Periodontally Accelerated Osteogenic Orthodontics(Paoo): A Novel Rapid Approach

Wilckodontics, also known as Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a relatively new treatment in the dental realm. It is a clinical procedure that combines selective alveolar corticotomy, particulate bone grafting and the application of orthodontic forces. Basically it is a combination of selective decortication facilitated orthodontic technique and alveolar augmentation. This procedure is theoretically based on the bone healing pattern known as the regional acceleratory phenomenon (RAP).2 Regional acceleratory phenomenon was developed by Frost and Jee in 19833,4. The decortication of bone results in an increased turnover of alveolar spongiosa with areas of alveolar demineralization. This results in osteopenia, where its mineral content temporarily decreased which enables teeth to be moved more rapidly and further through the collagenous soft tissue matrix of the bone . Following the completion of orthodontic treatment, remineralization takes place resulting in greater stability in the orthodontic treatment outcome. Dr. Thomas Wilcko (Periodontist) and William Wilcko (Orthodontist), of Erie, PA in 1995 further modified the corticotomy assisted orthodontic technique with the addition of alveolar augmentation and named the procedure as Periodontally Accelerated Osteogenic Orthodontics (PAOO) later patented as "Wilckodontics" based on the emerging concepts of Wilcko others. This procedure has been shown to be particularly effective in treating moderate to severe crowding, in Class II malocclusions requiring expansion or extractions, and mild Class III malocclusions. As long as healthy periodontium is present, PAOO can be done at any age (from 11 years to 77 years of age)

Clinical and systemic effects of periodontally accelerated osteogenic orthodontics: a pilot study / Efectos clínicos y sistémicos de la ortodoncia osteogénica periodontalmente acelerada: un estudio piloto

The aim of this study was to describe periodontal effects and treatment time of Periodontally Accelerated Osteogenic Orthodontics (PAOO) and to determine if Deoxypyridinoline could be used as a biochemical marker of bone turnover in patients undergoing PAOO. We compared 5 patients undergoing PAOO (5 males, mean age: 29.6±9.8 years) with 5 control patients undergoing self-ligating orthodontics (5 males, mean age: 28.5±6.3 years). All patients were evaluated using panoramic and lateral x-rays and CBCT and randomly selected in experimental and control groups. Both groups underwent self-ligating orthodontics using Damon Q braces. Only the experimental group underwent PAOO. The patients were evaluated periodontally at T1 (before surgery and orthodontic movement) and T2 (after orthodontic treatment). The total treatment time for the experimental group was 8.2±3.3 months and for the control group was 13.4±7.3 months. There were no differences between T2-T1 periodontal variables in either of the groups. Gingival recession was 0.49±0.26 mm at T1 and 0.42±0.3 mm at T2 in the experimental group. Gingival recession was 0.55±0.31 mm at T1 and 1.19±0.24 mm at T2 in the control group. Deoxypyridinoline urine levels showed great variance between individuals and between groups. There is a reduction in treatment time for patients undergoing PAOO with DAMON Q braces. There is no difference in the periodontal condition between PAOO and conventional orthodontics.

El objetivo de este estudio fue describir los efectos periodontales y el tiempo de tratamiento de ortodoncia osteogénica periodontalmente acelerada (OOPA) y para determinar si desoxipiridinolina podría ser utilizado como un marcador bioquímico de recambio óseo en pacientes sometidos a OOPA. Se estudiaron 5 pacientes sometidos a OOPA (hombres, edad media de 29,6±9,8 años) y 5 pacientes control sometidos a ortodoncia de autoligado (hombres, edad media de 28,5±6,3 años). Todos los pacientes fueron evaluados utilizando radiografías panorámicas y laterales, tomografía computadorizada de haz cónico, y luego distribuidos aleatoriamente en grupos experimentales y de control. Ambos grupos fueron sometidos a la ortodoncia de autoligado utilizando dispositivos ortodónticos Damon Q. Sólo el grupo experimental fue sometido a OOPA. Los pacientes fueron evaluados periodontalmente en T1 (antes de la cirugía y el movimiento de ortodoncia) y T2 (después de un tratamiento de ortodoncia). El tiempo total de tratamiento para el grupo experimental fue de 8,2±3,3 meses y para el grupo control 13,4±7,3 meses. No hubo diferencias entre las variables periodontales T2-T1 en cualquiera de los grupos. La recesión gingival en el grupo experimental fue de 0,49±0,26 mm en T1 y 0,42±0,3 mm en T2. En el grupo control, la recesión gingival fue 0,55±0,31 mm en T1 y 1,19±0,24 mm en T2. Los niveles de desoxipiridinolina en orina mostraron gran variación entre individuos y entre grupos. Hubo una reducción en el tiempo de tratamiento para los pacientes sometidos OOPA con dispositivos ortodónticos Damon Q. No hubo diferencia en la condición periodontal entre pacientes sometidos a OOPA y ortodoncia convencional.

Wilckodontics- A Magical Wand for Rapid Success-A Review.

The orthodontic treatment is, perhaps, in terms of duration, the longest-performed dental procedure. In this fast-paced world any treatment that would consume 1 – 2 years is unwelcome. It is universally accepted that if the duration of the orthodontic treatment is reduced, there will be an increased favorable attitude towards the orthodontic therapy. To accelerate the tooth movement the orthodontists and the periodontists together have worked out a success formula which is termed Periodontally Accelerated Osteogenic Orthodontics (PAOO) or wilckodontics. Theoretically this procedure is based on the healing property of bone known as (RAP) regional acceleratory phenomenon. This procedure involves the surgical demineralization of the cortical bone (corticotomy) thereby decreasing the resistance offered by the cortical bone of the teeth to the orthodontic force applied and use of particulate bone grafting. This method not only enhances the width of the alveolar bone but also decreases the duration of the treatment and chances of apical root resoption. It also increases the stability of the treatment by reducing the chances of relapse. A proper case selection, careful surgical procedure and accurate orthodontic movements are important for the success of wilckodontics. This review article includes history, biomechanics, indication, contraindication, case selection, treatment planning, surgical techniques and its modifications.