by M. Thomas Wilcko, DMD &
William M. Wilcko, DMD, MS
The Wilckodontics Accelerated Osteogenic Orthodontics
(AOO) procedure is a powerful orthodontic technique1-7 that
can make the treatment of very complicated scenarios more routine,
make the treatment of routine cases extremely fast and predictable
and provide a new "orthodontic patient population" for
the practitioner. The AOO technique does not owe its success to
revolutionary materials that have defined orthodontic progress
in the past, although the efficiency of one's orthodontic tooth
movement system can be greatly enhanced. The AOO treatment
instead focuses on enhancing the manner in which the periodontium
responds to applied forces and on providing for a
more intact periodontium and increased alveolar volume to support
the teeth and overlying soft tissues in retention. The surgical
component of the AOO technique is an in-office procedure.
The post-operative recovery should be no more uncomfortable
than that of other orthodontic-related surgeries such as third
molar removal, bicuspid extractions, exposures and gingival
grafting, and it is certainly less of an issue than the recovery following
Over the past two decades, attempts in engineering an "optimal
response" of the alveolar bone to applied "optimal force" has
produced refinements in selective alveolar decortications that
have propelled both orthodontics and periodontics directly into
the field of dentofacial orthopedics. Modern computerized
tomographic (CT) imaging suggested that what was for almost
half a century thought to be "bony block movement" could
more accurately be described as "bone matrix transportation"
and that this occurred subsequent to the demineralization of the
alveolar housing in response to osseous insult.¹ This cascading
physiologic response was consistent with the regional acceleratory
phenomenon (RAP) as initially reported by Frost8 in endochondral
long bones and later by Yaffe, et al.9 in the
membranous bones of the jaws. The metabolism in the healing
response was thus accelerated in both the hard and soft tissues of
the periodontium and when synthesized with the periodontal
tissue engineering principles of enhanced clot stabilization
around particulate bone grafting materials provided for orthodontic
tooth movement (OTM) 300 to 400 percent faster,
increases in the envelope of motion (degree of movement) two- to
three-fold, and increased alveolar volume for more stable clinical
outcomes and subtle facial morphing.
With the AOO technique, difficult orthodontic scenarios in
both adolescents and adults can be successfully treated with stable
results. The AOO treatment can replace some orthognathic
surgeries with severe Class III skeletal dysplasia being a notable
exception. With the AOO technique, one is no longer at the
mercy of the pre-existing alveolar volume and because of the low
morbidity patients 11 to 78 years of age have been treated with
marked biologic impunity.
The AOO technique stems from an innovative interpretation
of surgically stimulated tooth movement and simultaneous
alveolar augmentation. In synthesizing emerging concepts in
cellular and molecular biology Murphy10 has referred to the ability
to morph bone with orthodontic tooth movement done in
conjunction with periodontal bone activation and alveolar augmentation
as "in vivo tissue engineering." The AOO treatment
creates a four- to five-month "window of opportunity" that provides
more than enough time to accomplish the major tooth
movements when the correct protocols are used. The AOO
treatment also provides for an increased differential between
anchorage and activated teeth. The activated teeth move so readily
that the non-activated teeth provide better relative anchorage.
To accommodate the physiologic realities of the different
aspects of the AOO treatment, the orthodontist must utilize a
very different set of diagnostic and treatment planning parameters.
It is only after new protocols are mastered that the full
potential of the AOO treatment can be realized.
The Evolution in the Understanding of
Facilitated Tooth Movement Subsequent
to Selective Alveolar Decortication
Without Bone Grafting
Rudimentary surgical intervention to speed tooth movement
has been used in various forms for more than a hundred years. Heinrich Köle's publication in 195911 however, laid the
foundation for the subsequent evolution in decortication-facilitated
It was Heinrich Köle's belief that the continuity of the
denser cortical bone offered the greatest resistance to tooth
movement. He theorized that by disrupting the continuity of
the cortical layers of bone with corticotomy surgery the outlined
segments of bone containing one or more teeth could be more
readily moved with traditional orthodontic forces since they
would only be connected by less dense medullary bone. From
Köle's work arose the term "bony block movement" to describe
the suspected mode of tooth movement subsequent to corticotomy
surgery. Over the next 40 years, many variations of Köle's
technique were reported but the facilitated tooth movement in
all of these techniques continued to be attributed to "bony block
movement."12-15 Unfortunately, this lingering notion that the
facilitated tooth movement was the result of "bony block movement"
made it difficult to predictably provide for facilitated
tooth movement and led to some disappointing results, especially
in space closing procedures.
In 2001,³ however, Wilcko, et al. challenged the concept of
"bony block movement." They reported that in an evaluation of
corticotomized patients, utilizing hospital-based high resolution
CT scan imaging, that the small outlined blocks of bone lost
their structural integrity due to an apparent demineralization of
the alveolar housing over the root prominences. This apparent
demineralization occurred in close approximation to the circumscribing
corticotomy cuts both on the pressure side of the
teeth and on the tension side of the teeth. The initial alveolar
demineralization and subsequent remineralization was consistent
with the cascading physiologic events associated with RAP
and not "bony block movement."
Wilcko, et al.¹ went on to report that the remineralization
phase of the RAP was remarkably complete in the adolescent
at two years post corticotomy surgery. In the adult however
the remineralization was not only incomplete at two years
post corticotomy surgery, but it was still incomplete at 12
years post corticotomy surgery with a net loss of alveolar
bone. They attributed this net loss of alveolar bone in the
adult to the decreased recuperative potential of adult bone in
comparison to adolescent bone. Wilcko, et al.1,2 have additionally
reported that the tooth movement can be best surgically
facilitated by providing for a thin layer of activated bone over
the root surfaces in the direction of the intended tooth movement.
The demineralization of this thin layer of bone will
leave the soft tissue matrix of the bone and islands of osteoid
that can be carried with the root surfaces of the teeth where it
will remineralize in the desired position. This remineralization
process is almost complete in the adolescent, but only partially
complete in the adult.
The facilitated tooth movement subsequent to a corticotomy-based
surgery is thus a physiologically based periodontal ligament
(PDL) mediated process. An uninterrupted blood supply is critical.
The luxation of the teeth or any outlined single-tooth segment
of bone in a single-stage surgery (reflection of both facial
and lingual flaps) is absolutely contraindicated and can result in
intrapulpal and intraosseous morbidity. "Green-stick fracturing"
and luxation of small dentoalveolar segments will not serve a useful
purpose since these segments will quickly lose their structural
integrity as a result of the demineralization process.
