S u r g i c a l As s i s t a n c e f o r

Rapid Orthodontic
Treatment and Temporary
Sk eletal Anchora ge
Maxwell D. Finn, DDS, MD

KEYWORDS
 Corticotomies  Osteotomies  Regional acceleratory phenomenon  Anchorage  Osteogenic
 Orthognathic

KEY POINTS
 Surgically assisted osteogenic orthodontics is a departure from earlier described techniques such
as accelerated osteogenic orthodontics in that multiple modalities are combined not only to shorten
treatment time but to accomplish results that cannot be achieved with orthodontics alone.
 Accelerated osteogenic orthodontics simply improves treatment time of otherwise regularly per-
formed orthodontics, whereas surgically assisted osteogenic orthodontics can replace procedures
such as orthognathic surgery or facilitate otherwise improbable orthodontic mechanics.
 When appropriately used, surgically assisted osteogenic orthodontics can be a useful surgical op-
tion. There is a significant reduction in cost to the patient, especially when there is a lack of insur-
ance coverage for orthognathic techniques.
 Patient recovery is usually no more than a long weekend and overall treatment time is greatly
reduced. In addition, surgeons are able to work in the comfortable environment of their own offices.
 Decreased cost, recovery time, and treatment time, and an in-office environment all increase pa-
tient acceptance and allow surgeons to provide treatment to patients who might otherwise have
no options.

INTRODUCTION extractions. A variety of dentofacial deformities

Orthodontics and oral and maxillofacial surgery
have been codependent specialties for many
years. Orthodontics has relied on the specialty of
oral and maxillofacial surgery in numerous ways
to enhance orthodontic treatment and orthodontic
outcomes. Various procedures have been devised
over the years to enhance orthodontic treatment,
ranging from surgically exposing unerupted teeth,
are now more easily managed by both the ortho-
dontist and the oral and maxillofacial surgeon as
a result of these advances. In spite of this, a variety
of conditions that present to the orthodontist or the
oral and maxillofacial surgeon are complicated by
external factors such as cost, insurance coverage,
hospitalization, or the patient’s inability to miss
work. In the past, conditions were often seen
oralmaxsurgery.theclinics.com

that exceeded orthodontic treatment alone but

providing hard or soft tissue grafting, orthognathic that seemed too minor for surgical correction
surgery, or skeletal anchorage, in addition to the through orthognathic surgery. New techniques
routine procedures of third molar and premolar are now available to manage such patients with a

Disclosures: None.
Private Practice, 8222 Douglas Avenue, Suite 890, Dallas, TX 75225, USA
E-mail address: jawsurg@sbcglobal.net

