Orthodontically Driven Osteogenesis E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 540

Veröffentlichungsjahr: 2024

Beschreibung

A fully updated new edition of this state-of-the art reference for improving orthodontic outcomes

Orthodontically Driven Osteogenesis, Second Edition, offers a cutting-edge and comprehensive overview of regenerative corticotomy surgical techniques and their applications to dental practice. Covering all aspects of incorporating these techniques, the book includes information on selecting treatment options, improving orthodontic efficiency, and minimizing surgical exposure, with detailed step-by-step surgical techniques. The Second Edition has been rewritten with a new focus on 3D treatment planning and clear aligners, adding chapters completely dedicated to digitalization, minimally invasive tunnel technique, and orthognathic surgery, in addition to updates and new advances throughout.

Chapters are written by leading experts in the field, offering an authoritative, comprehensive resource with hundreds of high-quality images. A companion website provides video clips, the figures from the book in PowerPoint, and tables. Readers of the Second Edition of Orthodontically Driven Osteogenesis will also find:

• A new emphasis on digitalization, 3D planning, and clear aligner therapy
• Discussions of the process of selecting treatment options, improving orthodontic efficiency, and minimizing surgical exposure with a very strong emphasis on the osteogenic abilities of the technique
• Brand-new chapters on tunnel regenerative corticotomy and orthognathic surgery, as well as a new treatment of digitalization, 3D planning, and clear aligners
• A companion website with video clips, downloadable figures, and more

Orthodontically Driven Osteogenesis is ideal for orthodontists, periodontists, oral surgeons, and other general dentists with an interest in this topic.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright Page

Dedication Page

List of Contributors

Introduction

Orthodontically Driven Osteogenesis and 3D Digital Planning: New vs Innovation

1 Orthodontic Tissue Engineering: A 20‐Year Retrospective and Philosophical Polemic

©

Dedication

Introductory Rationale

Topical Issues

Conceptual Foundation Through Historical Evolution

21st Century Pioneers

Papillary Slough as a Troubling Complication

Managing Periodontal Infection

Oral Hygiene – A Pragmatic Imperative

Enhanced Bass Technique

Effective Oral Health Techniques

A Heretical Dehiscence Theory

How Fast is “Fast”? – A 4‐Day Treatment

Conclusions

Afterword for Academic Leaders

Acknowledgments

References

Recommended Reading

2 From Acceleration to Osteogenesis

Accelerated Tooth Movement

Corticotomy

Accelerated Tooth Movement in Laboratory Animals

Accelerated Tooth Movement in the Canine Laboratory Model

Tooth Movement Paradigms: PDL Cell‐Mediated versus Spongiosa Osteopenia

From Corticotomy to Grafting with Decortication (From Acceleration to Osteogenesis)

Histologic and Long‐Term CBCT Evaluation

Conclusions

Acknowledgments

References

3 From Corticotomy to Orthodontically Driven Osteogenesis: Surgical Considerations

Introduction

Historical Background

Biophysiologic Considerations

Indications for SAD or Corticotomy Alone

Contraindications

Advantages

Surgical Technique

Single Flap Regenerative Corticotomy (SFRC)

Tunnel Regenerative Corticotomy (TURC)

Conclusions

Acknowledgments

References

4 Orthodontically Driven Osteogenesis (ODO) Indications and Applications in Orthodontics

Introduction

The Basic Concepts

Orthodontic Implications of Bone Injury: The RAP

From Corticotomy to Grafting with Decortication

Practical Applications and Indications

Maximizing the Window of Opportunity

Contraindications

Applications

Decortication Procedures with Clear Aligners

Interprofessional Communication

Conclusion

Cases Presentation

3D Digital Planning and Clear Aligner Treatment

Conclusion

Acknowledgments

References

5 Three‐dimensional Digital Planning of Orthodontic Treatment

Introduction

Virtual Orthodontic Treatment

Potential of Virtual Three‐dimensional

Traditional Versus Printing Technology

Imaging

Digital Models

Virtual Three‐dimensional Orthodontic Planning Models

Integration of CBCT Into the Digital Orthodontic Treatment Flow

“ClinCheck” and CBCT Integration as a Planning Tool for ODO

References

6 From Orthodontically Driven Corticotomy to Orthodontically Driven Osteogenesis: Tissue Engineering to Enhance Orthodontic Treatment, Guided by the Orthodontist

Introduction

Surgical Techniques: The Beginning of Tissue Engineering in Orthodontics

Surgical Strategies: Single Flap Corticotomy (SFC) and Tunnel Regenerative Corticotomy (TURC)

The Concept of Orthodontically Driven Corticotomy (ODC): From ODC to ODO

Case Presentation

Conclusions

References

7 Orthodontic Treatment and Periodontal Side Effects

Introduction

Radiographic Evaluation of Orthodontic Side Effects

Research Experience

Results

Conclusions

Dehiscences and Fenestrations

Indications of Use for ODO

Case Presentation

Conclusions and Recommendations

Acknowledgments

References

8 Orthodontically Driven Osteogenesis: Tissue Engineering to Enhance Adult and Multidisciplinary Treatment

ODO in Multidisciplinary Treatment

Orthodontics for Prosthetic

Periodontics and Orthodontics Synergy: The Two Dental Specialties that Need a Healthy Periodontium

Case Presentation

Conclusions

References

9 Clear Aligners and Orthodontically Driven Osteogenesis:

Introduction

Birth and Development of the Invisalign Technique

Treatment Phases and Characteristics Peculiar to the Invisalign System

®

Advantages of the Invisalign System

Regenerative Corticotomy and Bone Engineering in Orthodontics with a Digital Approach

Orthodontics and Its “Limitations”

Orthodontically Driven Osteogenesis in Orthodontic Treatment Planning

Presentation of Clinical Cases

Conclusions

Modifying the Lower Third of the Face

References

10 Orthognathic Surgery and Orthodontically Driven Osteogenesis

Introduction

Diagnosis and Treatment Planning

Therapy Protocol

Discussion

Conclusions

References

11 Understanding the Etiological Relationship Between Orthodontic Tooth Crowding and Mucogingival Pathologies, “Big Teeth in Small Jaws”

Introduction

Vasculature of the Gingival Tissues

The Clinical Significance of Dehiscences and Fenestrations

Tooth Eruption Patterns

Consequences and Management Strategies, Including

Phenotype Modification

References

Index

End User License Agreement

List of Tables

Chapter 2

Table 2.1 Tooth movement following alveolar decortication injury is represe...

Table 2.2 Five investigations of tooth movement following alveolar decortica...

Table 2.3 Tooth movement data were extracted and collated from five investig...

Table 2.4 Results of Wilcoxon signed‐rank testing for paired samples for al...

Table 2.5 Results of Wilcoxon signed‐rank testing for paired samples for all...

Chapter 6

Table 6.1 Surgical approach available for segmental/sequential approaches i...

Chapter 7

Table 7.1 Central: thickness at T0 0.69 ± 0.22 and at T1 2.02 ± 0.41.

Table 7.2 Lateral: thickness at T0 0.59 ± 0.23 and at T1 1.76 ± 0.40.

Table 7.3 Canine: thickness at T0 0.54 ± 0.28 and at T1 1.52 ± 0.21.

List of Illustrations

Chapter 1

Figure 1.1 This treatment demonstrates what can be done to correct a deforme...