The design of the osseous insult used to activate the bone is
not critical since it is the degree of metabolic pertubation in
response to the osseous insult that sets the stage for the facilitated
However, there are preferred decortication designs that provide
greater blood supply for the grafting material and provide
greater alveolar demineralization. When performed properly, the
bone activation results in increased tissue turnover and a transient
demineralization of the alveolar housing, the degree of
which is directly commensurate with the intensity and proximity
of the surgical insult. This demineralization of the alveolar
housing occurs due to an increase in the number of osteoclasts
and in the absence of hyalinization necrosis and indirect resorbtion
or infection will leave behind the soft tissue matrix of the
bone. The demineralization is a prostaglandin mediated sterile
The response to the bone activation is very limited and
will only occur in very close approximation to the osseous
insult. For example, bone activation on the facial of the alveolus
will not provide for any significant demineralization on
the lingual of the alveolus. A thin layer of highly reactive bone
is very conducive to tooth movement. The opposite of this, a
thicker layer of relatively quiescent bone, would thus favor
Increasing Alveolar Volume for Increased
Post-treatment Stability and Subtle
The widely held notion that pre-existing alveolar volume is
immutable has placed substantial limitations on the amount of
tooth movement thought to be safely achievable with traditional
orthodontics and still provide a stable result. The Department of
Orthodontics of the University of Washington has collected
diagnostic records on more than 600 patients that are 10 or more
years into retention.17 Satisfactory mandibular alignment was
maintained in less than 30 percent of the patients after a decade
of retention. Relapse was typically accompanied by a decrease in
arch length and arch width. Interestingly, in a study of mandibular
incisor relapse Rothe, et al.18 reported that patients with thinner
mandibular cortices are at increased risk for dental relapse.
Utilizing high resolution CT scan imaging, Fuhrmann19
showed that in adults that had undergone traditional orthodontic
treatment there was bony dehiscence formation over the root
prominences that only partially resolved during retention. Even at
three years retention he found significant bony dehiscences that
had not repaired themselves, most notably on the facials of the
lower anterior teeth. There was not complete remineralization of
the presumed residual soft tissue matrix of the bone and this translated
to a net loss of alveolar volume. There was, thus, less bone
overlying the root prominences following treatment than had been
present prior to the traditional orthodontic treatment. Likewise,
our results have shown a net loss of alveolar volume in adults that
had been treated with corticotomy-facilitated orthodontics in the
absence of simultaneous bone grafting.¹ Even at 12 years retention,
there were still lingering alveolar dehiscences over the root prominences
that had only partially repaired themselves after debracketing.
No additional repair had taken place between two years
retention and 12 years retention. It would thus appear that adults
are likely to experience a net loss of alveolar volume regardless of
whether they underwent traditional orthodontics or corticotomy-facilitated
orthodontics with no bone grafting during the surgery.
The bone grafting/alveolar augmentation that is performed
in conjunction with the bone activation at the time of AOO surgery
will provide for additional alveolar volume over vital root
surfaces. The loss of alveolar volume that is associated with adult
orthodontic treatment can thus be prevented. Additionally, as
long as there has not been accompanying apical migration of the
epithelial attachment pre-existing alveolar dehiscences and fenestrations
can be corrected. In doing so, the roots of the teeth
can be sandwiched between intact facial and lingual layers of
bone of adequate thickness. This will in turn provide for
improved post-treatment stability. Additionally, the increased
tissue turnover and demineralization/remineralization subsequent
to the bone activation will contribute to post-treatment
stability through memory loss and improved bite settling.6
Materials and Methods
The AOO treatment must begin with thorough orthodontic
and periodontal evaluations. It is the orthodontist who must
design and coordinate the overall treatment plan. There can be
no active disease present at the time of the AOO surgery. Any
infections must be resolved prior to the surgery.
The AOO treatment is not a panacea and the patient must
be made aware of its limitations and potential complications.
The success of the AOO treatment is also dependent on patient
compliance especially in regards to keeping the orthodontic
adjustment appointments every two weeks.
Typically, the patient is bracketed and a light archwire
engaged sometime during the week prior to the AOO surgery.
The AOO is not a very invasive surgery, but it is long and
tedious. The surgery is typically done under IV or oral sedation.
Our preference is to typically reflect full thickness flaps both
facially and lingually around all of the teeth regardless of the
teeth that will be activated. Sulcular releasing incisions are preferred
and as much of the interdental papillae as possible
reflected with the flaps.
The activation of the bone will be performed in different
manners depending on the situation being addressed. Although
an emphasis is placed on activating the bone over the root prominences
in the direction of the intended tooth movement, the bone
in the direction away from which the teeth are being moved
should usually also be activated. It is preferable to have a thin layer
of bone over the root prominence in the direction of the intended
tooth movement. When a tooth is being moved through the long
axis of the alveolus an ostectomy is performed through the entire
thickness of the alveolus to create this situation. This facilitates
closing spaces distal to the canines or in the uprighting of molars.
In most other tooth movements, the bone activation is performed
with a combination of corticotomy cuts or intramarrow penetrating
that extend through the cortical layer of bone and only
barely into the medullary bone. Luxation of the teeth or any outlined
segments of bone is absolutely contraindicated.
The bone activation is followed by the placement of the particulate
bone grafting material over the activated bone both
facially and lingually. If, in the maxilla, only the anterior teeth
are being activated the bone grafting material can still be used
on the buccals of the upper posterior teeth to lessen the likelihood
of dark buccal corridors. The amount of the bone grafting
material that is used will depend on the extent of the preexisting
alveolar deficiencies, the increase in the dentoalveolar
deficiency that is anticipated, and the amount of lower facial
recontouring that one is attempting to achieve. Only resorbable
bone grafting material is used. One should anticipate at least a
50 percent reduction in volume as the particulate grafting materials
are eliminated and replaced with the patient's own natural
bone. Typically, .25 to .5cc of particulate bone grafting material
is used per activated tooth, but as much as 24cc of grafting
material has been used in a single case. The bone grafting material
maintains the space between the periosteum and the activated
bone. Micromovement of the particulate grafting material
must be minimized. The integrity of the flaps needs to be
respected and vertical releasing incisions and releasing incisions
at the base of the flaps need to be avoided as much as possible.
It is the continuity of the flaps that function as pouches to hold
the packed particulate grafting material in place that helps minimize
the micromovement of the bone grafting particles. The
goal is to end treatment with increased alveolar volume, but not
to have the new bone formation occur so rapidly as to impede
the tooth movement. Therapeutic levels of bone morphogenic proteins would be potentially problematic in this regard, but
growth factors that stimulate soft tissue maturation of the overlying
flap can have a positive impact on the bone formation in
a secondary fashion.
