An Evidence-Based Analysis of Periodontally Accelerated Orthodontic and Osteogenic Techniques: A Synthesis of Scientific Perspectives

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.