Ammar Sarraf PGY-4 December 19th, 2012

Kle 1959 Bony Blocks Modifications Generson 1978, Anholm in 1986, Gantes 1990, and Suya1 in 1991 built upon the supra-apical horizontal osteotomy

Theory change in 2001 by Wilcko Brothers

Normal Healing Process Direct correlation between degree and proximity of bone trauma and intensity of physiologic healing response.
5x turnover of bone Decreased bone density

Beings few days after insult Peaks at 1 to 2 months Continues for up to 2 years

Three Tissue Principles allow

Decortication initiates local tissue repair and production of osteoprogenitor cells and osteoinductive cytokines High turnover tissue results in functionally normal, reversible condition of osteopenia High turnover tissue is promoted in procise anatomic areas immediately adjacent to the area of desired tooth movements

Class I moderate to severe crowding Mild Class III Mild Class II For pre-surgical orthognathic surgery to decompensate

Activate orthodontic forces 1 week prior to surgery Activate every 2 weeks thereafter until tx complete

Prospective Human Trials

Fisher 2007
Evaluated tx effects in 6 consecutive patient who had bilaterally partially impacted canines Split mouth design Corticotomy tx side 33% less treatment time than conventional orthodontics

Decrease treatment time Less Root resorption due to decreased resistance of cortical bone More bone support due to the addition of bone graft

Extra-surgery Extra-surgical cost Possibility of iatrogenic damaged to structures

Buschang PH, Campbell PM, Ruso S. Accelerating tooth Movement with corticotomies: Is it possible and Desirable? Seminars in orthodontics, Vol 18, No4, 2012: 286-294. Fischer TJ: Orthodontic treatment accelerating with corticotomy-assisted exposure of palatally impacted canines. Angle Ortho 77:417-420, 2007. Wilcko MT, Wilcko WM, Pulver JJ, Bissada NF, Bouquot JE. Accelerated osteogenic orthodontics technique: a 1-stage surgically facilitated rapid orthodontic technique with alveolar augmentation.. J Oral Maxillofac Surg. 2009 Oct;67(10):2149-59