Figure 1.2 Phenotype development and recapitulating regional ontogeny in the...

Figure 1.3 This figure is intended to demonstrate the entire load dissipatio...

Figure 1.4 (a) The Max‐2000

®

appliance demonstrated here uses two acryl...

Figure 1.5 Here, shallow, diffusely located, and bloodless (arrows) “divots”...

Figure 1.6 Kole contrasted his technique with more morbid prior attempts to ...

Figure 1.7 Corticision is the use of transmucosal incisions into the bony al...

Figure 1.8 The case of patient X demonstrates that sequential PAOO protocols...

Figure 1.9 Sections of bone in various stages of porosity, C1 normal, C2 ost...

Figure 1.10 (a) The classic Victorian profile of Apollo Belvedere, unfortuna...

Figure 1.11 Beauty may be somewhat “in the eye of the beholder,” but it also...

Figure 1.12 Even when a midline discrepancy (a) is obvious, a generous displ...

Figure 1.13 The retrusive lower face due to injudicious dental extraction be...

Figure 1.14 The “Ferguson New Limits of Tooth Movement” revises the Proffitt...

Figure 1.15 This cross section of a long bone demonstrates how bone is resha...

Figure 1.16 This is a theoretical representation of a cell membrane mechanic...

Figure 1.17 The mechanosome network is displayed here by Bidwell and Pavalko...

Figure 1.18 (a) Applications of EV in OTE: The isolated EV filtrate (a) is e...

Figure 1.19 This demonstrates the original (2005) method of transmucosal alv...

Figure 1.20 If a papillary slough opens gingival embrasures, black triangula...

Figure 1.21 This demonstrates that papillary integrity (black Arrow) can als...

Figure 1.22 (a) Flap reflection reveals a massive infrabony defect at tooth ...

Figure 1.23 This is the predictable appearance of the fully developed alveol...

Figure 1.24 This image illustrates how copious bone can be created

de novo

w...

Figure 1.25 An end‐tuft toothbrush (ETB) and the enhanced Bass brushing tech...

Figure 1.26 Keratinized‐stratified squamous epithelium of the marginal gingi...

Figure 1.27 The effective debridement maintenance consists of three parts. (...

Figure 1.28 Properly loaded, the ETB (from Sunstar Americas, Inc. Schaumburg...

Figure 1.29 Conducted properly this flossing method with a Platypus

®

Or...

Figure 1.30 (a) The Red Patch of Atherton (arrow) represents a sulcular

ever

...

Figure 1.31 (a) This patient presented with moderate mandibular arch length ...

Chapter 2

Figure 2.1 Cho (2007) used 150‐g Ni–Ti closed coil springs placed 4 weeks af...

Figure 2.2 Iino

et al

. (2007) orthodontic appliance comprised of 1.0 mm wire...

Figure 2.3 Mostafa

et al

. (2009) moved maxillary first premolars (P1) distal...

Figure 2.4 Sanjideh

et al

. (2010) (a) moved maxillary third premolars (P3) m...

Figures 2.5 and 2.6 Safavi

et al

. (2012) protracted maxillary and mandibular...

Figure 2.7 Results of pooled data analysis demonstrate accumulation (in mill...

Figure 2.8 Preoperative record of a Class III surgical patient previously tr...

Figure 2.9 Postoperative records of the same patient. Note the movement of t...

Figure 2.10 CBCT pre and post op sections of a patient treated with ODO. Not...

Figure 2.11 Measurements in a patient treated with corticotomy and bone graf...

Figure 2.12 Measurements in patient treated with corticotomy alone

Figure 2.13 Orthognatic patient treated with ODO during decompensation. Note...

Figure 2.14 Same Patient. Frontal view.

Figure 2.15 CCBT preop and postop. Note augmentation.

Figure 2.16 Detail of teleradiography.

Figure 2.17 CBCT at the end of treatment.

Figure 2.18 Reentry of area previously treated with ODO. The surgeon had to ...

Figure 2.19 The histology resulted in viable bone, with particles of the ori...

Figure 2.20 A CBCT follow‐up was conducted 11 years after ODO, as the patien...

Chapter 3

Figure 3.1 (a) A sulcular incision has been made around the necks of the ind...

Figure 3.2 A full thickness mucoperiosteal flap has been reflected exposing ...

Figure 3.3 (a) Any appropriate rear‐vented handpiece and surgical/dental bit...

Figure 3.4 When indicated, bone grafting of the alveolus is performed with p...

Figure 3.5 31 year‐old female Class I malocclusion with inferior bilateral s...

Figure 3.6 Surgical procedure performed in a segmental SFC fashion. (a) Flap...

Figure 3.7 Case completed in 6 months of treatment. (a) Facial view finals f...

Figure 3.8 3D reconstruction 6 months after surgery. Presence of grafting ma...

Figure 3.9 (a) Complete mobilization of the mucogingival complex. (b) Decort...

Figure 3.10 (a–f) Intraoral view of 13 year old patient with severe crowding...

Figure 3.11 (a) Initial bonding in the upper arch. (b) Palatal expansion wit...

Figure 3.12 (a, b) Segmental tunnel regenerative corticotomy in the poster q...

Figure 3.13 Frontal view 3 weeks after upper surgery. the patient was bonded...

Figure 3.14 Preoperative view of the lower incisor area, where extremely thi...

Figure 3.15 (a, b) Positioning of the membrane through the vertical anterior...

Figure 3.16 (a) Preoperative view of paraxial slice in the canine area (lowe...

Figure 3.17 Postoperative panorex.

Figure 3.18 (a–e) Final intraoral view showing resolution of crowding in the...

Figure 3.19 (a–f) Extraoral view of the patient.

Figure 3.20 (a) Sagittal view at the molar area before treatment. (b) Sagitt...

Chapter 4

Figure 4.1 Demonstrates a series of selective alveolar decortication techniq...

Figure 4.2 Refinements of SAD engineered to augment the mass of the alveolus...

Figure 4.3 (a–e) Gingival recessions of various degrees in orthodontically t...

Figure 4.4 Significant augmentation of alveolus bone may be achieved by movi...

Figure 4.5 Lower facial profiles and labiomental folds may be profoundly imp...

Figure 4.6 Lower third facial improvement with ODO in the maxilla.

Figure 4.7 The patient presents a Class I case of severe arch length deficie...

Figure 4.8 Here, at the first active orthodontic appointment an initial leve...

Figure 4.9 After the bonding and initial archwires are placed, surgery comme...

Figure 4.10 The palatal incision extends from tuberosity to tuberosity a sty...

Figure 4.11 Alveolar decortication is achieved here with a surgical length, ...

Figure 4.12 (a–c) A hybrid bone graft is placed on the buccal and palatal as...

Figure 4.13 (a–e) Alveolar decortication is performed on the lingual and buc...

Figure 4.14 (a–c) Bone grafting is demonstrated here for mandibular dental a...

Figure 4.15 (a) The graft placement completely fills the space between the d...

Figure 4.16 At 1‐month 0.016

″

 × 0.022

″

stainless steel overlay a...

Figure 4.17 At 2 months orthodontic follow‐up shows that the overlay wire wa...

Figure 4.18 By 3 months the case demonstrates 0.017

″

 × 0.025

″

ni...