Oral Maxillofacial Surg Clin N Am 26 (2014) 539–550

http://dx.doi.org/10.1016/j.coms.2014.08.006
1042-3699/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
540 Finn
variety of orthodontic and surgical modalities
comprehensively categorized as surgically assis-
ted osteogenic orthodontics. These techniques
combine previous treatment modalities to treat pa-
tients in an outpatient environment providing
minimal recovery time and cost with predictable
outcomes. This article reviews the historical
progression of surgically assisted osteogenic
orthodontics, the surgical instrumentation neces-
sary for various treatments, the techniques
involved, and specific cases as examples of these
benefits.
HISTORICAL PERSPECTIVES
In 1959, Heinrich Kole1 described a variety of sur-
gical operations of the alveolar ridge to correct
occlusal abnormalities. He showed that osteoto-
mies could be performed around various teeth to
facilitate orthodontic treatment with block move-
ments of teeth and bone.1 It was thought at that
time that reduction in resistance of the cortex or
other bony obstacles could be facilitated to allow
improved or enhanced orthodontic movement. It
is questionable in retrospect whether what was
being described were corticotomies or true os-
teotomies between teeth. Later, in 1975, Lines2
described corticotomies to facilitate rapid maxil-
lary expansion; known today as rapid palatal
expansion. In 1976, Bell and Epker3 went on to
describe selected osteotomies for rapid maxillary
expansion minimizing resistance further, at re-
gions such as the zygomatic buttress. These os-
teotomies were further enhanced in 1984 by
Kraut4 with the addition of a midpalatal osteotomy
for rapid maxillary expansion. These techniques
are now comprehensively considered as surgically
assisted rapid palatal expansion, and are facili-
tated by orthodontic mechanics combined with
osteotomies and distraction osteogenesis. In
1983, the orthopedic surgeon Frost5 described
the regional acceleratory phenomenon (RAP).
Described as a complex reaction of mammalian
tissues to diverse noxious stimuli such as trauma,
osteotomies, or corticotomies, this phenomenon
involves hard and soft tissues alike, and involves
an acceleration and domination of most ongoing
normal vital tissue processes. This save-our-
ship–type phenomenon takes on a metabolic pri-
ority, allowing increased metabolism of bone; a
process that is known to be an essential part of or-
thodontic movement. In 2001, Wilcko and col-
leagues6 reported 2 cases that theoretically used
corticotomies and alveolar bone reshaping to
take advantage of the RAP. The term accelerated
osteogenic orthodontics was coined and patented
by Wilckodontics. The case report described a
technique involving buccal and lingual flaps to
expose the alveolus and create interdental corti-
cotomies that are then connected at the apex
with an apical corticotomy and multiple cortical
perforations to induce the RAP and therefore
enhance and accelerate bone metabolism. The
emphasis of this technique was to significantly
reduce the treatment time of conventional ortho-
dontic treatment. In 2009, Wilcko and colleagues7
described the same procedure with the addition of
grafting, redefining the technique as periodontal
accelerated osteogenic orthodontics (PAOO).8
The differentiation was then made that accelerated
osteogenic orthodontics was a process of creating
corticotomies to enhance the RAP and expedite
orthodontic treatment, and PAOO was the same
technique incorporating the addition of superficial
grafting with other minor refinements to the orig-
inal publication. Both procedures were described
as being performed at or just before the onset of
orthodontic treatment to induce the RAP and allow
accelerated orthodontic treatment. In 2009, Roble
and colleagues9 differentiated accelerated osteo-
genic orthodontics and PAOO as a component of
a broader group of surgically facilitated orthodon-
tic therapy, which included 2 distinct concepts: (1)
corticotomies of the alveolar bone to induce the
RAP, or (2) osteotomies of bone around teeth to
induce the RAP with the addition of distraction os-
teogenesis (Table 1). Roble and colleagues9
appropriately pointed out that Kole’s1 original
concept was abandoned most likely because of
a lack of orthodontic sophistication as a limitation
of the time. With modern orthodontic therapy and
the RAP, osteotomies such as that described by
Kole1 can be made to improve orthodontic out-
comes. In 2012, Liou and colleagues10 defined
and scientifically illustrated the postsurgical
Table 1
Surgically facilitated orthodontic therapies
Surgically assisted osteogenic orthodontics
All-encompassing with use of corticotomies,
osteotomies, skeletal anchorage, and
grafting with orthodontics
Surgically facilitated orthodontic therapy
Differentiated by corticotomy vs osteotomy
Corticotomies Osteotomies
The use of The use of single
corticotomies or or multiple
decortication to osteotomies
induce RAP Typical of
Typical of accelerated distraction
osteogenic osteogenesis
orthodontics

