Modified Periodontally Accelerated Osteogenic Orthodontics (PAOO) in Treatment of Skeletal Class Ⅱ Malocclusion: A Case Report

doi:10.13701/j.cnki.kqyxyj.2025.08.016

Abstract

Abstract: This article reports a clinical case of skeletal Class Ⅱ malocclusion treated with modified periodontally accelerated osteogenic orthodontics (PAOO). During the presurgical orthodontic decompensation phase, the modified PAOO technique was performed, featuring a papilla-preserving incision design, full-thickness flap elevation, piezocision-assisted interradicular corticotomy, bone augmentation without collagen barrier membrane (using bone graft material alone), and an innovative suturing method. A 24-month follow-up demonstrated significant increases in labial bone plate thickness and keratinized gingiva width at the surgical site, with stable long-term outcomes and no notable gingival recession or severe periodontal inflammatory reactions. The modified protocol effectively reduced surgical trauma and complication risks while ensuring therapeutic efficacy.

Key words: periodontally accelerated osteogenic orthodontics, corticotomy, alveolar bone argumentation, combined orthodontic-orthognathic treatment, skeletal class Ⅱ malocclusion

ZENG Yu, WANG Xiaoxuan, ZHANG Maoqi, ZHANG Aijuan, GAO Ya, XIONG Hui, CAO Zhengguo. Modified Periodontally Accelerated Osteogenic Orthodontics (PAOO) in Treatment of Skeletal Class Ⅱ Malocclusion: A Case Report[J]. Journal of Oral Science Research, 2025, 41(8): 727-732.