Figure 4.19 At 3.5 months the orthodontic care demonstrates 0.016

″

 × 0...

Figure 4.20 At month 4.5 the maxillary archwire was sectioned between the ma...

Figure 4.21 At 5 months double box‐elastic modules were added on the right s...

Figure 4.22 At 6 months arch coordination is complete but interarch spaces a...

Figure 4.23 At the 7‐month follow‐up appointment the previous sectioned arch...

Figure 4.24 At 8 months the patient was debonded and fixed intercanine retai...

Figure 4.25 The final intraoral and extraoral composite pictures demonstrate...

Figure 4.26 Here in Case #2 a young adult female presented with Class I skel...

Figure 4.27 The patient was bonded with ideal orthodontic bracket positions ...

Figure 4.28 At the 1‐month follow‐up appointment an elastic chain was applie...

Figure 4.29 At 2 months an advancing maxillary overlay 0.0018

″

wire is...

Figure 4.30 At 4.5 months one sees 0.017

″

 × 0.025: nickel–titanium arc...

Figure 4.31 At 5 months 0.016 × 0.022

″

nickel–titanium archwires were ...

Figure 4.32 At 6 months the case is coming to completion as individual adjus...

Figure 4.33 By the 7th month the maxillary left canine is disengaged. The pr...

Figure 4.34 Case completed in 8 months and 18 appointments, with no extracti...

Figure 4.35 Pretreatment extra oral view.

Figure 4.36 Pretreatment OPT.

Figure 4.37 Pretreatment extra oral view 3/4 pics.

Figure 4.38 Pre‐treatment lateral right, the left photo shows convexity in t...

Figure 4.39 Pretreatment submental extra oral view.

Figure 4.40 Intraoral view with details of deterred periodontal condition, w...

Figure 4.41 Initial radiographic documentation.

Figure 4.42 Pretreatment digital rendering of the symphysis area.

Figure 4.43 Pretreatment digital rendering of the symphysis area.

Figure 4. 44 (a) Pretreatment digital rendering of maxillary lateral sector....

Figure 4.45 3D digital planning. Initial phase.

Figure 4.46 (a) Pretreatment digital rendering. (b) Cross‐sectional of the l...

Figure 4.47 3D digital planning with planned results.

Figure 4.48 3D digital planning with planned results frontal final view.

Figure 4.49 3D digital planning with planned results final 3/4 view.

Figure 4.50 3D digital planning with planned results: final right lateral vi...

Figure 4.51 3D digital planning with planned results: final left lateral vie...

Figure 4.52 3D digital planning with planned results intraoral final view 1/...

Figure 4.53 3D digital planning with planned results intraoral final view 2/...

Figure 4.54 3D digital planning with planned results final resume.

Figure 4.55 Extra oral final 3/4 smiling view.

Figure 4.56 Bone generated area in upper C.B.C.T. final – 3D rendering and s...

Figure 4.57 Bone generated area in lower C.B.C.T. final – 3D rendering and s...

Figure 4.58 Comparison pre and post ODO, upper C.B.C.T. – 3D rendering and s...

Figure 4.59 Comparison pre and post ODO, lower C.B.C.T. – 3D rendering and s...

Figure 4.60 Post‐ODO: C.B.C.T. upper buccal view (Digital Rendering).

Figure 4.61 Post‐ODO: C.B.C.T. lower buccal view (Digital Rendering).

Figure 4.62 Post‐ODO: C.B.C.T. lower lingual view (Digital Rendering).

Figure 4.63 Post‐ODO: lingual view (Digital Rendering).

Figure 4.64 3D Rendering Digital Oral Scan Buccal view. Arrows indicating Os...

Figure 4.65 3D Rendering Digital Oral Scan. Lingual view. Arrows indicating ...

Figure 4.66 Starting case.

Figure 4.67 Extra oral 3/4 pics.

Figure 4.68 Lateral right, with normal profile.

Figure 4.69 Lateral left, with normal profile.

Figure 4.70 Intra oral smile; lower crowding and upper arch with dental disc...

Figure 4.71 Intra oral smile; Angle first class with lower crowding and narr...

Figure 4.72 Lip competence.

Figure 4.73 Increased OVJ.

Figure 4.74 Cephalometry.

Figure 4.75 Model's measurements.

Figure 4.76 Initial Radiographic Documentation.

Figure 4.77 Starting 3D Digital Planning.

Figure 4.78 3D Digital Planning final result's project.

Figure 4.79 Pre‐ODO, Upper Buccal review (Digital Rendering).

Figure 4.80 Pre‐ODO, Lower Buccal review (Digital Rendering).

Figure 4.81 Pre‐ODO, (#3.2) cross sectional on the right (Digital Rendering)...

Figure 4.82 Pre‐ODO, (#4.2) cross sectional on the right (Digital Rendering)...

Figure 4.83 3D Digital Planning with result obtained.

Figure 4.84 Frontal final view.

Figure 4.85 Final 3/4 view.

Figure 4.86 Final right lateral view.

Figure 4.87 Final left lateral view.

Figure 4.88 Intraoral final view 1/2.

Figure 4.89 Intraoral final view 2/2.

Figure 4.90 Final OVJ.

Figure 4.91 Final 3/4 smiling view.

Figure 4.92 Final patient’s happiness.

Figure 4.93 1st year radiological follow‐up.

Figure 4.94 2nd year follow‐up frontal view.

Figure 4.95 2nd year follow‐up right 3/4 view.

Figure 4.96 2nd year follow‐up right lateral view.

Figure 4.97 2nd year follow‐up left 3/4 view.

Figure 4.98 2nd year follow‐up left lateral view.

Figure 4.99 2nd year intraoral follow‐up view 1/2.

Figure 4.100 2nd year intraoral follow‐up view 2/2.

Figure 4.101 2nd year follow‐up lips and over‐jet.

Chapter 5

Figure 5.1 Orthodontic case with initial diagnostic data collection.

Figure 5.2 Image of a pair of aligners.

Figure 5.3 Final set‐up of virtual orthodontic correction programming.

Figure 5.4 Easy‐to‐use intraoral scanner in their daily use and dental workf...

Figure 5.5 Virtual face reconstruction in digital programming in maxillofaci...

Figure 5.6 Virtual digital models with arch displacement analysis.

Figure 5.7 Virtual digital models with analysis of transverse diameters.

Figure 5.8 Integration of CBCT into ClinCheck software.

Figure 5.9 The virtual orthodontic programming simulation software ClinCheck...

Figure 5.10 Virtual example of fenestrations and dehiscences in the ClinChec...

Figure 5.11 Virtual example of root and crown displacements in the ClinCheck...

Figure 5.12 Visualization of CBCT integration and ODO.

Chapter 6

Figure 6.1 The Wilcko’s were the first to demonstrate that the movement does...

Figure 6.2 Lingual approach in the SFC technique.

Figure 6.3 Use of rotatory instrument under copious irrigation in corticotom...

Figure 6.4 Use of piezoelectric scalpel. (a) Refinement of initial corticoto...

Figure 6.5 The use of rotatory instruments is less indicated of a piezoelect...

Figure 6.6 Thinning of the alveolar bone surrounding the tooth in the antici...

Figure 6.7 Application of a xenogeneic grafting material at the corticotomy ...

Figure 6.8 Fast resorbing grafting materials should be avoided in corticotom...