orthodontic acceleration with which surgeons and
orthodontists are familiar as a part of the concept
of RAP. It has been recognized by orthodontists
and surgeons that, after orthognathic surgery,
there is an acceleration phenomenon of orthodon-
tic treatment, allowing teeth to move more rapidly
and complicated movements to be achieved more
easily. The biological markers serum alkaline
phosphatase and C-terminal telopeptide of type I
collagen (ICTP) were identified as correlating with
this phenomenon. Correlating the spikes in serum
ICTP with tooth mobility using the Periotest
method, Liou and colleagues10 defined that the
acceleratory changes previously observed seem
to last approximately 3 to 4 months. In 2014,
Teng and Liou11 showed that the inductive effect
of interdental osteotomies is regional and not site
specific or systemic. This finding correlates well
with the phenomenon observed after orthognathic
surgery, and further supports limited access for
dentoalveolar treatment to only the facial aspect,
compared with the bidirectional approach of
AOO. They also suggested that the intensity of
the RAP may be related to the extent of the osteot-
omy. This in turn predicts an improved outcome
with interdental osteotomies versus corticotomies
alone.
The use of dental implants as absolute ortho-
dontic anchorage dates back to 1995, and for at
least the past 10 years the use of temporary
anchorage devices has been described to facili-
tate orthodontic movement.12 Devices that have
been used range from miniscrews to bone plates
as a form of temporary anchorage to complement
orthodontic treatment. Skeletal anchorage using
bone plates in the maxillofacial region has addi-
tionally been described as an important adjunct
to facilitate difficult orthodontic movement with
predictable success.13 This technique includes
plate anchorage at the zygomatic buttress, piri-
form rim, mandibular ramus, or the corpus of the
mandible. In 2011, Finn and Adams14 presented
a compilation of surgically assisted orthodontic
cases incorporating corticotomies, osteotomies,
and skeletal anchorage, to treat a variety of cases
and coined the all-encompassing term of surgi-
cally assisted osteogenic orthodontics. In 2012,
Finn15 (the author) further presented the surgical
techniques involved in surgically assisted osteo-
genic orthodontics and showed cases that previ-
ously would have necessitated orthognathic
surgery. It is now apparent that mild to moderate
dentofacial anomalies can readily be managed in
an outpatient environment using these concepts
in a way that minimizes cost, the need for hospital-
ization, and prolonged recovery, and provides a
stable outcome.
Surgical Assistance 541
SURGICAL TECHNIQUES AND MATERIALS
Surgically assisted osteogenic orthodontics in-
cludes procedures that should be comfortable
for any surgeon currently in practice with experi-
ence in orthognathic surgery, skeletal anchorage
devices, or bone grafting. Initial evaluation of any
patient being considered for surgically assisted
osteogenic orthodontics or orthognathic surgery
should be the same. It is common to have a patient
referred for orthognathic surgery who, after careful
consideration, can be corrected through surgically
assisted osteogenic orthodontics. In addition, pa-
tients referred for surgically assisted osteogenic
orthodontics may be too complex and compli-
cated, requiring traditional orthognathic surgery.
Therefore, a comprehensive examination keeping
all modalities in mind is prudent. As with any or-
thognathic evaluation, a clear history of the pa-
tient’s condition and concerns should be
determined at the onset. A thorough health history
should also be considered to include any medica-
tions, allergies, or comorbidities. Clinical examina-
tion should include an extraoral examination
evaluating both the facial profile and facial bal-
ance. A nasal examination should be performed
as well to assess any deformities, such as devia-
tion of the septum or nasal airway obstruction. A
maxillary and mandibular examination should
include evaluation of arch form, midline positions,
presence of a cant, vertical and transverse dimen-
sions, periodontal status, and any additional
dental considerations. The skeletal classification
should be assessed to include the amount of over-
jet or overbite as well as tooth exposure in repose.
In addition, a comprehensive temporomandibular
joint examination should be included, determining
range of motion and any associated joint disorder.
Radiographic examination, at a minimum, should
include a panoramic radiograph and lateral ceph-
alometric film. In many instances, cone-beam
computed tomography is also helpful. Once all
these factors have been evaluated, a diagnosis
can be made and appropriate treatment recom-
mendations offered. Typical cases that are
amenable to surgically assisted osteogenic ortho-
dontics include maxillary transverse discrep-
ancies, anterior or lateral open bites, ankylosed
teeth, and mild class II and class III deformities.
Once it has been determined that a patient is a
candidate for surgically assisted osteogenic ortho-
dontics, a thorough consultation with the treating
orthodontist is important in determining logistics
for timing of the procedure and expectations for
outcome. Compared with accelerated osteogenic
orthodontics, surgically assisted osteogenic or-
thodontics should be performed after an initial
542 Finn
Fig. 1. (A) Surgical tray. (B) Osteotomes.
phase of orthodontic treatment to allow for some
leveling and aligning of the dentition, as well as al-
lowing time for the orthodontist to achieve the
appropriate wire dimension before the surgical
procedure. It is beneficial to allow some of the
more mundane orthodontic manipulation to occur
before the procedure to maximize the benefits of
the surgery immediately following. Although root
flaring is commonly used in the preparation for a
segmental osteotomy, is not beneficial in the setup
for interdental osteotomies. Attempting to parallel
the roots is more favorable because it allows the
safe use of the osteotome, whereas flared roots
may be beneficial in one interdental site but
compromise the adjacent site. It is also important
that the orthodontist be prepared to see the pa-
tient immediately after surgery and frequently
over the initial few postoperative months. This
approach allows the orthodontist to take full
advantage of RAP. As discussed earlier, this is
Fig. 2. (A) Maxillary corticotomies. (B) Osteotomies. (C) Example of zygomatic anchorage. (D) Bone grafting. (E)
Tissue closure.
typically an outpatient procedure performed in
the office under intravenous anesthesia. This
method again reduces costs by avoiding hospital-
ization and further improving the convenience for
both the patient and the surgeon. The level of
sedation is patient dependent but most patients
require a deep sedation with typical drugs
including fentanyl, midazolam, and propofol. Pre-
operative or intraoperative antibiotics and steroids
also are recommended, as well as a postoperative
regimen to include antibiotics and narcotic pain
medications as with any in-office surgical
procedure.
As with any procedure, a thorough informed
consent should be obtained. Although rare, addi-
tional risks include tooth injury or loss and the
need for possible additional treatment including
hardware removal. Additional options should be
addressed, especially if orthognathics are being
considered.
 Surgical Assistance 543

Fig. 3. (A) Before treatment. (B) Lateral cephalometric radiograph. (C) Panoramic radiograph. (D) Surgical plan.