Non-resorbable, non-wicking sutures are used and left in
place for a minimum of two weeks to allow for re-establishment
of the epithelial attachment. The patients should be checked
four to five days following the surgery to make certain that the
flaps have not released.
The patients must not take non-steroid anti-inflammatory
drugs (NSAIDs) beyond the first week after the surgery. The
NSAIDs are prostaglandin inhibitors and can reduce the sterile
inflammatory process that is needed to facilitate the rapid
The orthodontic adjustments are usually made at two-week
intervals. Major movements, especially those requiring orthopedic
forces, are not begun until at least two weeks following the surgery
to give the RAP a chance to take effect. There are occasions in
which the orthodontist will include the use of TADs for increased
anchorage or to alter the location of effective anchorage.
AOO Treatment Demonstrating Intrusion/Extrusion,
Decrowding and Difficult Crossbite Correction
A male, age 23, presented with Class II molar and canine
relationships, severe lower constriction with lower left posterior
lingual crossbites and supraeruption of the upper first molars
(Figs. 1a, 2a, 3a, 4a, 4b, 6a, 7a, 8a). It was estimated that the
length of treatment utilizing traditional orthodontics would
be two to 2.5 years along with possible orthognathic surgery.
Patient 1 was completing his graduate studies and was anticipating
having to leave the area to secure employment. He opted
for the AOO treatment and from bracketing to debracketing
the total treatment time was six months and two weeks (Figs.
1b, 2b, 3b, 8d).
The orthodontic objectives were to align the upper and
lower teeth, correct the lower left lingual posterior crossbite,
open the vertical and skeletal bite and coordinate the archform
while obtaining the "best bite possible." Knowing that one can
decrowd, intrude and extrude teeth two to three times further
than is possible with traditional orthodontics, necessitates that
the orthodontist develop an anchorage system that makes these
significant movements possible.
The upper first molars were designated as the vertical
anchorage units and the orthodontic appliances were designed
around them. Additionally, the bite had to be mechanically
opened to allow adequate clearance for the dramatic tooth
movements. Key to this was bonding a large gauge wire across
the occlusal surfaces of the lower right second bicuspid and second
molar (Fig. 8c). The occlusal surface of the lower left molar was built up with bonding material to balance the right side.
The lower second molars and upper first molars were banded,
bondable brackets placed on all of the other teeth, and the movement
was achieved with archwire therapy.
At the direction of the orthodontist, bone activation was
performed both facially and lingually in the manner of circumscribing
corticotomy cuts and intramarrow penetrating around
all of the remaining upper and lower teeth except around the
upper first molars which would serve as the anchorage units. The
bone activation can be seen on the facials of the upper anterior
teeth in figure 5a. This patient had a fairly intact layer of bone
and crestal globella on the facials of most of his teeth. Particulate
bone grafting material was layered over the activated bone both
facially (Fig. 5b) and lingually.
At three months post AOO surgery the major movements
had been accomplished and the lower left lingual posterior crossbite
was corrected (Figs. 6b, 7b). The large gauge wire bonded to
the occlusals of teeth #29 and #31 was removed. The leveling
and aligning and the archform coordination required 3.5
months of additional treatment. The AOO treatment can provide
rapid tooth movement over substantial distances, additional
alveolar bone and more intact periodontium for a stable result
(Figs. 1b, 2b, 3b, 8d). As was demonstrated in this case, developing
the proper anchorage system and being fully aware of the
increase in the distance that the teeth can be moved can be critical
in realizing the full potential of the AOO treatment.
Fig. 1a: Patient 1: Before AOO treatment, anterior view.
Fig. 1b: Patient 1: Two years retention, anterior view.
Fig. 2a: Patient 1: Before AOO treatment, profile.
Fig. 2b: Patient 1: 16 months retention, profile.
Fig. 3a: Patient 1: Sectional ceph, pre-treatment, profile.
Fig. 3b: Patient 1: Sectional ceph, three years retention, profile.
Fig. 4a: Patient 1: Before AOO treatment with teeth separated, anterior view. Fig. 4b: Patient 1: Before AOO treatment, models showing complete lingual crossbite
of lower left posterior teeth, inferior left lateral view.
Fig. 5a: Patient 1: AOO surgery, following bone activation, note the relatively thick
layer of bone present over the root prominences, right oblique view. Fig. 5b: Patient 1: AOO surgery, particulate bone grafting layered over activated
bone, right oblique view.
Fig. 6a: Patient 1: Before AOO treatment, left lateral view.
Fig. 6b: Patient 1: Three months post AOO surgery, left lateral view.
Fig. 7a: Patient 1: Before AOO treatment, lower occlusal view. Fig. 7b: Patient 1: Three months post AOO surgery, lower occlusal view.
Fig. 8a: Patient 1: Before AOO treatment, right oblique view. Fig. 8b: Patient 1: After bracketing, before AOO surgery, right oblique view. Fig. 8c: Patient 1: After debracketing, right oblique view. Fig. 8d: Patient 1: Two years retention, after placement and restoration of the lower
implants, right oblique view.
Fig. 9a: Patient 2: Before AOO treatment, right lateral view.
Fig. 9b: Patient 2: Nine years retention, right lateral view.
AOO Treatment Demonstrating Extraction/Retraction
for Space Closing and Utilizing Orthopedic Forces
Using 0-0 Retractors
A female, age 11, presented with Class II molar and canine
relationships, mild to moderate upper and lower crowding, constriction
of the upper and lower arches, prominent upper
canines and procumbent/protrusive upper incisors (Fig. 9a).
This patient also displayed a convex profile and lip incompetence.
Additionally, she exhibited lower retrognathic and lower
lip curl. The parents and patient were unreceptive to conventional
orthodontic treatment functional therapy, and orthognathic
surgery due to the length of treatment. The AOO
treatment was presented as an option. They opted for the AOO treatment and the resulting total treatment time from bracketing
to debracketing was seven months and two weeks (Fig. 9b).
