implants - international magazine of oral implantology

special _ orthodontics I especially, efficient interdisciplinary collaboration may result in a great benefit for the patients.5–12 Periodontally accelerated orthodontic move- ment, as described by Wilcko, appears particularly feasible in those multidisciplinary cases for which treatment planning requires orthodontic move- mentandoralorperiodontalsurgery.Inthesecases, corticotomy can be combined with wisdom tooth extraction and/or a regenerative technique, such as guided bone regeneration (GBR), in order to avoid multiple surgeries. Recently some orthodon- tic therapies, especially the so-called low-friction therapies, have demonstrated clinically and radi- ographically that it is possible to expand dental archeswithoutinterferingwithperiodontalhealth, by augmenting the alveolar bones. Melsen et al.13 confirmedwhatwaspreviouslysuggested,thatthe tooth will move with the bone and not in bone, es- pecially when light orthodontic forces are applied. Dehiscence and fenestration, which are difficult to diagnosepreoperatively,mayrepresentalimitation ofthistechnique.Sincethetoothwillmovewiththe periodontium, in cases in which the periodontium is not present, we might create recession and at- tachment loss.14 A recent study on modern Ameri- can skulls found that a dehiscence was present in 40.4% of the skulls, and a fenestration was present in61.6%ofskulls.15 Ifthisdataistranslatedinclin- icaltreatment,itmaymeanthatpotentiallyatleast 50% of orthodontic patients undergoing expand- ing movement could be at risk of gingival recession and periodontal damage. It would be advisable, then, to introduce routine 3-D X-rays into the pre- operativework-up(i.e.conebeam).Thecone-beam examination,withareduceddoseofradiationcom- pared with the fan beam (CT scan) and better defi- nition,16 could be used routinely in those patients with a thin, scalloped periodontium, where the risk of post-operative recessions is higher. The PAOO technique has been found not only to be pre- dictable in solving dehiscence and fenestration above the roots,17 but also to produce a noticeable change in the cephalometric analysis of points A and B.17 With the PAOO technique, the patient needs to be seen routinely for changing the wires, as the teeth movements are much faster than in regularorthodontictreatment.Theuseofsegmen- tal corticotomy (applied only to the teeth that have to move more than the others) can dramatically changetherelationshipamongstgroupsofteeth.18 This has to be kept in mind, since it may require changes in distributing the anchorage by the or- thodontist. The teeth in the area of surgery will be moving much faster than the other teeth. _Conclusions When the treatment plan requires orthodontic movementandoralorperiodontalsurgery,cortico- tomy can be combined with a wisdom tooth ex- traction and/or a regenerative technique, such as GBR,inordertoavoidmultiplesurgeriesandtoop- timise the final outcome for the patient. Another indication is for instances in which the risk of cre- ating root dehiscence in patients with thin peri- odontium is very high even with slow orthodontic movement and light forces applied. Root recession can be present even without clinical manifestation of gingival recession. An efficient multidisciplinary approach to a complex case may result in a faster and better treatment. The PAOO technique can be used for faster dental movement, to treat and pre- vent periodontal problems and to regenerate ridge defects, allowing implant placement._ Editorialnote:Alistofreferencesisavailablefromthepub- lisher. I 19implants2_2011 Federico Brugnami,DDS Piazza dei prati degli Strozzi 21 00195 Roma,Italy Tel.:+39 06 39730191 Fax:+39 06 39730195 fbrugnami@gmail.com Alfonso Caiazzo,DDS Private Practice,Salerno,Italy _contact implants Fig. 5Fig. 4 Fig. 4_At the time of implant placement a corticotomy was performed to accelerate the orthodontic movement and facilitate the implant restoration. Regeneration with a first layer of autologous graft collected during site preparartion, covered with xenograft and a re- sorbable membrane (Endobone and Osseoguard, Biomet 3i, Palm Beach Gardens, USA) was performed simul- taneosuly to the placement. Fig. 5_Provisional restoration in place.