A dentoalveolar surgical tray set up with the
addition of a mallet and a series of osteotomes,
as well as grafting materials and an assortment
of temporary anchorage devices, generally suf-
fices. The most beneficial osteotomes tend to be
a spatula osteotome and an assortment of thin bi-
beveled osteotomes of varying widths (Fig. 1).
Grafting materials typically include a particulate
graft material of the surgeon’s choice. The mate-
rials can be allograft, xenograft, or synthetic. The
use of bone morphogenetic protein has shown no
distinct advantages.16 The addition of platelet-
rich plasma is recommended because it allows
graft stability and improved soft tissue healing.
If a barrier membrane is to be used, a resorbable
membrane is preferable. The orthodontic wire
can be removed before surgery but is not a
requirement. However, surgical closure is more
easily accomplished without an orthodontic wire
in place. If more aggressive tooth movement is
required, such as with ankylosed teeth, it is ad-
vantageous to have a wire in place.
At the time of surgery, the appropriate monitors
are applied and the patient is sedated in the sur-
geon’s typical fashion and adequate local anes-
thesia is administered. The surgical incision can
vary to include an intrasulcular incision, a papilla-
sparing incision, or a vestibular incision at the

Fig. 4. (A) Surgical access. (B) Osteotomies. (C) Maxillary graft. (D) Mandibular anchors.
544 Finn
Fig. 5. Three days after surgery.
mucogingival junction. It is the author’s preference
to perform an intrasulcular incision to include
papilla with distal vertical release incisions. This
technique affords excellent visibility of the alveolus
as well as the root form and supporting interdental
bone. It also allows improved coverage of any
grafting materials on closure. Vertical corticoto-
mies can then be performed between the involved
teeth, similar to techniques used for interdental os-
teotomies in segmental Le Fort procedures. A
small-diameter burr such as a 701 is excellent for
accomplishing this procedure. Other surgeons
may prefer to use a piezo saw. It is preferable to
stop the vertical cut just apical to the interdental
crest for improved papilla support. The length of
the vertical cut should extend apically safely
beyond the apex of any involved teeth. After this
cut is completed, a horizontal corticotomy is also
performed apical to all root tips connecting the
previously made vertical cuts (Fig. 2A). Once all
cuts are defined, a spatula osteotome is used to
complete the interdental osteotomies through to
the palatal plate, again typical of the interdental
Fig. 6. (A, B) Before treatment. (C, D) After treatment.
cuts made for a Le Fort I segmental osteotomy
(see Fig. 2B). It is advantageous to start with the
osteotome at the apicalmost portion of the vertical
osteotomy, where there is minimal risk of root
injury. The osteotomy is completed with move-
ments of the osteotome in a coronal direction,
again stopping short of the interdental crest of
bone for support of the papilla. It is anticipated
that defining the cut in this fashion allows for sep-
aration of the bone between root structures as the
surgeon progresses coronally and allows for mi-
crofracture through the interdental crestal bone.
These dentoalveolar segments can then be mobi-
lized slightly with the use of a bibeveled osteotome
or a dental elevator at the coronal level. At this
point, any skeletal anchorage devices can be
applied; it is self-explanatory that the screw
anchorage for a plate should be apical to any hor-
izontal cut on stable bone (see Fig. 2C). A button-
hole can be made in the mucoperiosteal flap at the
vestibular aspect to allow for exposure of the in-
traoral portion of a plate. Plate anchorage is pref-
erable rather than screw anchors in the areas of
osteotomies, for obvious reasons. Any grafting
procedures can now be performed, typically with
the application of platelet-rich plasma to the
bony surface first, followed by the onlay of the par-
ticulate graft material and additional platelet-rich
plasma (see Fig. 2D). It has been shown that
this creates an improvement in post treatment
alveolar bulk and provides coverage of facial plate
dehiscences frequently seen at the time of sur-
gery.17 Closure of the tissue is performed with in-
terrupted 3-0 chromic sutures at the interdental
spaces (see Fig. 2E). Moist gauze rolls are then
placed at the facial surface of gingival tissues for
pressure hemostasis. If skeletal anchorage was
used, elastics can be placed at the time of the
 Surgical Assistance 545