Fig. 10a: Patient 2: AOO surgery, yellow arrows indicate ostectomies, blue arrows
indicate bone thinning, palatal view. Fig. 10b: Patient 2: AOO surgery, yellow arrow indicates ostectomy, bone activation
achieved with circumscribing cuts and intramarrow penetrating, left lateral view. Fig. 10c: Patient 2: AOO surgery, bone activation achieved with circumscribing corticotomy
cuts and intramarrow penetrating 6-6, lower anterior facial view. Fig. 10d: Patient 2: AOO surgery, particulate bone grafting mixture placed over
activated bone both facially and lingually, lower anterior facial view. Fig. 11a: Patient 2: O-O unilateral orthopedic retractors inserted two weeks following
the AOO surgery, palatal view. Fig. 11b: Patient 2: After four weeks of retraction the space closing is complete and
the O-O retractors have been removed, palatal view. Fig. 12a: Patient 2: Surface CT scan imaging, after removal of the upper first bicuspids
and prior to the AOO surgery, palatal view. Fig. 12b: Patient 2: Surface CT scan imaging 2.5 years after completion of the AOO
treatment, total AOO treatment time was seven months and two weeks, palatal view. Fig. 13a: Patient 2: Surface CT scan imaging, after removal of the upper first bicuspids
and prior to the AOO surgery, anterior view. Fig. 13b: Patient 2: Note the increased alveolar volume, anterior view.
Fig. 14a: Patient 2: Surface CT scan imaging, after removal of the upper first bicuspids
and prior to the AOO surgery, left lateral view. Fig. 14b: Patient 2: Left lateral view.
Fig. 15a: Patient 2: Surface CT scan imaging, after removal of the upper first bicuspids
and prior to the AOO surgery, lower right oblique view. Fig. 15b: Patient 2: Lower right oblique view.
Fig. 16a: Patient 2: Surface CT scan imaging, after removal of the upper first bicuspids
and prior to the AOO surgery, note the sparcity of bone on the linguals of the
lower incisors and the severe bony dehiscences on the linguals of the lower central
incisors, lower lingual view. Fig. 16b: Patient 2: Lower lingual view.
Two weeks following the AOO surgery the unilateral labial
O-O retractors were inserted into the buccal tubes of the upper
first molars (Fig. 11a). After four weeks of adjustments utilizing
orthopedic forces, the space closing/retraction was complete and
the O-O retractors were removed (Fig. 11b). Space closing/
retraction is typically delayed for two to four weeks following
the AOO surgery to provide time for the thin layer of activated
bone to demineralize and undergo an increase in the rate of
turnover. By doing so, the tooth movement could be facilitated
without increasing the risk of root resorption.
The leveling and aligning was completed over the next six
months and the case was debracketed at seven months and two
weeks post AOO surgery. The case was completed with a Class
I canine relationship and a Class II molar relationship. The
patient and her parents were very pleased with the treatment
outcome and at nine years retention the case was still remarkably
stable (Fig. 9b).
At 2.5 years retention a surface CT scan imaging analysis
was repeated (Figs. 12b, 13b, 14b, 15b, 16b). The increased volume
of bone in the upper and lower anterior/bicuspid areas was
very evident in comparison to the pre-treatment CT scans. The
upper first bicuspid sites remained closed and the teeth
remained aligned. The bone grafting of the ostectomy sites provided
for a consolidated upper alveolus. Likewise, on the linguals
of the lower incisors there was now a thick layer of bone.
At pre-treatment there were severe bony dehiscences on the lingual
root prominences of the lower incisors, but at 2.5 years into
retention the roots of the lower incisors were sandwiched
between two intact layers of bone.
This case demonstrates that the pre-treatment angulation of
the teeth can play an important role in the amount of tooth movement
that can be anticipated. In this case the space closing of the
edentulous upper first bicuspid sites was accomplished in four
weeks. Regardless of whether the space closing had been accomplished
with orthopedic or orthodontic forces, the bone thinning
on the distals of the upper canines and on the linguals of the upper
anterior teeth was of paramount importance in closing the upper
first bicuspid spaces and retracting the upper anterior teeth.
This case demonstrated that a tall thin symphysis could be
widened to provide additional bone between which the roots of
the teeth were sandwiched following treatment (Figs. 15a, 16b).
The layer of bone was even thickened on the linguals of the
lower incisors where there was no pre-existing concavity in the
archform and in doing so the severe bony dehiscences on the linguals
of the lower incisors were corrected.
The pre-treatment angulation of the teeth impacts heavily
on the amount of movement that can be anticipated when utilizing
the AOO technique. In this case there was substantial
proclination of the upper incisors (Fig. 9a). The key aspect in
this case became the retraction of the upper anterior teeth following
the removal of the upper first bicuspids. Since the
molars were in full Class II malocclusion, the space closure was
accomplished by retracting the anterior segment and slipping
Although extractions are typically performed at the time of
the AOO surgery, in this particular case the upper first bicuspids
were removed one month prior to the AOO surgery. Following
the extraction of the upper first bicuspids and prior to the AOO
surgery, surface CT scan imaging was performed (Figs. 12a, 13a,
14a, 15a, 16a). The extent of the proclination of the upper anterior
teeth and the surprising absence of bone over the lingual
root prominences of the lower incisors was very apparent.
The AOO surgery was performed during the week following
the bracketing and archwire engagement. At the direction of the
orthodontist, bone activation was performed both facially and
lingually in the manner of circumscribing corticotomy cuts and
intramarrow penetrating around the lower anterior teeth and
lower bicuspids. In the upper arch, the bone activation was
accomplished with ostectomies at the edentulous upper first
bicuspid sites, bone thinning on the distals of the upper canines
and on the linguals of the upper anterior teeth, and circumscribing
corticotomy cuts and intramarrow penetrating both
facially and lingually around all of the remaining upper teeth
(Figs. 10a, b, c). The yellow arrows indicate the through and
through ostectomies at the upper first bicuspid sites (Figs. 10a,
b). The blue arrows indicate the bone thinning on the linguals
of the upper anterior teeth. Thinning the layer of bone to a
thickness of 2mm or less on the distal of the upper canines and
on the linguals of the upper anterior teeth would greatly facilitate
the retraction of the upper anterior teeth. A thin layer of
activated bone over the root prominences in the direction of the tooth movement will facilitate tooth movement. The particulate
bone grafting mixture was layered both facially and lingually
over the activated bone. The ostectomy sites were also filled with
bone grafting material (Fig. 10d).
AOO Treatment Demonstrating Anterior Protraction
for Space Opening and Prosthetic Replacements
A female, age 42, presented with a Class III malocclusion
and an almost complete upper lingual crossbite (Figs. 17a, 19a).
The upper second bicuspids were missing. It was not able to be
determined if the second bicuspids had been removed or were
congenitally missing. From bracketing to debracketing her total
AOO treatment time was nine months and two weeks (Figs.
The orthodontic treatment plan centered around opening
the upper second bicuspid spaces with stopped/advanced archwires.
