Periodontally Accelerated Osteogenic Orthodontics (PAOO)

The numbers of adult patients seeking orthodontic treatment to correct esthetic, functional and bite (occlusal) related issues has increased significantly. It has been shown that the greatest impediment to adults pursuing orthodontic treatment relates to the length of time required to complete treatment. Conventional orthodontic therapy especially involving adult patients typically is associated with long treatment times, the potential risk of periodontal deterioration and damage to the tooth roots (resorption). This is a particular concern for patients with a thin skeletal biotype.  In addition, significant jaw discrepancies and the anatomic limits related to the position of the upper and lower jaws can hinder achieving optimal orthodontic treatment results. In the past, invasive surgical procedures were put forth as alternative methods to accelerate and optimize orthodontic tooth movement.

With these factors as a backdrop, over the past couple decades efforts have been made to accelerate orthodontic tooth movement in a manner that nor merely preserves, but wherever possible, regenerates the jawbone thereby enabling a better and more stable orthodontic treatment result. 

Periodontally Accelerated Osteogenic Orthodontics (PAOO) represents a paradigm shift in orthodontic treatment that is especially geared to assist the adult patient. Through a series of precise micro-surgical cuts to the outer layer of the jawbone (cortex), studies have demonstrated a dramatic increase in the turnover of internal (trabecular) bone. This has been described as a Regional Acceleratory Phenomenon (RAP) which encompasses a complex cascade of physiologic healing events that result in accelerated bone turnover and reduced bone density (osteopenia). Surgical wounding of the outer (cortical) layer of the jawbone is followed by a transitory burst in bone remodeling. PAOO facilitates orthodontic movement through a process defined as bone matrix transposition. The net effect of these physiologic changes is a threefold acceleratory factor in the rate of orthodontic movement. The power of PAOO is more than simply a question of speed. PAOO represents a much more elegant approach that establishes through the deposition-augmentation of new bone, a more secure foundation with teeth positioned in ideal locations that best support optimal function and cosmetics. The exceptional orthodontic results achieved with PAOO are often unattainable through conventional orthodontic means.

How is PAOO Performed

As with all surgical care, Dr. Novack is committed to ensuring your entire experience is comfortable and pain free.  A local anesthetic is used so that you will feel no pain. Please refer to our Sedation Tab which discusses various sedative options to improve your experience by reducing anxiety and establishing a state of calm.

Incisions are made in the gums in those areas where teeth are to undergo orthodontic treatment. Thereafter, the gums are carefully moved aside to expose the underlining jawbone. Dr. Novack employs Piezosurgery instrumentation (Please refer to the Piezosurgery Tab) to create precise cuts in the outer (cortex) layer of the bone on those teeth requiring orthodontic movement. The outer bone layer (cortex) is perforated to induce a RAP. By employing modulated ultrasonic vibrations, Piezosurgery precisely cuts the jawbone while preserving the integrity of the teeth and other vital structures. This approach provides unparalleled precision and patient safety. In areas of bone deficiency, a bone graft will be placed to increase jawbone support surrounding the teeth as they are moved into optimum orthodontically defined locations. You will be reassured to know Dr. Novack employs donor (allograft) bone to reduce our patients’ post operative discomfort (morbidity). Please refer to the Bone Grafting Tab. Through regeneration-reconstruction of the jawbone, an improved and much more stable orthodontic treatment result is achieved. As a result of the precision surgical approach Dr. Novack employs, our patients experience remarkably little trauma, reduced pain and faster and improved healing. Typically within a couple of days, you should be able to resume your normal life activities.

Critical to the success of any periodontal surgical procedure is the need to establish and then maintain periodontal health.  Dr. Novack’s holistic approach to periodontal treatment ensures that prior to any surgery being performed; periodontal health is achieved for our patients’. Your surgery will be performed with the utmost respect for your continued periodontal health. It has been well established that orthodontic forces represent a stress to the teeth. Throughout the time required to complete active orthodontic therapy, although with a PAOO approach considerably reduced, you will be seen for Periodontal Supportive Maintenance care to maintain your periodontal health. Please refer to the Periodontal Supportive Maintenance Tab which explains the procedure.       

Through close collaboration with your orthodontist, each phase of your care will be orchestrated in a manner that maximizes treatment success.