Figure 6.9 (a, b) The volume of the graft material used is dictated by the d...

Figure 6.10 In some cases a tunnel approach to grafting is not suggested sin...

Figure 6.11 Since most of SFC are done in sextants or quadrants, the mobilit...

Figure 6.12 Fixation pins may interfere with tooth movement and should be av...

Figure 6.13 A case of palatal expansion in which a SFC was used with a piezo...

Figure 6.14 A case of moderate lower arch crowding in which the Piezocision ...

Figure 6.15 A case of moderate lower arch crowding treated without corticoto...

Figure 6.16 Preoperative opt of a patient with missing first lower right mol...

Figure 6.17 The right side was treated with a Piezocision

®

. (a) Preoper...

Figure 6.18 The left side was treated with a PAOO

®

approach, at the tim...

Figure 6.19 (a) Pretreatment CBCT panorex showing the missing teeth and incl...

Figure 6.20 Lateral intraoral view of the patient with a Class II malocclusi...

Figure 6.21 Corticotomy was performed on the upper arch bilaterally at the s...

Figure 6.22 Occlusal view at 8 weeks after corticotomy.

Figure 6.23 Final intraoral view after 11 months of treatment. (a) Right sid...

Figure 6.24 (a–c) Preoperative intraoral view.

Figure 6.25 (a) Extraoral view of smile. (b) Preoperative OPT.

Figure 6.26 (a–c) Indirect bonding before corticotomy.

Figure 6.27 Segmental single flap corticotomy in the anterior upper sextant....

Figure 6.28 (a) Scraping instrument used for thinning alveolar bone in the a...

Figure 6.29 Final intraoral view at end of treatment. Treatment was complete...

Figure 6.30 (a) Final extraoral smile detail. (b) Postoperative OPT.

Figure 6.31 (a–e) Preoperative intraoral images.

Figure 6.32 (a, b) Initial radiograph.

Figure 6.33 (a–c) Extraoral picture, showing a flat/concave profile.

Figure 6.34 (a, b) Details of the rotation of lower left second premolar.

Figure 6.35 (a, b) Details of the upper right premolar’s rotations.

Figure 6.36 Minimally invasive flapless corticotomy in the area of the upper...

Figure 6.37 De‐rotation pre‐op (a) and after 3 months (b).

Figure 6.38 After leveling and aligning were completed, the patient was read...

Figure 6.39 (a) Single flap corticotomy in the upper arch. (b, c) With posit...

Figure 6.40 Xenogeneic bone graft and collagen membrane for guided bone rege...

Figure 6.41 (a, b) Expansion arch 0.016 stainless steel is placed at the end...

Figure 6.42 Pre‐ and postoperative CBCT showing buccal plate regeneration an...

Figure 6.43 (a) Mesialization of the lower second left molar to close the sp...

Figure 6.44 Opening of space at incisor level to allow implant placement. (a...

Figure 6.45 (a, b) Radiographic evaluation before implant placement. (a) Pre...

Figure 6.46 (a, b) Implants positioning.

Figure 6.47 (a–e) Final orthodontic treatment. Implant restorations on the l...

Figure 6.48 (a–c) Final extraoral images showing an improvement of the infer...

Figure 6.49 Definitive restoration of implants.

Figure 6.50 15‐year‐old female presented to her orthodontist with Class II m...

Chapter 7

Figure 7.1 Upper left central incisor showing a gingival recession. Although...

Figure 7.2 The patient was treated with the principle of Piezocision

®

(...

Figure 7.3 Derotation of the tooth and spontaneous resolution of the mucogin...

Figure 7.4 (a) 3D reconstruction area: the pretreatment CBCT confirms the la...

Figure 7.5 (a) Bidimensional axial view of the incisor: The pretreatment is ...

Figure 7.6 Post orthodontic treatment recessions in several cases: Recession...

Figure 7.7 Sagittal images of mandibular frontal teeth (43–33) from a patien...

Figure 7.8 42‐year‐old white female presented with a Class II Division I mal...

Figure 7.9 Axial views of a 5‐year follow‐up CBCT. (a) Inferior anterior gro...

Figure 7.10 (a) Using the axial view, one reference line was placed between ...

Figure 7.11 Pre and postoperative CBCT without bone graft. (a) Pre‐ and post...

Figure 7.12 Pre‐ and postoperative CBCT with bone graft in the anterior lowe...

Figure 7.13 A 21‐year‐old female presented with skeletal and dental Class II...

Figure 7.14 (a) Corticotomy and bone graft were performed in the upper jaw, ...

Figure 7.15 At the end of treatment, in 11 months, sagittal and transverse d...

Figure 7.16 Radiographic 3D evaluation of preoperative and postoperative CBC...

Figure 7.17 2D sagittal preoperative and postoperative reconstruction showin...

Figure 7.18 Extra‐oral pre‐op and post‐op profile evaluation (block eyes) sh...

Figure 7.19 3D visualization of occlusion, bone, and soft tissues of the fac...

Figure 7.20 A 44‐year‐old woman presented with a unilateral crossbite on the...

Figure 7.21 A 29 year old man presented with a skeletal and dental Class III...

Figure 7.22 (a) Facial Photographs pretreatment lateral view. (b) Photograph...

Figure 7.23 (a) Pretreatment intraoral view Frontal. (b) Right side. (c) Lef...

Figure 7.24 (a) Upper arch. (b) Lower arch.

Figure 7.25 (a) Pre‐op cephalometric rx. (b) Pre‐op OPT.

Figure 7.26 Andrews analysis. In green are the anticipated position of the i...

Figure 7.27 Patient at the day of surgery.

Figure 7.28 (a) Full thickness mucoperiosteal single flap elevation. (b) Out...

Figure 7.29 Nickel–titanium 0.014 was reactivated at the end of surgery.

Figure 7.30 (a) Sutures removal at 1 week follow up. (b) Note extremely rapi...

Figure 7.31 (a) 2 weeks periodontal follow up. (b) 3 weeks follow‐up. (c) 5 ...

Figure 7.32 Progress 2 months in treatment: teeth have been aligned using th...

Figure 7.33 (a) Progress 4 months in treatment; correcting the upper left ca...

Figure 7.34 Progress radiographs; checking exact inclination of upper inciso...

Figure 7.35 Final intraoral photographs. (a) Right side. (b) Frontal view. (...

Figure 7.36 Post treatment radiographs. (a) Cephalometric x‐ray. (b) OPT.

Figure 7.37 Final extraoral photographs. (a) Frontal view. (b) Lateral view....

Figure 7.38 Composite picture of pre and postoperative CBCT showing a robust...

Chapter 8

Figure 8.1 (a–c) A 42‐year‐old white female presented with a Class II Divisi...

Figure 8.2 Detail of the anterior sextant, showing mild crowding and gingiva...

Figure 8.3 Occlusal view of edentulous ridge before augmentation.

Figure 8.4 At the reentry time, an adequately regenerated area was evident, ...

Figure 8.5 The histology showed residual particles of the graft which were c...

Figure 8.6 According to histologic sample harvested in the area, the inner p...

Figure 8.7 End of orthodontic treatment, before definitive prosthetic treatm...

Figure 8.8 (a, b) Pre‐ and postoperative detail of over‐bite correction, bef...

Figure 8.9 Delivery of final restorations. Note excellent final esthetic as ...