The upper and lower archforms would then be coordinated
The pre-treatment angulation of teeth always plays an
important role in determining the degrees of movement that can
be reasonably anticipated. More movement can be achieved if
the teeth are initially tipped away from the direction of the
intended tooth movement and fortunately that was the situation
in this case. The upper incisors were lingually inclined and the
upper canines and first bicuspids were tipped slightly distally.
The orthodontist determined that all of the upper and lower
teeth should be activated both facially and lingually and then bone
grafted. Even though there were significant bony dehiscences present
over the facial and lingual root prominences of many of the
lower teeth, the greatest sparsity of bone was found on the facials
of the upper canines where there were bony dehiscences extending
almost to the apices of these two teeth (Fig. 18a). The bone activation
was performed in the manner of circumscribing corticotomy
cuts and intramarrow penetrating (Fig. 15a). The particulate
bone grafting was then performed both facially and lingually over all of the activated bone (Fig. 18b). This was especially important
on the facials of the upper anterior teeth and upper first
bicuspids. These teeth were undergoing the most substantial
movement in order to open the upper second bicuspids spaces
and to correct the upper lingual crossbite.
After five months of treatment and utilization of the stopped/
advanced archwire, the spaces for the upper second bicuspids
had been opened and the upper lingual crossbite corrected. The
resulting anterior openbite was being closed down with vertical
elastics (Fig. 18c). After seven months of treatment, the active
orthodontic movement was completed (Fig. 18d). At this point it
was decided to leave the patient bracketed for a couple of additional
months to give the periodontium time to mature while the
cellular activity was returning to a normal steady state. The case
was then debracketed at nine months and two weeks following
the AOO surgery (Figs. 17b, 19b). At 1.5 years into retention the
spaces were restored with conventional fixed bridgework and the
case had remained stable (Figs. 17c, 19c).
Rapid Forced Eruption of a Deeply Impacted Upper
Right Canine in Conjunction with Traditional
A male, age 14, presented after approximately a year of traditional
orthodontic treatment with a deeply impacted upper
right canine. The space for the upper right canine had been
opened greater than the width of the canine in anticipation of
the exposure and forced eruption of this tooth (Fig. 20a). It
was determined that the crown of the upper right canine was
positioned in the palate and radiographically the crown
appeared to be approximating the apices of the upper right lateral
and central incisors (Fig. 23a).
The exposure surgery was initiated by the removal of the
upper right primary canine and reflection of both facial and
lingual full thickness flaps with distal releasing incisions on
the mesial of the upper right first bicuspid (Figs. 21a, 22a).
An ostectomy was then performed through the entire thickness
of the alveolus to expose as much of the facial of the
anatomic crown of the canine as possible. Only .5 to 1mm of
the cervical area of the root surface was exposed (Figs. 21b,
22b). The bone was not thinned on the proximal surfaces of
the adjacent teeth.
Fig 17a: Patient 3: Before AOO treatment, right oblique view.
Fig. 17b: Patient 3: Immediately post debracketing, right oblique view. Fig. 17c: Patient 3: 1.5 years retention, following replacement of the missing upper second
bicuspids with fixed bridgework, right oblique view.
Fig. 18a: Patient 3: AOO surgery, following bone activation, note the sparcity of bone over the root prominences of the upper canines, right oblique view. Fig. 18b: Patient 3: AOO surgery, shows the particulate bone grafting mixture layered over the activated bone and root prominences, right oblique view. Fig. 18c: Patient 3: Progress after five months of AOO treatment, beginning to close down the bite, right oblique view. Fig. 18d: Patient 3: Progress after seven months of AOO treatment, the active orthodontic
movements have been completed, right oblique view.
Fig. 19a: Patient 3: Before AOO treatment, palatal view. Fig. 19b: Patient 3: Immediately post debracketing, palatal view. Fig. 19c: Patient 3: 1.5 years retention, following replacement of the missing upper second bicuspids with fixed bridgework, palatal view.
Fig. 20a: Patient 4: After eight months of traditional orthodontic treatment, right
oblique view. Fig. 20b: Patient 4: After forced eruption of tooth #6 and three days following debracketing, right oblique view. Fig. 20c: Patient 4: Eight months retention, right oblique view. Fig. 21: Patient 4: Palatal view: (a.) Following removal of the upper right primary canine and flap reflection, a distal vertical releasing incision was used. (b.) After through and through osteotomy to expose the facial of the upper right permanent canine. (c.) After bracketing, the bracket on the facial of tooth #6 is attached to the brackets on the adjacent teeth with chain elastic to provide for a "tripoding" effect. A backup ligature wire is also attached to the bracket and archwire. (d.) After suturing of the flaps. (e.) Shows tooth #6 at six months post exposure surgery, at this appointment the chain elastic was removed and the archwire was engaged in the bracket. (f.) Shows tooth #6 at eight months retention.
Fig. 22: Patient 4, right oblique view: (a.) Following removal of the upper right primary
canine and flap reflection, distal vertical releasing incision was used. (b.) After
through and through osteotomy to expose the facial of the upper right permanent
canine. (c.) After bracketing, the bracket on the facial of tooth #6 is attached to the
brackets on the adjacent teeth with chain elastic to provide for a "tripoding" effect. A
backup ligature wire is also attached to the bracket and archwire. (d.) After suturing
of the flaps. (e.) Shows tooth #6 at six months post exposure surgery, at this
appointment the chain elastic was removed and the archwire was engaged in the
bracket. (f.) Shows tooth #6 at eight months retention.
Fig. 23a: Patient 4: After eight months of traditional orthodontic treatment, presurgery periapical radiograph, right oblique view. Fig. 23b: Patient 4: Periapical radiograph taken three days post debracketing. Fig. 23c: Patient 4: Periapical radiograph taken at eight months retention.
The ostectomy provides a clear and direct path for the
canine to move into the proper position. There can be no
bone left touching the enamel in the direction of the
intended tooth movement or the tooth will hang up. Once
the sheath is removed from around the crown the ability of
the crown to resorb bone is lost. The ostectomy also provides
clearance for the most ideal placement of the bracket on the
crown of the canine and for the chain elastic that connects
this bracket to the brackets on the adjacent teeth (Figs. 21c,
22c). The chain elastic thus provides a tripoding effect. By
preferential adjustment of the tension on the two arms of the
chain elastic, the canine can be guided directly into the
desired position. Please note that in this case there is also a
backup ligature wire extending from the bracket on the
canine to the archwire. The use of the backup ligature wire
has since been discontinued. The hook on the bracket that
extends apically should prevent the chain elastic from slipping
off the bracket during adjustments. Intramarrow penetrating
was performed facially and transmucosal penetrating
was performed lingually to activate the bone. The flaps were
then returned to their original positioning and sutured with
a resorbable material (Figs. 21d, 22d).
