Australasian Dentist Magazine Sept-Oct 2021

Category 60 Australasian Dentist treatment. It is a surgical procedure and rapid tooth movement is achieved by disrupting the continuity of the cortical bone by a selective cut and preserving the vitality of the teeth and marginal periodontium. The biology behind corticotomy-assisted orthodontics is the regional acceleratory phenomenon (RAP). This procedure reduces the treatment time and facilitates expansion of the dental arch in Class I malocclusion with crowding, Class II malocclusions which requires expansion or extractions and mild Class III malocclusions. Also produces less root resorption rate due to decreased resistance from the cortical bone for tooth movement and provides improved post- orthodontic stability and slower relapse tendency. and fenestration. Also stabilize the post orthodontic periodontium while shortening total active treatment time and reduces side effects like inadequate basal bone, root resorption, tooth devitalisation, periodontal infection and relapse. Piezocision Assisted Orthodontics: It is a minimally invasive surgical procedure where micro-incision is performed on the buccal gingiva that allows the piezoelectric knife to give osseous cuts to the buccal cortical plates and initiate RAP. This procedure provides rapid tooth movement without an extensive traumatic surgical approach. It also combines piezocision with selective tunneling when soft or hard tissue grafting is required. Studies stated that it can be repeated more than once in the same area to re-activate the RAP (after 5-6 months) and keep the area demineralized, depending on the difficulty of the movements being performed and the morphology of the patient’s bone. of the central incisor(s) after appliance removal. Hemisected molar: About 7 or 8 mm space may be created between the roots of the hemisected molar. After the completion of orthodontic treatment, these teeth should be stabilized for at least 6 months and re-assessed periodontally before restorative therapy. Periodontal maintenance therapy During orthodontic therapy, the patients should take care of oral hygiene and follow instructions on brushing and inter-dental aids strictly e.g. use of orthodontic brush, dental floss etc. The orthodontist should check plaque removal effectiveness and emphasize its importance in between the visits. Periodic periodontal evaluation and check-up should be carried out by the periodontist. After orthodontic therapy, patients must be motivated to maintain good oral hygiene and should maintain regular follow-up. u Dr Geoffrey Hall Specialist orthodontist BDSc ( Melb) Cert Orth( Uni of Penn) MRACDS ( Orth) FACD ,FICD Founder and Director of OrthoED, Smilefast and CAPS geoff@orthoed.com.au TEL 1300 073 427 03 91080475 REFERENCES Alankar Ashok Shendre et al, The Relationship Between Orthodontics and Periodontics: An Interdisciplinary Approach, Research & Reviews: Journal of Dental Sciences Volume 4 | Issue 4 | December, 2016 Anisha Janu et al, Periodontal Procedures adjunct to Orthodontic Treatment, Orthodontic Journal of Nepal, Vol. 5, No. 1, June 2015 Aous Dannan, An update on periodontic- orthodontic interrelationships, J Indian Soc Periodontol. 2010 Jan-Mar; 14(1): 66–71. Apeksha Ghai et al, Perio-ortho symbiosis: A review article, International Journal of Applied Dental Sciences 2020; 6(3): 321-323 Deepthi et al, Ortho-perio relation: A review. J Indian Acad Dent Spec Res 2015;2:40-4 Graber, Vanarsdall- Orthodontic Current Principles and Techniques (6th edition) Nadimpalli Harshita et al, Perio-Ortho Interactions-A Review, J. Pharm. Sci. & Res. Vol. 10(5), 2018, 1053-1056 Newman and Carranza’s, Clinical Periodontology (13th Edition) Figure 11 Gingivectomy Periodontally Accelerated Osteogenic Orthodontics (PAOO): Also termed Wilckodontics, is a revised corticotomy- facilitated technique, which involves a full-thickness labial and lingual flap elevation accompanied by selective surgical scarring of the labial and lingual cortical bones (corticotomy) followed by placement of the particulate graft material, surgical closure, and orthodontic force application. Placement of brackets and activation of arch wires are done 1 week prior to the surgical treatment. The initiation of orthodontic force should not be delayedmore than 2weeks after surgery. The time period for RAP usually lasts for 4-6 months. A delay in activation of the orthodontic appliance will fail to take full advantage of the regional acceleratory phenomenon. PAOO technique creates increased alveolar bone width, resolves anterior crowding, close extraction or edentulous space, forward movement of lower anterior teeth, intrusion, correction of open bites and correct dehiscence Corticotomy PAOO-Corticotomy with bone grafting Figure 12 Corticotomy assisted orthodontics 5. Periodontal maintenance therapy after orthodontic treatment Debonding/Debanding: After completion of orthodontic treatment, it should be made mandatory that the patient should follow periodontal maintenance for at least 6 months. After appliance removal, periodontal service shall be required to eliminate periodontal pockets, assist in adequate bone remodelling and narrowing of periodontal space. A radiographic re-evaluation should be carried out by the periodontist to evaluate further periodontal needs Gingival invaginations: Incomplete adaptation of supporting structures during orthodontic closure of extraction spaces leads to infolding or invagination of the gingiva also called as gingival clefts. They vary from slight fissures to deep gaps. They act as a site for plaque retention and are considered as one of the risk factors for periodontal disease. A surgical correction of these invaginations is usually performed to eliminate plaque accumulation. Gummy smile: Occurs due to delayed apical migration of the gingival margins. Gingivectomy/Gingivoplasty is performed to level the margins accordingly. In case of correction by tooth movement, intrusion should be accomplished at least 6 months before appliance removal. This allows reorientation of the principal fibers of the periodontium and avoids re-extrusion Figure 13 Piezocision Assisted Orthodontics Figure 14 Gingival clefting with space closure clinical