Figure 8.10 Patient presented a very mild crowding and central incisors over...

Figure 8.11 After a light interproximal reduction (IPR or stripping) a lingu...

Figure 8.12 Following the technique described by Dibart, called Piezoincisio...

Figure 8.13 A 2–3 mm deep corticotomies were performed trough the incisions ...

Figure 8.14 One‐week follow‐up: the vertical cuts in the mucosa are complete...

Figure 8.15 At the 18‐day follow‐up, the crowding was almost completely reso...

Figures 8.16 and 8.17 After 12 more days of stabilization, for a total of 30...

Figure 8.18 Six months follow‐up, showing stability of results and nice soft...

Figure 8.19 (a, b) Preoperative view showing extrusion of the upper posterio...

Figure 8.20 Corticotomy in the buccal side and positioning of a bone anchora...

Figure 8.21 Corticotomy on the lingual side.

Figure 8.22 Orthodontic traction with 2 × 150 g Ni–Ti closed coils.

Figure 8.23 Once the intrusion was achieved an active contention was maintai...

Figure 8.24 (a) Bone plate removal. A Note overall good soft tissue reaction...

Figure 8.25 End of treatment. Note cervical alignment of posterior right sex...

Figure 8.26 (a, b) Pre‐ and postoperative periapical radiograph showing the ...

Figure 8.27 Preoperative panorex showing chronic generalize adult moderate p...

Figure 8.28 Upper right quadrant. (a) Periapical radiograph showing: on toot...

Figure 8.29 Upper Anterior sextant. (a) Probing depth at the distal line ang...

Figure 8.30 Upper left sextant. (a) Buccal view of the upper right first upp...

Figure 8.31 (a) Adjunctive segmental bracketing of the teeth at the time of ...

Figure 8.32 Occlusal view of movement. (a) At the end of surgery. (b) At the...

Figure 8.33 Radiographic series. (a) Bone expansion at the time of implant p...

Figure 8.34 Buccal view of final result.

Figure 8.35 Postoperative CBCT showing the implant completely surrounded by ...

Figure 8.36 The lower right sextant: (a) periapical radiograph showing #31 m...

Figure 8.37 (a) Six months after periodontal regeneration corticotomy to enh...

Figure 8.38 (a) Positioning of the implant are of #30: as close as possible ...

Figure 8.39 (a) Radiograph showing the most distal possible insertion path o...

Figure 8.40 Clinical view of final restoration on #30 and good periodontal a...

Figure 8.41 One‐year follow‐up OPT, showing the excellent full mouth rehabil...

Figure 8.42 (a–e) Preoperative photograph.

Figure 8.43 (a, b) Upper bracketing. (c) Schematic drawing representing rati...

Figure 8.44 (a–f) Final clinical photographs.

Figure 8.45 Details of rotation of tooth #1: (a) at time of implant placemen...

Figure 8.46 Buccal view of the same area. (a) At the beginning and (b) at th...

Figure 8.47 OPT at beginning of treatment.

Figure 8.48 OP at the end of treatment.

Figure 8.49 Full mount radiograph showing a generalized moderate to severe c...

Figure 8.50 (a–c) From the orthodontic and occlusal point of view the case p...

Figure 8.51 The periodontal surgery in the anterior lower quadrant was sched...

Figure 8.52 Schematic drawing of timing of corticotomy application, accordin...

Figure 8.53 (a, b) Flapless corticotomy in the upper anterior sextant.

Figure 8.54 Flapless corticotomy in the upper posteriors sextants.

Figure 8.55 (a) Occlusal view at the resolution of anterior crowding. (b) De...

Figure 8.56 (a) Arch expansion completed. (b) Detail of the right upper quad...

Figure 8.57 (a–c) Final photograph at 1 year.

Figure 8.58 Improved possibility to perform proper oral hygiene.

Figure 8.59 Full mouth final radiograph

Figure 8.60 (a) Preoperative lower jaw 3D reconstruction, showing a generali...

Figure 8.61 (a) Preoperative maxilla 3D reconstruction, showing a generalize...

Figure 8.62 (a–e) Three‐year follow‐up showing excellent periodontal and occ...

Figure 8.63 Three‐year follow up OPT.

Figure 8.64 (a) Patient with Class III dental and posterior crossbite, right...

Figure 8.65 (a) Extraoral a frontal showing a gummy asymmetric smile with bu...

Figure 8.66 OPT preop.

Figure 8.67 Periapical radiograph: (a) Upper right showing horizontal bone l...

Figure 8.68 3D visualization of the maxilla. A very thin buccal plate is evi...

Figure 8.69 (a) Axial view of the maxilla at the marginal bone level showing...

Figure 8.70 Paraxial view of incisors area. The sections taken 1 mm apart ar...

Figure 8.71 (a) ClinCheck visualization of planned movements in the Maxilla:...

Figure 8.72 (a) The surgical procedure was planned combining the esthetic cr...

Figure 8.73 (a–c) Trimming of mucodermal (Mucoderm

®

) derivatives to act...

Figure 8.74 Mucodermal membrane in place between the bone and the mucosa.

Figure 8.75 (a, b) A modified tuberculin syringe may be used to load the bon...

Figure 8.76 (a–c) Under the membrane and on top of the buccal plate of the t...

Figure 8.77 (a) Grafting completed. (b) Suturing. (c) Digital pressure to fi...

Figure 8.78 (a–c) Lateral and frontal view at midterm refinement. Note corre...

Figure 8.79 Extraoral frontal and lateral views. Upper lip seems more suppor...

Figure 8.80 (a–c) Lateral right frontal and lateral left of final treatment:...

Figure 8.81 (a) Occlusal upper view. (b) Occlusal mandibular view both showi...

Figure 8.82 (a–c) Extraoral views showing harmonious final results.

Figure 8.83 Harmonious smile.

Figure 8.84 Details of the anterior restoration.

Figure 8.85 Final OPT.

Figure 8.86 Final periapical radiograph showing maintenance of the interprox...

Chapter 9

Figure 9.1 Initial extraoral photographs.

Figure 9.2 Initial intraoral photographs.

Figure 9.3 Initial photographs with details of right and left overjet.

Figure 9.4 Detail of vestibular area with tunnel surgery in lower arch.

Figure 9.5 Final extraoral photographs.

Figure 9.6 Final intraoral photographs.

Figure 9.7 Final photographs with details of right and left overjet.

Figure 9.8 Initial and final photos showing successful orthodontic correctio...

Figure 9.9 Occlusal pictures of the upper arch at the beginning and end of o...

Figure 9.10 Images derived from CBCT in which periodontal support is evident...

Figure 9.11 Initial extraoral photographs.

Figure 9.12 Initial intraoral photographs.

Figure 9.13 Sequence of successful distalization in lower arch and correctio...

Figure 9.14 Detail of the vestibular area with tunnel surgery in lower arch....

Figure 9.15 Final extraoral photographs.

Figure 9.16 Final intraoral photographs.

Figure 9.17 Initial and final photographs showing successful orthodontic cor...

Figure 9.18 Images derived from CBCT in which periodontal support is evident...

Figure 9.19 Extraoral pictures before and after treatment of a young patient...

Figure 9.20 Extraoral pictures before and after treatment of an adult patien...

Figure 9.21 Extraoral pictures before and after treatment of a young patient...

