CE - CSP:Accelerated Osteogenic Orthodontics

 

I attended the annual CSP (California Society of Periodontists) meeting on the weekend of 4/24/10. There was a lecture was on Wilckodontics by Thomas Wilcko. It is an accelerated form of orthodontic therapy that allows completion of treatment in 3-8 mos. vs. 18-24 mos for traditional orthodontic treatment. It combines the concept of alveolar decortication to induce “rapid bone turnover” to accelerate orthodontic movement and a ridge augmentation to increase or improve support after the movement is completed. This new form of orthodontic therapy is called Accelerated Osteogenic Orthodontics ™ or AOO.™

 The procedure itself is fairly straight forward from a surgical standpoint. Briefly, the cortex between the teeth is surgically injured by localized decortication. This results in a rapid remodeling process whereby the bone interproximally demineralizes making resistance to tooth movement easier. The orthodontist then takes advantage of the time window, when” the bone is soft,” to rapidly move the teeth into ideal position saving many months of treatment. At the time of the decortication, bone grafts are placed on the alveolar surfaces which then matures after the teeth are moved. The bone grafts calcify and act as “buttressing support” for the teeth in their new position which increases post-op stabilization. This could eliminate the need for “post-treatment retention.”

 Dr. Wilcko showed histologic and clinical documentation for the procedure and case studies demonstrating efficacy. The most interesting part of the presentation for me was not the increase in speed of treatment, though it is a clear advantage, but the ability to treat patients with this approach that would normally require much more aggressive surgical procedures. AOO allows an increase in the amount of tooth movement possible. The “envelope of movement” is increased by enlarging the envelope of bone through the ability to increase bone movement. This makes it possible to avoid some borderline orthognathic cases. Some patients who would normally require a much more traumatic and costly mandibular or maxillary advancement, could be treated with “AOO”. Because of the decrease in localized bone density and stimulating rapid bone turnover, AOO also allows movement of teeth that traditional orthodontics not be able to move. Finally, AOO has documented clearly superior results in the resistance to post-orthodontic relapse.

From a practical standpoint I think the advantage of being able to move teeth that traditional orthodontics have trouble moving because it allows more and easier movement is the most advantageous use of this treatment approach. Difficult movements such as intrusion, protraction and root rotation are examples of challenges in which AOO could benefit Orthodontic therapy.

 There was also a great review of the current status of hormone replacement therapy for women and new concepts in the role of hormone therapy in osteopenia and osteoporosis. There was a review bisphosphonate's and osteonecrosis. The good news is that there is a new drug that will get FDA