Since this forced eruption was done in conjunction with
traditional orthodontic treatment, the adjustments were being
performed at six-week intervals. At approximately six months
following the exposure surgery (at the fourth adjustment
appointment), the upper right canine had been brought into
position and was ready to be engaged in the archwire (Figs. 21e,
22e). At three days post debracketing the area can be seen clinically
in figure 20b and radiographically in figure 23b. Even
though the deeply impacted upper right canine was brought
into position in only six months there has been no significant
apical root resorption and the periodontium was intact. At eight
months retention the case had remained stable and there was no
evidence of vertical relapse of the upper right canine (Figs. 20c,
21f, 22f, 23c).
We suspect that these forced eruptions tend to remain stable
and they do not retract apically for a couple reasons. The bone
activation likely provides for some loss of memory just by virtue
of the demineralization/remineralization process. Perhaps, even
more pertinent in these situations is that the bone activation
provides for a two- to three-fold increase in the rate of the tissue
turnover. This is a transient phenomenon, but it will take time
for the bone turnover to return to a steady state. In the average
person this could take one to two years to resolve.
Since these forced eruptions are being done in conjunction
with traditional orthodontics, even after the forced eruption
itself is complete, the patient might still be bracketed for
another year or more while the finer leveling and alignment
movements are completed and the bite is set. It is during this
year or so that the increased rate of tissue turnover in the periodontium
might provide for increased stability. The more
times the supporting tissues turn over while a tooth is held in
the same position, the more likely this tooth will remain stable.
There is no need to do bone grafting in conjunction with
the forced eruption of deeply impacted teeth since stretching
of the periodontal ligament (PDL) will cause the bone to fill in
on the tension side of the root.
These deeply impacted canines should absolutely never be
luxated. Ankylosed teeth cannot be forcibly erupted using this
technique. These forced eruptions are strictly PDL mediated.
Luxation can lead to a damaged PDL and cause the tooth to
AOO Treatment Demonstrating Orthopedic
Dentoalveolar Expansion to Correct Maxillary Arch
Constriction in the Molar/Bicuspid Areas and
Sequencing for the Forced Eruption of the Palatally
Impacted Upper Left Canine
A female, age 23, presented with severe upper crowding and
moderate lower crowding, an Angle Class I relationship on the
right side and an Angle Class II relationship on the left side, a 3 to
4mm anterior openbite, a 2mm upper midline shift to the left side
and multiple upper anterior and posterior teeth in lingual crossbite
with constriction of the upper arch (Figs. 24a, 25a). The patient
was completing her graduate studies and wanted to improve her
appearance in anticipation of job interviews. The total AOO treatment
time from bracketing to debracketing and including the
forced eruption of tooth #11 was 11 months (Figs. 24b, 25b).
A deeply impacted tooth cannot be forcibly erupted simultaneously
with the AOO treatment since the deeply impacted
tooth will act as the unwanted anchor toward which the activated
teeth will be very readily inclined to move. A deeply
impacted tooth will need to be forcibly erupted either prior to
the AOO activation of the teeth or following the major movement
of the activated teeth. In this case a space had to be created
before the impacted canine could be forcibly erupted. It was
decided to first complete the major movements and open the
space utilizing the AOO treatment and then forcibly erupt the
impacted upper left canine. The upper left canine had caused
extensive root resorption of the upper left lateral incisor and it
was anticipated that the upper left lateral incisor would need to
be removed and replaced at some point following the orthodontic
In the lower arch, the molars were designated as the anchorage
units and the bone activation and bone grafting were performed
around the lower anterior teeth and lower bicuspids
where a moderate amount of overlap crowding would need to be
resolved. In comparison, however, all of the upper teeth would
be undergoing a much more extensive amount of movement.
Accordingly, the orthodontist designated that bone activation be
performed both facially and lingually around all of the upper
teeth. The bone activation was performed in an aggressive fashion
and extended into the furcations of the upper molars to
attempt to impact on the bone on the buccal of the palatal roots
of these teeth (Fig. 26a). It is impossible to create a thin layer of
bone on the buccal of the palatal root to facilitate the tooth
movement, but osseous insult in close approximation to the bone on the buccal of the palatal root will at least provide for
increased cellular activity and decreased mineral content.
Fig. 24a: Patient 5: Before AOO treatment, constricted maxilla with unerupted upper left canine, anterior view. Fig. 24b: Patient 5: Post debracketing, anterior view. Fig. 25a: Patient 5: Before AOO treatment, constricted maxilla with unerupted upper left canine, palatal view. Fig. 25b: Patient 5: Post debracketing, palatal view. Fig. 26a: Patient 5: AOO surgery, bone activation performed around all teeth, arrow indicates incisal edge of unerupted upper left canine, palatal view. Fig. 26b: Patient 5: Showing the dentoalveolar expander inserted 2.5 weeks following the AOO surgery and prior to the suture removal, palatal view. Fig. 26c: Patient 5: 5.5 weeks post AOO surgery, the dentoalveolar expansion is complete after three weeks of adjustments by the patient, palatal view. Fig. 26d: Patient 5: 2.5 months post AOO surgery, showing the TPA for crossarch stabilization one month after removal of the dentoalveolar expander, palatal view. Fig. 26e: Patient 5: Five months post AOO surgery, the space has been opened for tooth #11 utilizing a stopped and advanced wire, palatal view. Fig. 26f: Patient 5: Six months post AOO surgery, tooth #11 has been surgically exposed and bracketed both facially and lingually, palatal view. Fig. 26g: Patient 5: 7.5 months post AOO surgery and six weeks post exposure surgery, tooth #11 is ready to be engaged in the archwire, palatal view. Fig. 26h: Patient 5: 8.5 months post AOO surgery and 10 weeks post exposure surgery, palatal view.
The dentoalveolar expander was inserted in the palate 19 days
following the AOO surgery and prior to the completion of the
removal of the sutures (Fig. 26b). The expansion protocol can be
different from palatal expansion since we are creating dentoalveolar
expansion and not sutural expansion. After three weeks of
daily adjustments by the patient the dentoalveolar expansion was
complete at 5.5 weeks post AOO surgery and the expander was
ready to be removed (Fig. 26c). It is imperative that a TPA be
placed immediately following the removal of the expander to help
maintain the increased arch width (Fig. 26d). No diastema was
created between the upper central incisors because the expansion
was almost completely dentoalveolar and not sutural.
