuous compressive force c-fms Colony-stimulating factor 1 receptor Col 1 Type I collagen CGRP Calcitonin gene-related peptide EDTA Ethylenediaminetetraacetic acid ELISA Enzyme-linked immunoassay FCS Fetal calf serum FGF-2 Fibroblast growth factor-2 GAPDH Glyceraldehyde-3-phosphate dehydrogenase GCF Gingival crevicular fluid HOB Primary human osteoblast-like cell List of publications This thesis is based on the following articles:
Indian Journal of Orthodontics and Dentofacial Research, 2019
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<0.001). Group II had a mean retraction of 7.07 ± 0.35 mm (p<0.001) after 3 months. CBCT showed a statistically significant increase in bone density in the both PAOO group with surgical bur and peizocision 12 months after the surgery. Root resorption was negligible in Periodontally Accelerated Osteogenic Orthodontic (PAOO) with surgical bur (0.34mm) as compared to PAOO with peizocision (0.51mm). 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 was seen in the post-operative CBCT.
Cureus
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.
The Angle orthodontist, 2017
To evaluate the effect of corticotomy and corticision, with and without a full mucoperiosteal flap, on the rate of tooth movement and alveolar response in a rat model. Sixty male, 6-week-old Wistar rats were divided into five groups based on surgical procedure, as follows: control (no tooth movement), orthodontic tooth movement (OTM) only, corticotomy, corticision, and corticision with full mucoperiosteal flap (corticision + flap). A force of 10-15g was applied from the maxillary left first molar to the maxillary incisors using nickel-titanium springs. Surgery was performed at the time of appliance placement (day 0), and tooth movement occurred for 21 days. Micro-computed tomography was performed on day 21 to evaluate the amount of tooth movement and alveolar bone parameters. Histomorphometry, including tartrate-resistant acid phosphatase staining, was performed to quantify the osteoclast parameters at day 21. No statistical differences in the amount of OTM, bone volume fraction, an...