References

[1] 贺红.正畸牙移动中牙周界限的探讨[J].中华口腔医学杂志,2021,56(10): 966-970.
[2] Murphy KG, Wilcko MT, Wilcko WM, et al. Periodontal accelerated osteogenic orthodontics: a description of the surgical technique [J]. J Oral Maxillofac Surg, 2009, 67(10): 2160-2166.
[3] Wilcko WM, Wilcko T, Bouquot JE, et al. Rapid orthodontics with alveolar reshaping: two case reports of decrowding [J]. Int J Periodontics Restorative Dent, 2001, 21(1): 9-19.
[4] Wilcko MT, Wilcko WM, Pulver JJ, et al. Accelerated osteogenic orthodontics technique: a 1-stage surgically facilitated rapid orthodontic technique with alveolar augmentation [J]. J Oral Maxillofac Surg, 2009, 67(10): 2149-2159.
[5] Gonen ZB, Alkan A, Ekizer A, et al. Evaluation of vestibular bone thickness in class Ⅰ malocclusion treatment with corticotomy-assisted rapid orthodontics [J]. J Craniofac Surg, 2019, 30(8): e727-e733.
[6] Jing WD, Jiao J, Xu L, et al. Periodontal soft- and hard-tissue changes after augmented corticotomy in Chinese adult patients with skeletal Angle Class Ⅲ malocclusion: A non-randomized controlled trial [J]. J Periodontol, 2020, 91(11): 1419-1428.
[7] Xu X, Wu JQ, Jiang JH, et al. Periodontal effect of periodontally accelerated osteogenic orthodontics in skeletal angle class Ⅲ: A nonrandomized, controlled trial [J]. Int J Periodontics Restorative Dent, 2020, 40(4): e169-e177.
[8] Mheissen S, Khan H, Samawi S. Is Piezocision effective in accelerating orthodontic tooth movement: A systematic review and meta-analysis [J]. PLoS One, 2020, 15(4): e0231492.
[9] Rekhi U, Catunda RQ, Gibson MP. Surgically accelerated orthodontic techniques and periodontal response: a systematic review [J]. Eur J Orthod, 2020, 42(6):635-642.
[10] Kao RT, Curtis DA, Kim DM, et al. American Academy of Periodontology best evidence consensus statement on modifying periodontal phenotype in preparation for orthodontic and restorative treatment [J]. J Periodontol, 2020, 91(3): 289-298.
[11] 曾宇,褚耀耀,王晓璇,等.正畸治疗相关牙周炎症问题的考量及治疗策略[J].中国实用口腔科杂志,2023,16(1): 27-34.
[12] Gao J, Nguyen T, Oberoi S, et al. The significance of utilizing a corticotomy on periodontal and orthodontic outcomes: A systematic review and meta-analysis [J]. Biology (Basel), 2021, 10(8):803.
[13] Alsino HI, Hajeer MY, Burhan AS, et al. The effectiveness of periodontally accelerated osteogenic orthodontics (PAOO) in accelerating tooth movement and supporting alveolar bone thickness during orthodontic treatment: A systematic review [J]. Cureus, 2022, 14(5): e24985.
[14] Wilcko MT, Ferguson DJ, Makki L, et al. Keratinized Gingiva height increases after alveolar corticotomy and augmentation bone grafting [J]. J Periodontol, 2015, 86(10): 1107-1115.
[15] Ferreira CF, Wong D, Binkley LH. "Crawling attachment" during periodontally accelerated osteogenic orthodontics procedure [J]. Contemp Clin Dent, 2021, 12(2): 179-183.
[16] Wu J, Jiang JH, Xu L, et al. A pilot clinical study of Class Ⅲ surgical patients facilitated by improved accelerated osteogenic orthodontic treatments [J]. Angle Orthod, 2015, 85(4): 616-624.
[17] Battista MD, Kernitsky J, Exarchos E, et al. Quantification and comparison of the regional acceleratory phenomenon in bone following piezosurgery or bur osteotomy: A pilot study in rats [J]. Clin Exp Dent Res, 2023, 9(1): 66-74.
[18] Dibart S. Piezocision^TM: Accelerating orthodontic tooth movement while correcting hard and soft tissue deficiencies [J]. Front Oral Biol, 2016, 18:102-108.
[19] Ma Z, Zheng J, Yang C, et al. A new modified bone grafting technique for periodontally accelerated osteogenic orthodontics [J]. Medicine (Baltimore), 2018, 97(37): e12047.
[20] Liu X, Fan B, Abdelrehem A, et al. Membrane fixation for osseous graft stabilization in periodontally accelerated osteogenic orthodontics: a comparative study [J]. BMC Oral Health, 2020, 20(1): 22.
[21] Ferguson DJ, Wilcko MT, Wilcko WM, et al. The contribution of periodontics to orthodontic therapy [M]. Blackwell Munksgaard. 2007: 23-50.
[22] Ahn HW, Seo DH, Kim SH, et al. Morphologic evaluation of dentoalveolar structures of mandibular anterior teeth during augmented corticotomy-assisted decompensation [J]. Am J Orthod Dentofacial Orthop, 2016, 150(4): 659-669.
[23] Singh S, Jayan B. Comparative evaluation of periodontally accelerated osteogenic orthodontics (PAOO) versus conventional orthodontic tooth movement in adult patients with bimaxillary dentoalveolar protrusion [J]. Int J Periodontics Restorative Dent, 2019, 39(4): 571-577.
[24] Ma ZG, Yang C, Xie QY, et al. A novel surgical technique for augmented corticotomy-assisted orthodontics: Bone grafting with periosteum [J]. J Oral Maxillofac Surg, 2016, 74(1): 170-180.
[25] Saint-Surin I, Castrot R, Vandersteen C, et al. Combined mentalis weakening and periosteal flaps in mandibular anterior alveolar corticotomy-assisted orthodontics with bone grafting [J]. J Stomatol Oral Maxillofac Surg, 2021, 122(3): 311-314.
[26] Ma Z, Zhu Y, Zhan Y, et al. Periosteum coverage versus collagen-membrane coverage in periodontally accelerated osteogenic orthodontics: a randomized controlled clinical trial in Class Ⅱ and Class Ⅲ malocclusions [J]. BMC Oral Health, 2022, 22(1): 439.
[27] 杨栋,华先明,李寒月,等.一种牙周加速成骨正畸的改良术式和改良悬吊缝合法的设计、应用及初步评价[J].口腔医学研究,2019,35(9): 841-845.
[28] Chowdary PC, Pavan Kumar YS, Murthy KRV, et al. A novel modified-vista technique with connective tissue graft in the treatment of gingival recession-A case report [J]. Clin Adv Periodontics, 2020, 12(2):75-79.
[29] Haugland L, Kristensen KD, Lie SA, et al. The effect of biologic factors and adjunctive therapies on orthodontically induced inflammatory root resorption: a systematic review and meta-analysis [J]. Eur J Orthod, 2018, 40(3): 326-336.
[30] Patterson BM, Dalci O, Papadopoulou AK, et al. Effect of piezocision on root resorption associated with orthodontic force: A microcomputed tomography study [J]. Am J Orthod Dentofacial Orthop, 2017, 151(1): 53-62.
[31] Raza M, Sharma P, Kumar P, et al. Comparison of canine retraction by conventional and corticotomy-facilitated methods: A split mouth clinical study [J]. J Orthod Sci, 2021, 10:9.
[32] Arana JG, Rey D, Ríos H, et al. Root resorption in relation to a modified piezocision technique [J]. Angle Orthod, 2022, 92(3): 347-352.
[33] Dab S, Chen K, Flores-Mir C. Short- and long-term potential effects of accelerated osteogenic orthodontic treatment: A systematic review and meta-analysis [J]. Orthod Craniofac Res, 2019, 22(2): 61-68.