Orthodontically Driven Osteogenesis

Federico Brugnami, DDS, Specialty in Periodontics, received his DDS from the University La Sapienza of Rome Italy, and his certificate at Tufts University School of Dental Medicine, Boston, MA, USA. He maintains a private practice limited to periodontics, oral implants, and adult orthodontics in Rome, Italy. Alfonso Calazzo, DDS, is a visiting assistant professor of Oral and Maxillofacial Surgery in the Henry M. Goldman School of Dental Medicine at Boston University in Boston, Massachusetts, USA. He also maintains a private practice limited to oral surgery and implant dentistry in Salerno, Italy. Simonetta Meuli, DDS, PhD, DDS, Specialization in Orthodontics, is a Visiting Professor at the School of Specialization of Orthodontics, Catholic University of the Sacred Heart in Rome, Italy and is a Visiting Professor at the School of Specialization of Orthodontics, Unicamillus International University in Rome, Italy.

List of Contributors xiii

Introduction xiv

1 Orthodontic Tissue Engineering: A 20-Year Retrospective and Philosophical Polemic 1
Neal C. Murphy

Dedication 1

Introductory Rationale 1

Topical Issues 4

The Alveolus Bone Is Not a Process 7

Epigenetics and the Waddington Landscape 8

From Osteotomy to Corticotomy to Tissue Engineering 10

Farrar Revisited: Bending Bone and CPO 11

Histophysiology of Orthodontically Driven Osteogenesis 14

Cell-Level Orthodontics 15

Timid Surgery and Its Consequences 15

Conceptual Foundation Through Historical Evolution 16

German Roots 16

The Introduction Into English 17

Suya and the Asian Connection 18

1980s: Anholm and the Loma Linda Investigation 18

A 20th Century Summary 20

21st Century Pioneers 21

The Entry of Academics 21

"Wilckodontics," PAOO/AOO, and Tissue Engineering 21

The Small Window Myth 24

The "Need" for Extraction Myth 24

On Beauty 25

From PAOO to SCAT; Dead Cells to Living Tissue 29

Beyond the Ligament with Mechano-biology 31

The Mechanosome 33

Enter the Exosome 35

TMP and MOP Nonsurgical Alternatives 35

The Problems with Orthodontics 38

Papillary Slough as a Troubling Complication 38

Managing Periodontal Infection 39

PAOO and SCAT Step-by-Step 40

Ortho-Infection 44

Oral Hygiene - A Pragmatic Imperative 46

Compliance Dialogue 47

Enhanced Bass Technique 47

Effective Oral Health Techniques 49

A Heretical Dehiscence Theory 49

How Fast is "Fast"? - A 4-Day

Treatment 51

Conclusions 52

Afterword for Academic Leaders 54

Acknowledgments 55

References 55

Recommended Reading 59

2 From Acceleration to Osteogenesis 60
Federico Brugnami

Accelerated Tooth Movement 60

Corticotomy 61

Accelerated Tooth Movement in Laboratory Animals 61

Accelerated Tooth Movement in the Canine Laboratory Model 62

Canine Study Description and Design 62

Canine Tooth Movement Data 68

Tooth Movement Paradigms: PDL Cell-Mediated versus Spongiosa Osteopenia 71

From Corticotomy to Grafting with Decortication (From Acceleration to Osteogenesis) 72

Histologic and Long-Term CBCT Evaluation 74

Conclusions 81

Acknowledgments 82

References 82

3 From Corticotomy to Orthodontically Driven Osteogenesis: Surgical Considerations 87

Alfonso Caiazzo and Federico Brugnami

Introduction 87

Historical Background 88

Biophysiologic Considerations 89

Indications for SAD or Corticotomy Alone 89

Contraindications 90

Advantages 90

Surgical Technique 90

Preoperative Considerations 90

Incision Design 91

Flap Reflection and Exposure 91

Corticotomy/Surgical Decortication 92

Bone Grafting 92

Suturing 94

Postsurgical Considerations 94

Single Flap Regenerative Corticotomy (SFRC) 95

Case 1 (SFRC) 96

Tunnel Regenerative Corticotomy (TURC) 96

Case 2 100

Conclusions 103

Acknowledgments 108

References 110

4 Orthodontically Driven Osteogenesis (ODO) Indications and Applications in Orthodontics 111
Simonetta Meuli, Federico Brugnami, and Gianfranco Giordano

Introduction 111

The Basic Concepts 113

Orthodontic Implications of Bone Injury: The RAP 114

From Corticotomy to Grafting with Decortication 115

Practical Applications and Indications 117

Maximizing the Window of Opportunity 120

Contraindications 120

Applications 121

Segmental Alveolar Decortication 121

Decortication Procedures with Clear Aligners 121

Interprofessional Communication 121

Conclusion 122

Cases Presentation 122

Introductory Note 122

Case 1 123

Case 2 124

3D Digital Planning and Clear Aligner Treatment 124

Case 3 124

Case 4 136

Conclusion 151

Acknowledgments 151

References 163

5 Three-dimensional

Digital Planning of Orthodontic Treatment: A Powerful Tool in Understanding, Communicating, and Planning Orthodontically Driven Osteogenesis 167
Simonetta Meuli