Figure 9.22 Extraoral pictures before and after treatment of a young patient...

Figure 9.23 Extraoral pictures before and after treatment of an adult patien...

Figure 9.24 Perioral support by newly generated bone structure.

Chapter 10

Figure 10.1 Angle facial convexity.

Figure 10.2 Naso‐labial angle.

Figure 10.3 Extraoral pictures.

Figure 10.4 Extraoral pictures of smiling subjects.

Figure 10.5 Intraoral pictures.

Figure 10.6 Projections using CT scans.

Figure 10.7 Intraoral scansion and virtual casts.

Figure 10.8 Using of ClinCheck software.

Figure 10.9 Buttons and power‐arms for intra‐surgery intra‐arches fixation....

Figure 10.10 Final extraoral pictures.

Figure 10.11 Final extraoral pictures of smiling subjects.

Figure 10.12 Final intraoral pictures.

Figure 10.13 Projections from the final CT scan.

Figure 10.14 Function and mandibular movements (protrusive and lateral).

Figure 10.15 Extraoral pictures.

Figure 10.16 Intraoral pictures.

Figure 10.17 Projections using CT scans.

Figure 10.18 Intraoral scansion and virtual casts.

Figure 10.19 Using ClinCheck software.

Figure 10.20 Buccal buttons for intra‐surgery intra‐arches fixation.

Figure 10.21 Extraoral pictures.

Figure 10.22 Extraoral pictures of smiling subjects.

Figure 10.23 Intraoral pictures.

Figure 10.24 Projections using CT scans.

Chapter 11

Figure 11.1 (a) Ideal facial and lingual alveolar bone morphology, exceeding...

Figure 11.2 Klinorhynchy: a downwardly oriented facial skeleton in relation ...

Figure 11.3 Representative images demonstrate ideal mammalian occlusion, var...

Figure 11.4 Anatomy of periodontium.

Figure 11.5 Cephalometry with points A and B.

Figure 11.6 Vascularity of the periodontal tissues image.

Figure 11.7 Dehiscences and fenestrations. (a) Fenestration. (b) Dehiscence ...

Figure 11.8 Clinical consequences of dehiscences demonstrating reduced vascu...

Figure 11.9 Representative CBCT image, buccolingual orientation.

Figure 11.10 SFO treatment mandibular central incisor. (a) Pretreatment. (b)...

Figure 11.11 SFO treatment mandibular canine. (a) Pretreatment. (b) Posttrea...

Figure 11.12 Sagittal image representing both facial and lingual alveolar bo...

Figure 11.13 Adult demonstrating robust newly generated facial alveolar bone...

Figure 11.14 Sagittal images demonstrating features of the RSBI bone index. ...

Figure 11.15 Robust vascularity. Numerous Foramina.

Figure 11.16 Clinical image of a patient with a crowded dentition, demonstra...

Guide

Cover Page

Table of Contents

Title Page

Copyright Page

Dedication Page

List of Contributors

Introduction

Begin Reading

Index

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Orthodontically Driven Osteogenesis

Second Edition

Edited by

Federico Brugnami

Private Practice Limited to Periodontics, Oral Implants and Adult Orthodontics Rome, Italy

Alfonso Caiazzo

Department of Oral and Maxillofacial Surgery, Practice Limited to Oral Surgery and Implants, Centro Odontoiatrico Salernitano, Italian Society of Oral Surgery and Implants (SICOI), MGSDM Boston University Salerno, Italy

Simonetta Meuli

Visiting Professor, School of Specialization of Orthodontics, Catholic University of the Sacred Heart, Rome, ItalyVisiting Professor, Unicamillus International School, University, Rome, Italy

Copyright © 2024 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies.

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Library of Congress Cataloging‐in‐Publication DataNames: Brugnami, Federico, 1967– editor. | Caiazzo, Alfonso, 1968– editor. | Meuli, Simonetta, editor.Title: Orthodontically driven osteogenesis / [edited by] Federico Brugnami, Alfonso Caiazzo, Simonetta Meuli.Other titles: Orthodontically driven corticotomyDescription: Second edition. | Hoboken, New Jersey: Wiley‐Blackwell [2024] | Preceded by Orthodontically driven corticotomy / edited by Dr. Federico Brugnami, Dr. Alfonso Caiazzo. 2015. | Includes bibliographical references and index.Identifiers: LCCN 2024007084 (print) | LCCN 2024007085 (ebook) | ISBN 9781119700562 (hardback) | ISBN 9781119700555 (adobe pdf) | ISBN 9781119700579 (epub)Subjects: MESH: Orthodontics–methods | Tissue Engineering–methods | Tooth Movement Techniques | Osteogenesis, Distraction–methodsClassification: LCC RK521 (print) | LCC RK521 (ebook) | NLM WU 400 | DDC 617.6/43–dc23/eng/20240405LC record available at https://lccn.loc.gov/2024007084LC ebook record available at https://lccn.loc.gov/2024007085

Cover Design: WileyCover Image: © Federico Brugnami

Federico BrugnamiTo Giulia, my daughter and center of gravity

Alfonso CaiazzoTo my parents, my inspiration

Simonetta MeuliTo my sons, Giovanni and Paolo

List of Contributors

Giulia AmodeoUOC Maxillofacial DepartmentSan Filippo Neri Hospital, Rome, ItalySmileHouse Foundation, Rome, Italy

Federico BrugnamiPrivate Practice Limited to PeriodonticsOral Implants and Adult OrthodonticsRome, Italy

Alfonso CaiazzoPrivate Practice Limited to Oral Surgery andImplant Dentistry, Salerno, ItalyDepartment of Oral and Maxillofacial SurgeryPractice Limited to Oral Surgery and ImplantsCentro Odontoiatrico Salernitano ItalianSociety of Oral Surgery and Implants (SICOI)MGSDM Boston University, Salerno, Italy

Gianfranco GiordanoAMCO, Velletri, Rome, Italy

Sergio MarroccoUOC Maxillofacial Department, San FilippoNeri Hospital, Rome, ItalySmileHouse Foundation, Rome, Italy

Simonetta MeuliVisiting Professor, School of Specializationof Orthodontics, Catholic University of theSacred Heart, Rome, ItalyVisiting Professor, Unicamillus InternationalSchool, University, Rome, Italy

Neal C. MurphyDepartments of Orthodontics & PeriodonticsSchool of Dental Medicine, Cleveland ClinicCampus, Case Western Reserve UniversityCleveland, OH, USA

Colin RichmanDepartment of Periodontics, Practice limitedto Periodontics (Focussed on SFT, LANAP/LAPIP/Oral‐Systemic‐Condition), Diplomate,American Board of Periodontology, AugustaUniversity, Augusta, Georgia, USA

Domenico ScopellitiUOC Maxillofacial Department, San FilippoNeri Hospital, Rome, ItalySmileHouse Foundation, Rome, Italy

