Download Periodontally Accelerated Osteogenic Orthodontics.

Periodontally Accelerated
Osteogenic Orthodontics.
Female, 35yrs; 9 months appliances, Bicuspid extraction.
Note integrity of recession sites post treatment.
Pre-treatment, generalized of Periodontitis, in posterior segments.
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Teenager, less than 6 months in appliances
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Above: Pre treatment
Below: Post treatment
Note: dehiscences fenestrations
Treatment time: 7-8 months.
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Indications for PAOO!
Pre-treatment, above,
soft tissues look great.
After flap reflection,
look closely!
A disaster waiting to
happen!!!
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Pre-treatment on the left, Posttreatment on the right
6 months of treatment time
Note dehiscences pre-grafting.
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Above: #8/9 Ankylosed. Patient in appliances for 3 years.
Below: 3 months foll0wing PAOO treatment
Note the risk of completing orthodontic treatment in these
sites with deep dehiscences.
Bone grafting, achieved through the use of the
PAO technique reduces the risk of future severe recession
problems.
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Risk factors
associated with
conventional
orthodontics.
These cases represent extreme complications, but are
inserted to make a
point
Gingival Recession
Apical Root Resorption
Plus
Gingival Recession
2006
2007
2008
?Etiology
Relapse,
Decalcification,
Frenum,
Local Recession.
Example of a high risk patient both wanting
and needing orthodontic treatment.
Risk factors include:
Gingival recession
Crowded mandibular anterior teeth.
Root proximity problems, and thus thin interdental
bone
Periodontitis in all posterior teeth (6-8mm probing )
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“Why
PAOO (Wilckodontics) should be a routine part of
Periodontal/Orthodontic practice!”
Colin Richman DMD
Periodontics and Dental Implants
[email protected] - 404/784-7272;
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Pre-treatment narrative
Note the quality and quantity of attached tissue in this crowded, class 1 case, suggesting
adequate facial alveolar bone.
However, at the time of PAO surgery, I was surprised to note the extent of facial
dehiscences/fenestrations present.
These lesions where treated according to classic PAO principles, including cortical
perforations and hard and soft tissue grafting.
Legend
Page 1.
Upper left/right images: Pre-orthodontic, pre PAOO treatment.
Middle left and right images: PAO surgery, with simultaneous initiation of
Orthodontic treatment.
Page 2.
Left side: Pre-treatment images.
Right side: 2 weeks post surgery with 2 weeks concurrent post-initiation of orthodontic
forces.
Note the amount of mandibular tooth movement, and arch unraveling in the
upper images,
Note the amount of space closure of the maxillary molar-bicuspid site, (lower images).
The benefits of PAO treatment for this patient will include:
(a) Less Risk of Post Orthodontic gingival recession and subsequent
Cervical Abrasion (NCCL)
(b) Greater Post Orthodontic Stability and Retention
(c) Accelerated treatment time - 60-70%
(d) Less Risk of Root resorption and less risk of an unfavorable
crown to root ratio.
Colin Richman DMD
Periodontics and Dental Implants
[email protected] - 404/784-7272;
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Colin Richman DMD
Periodontics and Dental Implants
[email protected] - 404/784-7272;
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Above: Root surface and bone preparation with perioosteal
fenestrations.
Middle: Grafting with Bio-Oss and DFDBA.
Below: Two weeks Post-surgery.
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