Case Presentation
The patient was a 46 year-old, female with no significant medical history. She was referred for periodontal risk assessment prior to orthodontic treatment.
Clinical and radiographic examination including CBCT were performed. Clinically, patient had a very thin biotype 8 (Fig 1,2,3). Radiographically, CBCT revealed no buccal plate on mandibular anterior teeth # 22-27 (Fig 4). Considering orthodontic treatment plan which was up righting of mandibular anterior teeth, she was considered as high risk for gingival recession during orthodontic treatment. Hence, the goals were to enhance buccal bone support, soft tissue thickness and prevent the complications following orthodontic treatment. The treatment plan which was included…show more content… Orthodontic brackets were placed in all mandibular teeth without activation.
Surgery was performed under local anesthesia. Full thickness envelope flap was reflected facially. (Fig 5,6).
Circumferential corticotomy was performed in inter-radicular areas from 2 to 3 mm below the crest to 5 mm beyond the apices of the roots9. Penetration to cancellous bone was considered in the depth of each cut. (Fig 7). Following corticotomy, particulate allograft was placed with an average thickness of 3 mm9 (Fig 8) and was covered with Alloderm. Alloderm was stabilized by Sling sutures at the coronal part and tacks on apical and lateral parts (Fig 9). Primary closure was achieved with combination of Vertical mattress and Sling sutures (Fig 10).
Post operative instructions was reviewed. . Immediately following surgery10, orthodontic activation started and continued in two-week intervals and finished six months after surgery.
Periodontal maintenance was performed every three months while patient was receiving orthodontic treatment.
Clinical Outcomes
The healing was uneventful in all follow-up visits. No gingival recession was observed during and one year following the treatment (Fig 11). Tissue biotype enhanced (visibility of…show more content… Techniques such as PAOO have broadened the scope of treatment possibilities.2,4,13 This approach has provided opportunities to accelerate and facilitate tooth movement through corticotomy while simultaneously increasing the volume of alveolar bone.2,13
Furthurmore, CBCT imaging should be considered as a means to properly identify and manage those at increased risk of developing dent-alveolar bone deficiencies related to orthodontic tooth movement, particularly in skeletally mature patients with thin periodontal biotype.14
With limitation of this study, PAOO combined with Alloderm could be considered in orthodontic patients with thin biotype and lack of buccal plate provided that CBCT and clinical evaluation justify it; However, more evaluation regarding the consistency and stability of the outcomes should be done in controlled clinical trials and in longer period of