Introduction

Improving orthodontic treatments by minimizing side effects and broadening their range has been a top priority for clinicians and researchers. Corticotomy, an established technique, has recently gained increased attention. However, confusion and misinterpretation surrounding the term, its application, and its benefits have led to global horizontal (pioneers worldwide) and low vertical diffusion (members of the same society). This underscores the need for a dedicated book on corticotomy or Periodontally Accelerated Osteogenic Orthodontics®. The introduction to the first edition, written 10 years ago, remains relevant today. Despite yearly evidence demonstrating the procedure’s effectiveness and safety, orthodontic attention remains unchanged, shifting focus to 3D Digital Planning and Clear Aligners. The preferred terms used to describe the procedures have also evolved, with corticotomy‐facilitated orthodontics (CFO), accelerated osteogenic orthodontics (AOO), and selective alveolar decortication gaining preference. Orthodontically driven osteogenesis (ODO), or the ability to grow new bone, is now favored over regenerative. The osteogenic potential, combined with bone grafting, can expand basal bone. This leads to two positive effects: less extraction of healthy premolars in growing patients and a more robust periodontium that prevents recessions during orthodontic movement. This concept initiates tissue engineering in orthodontics, where orthodontists and dental surgeons should define themselves as dentoalveolar orthopedists and embrace this new treatment philosophy. This approach maintains the promise of a faster orthodontic treatment and expands the limits of a safer one. It also offers a sound alternative to more invasive procedures, such as orthognathic procedures and can even modify the lower third of the face. This is impressive for a localized periodontal surgery when correctly combined with orthodontic treatment.

Orthodontically Driven Osteogenesis and 3D Digital Planning: New vs Innovation

As per the principles of innovation and change, “technology transfer” encompasses all activities that result in any user adoption of a new product or procedure. The term “new” here denotes any improvement over existing technologies or processes rather than a recent invention. Technology transfer necessitates active interaction between technology sponsors and users, which leads to actual innovation. It is crucial to differentiate between innovators or early adopters and late adopters. Innovators are individuals or groups willing to take risks by adopting new methods, products, or practices not widely used. They provide practical evidence that an innovation works, which is vital for later adopters.

Conversely, diffusion refers to the spread of an idea, method, practice, or product throughout a social system. There are various kinds of technology transfer, including horizontal transfer (the movement of information on technology between innovators within an organization or between similar organizations) and vertical transfer (the movement of information on technology from innovators to late adopters of an organization or system of organizations).

ODO has been increasingly successful worldwide, resulting in extensive horizontal diffusion. However, paradoxically, the highest percentage of orthodontists in any developed country will either ignore or be skeptical of ODO and fail to present it to their patients as a viable and valuable alternative due to a lack of vertical diffusion. There are different reasons to explain this difference in diffusion, but it is important to note that natural resistance to change is just one factor.

The innovation is not disseminated. Given that the “innovation” is truly innovative, one of the most important driving factors is the economical one. For example, most of the innovations in dentistry in the last 30 years, from implants to membranes to clear aligners or straight wire, have been “encouraged” by suppliers and manufacturers. It is the same as in the pharmaceutical business: any revolutionary drug to cure a rare syndrome would suffer a difference in diffusion compared to Viagra

®

or Biposphonates or Statins.

The innovation is disseminated to the wrong people. The information is not referred to the proper person or somehow gets lost on the way.

The innovation is not understood by the potential user.

Most of the time, this is created by a superficial knowledge of the technique or misinterpretation, lack of homogenous terminology, and underestimation of potential benefits.

3D digital planning may be the correct driver for the diffusion of ODO: It becomes more difficult to ignore when the roots extend beyond the original bony envelope.

Federico Brugnami, Alfonso Caiazzo, and Simonetta Meuli

1Orthodontic Tissue Engineering: A 20‐Year Retrospective and Philosophical Polemic©

Neal C. Murphy

Clinical Professor, Departments of Orthodontics & Periodontics, School of Dental Medicine, Cleveland Clinic Campus, Case Western Reserve University, Cleveland, OH, USA

Dedication

This chapter is dedicated to Professor Spiro Chaconas, Founder and Chairman Emeritus, Section of Orthodontics, UCLA School of Dentistry. Professor Chaconas, presently enjoying a well‐deserved retirement in Sothern California, was an exceptional leader, friend, and mentor for over three generations of orthodontists at UCLA. He taught his protégés to enter private practice with confidence and engage the inevitable vicissitudes of our careers – many rather brutal – with professional élan, stoic indifference, transcendent vision, and personal humility. We did.

Thank you, Spiro.

Introductory Rationale

Since 2001, this author – dual‐certified in both orthodontic and periodontic – has collaborated with a number of orthodontists and periodontists in an effort to engineer a novel alveolus bone that could accommodate the full complement of human dentition. This was attempted to liberate a naturally “full” smile from the strictures of skeletal malalignment and so‐called arch length deficiencies. By the year 2023, we were able to develop protocols that achieved that goal and accelerate the rate of tooth movement three to fourfold. In addition, instances of pernicious side effects like apical root resorption and periodontal attachment loss were predictably minimized or nonexistent compared to traditional edgewise therapies. In that regard, our protocols, both surgical and nonsurgical in a phrase, proved to be “faster, safer, and better.” These revelations were brought into high relief by a 20‐year retrospect as attested to by studies cited herein.

Orthodontists’ attempts to enhance the esthetic value of the patients’ lower face are indeed laudable goals. However, the wide‐spread popularity of extraction therapy presents a sobering challenge because it notoriously has been haunted by the unfortunate and unpredictable side effects of premature lower face aging and unsightly flattened (so‐called “dished‐in”) profiles in maturity. Moreover, since these unsightly facial profiles often become most apparent years after active therapy has ended, they are subtle assaults on facial beauty. While evident to the general population, the iatrogenic deformity presents a pattern that is vaguely unsightly but nondescript to laymen. This chapter explains that cell‐ and tissue‐level biology is often ignored in orthodontic curricula and sacrificed by inordinate preoccupations with gross anatomy. But periodontology revels in cell‐level dynamics and affords us, as specialty science integrators, to reveal a universe of new orthodontic science, we call “orthodontic tissue engineering (OTE).”

If dentists claim a desire for “best care,” we must ask how one defines that superlative term. By definition, a superlative is an absolute, and whatever treatment most closely approximates that ideal is reasonably argued as “best.” Is “best care” which is predictable, fastest, with fewest pernicious side effects, least painful, most stable, and most compatible with contemporary cultural values?

This chapter is an attempt to organize a compelling rationale for this new protocol in terms of the underlying cellular dynamics that allow it to achieve case outcome stability superior to the very unstable outcomes that are predictably disappointing in traditional care. Ironically, the new concept of “accelerated orthodontic therapy” was met with political opposition and excessively cynical skepticism by established practitioners. Yet truth prevails and the luddites and clinical nay‐sayers of the 20th century were proven wrong by 21st‐century science. This chapter boldly addressees this controversy as a tribute to intrepid clinicians who preceded us and as a scientific reminder that hard data and scientific epistemological inquiry, however, disruptive to prevailing thought and wishes, will out.

This definition seems sensible to us. Therefore, the aim of this chapter is to describe the ramifications of an emerging perspective and clinical protocol in those terms. Although unheard of by some, the subject is neither new nor novel because it has been evolving over time within the ebb and flow of scientific evolution. It nonetheless brings disruptive issues and protocols that are certainly more predictable, faster, with fewest pernicious side effects, less painful in adjustments, more stable, and more compatible with contemporary cultural values than traditional extraction alternatives. The problem with science is that it has no master. So, it flies in the face of convention and traditional bias.