Introduction 167

Virtual Orthodontic Treatment 167

Potential of Virtual Three-dimensional 169

Traditional Versus Printing Technology 169

Imaging 171

Digital Models 171

Virtual Three-dimensional Orthodontic Planning Models 172

Integration of CBCT Into the Digital Orthodontic Treatment Flow 174

"ClinCheck" and CBCT Integration as a Planning Tool for ODO 176

References 176

6 From Orthodontically Driven Corticotomy to Orthodontically Driven Osteogenesis: Tissue Engineering to Enhance Orthodontic Treatment, Guided by the Orthodontist 178
Federico Brugnami and Alfonso Caiazzo

Introduction 178

Surgical Techniques: The Beginning of Tissue Engineering in Orthodontics 178

Surgical Strategies: Single Flap Corticotomy (SFC) and Tunnel Regenerative Corticotomy (TURC) 179

The Concept of Orthodontically Driven Corticotomy (ODC): From ODC to ODO 185

Surgical Strategies in ODO: Segmental, Sequential, Segmental, and Sequential Approaches 185

Segmental Approach 185

Sequential Approach 190

What is ODC? 190

Case Presentation 191

Case 1 191

Case 2 194

Case 4 197

Conclusions 203

References 206

7 Orthodontic Treatment and Periodontal Side Effects: Orthodontically Driven Osteogenesis to Stretch the Limits of a Safe Orthodontic Treatment 208
Federico Brugnami and Alfonso Caiazzo

Introduction 208

Radiographic Evaluation of Orthodontic Side Effects 210

Research Experience 214

Material and Methods 216

Results 218

Conclusions 218

Dehiscences and Fenestrations 220

Indications of Use for ODO 225

Case Presentation 225

Conclusions and Recommendations 230

Acknowledgments 234

References 234

8 Orthodontically Driven Osteogenesis: Tissue Engineering to Enhance Adult and Multidisciplinary Treatment 237
Federico Brugnami and Alfonso Caiazzo

ODO in Multidisciplinary Treatment 237

Orthodontics for Prosthetic 238

Periodontics and Orthodontics Synergy: The Two Dental Specialties that Need a Healthy Periodontium 238

Case Presentation 238

Case 1 Mutilated Dentition #1: Orthodontics and Prosthodontics Connection, Enhancing the Periodontal Outcome 238

Technical Procedure 240

Case 2 The Summer Break Case: An Alternative to Veneers to Correct Esthetics in the Anterior Area 243

Case Management 243

Clinical Outcomes 244

Case 3 Mutilated dentition #2: Adjunctive Corticotomy-enhanced Segmental Orthodontics to Intrude Over-erupted

Molars and Allow Teeth Replacement in the Opposite Arch 244

One-shot Surgical Procedure Combining Corticotomy with Anchorage Plate Positioning, Wisdom Extraction, and Periodontal Surgeries 244

Case 4 Mutilated Dentition #2. Adjunctive Corticotomy-facilitated Segmental Orthodontics to Enhance Periodontics and Prosthodontics 246

Case 5 Mutilated Dentition #3: Segmental Corticotomy to Treat Unilateral Crossbite with Crowding, Rotations, and Missing Dentition 249

Case 6 Corticotomy in Periodontal Patients: Enhancing Orthodontic Treatment to Facilitate Periodontal Maintenance 249

Case 7 Malocclusion and Mutilated Detention in a Periodontally Compromised Patient: The Perfect Storm 261

Conclusions 268

References 276

9 Clear Aligners and Orthodontically Driven Osteogenesis: Boosting Treatment in the Gray Areas Between the Straightforward and the Orthognathic Cases 277
Simonetta Meuli and Federico Brugnami

Introduction 277

Birth and Development of the Invisalign Technique 277

Treatment Phases and Characteristics Peculiar to the Invisalign System 278

Advantages of the Invisalign System 279

Regenerative Corticotomy and Bone Engineering in Orthodontics with a Digital Approach 280

Orthodontics and Its "Limitations" 280

Orthodontically Driven Osteogenesis in Orthodontic Treatment Planning 281

Presentation of Clinical Cases 282

Case 1 282

Case 2 283

Conclusions 287

Modifying the Lower Third of the Face 289

References 293

10 Orthognathic Surgery and Orthodontically Driven Osteogenesis 295

Simonetta Meuli, Federico Brugnami, Sergio Marrocco, Giulia Amodeo, and Domenico Scopelliti

Introduction 295

Diagnosis and Treatment Planning 296

Case 1 297

Therapy Protocol 299

Discussion 302

Case 2 303

Conclusions 307

References 309

11 Understanding the Etiological Relationship Between Orthodontic Tooth Crowding and Mucogingival Pathologies, "Big Teeth in Small Jaws" 312
Colin Richman

Introduction 312

Fundamental Etiological Factors Associated with Orthodontic Tooth Crowding 312

Anthropological Factors 312

Genetic Factors 312

Dietary Factors 314

Comparative Anatomical Observations Relative to Other Mammalian Species Nurtured and Living in Their Natural Habitats 314

Vasculature of the Gingival Tissues 314

The Clinical Significance of Dehiscences and Fenestrations 316

Tooth Eruption Patterns 318

Consequences and Management Strategies, Including Phenotype Modification 319

References 323

Index 325