(44) The Application of Tooth Derived Bone Graft Material in Periodontally Accelerated Osteogenic Orthodontics Surgery

Introduction: Periodontally accelerated osteogenic orthodontics (PAOO) surgery has expanded the limitation of orthodontic movement with deficient alveolar ridge width by corticotomy and grafting. It provides a possibility to achieve orthodontically preferred tooth position in the presence of thin buccal and lingual plates without compromising periodontal health and the stability of orthodontic results. Traditionally, a corticotomy-facilitated bone augmentation approach utilizes allograft material; however, autografts are still known to be the gold standard due to its osteoinductivity, osteoconductivity, and osteogenicity. Autogenous bone grafts harvested from extra-oral sites have some limitations, such as high morbidity and increased risk for surgical complications. With advancements in tissue engineering, much research has proven human tooth as one of the intraoral donor sites due to its chemical similarities to bone. In addition, many surgical patients need tooth extractions for orthodontic purposes. Therefore, we proposed a novel surgical approach by combining the processed autogenous tooth bone graft material with allograft in PAOO.

Methods: Two PAOO cases are reported in this case series. The first surgery was performed on maxillary arch for a class III patient in Invisalign treatment to augment the maxilla buccally; one premolar was extracted for orthodontic purpose. The second case was operated on the mandibular arch for a class II patient in traditional braces by grafting both buccal and lingual aspects of the ridge; two first bicuspids were extracted. In both cases, the extracted teeth were cleaned and processed in KometaBio Dentin Grinder to obtain autogenous demineralized dentin matrix (ADDM); freeze-dried bone allograft (FDBA) was mixed with ADDM to graft corticotomy sites post bone perforation. Primary closure was achieved in both cases. Patients returned for active orthodontic treatment and suture removal two weeks post-surgery.

Results: In addition to its biocompatibility, osteoinductivity, and osteoconductive property, tooth derived bone graft material in PAOO surgeries has shown enhanced bone-remodeling capabilities. The soft and hard tissue of both patients healed superiorly post operatively, and the accelerated orthodontic movement was observed compared to Clincheck. This proposed novel approach utilizes the extracted teeth as part of grafting material, which benefited patients clinically and financially.

Conclusions: Within the limitations of this case series, tooth derived bone grafting has been shown to be clinically safe and optimized bone remolding activity in PAOO assisted orthodontic treatment. The combined grafting material maximized the induction of growth factors and expanded the choice of autogenous donor sites. However, there is insufficient evidence regarding the effects of autogenous teeth used for bone grafting to support any definitive conclusions in orthodontics for long term follow up.

Lead Author's Contributions to the Research Project. : The lead author performed and documented the PAOO surgery and orthodontic treatment under supervision of attending faculties in Periodontics and Orthodontics Departments at Penn Dental Medicine.