Cone beam computed tomography of bone dimensions in periodontally accelerated osteogenic orthodontics: A retrospective study

BACKGROUND: Periodontally accelerated osteogenic orthodontics (PAOO) or surgically facilitated orthodontics involves corticotomies and bone grafts during orthodontic treatment. It aims to enhance the range and rate of tooth movement and improve alveolar bone dimension and gingival architecture. Limited evidence exists on bone dimension changes due to PAOO. This retrospective study assesses PAOO's effects on alveolar bone thickness. METHODS: Patient records from 15 arches treated with PAOO were compared to 15 age and sex-matched control arches treated without PAOO. Pre- and post-orthodontic cone-beam computed tomography images measured radicular bone thickness at central and lateral incisors in sagittal sections at 3, 6, 9, and 12 mm from the cemento-enamel junction (CEJ). The vertical distance of crestal bone from CEJ was also measured. Fenestrations or dehiscence were quantified on buccal root surface cross-sections. RESULTS: Of the 15 PAOO-treated arches, 10 were augmented on the compression side of tooth movement, while five were augmented on the tension side. In cases augmented on the compression side, the PAOO group showed a significant increase in the buccal radicular bone at 3, 6, and 9 mm from the CEJ. A significant loss in lingual crestal bone height was observed in the PAOO group. Additionally, there was a significant reduction in fenestrations and dehiscence in the PAOO group. CONCLUSIONS: Within our study's limitations, results suggest that PAOO increases alveolar bone thickness and reduces fenestration and dehiscence incidence when performed on the compression side of orthodontic movement. However, it is associated with lingual crestal bone loss. Further prospective studies with standardized protocols are needed to better define PAOO's efficacy. KEY POINTS: Periodontally accelerated osteogenic orthodontics (PAOO) increases the thickness of alveolar bone when performed on the compression side of the orthodontic tooth movement. PAOO may prevent alveolar fenestrations and dehiscence of root surfaces after orthodontic treatment. PAOO may reduce orthodontic treatment time in select cases. PLAIN LANGUAGE SUMMARY: With an improved awareness of dental esthetics and function, an increased number of adult individuals are seeking orthodontic therapy. Adult patients present with unique challenges for the treating orthodontist such as extensive restorative work, missing teeth, thin alveolar bone, and thin gingival tissues. This might result in increased recession, bone loss and fenestration, and dehiscence. Periodontally accelerated osteogenic orthodontics (PAOO) allows for quicker tooth movement, as well as increasing alveolar bone thickness to prevent subsequent hard and soft tissue deficiencies. In this retrospective study, we compared the effects of orthodontic treatment completed with and without PAOO on alveolar bone thickness. Our findings demonstrated increased bone thickness and a decrease in the incidence of fenestration and dehiscence in the PAOO group. The crestal bone height remained the same on the buccal, but there was a significant loss of vertical bone on the palatal side of the root in the PAOO group. Trends were seen of more tooth movement in the PAOO group and a reduction in treatment time. Further research is needed to reduce sample inconsistency and standardize the PAOO technique.