Immediately following the completion of the dentoalveolar
expansion a stopped/advanced archwire was inserted to begin
opening the space in which to forcibly erupt the upper left
canine. Five months following the AOO surgery and 3.5
months after the completion of the dentoalveolar expansion, the
space opening for the upper left canine was complete (Fig. 26e).
Six months following the AOO surgery and after completion
of the major tooth movements, the impacted upper left
canine was surgically exposed (Fig. 26f ). Note that the crown of
tooth #11 is now positioned somewhat distal to tooth #10 in
comparison to the AOO surgery at which time the crown of
tooth #11 was positioned directly on the lingual of tooth #10
after having erupted through the root of this tooth (Fig. 26a).
An ostectomy was performed between teeth #10 and #12 so that
a bracket could be placed on the facial of tooth #11 and then
joined to the brackets on the adjacent teeth with a chain elastic
and thus provide for a tripoding effect. Additionally, a bracket
was also placed on the lingual of the crown of tooth #11. A
stainless steel finger spring was attached to this bracket from the
TPA to aid in quickly extruding the crown of #11 away from the
badly resorped root of tooth #10. After six weeks of forced eruption
tooth #11 had been brought down into position and was
ready to be engaged into the archwire (Fig. 26g). At 8.5 months
following the AOO surgery and 10 weeks after the exposure
surgery, tooth #11 was engaged in the archwire and level and
aligning was being performed in preparation for debracketing
(Fig. 26h). The total AOO treatment time from bracketing to
debracketing was 11 months (Figs. 24b, 25b).
In this case, it was necessary to use an orthopedic dentoalveolar
expander because of the constriction of the arch in the molar
areas. It would not have been possible to correct the constriction
in the molar areas with archwire therapy alone. The dentoalveolar
expander was inserted 2.5 weeks after the AOO surgery to allow
adequate time for the increased cellular activity and demineralization
to occur. The expansion is PDL mediated and dentoalveolar
in nature and as such does not result in any significant sutural
expansion or the creation of a diastema between the upper central
incisors (even in adolescents). Six millimeters of expansion in the
upper posterior areas can be readily achieved and can be expected
to remain stable with routine post-treatment retention.
AOO Treatment Demonstrating Archwire Expansion
for the Correction of Maxillary Arch Constriction in
the Anterior/Bicuspid Areas
A male, age 23, presented with Class I canine and molar
relationships, very substantial upper and lower crowding, severe
upper arch constriction in the anterior and bicuspid areas, and
bilateral crossbites in the anterior and posterior areas. The estimated
length of treatment utilizing traditional orthodontic therapy
along with assisted surgical expansion was two to 2.5 years.
The total AOO treatment time from bracketing to debracketing
ended up being six months and two weeks (Figs. 27c, 29c).
The AOO surgery was performed in both the upper and lower
arches and all of the teeth were activated and bone grafted. Of particular
interest in this case is that the severe maxillary constriction
was present in the anterior and bicuspid areas, but not in the
molar areas. This is very evident in the pre-surgery clinical photographs
and in the pre-treatment surface CT scan imaging (Fig. 28a, 30a). With archwire therapy alone the severe anterior/bicuspid
constriction was corrected in only four months (Figs. 29b,
29e). The finer finishing movements were completed in the following
2.5 months and the case debracketed (Figs. 27c, 29c).
There are numerous observations that can be made in a comparison
of the pre-treatment photographs (Figs. 27a, 29a) and
post-treatment photographs (Figs. 27c, 29c) and in a comparison
of the pre-treatment surface CT scan imaging (Figs. 28a, 30a,
31a) and post-treatment surface CT scan imaging (Figs. 28b, 30b,
31b). The cross-arch expansion in the canine areas was 8mm cusp
tip to cusp tip. Additionally, in a comparison of the pre- and posttreatment
surface CT scan imaging it is readily apparent that
there is considerably more bone over the root prominences both
facially and lingually following treatment than was present prior
to the AOO treatment. Even the dentoalveolar deficiency at B
point was filled in.
Fig. 27a: Patient 6: Pre AOO surgery, constricted maxilla mesial to the molars, anterior
view. Fig. 27b: Patient 6: Four months post AOO surgery, most of the constriction and decrowding has already been corrected, anterior view. Fig. 27c: Patient 6: Post debracketing, anterior view. Fig. 28a: Patient 6: Surface CT scan imaging prior to the AOO treatment, anterior view. Fig. 28b: Patient 6: Surface CT scan imaging post AOO treatment, anterior view. Fig. 29a: Patient 6: After bracketing but pre AOO surgery, constricted maxilla mesial to the molars, palatal view. Fig. 29b: Patient 6: Four months post AOO surgery, most of the constriction has been corrected, palatal view. Fig. 29c: Patient 6: Post debracketing, palatal view.
Fig. 30a: Patient 6: Surface CT scan imaging prior to AAO treatment, palatal view. Fig. 30b: Patient 6: Surface CT scan imaging post AOO treatment, palatal view. Fig. 31a: Patient 6: Surface CT scan imaging prior to the AOO treatment, left lateral view. Fig. 31b: Patient 6: Surface CT scan imaging post AOO treatment, left lateral view.
|The roots of all of the upper and lower teeth
were sandwiched between thicker layers of bone at post-treatment
than existed at pre-treatment. At eight months retention both
upper and lower arches were re-entered to harvest bone biopsies.
On the buccal of the upper left first bicuspid where there was a
dehiscence extending almost to the apex of the root at pre-treatment,
there was now a healthy layer of bone 3 to 4mm in thickness.³ A similar situation was found on the facials of the lower
anterior teeth, most notably on the facial of the lower left canine.
This case also serves as a good example in demonstrating the
significance of the pre-treatment angulation of the teeth. The
upper canines and bicuspids were lingually inclined at pre-treatment
making it feasible to correct much of the crossbite by tipping
these teeth facially. Likewise, the upper and lower incisors
were relatively upright which facilitated tipping them facially to
accomplish the upper and lower decrowding. Had these teeth
been tipped labially at pre-treatment considerably less correction
would have been possible.
The Accelerated Osteogenic Orthodontic technique can
provide the trained practitioner with the ability to accomplish
treatments in an in-office setting that would have previously not
been a consideration. Central to this inevitable progress has been
the spirit of interdisciplinary collaboration that has synthesized
modified traditional orthodontic tooth movement protocols
with periodontal tissue engineering and regenerative surgery.
The result of this has not only been rapid orthodontic tooth
movement with drastically shortened treatment times but also
an increased scope of treatment with reduced side effects such as
root resorption,20 relapse,1,2,7 inadequate alveolar bone¹ and bacterial
time/load factors like caries and infection.