Late 20th‐century science has delivered a collection of empirical observations and corticotomy protocols that are embodied under the collective rubric, surgically facilitated orthodontic therapy (SFOT) which in this book will be called orthodontically driven osteogenesis (ODO). This term referring to a particular histological reaction, subsumes a number of protocols that are mere variants of the same basic biological phenomena. These terms include but are not limited to “selective alveolar (‐us) decortication” (SAD), decortication without a bone graft, “stem cell orthodontic therapy” (SCOT), “stem cell alveolar therapy” (SCAT), “corticision” when a scalpel is used, “accelerated osteogenic orthodontics” (AOO) where a bone graft is combined with SAD, “periodontal(ly) accelerated osteogenic orthodontics” (PAOO) synonymous with AOO, and here, “orthodontic tissue engineering” (OTE) referring to a 21st century protocol focusing on permanent alveolus bone phenotype alteration. We posit that emerging periodontal sciences, the biology of healing bone, and cell‐level biology, which underlie ODO, are as integral to orthodontics, as civil engineering is to good architectural design. ODO is an example of the clinical science of engineered morphogenetic bone modeling – pioneered by the Russian orthopedist Professor Gavriil Ilizarov – synthesized with traditional orthopedic biomechanics (Figure 1.1). This Russian orthopedic surgeon proved beyond doubt and under great oppression that bone is malleable and can be reshaped to a more physiological form at will. That principle applies to the alveolus bone as well (Figure 1.1).

We pose a challenge to traditional biomechanics to enhance clinical efficacy, ameliorate pernicious side effects, and advance the orthodontic specialty beyond the strictures of simple mechanical art. The issues discussed in this polemic are based on the dual‐certified author’s 50 years of integrating periodontics and orthodontic in an urban private, but academic, practice and 20 years of understanding ODO. It also reflects the combined work of a growing global community of biologists and dentists, formally trained, or passionately interested in reengineering the mass and shape of the foundation of the human dentition. Hence, we write in the first‐person plural, not to imply lock‐step concordance, but rather a general agreement that is compatible with a wide variety of readers. Some repetition will be noticed in this discourse, but that serves as an intentional pedagogical device. The subject matter is quite novel to some readers because we employ a technical prose of molecular biologists, tissue engineers, periodontists, and orthodontists. Moreover, repetition of a new concept within several different contexts can only enrich the conceptualization. Hopefully, the literary device will edify and not distract.

Figure 1.1 This treatment demonstrates what can be done to correct a deformed long bone. The same principle used by Gavriil Ilizarov can be applied to the alveolus bone in correcting dentoalveolar deformities. The leg deformity in (a) represents a deformed bone. (b) The Ilizarov orthopedic device with his surgical protocol can lengthen long bones at the rate of 1 mm/day. (c) Demonstrates an improved esthetic appearance and function. This is what OTE attempts to do with the dental alveolus bone.

Source: Dong et al. (2021)/Reproduced with permission from Tsinghua University Press Ltd.

Our objective here is not to proselytize but rather to serve examples of what can be achieved by others who wish to minimize extraction therapy side effects. But we hope this is received in a provocative manner to stimulate a meaningful dialectical exchange rather than contentious debate, misinformation, distortions, and misrepresentations that have marred the development of this topic. What is practiced by others is beyond our scope of control. So, we do not call for the immediate condemnation of those who are uncomfortable with protocols presented herein. We focus on scientific advances in ancillary biological fields too fascinating to ignore. And, these innovations can serve as both a beacon and safe harbor for those who are dissatisfied with the limits of the status quo. We are here to show a better path but only for those who wish to embark upon it.

We do not seek to condemn legitimate extraction therapy categorically, but we are intentionally provocative about the perfunctory use of healthy tooth extraction merely for the sake of mindless expediency. We also object philosophically to the excuse of “art” as a refuge from the inarguable demands of science. The fact is that ODO is here to stay, and its use will most likely continue to proliferate worldwide, as any scientific innovation always does. A recent review of the subject published by Hoogeveen et al. (2014) concludes that SFOT “… might effectively shorten the duration of treatment, but careful treatment planning, early activation of appliances, and short intervals between checkups are recommended. SFOT … is not associated with complications such as loss of tooth vitality, periodontal problems, or severe root resorption … prospective research is still needed … ” (Emphasis added).

The lack of prospective, multi‐replicated, double‐blind, placebo‐controlled, multisite, and human clinical studies to which they allude, does not invalidate the ODO innovation. Rather, the lack of such a prospective gold‐standard analysis speaks to the impracticality of such studies, the lack of funding, and the inchoate nature that SFOT shares with many effective clinical disciplines. In this chapter, we elaborate on the necessary items of interest that accord with “careful treatment planning.”

Topical Issues

Since the dawn of the orthodontic specialty a philosophical debate has reigned over the intellectual life of most orthodontists: Are we artists or scientists? One reconciliation of this ostensible dichotomy is that art is a goal, and science is the method. The corollary presumption is that an artful outcome via science also represents an optimal physiologic state, e.g., mutually protected occlusion.

Many orthodontists believe that only the most efficient methods of biomechanical loading should define our specialty. To them, periodontal biology is considered an ancillary and often irritating companion. We disagree. We propose that the periodontium is a useful but ignored asset in the creation of optimal function and esthetically harmonious outcomes. These are the axioms upon which we base our posits: Tissue is a collection of cells serving a common function. An organ is a collection of tissues serving a common function. Engineering is the physical manipulation of a natural phenomenon toward a predesigned schema. OTE in the title refers to the burgeoning science of manipulating the dentoalveolar complex and rerouting its architectural development to a predetermined and improved pattern. A plethora of protocols have blossomed over the last two decades and presently constitute a complex collage of techniques. In this proliferation, critical problems of clinical management and intellectual development have arisen that we have solved. These solutions we share.

As a civil engineer can manipulate the course of a river to convert fluid dynamics to electromagnetic potentials, we proffer nothing less vis a vis alveolar bone physiology. We propose that the orthodontist can manipulate the alveolus bone to facilitate orthodontic tooth movement (OTM) and in the process make better bone. The materials of OTE are a collection of surgical and nonsurgical periodontal protocols that are applied to areas of bone beneath a dentition needing orthodontic treatment. The principal method is a collection of selective alveolar decortication (SAD) protocols referred to in the aggregate as “Surgically Facilitated Orthodontic Therapy” (SFOT). For the sake of convenience, in this review, we shall use the acronyms SFOT, OTE, and ODO roughly synonymously, while the latter encompasses more nonsurgical modalities.

Since 1981, this author has attempted to integrate tissue dynamics into the biomechanical procedures of clinical orthodontics. At that time, tissue engineering was just beginning to appear in the biological literature. In retrospect, we see that the manipulative techniques of OTE paralleled similar 21st‐century bioengineering protocols in other fields of the human body from dermatology to consciousness (Nilforoushzadeh et al., 2022).

The popular emergence of SFOT in the early 1990s in the United States brought a promise of sustaining real‐world benefits to patients. Faster care, less infection, and significant reduction of that embarrassing ghost of orthodontics, relapse, are OTE’s most salient merits. In 2006, we were able to organize these new clinical observations with new science in a seminal book chapter published by the Harvard Society for the Advancement of Orthodontics. The title, Tissue Engineering for Orthodontists – a modest first step (Murphy, 2006) foretold this chapter, a modest second step