Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
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.
wit
Teenager, less than 6 months in appliances
bel
Above: Pre treatment Below: Post treatment Note: dehiscences fenestrations Treatment time: 7-8 months.
thu
Indications for PAOO!Pre-treatment, above, soft tissues look great. After flap reflection, look closely! A disaster waiting to happen!!!
ros
odo
Pre-treatment on the left, Post-treatment on the right 6 months of treatment time Note dehiscences pre-grafting.
Above: #8/9 Ankylosed. Patient in appliances for 3 years. Below: 3 months foll0wing PAOO treatment
dav
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.
Risk factors associated with
conventional orthodontics.
These cases repre-sent extreme com-plications, but are inserted to make a
point
Gingival Recession
Apical Root Resorption Plus
Gingival Recession
2006 2007 2008
??EtiologyEtiology
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 )
1
1
“Why PAOO (Wilckodontics) should be a routine part of
Periodontal/Orthodontic practice!”
Colin Richman DMD Periodontics and Dental Implants
[email protected] - 404/784-7272;
2
2
Colin Richman DMD Periodontics and Dental Implants
[email protected] - 404/784-7272;
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.
4
4
Above: Root surface and bone preparation with perioosteal fenestrations. Middle: Grafting with Bio-Oss and DFDBA. Below: Two weeks Post-surgery.