The AOO treatment should not be considered a rescue technique
or a treatment of last resort. Teeth that have become ankylosed
as a result of blunt trauma or previous luxation will not be
amenable to this treatment. Although borderline dental Class III
occlusion might be amenable to treatment, severe skeletal Class
III situations cannot be adequately addressed with this technique.
The movement accomplished with the AOO technique is
dentoalveolar in nature and as such the surrounding periodontium
must be healthy. Reduced alveolar vitality that can result
from the use of bisphosphonates or long-term corticosteroid
therapy precludes the use of this technique.
In otherwise healthy individuals however even severe malocclusions
can usually be adequately addressed. Age in itself is not
a limiting factor. In fact, due to the ability to increase the tissue
turnover rate by two- to three-fold the AOO treatment can be
viewed as a "transient fountain of youth" for older individuals.
Our oldest patient was 78 years of age at the time of her AOO
treatment. The total AOO treatment time for her case was four
months and two weeks. At 88 years of age she is still enjoying
the benefits of her treatment.
It is fair to say that the majority of our AOO patients would
not have followed through with needed orthodontic work were
the AOO treatment not an available option. For this underserved
population of patients, the AOO treatment has filled a
void that until now has not been adequately addressed. If you
have enthusiasm for continued practice growth and if you welcome
the thrill of a challenge, becoming trained in the AOO
technique is something that you will want to consider.
- Wilcko MT, Wilcko WM, Bissada NF. An evidence-based analysis of periodontally accelerated orthodontic
and osteogenic techniques: A synthesis of scientific perspectives. Semin Orthod 14:305-316, 2008
- Wilcko MT, Wilcko WM, Pulver JP, Bissada NF, Bouguot JE: Accelerated osteogenic orthodontics technique:
a 1-stage surgically facilitated rapid orthodontic technique with alveolar augmentation. J Oral
Maxillofac Surg 67:2149-2159, 2009.
- Wilcko WM, Wilcko MT, Bouquot JE, et al: Rapid orthodontics with alveolar reshaping: two case reports
of decrowding. Int J Periodontics Restorative Dent 21:9-19, 2001.
- Wilcko WM, Ferguson DJ, Bouquot JE, et al: Rapid orthodontic decrowding with alveolar augmentation:
case report. World J Orthodont 4:197-505, 2003.
- Wilcko MT, Wilcko WM, Breindel-Omniewski K, et al: The periodontally "accelerated osteogenic orthodontics
"technique (PAOO™) technique: Efficient space closing with either orthopedic or orthodontic
forces. J Implant Adv Clin Dent 1:45-68, 2009.
- Ferguson DJ, Wilcko WM, Wilcko MT: Selective alveolar decortication for rapid surgical-orthodontic resolution
of skeletal malocclusion treatment, in Bell WE, Guerrero C (eds): Distraction Osteogenesis of
Facial Skeleton. Hamilton, BC, Decker, 2006:199-203.
- Wilcko MT, Wilcko WM, Marquez MG, et al: Chapter 4: The contributions of periodontics to orthodontic
therapy, in Dibart S (ed): Practical Advanced Periodontal Surgery. Ames, IA, Wiley Blackwell,
- Frost HM. The biology of fracture healing. An overview for clinicians. Part 1, Clin Orthop Rel
- Yaffe A, Fine N, Binderman I: Regional acceleratory phenomenon in the mandible following mucoperiosteal
flap surgery. J Periodontal 65:79-83, 1994.
- Murphy NC: In vivo tissue engineering for orthodontists: a modest first step, in Davidovitch Z, Mah J,
Suthanarak S (eds): Biological Mechanisms of Tooth Eruption, Resorption and Movement. Boston,
Harvard Society for the Advancement of Orthodontics, 2006:385-410.
- Köle H: Surgical operations of the alveolar ridge to correct occlusal abnormalities. Oral Surg Oral Med
Oral Pathol 12:515-529. 1959.
- Suya H. Corticotomy in orthodontics. In: Hösl E, Baldauf A (eds). Mechanical and Biological Basics in
Orthodontic Therapy. Heidelberg, Germany, Hütlig Buch, 1991:207-226.
- Anholm M, Crites D, Hoff R, Rathbun E. Corticotomy-facilitated orthodontics. Calif Dent Assoc J 7:8-
- Gantes B, Rathbun E, Anholm M. Effects on the periodontium following corticotomy-facilitated orthodontics.
Case reports. J Periodontal 61:234-238, 1990.
- Generson RM, Porter JM, Zell A, Stratigus GT: Combined surgical and orthodontic management of anterior
open bite using corticotomy. J Oral Surg 34:216, 1978.
- Sebaoun J-D, Ferguson DJ, Wilcko MT, et al: Corticotomie. Alv olaire et traitements orthodontiqes rapides.
Orthod Fr 78:217-225, 2007.
- Little RM: Stability and relapse of dental arch alignment, in Burstone CJ, Nanda R (eds): Retention and
Stability in Orthodontics. Philadelphia, Saunders, 1993:97-106.
- Rothe LE, Bollen RM, Herring SW, et al: Trabecular and cortical bone as risk factors for orthodontic
relapse. Am J Orthod Dentofacial Orthop 130:476-484, 2006.
- Fuhrmann R: Three-dimensional evaluation of periodontal remodeling during orthodontic treatment.
Semin Orthod 8:23-28, 2002.
- Machado IM, Ferguson DJ, Wilcko WM, et al: Reabsorcion radicular desques del tratamiento ortodoncico
con o sin corticotomia alveolar. Rev Ven Ort 19:647-653, 2002.
|The Wilcko brothers developed and present a certification course
in the Wilckodontics AOO system. This method of treatment and
associated devices (Wilckodontics, Accelerated Osteogenic
Orthodontics, AOO and Periodontally Accelerated Osteogenic
Orthodontics, PAOO) are patented by Wilckodontics, Inc. You can
learn more by visiting www.fastortho.com. They can be contacted at
Dr. Thomas Wilcko received his certificate in periodontics
from Harvard University and is a clinical associate
professor in the Department of Periodontics at Case
Western University. He has co-authored numerous peerreviewed
articles, abstracts and textbook chapters. His
areas of research include pyrophosphate inhibitors, free radical stability,
ultrasound, prostaglandin precursors and bone vitality.
Dr. William Wilcko received his certificate in orthodontics
from West Virginia University and is a past president of the
Colorado Summer Meeting. His areas of research include
bioactive pheromones, acyl free radicals, bone inducing
endodontic sealers and CT scan imaging of osseous
responses. He has co-authored numerous peer reviewed articles,
abstracts and textbook chapters.