Fig. 7. (A) Before treatment. (B) Surgical plan. (C) Osteotomies with zygomatic anchor.

surgery. After recovery, the patient is released and
maintained on a soft diet for approximately 2 weeks
to allow complete gingival healing, after which the
diet can be advanced slowly as tolerated. It is
extremely important that the patient is seen early
in the postoperative period by the orthodontist to
verify that all appropriate mechanics are in place.
CASE PRESENTATIONS
Case Number 1
A 17-year-old girl presents with an anterior
open bite and a history of a tongue thrust that
has been addressed with speech therapy. A
comprehensive oral and maxillofacial examina-
tion reveals her to have limited incisive show
associated with an anterior vertical maxillary defi-
ciency. Presence of mamelons shows that she
has not been in a normal overjet or overbite rela-
tionship in the past, and she additionally has
impacted third molars (Fig. 3A). Based on clin-
ical, radiographic, and model examination it was
decided that she would benefit from interdental
osteotomies of the anterior maxilla to include
teeth numbers 6 to 11, as well as supplemental
grafting, mandibular temporary anchorage de-
vices, and removal of all third molars (see
Fig. 3B–D). The procedure was performed with

Fig. 8. (A) Extended 1.5-mm T plate. (B) Modified T plate. (C) Radiographic placement.
546 Finn

Fig. 9. (A) One week postoperative zygomatic elastic. (B) Frontal view. (C) Occlusal view.

Fig. 10. (A) Before treatment. (B) Completed.

Fig. 11. (A) Before treatment. (B) Maxillary arch. (C) Lateral cephalometric radiograph. (D) Panoramic radiograph.

Fig. 12. Surgical plan.
the use of an intrasulcular incision and a vertical
releasing incision behind the second premolar
on each side. Corticotomies were performed
from the distal of tooth #6 to the distal of tooth
#11 with a horizontal corticotomy consistent
with that described earlier. The interdental os-
teotomies were then completed with the use of
a spatula osteotome and particulate allogeneic
graft combined with platelet-rich plasma was
placed over the facial surfaces. Tissues were
then closed in an interrupted fashion using a
3-0 chromic suture, and temporary anchorage
devices were placed in the mandibular alveolus
between teeth #22 and 23 and teeth #26 and
27 (Fig. 4). A combination of orthodontic me-
chanics and elastic traction from the mandibular
anchors was used to facilitate closure of the
open bite and improvement of the maxillary inci-
sive exposure (Fig. 5). The interdental
Fig. 13. (A) Maxillary osteotomies. (B) Mandibular osteotomies. (C) Maxillary graft. (D) Mandibular graft.
Surgical Assistance 547
osteotomies combined with orthodontic action
and the RAP allowed treatment of this case to
be completed in 3 months (Fig. 6).
Case Number 2
A 38-year-old woman presents with an anterior
open bite, a maxillary transverse deficiency, as
well as moderate anterior dental crowding and
zero overjet. Based on clinical, radiographic, and
model examination it was determined that she
would benefit from interdental osteotomies of the
complete maxillary arch and, because of the
normal incisive exposure, that she would benefit
from posterior impaction through the use of zygo-
matic plate anchorage with supplemental facial
grafting. An intrasulcular incision was made from
the right to left maxillary tuberosities with vertical
releases in the tuberosity regions. Interdental os-
teotomies were performed with the use of a
spatula osteotome after initial corticotomies were
performed with a 701 drill. Again, a horizontal cor-
ticotomy was performed per protocol. In addition,
zygomatic anchorage was incorporated with the
use of a bone plate at both the right and left zygo-
matic buttress regions above the horizontal cut
with the screw anchorage far enough away from
the apices of the molars to allow for apical intru-
sion (Fig. 7). A buttonhole incision was created in
the right and left maxillary vestibular regions to
allow for the oral component of the plate to extend
into the maxillary vestibule. It can be difficult to
have the appropriate length of plate to be above
the horizontal cut but to extend far enough apically
to be clearly within the vestibule. In more recent
548 Finn
Fig. 14. (A) Three months after surgery. (B) Nine months after surgery. (C) Before treatment. (D) Completed.
cases, an extended 1.5-mm T plate has been
modified and used to allow better positioning.
The upper limbs of the T are cut to be only 3 holes
wide (Fig. 8). A single screw is placed loosely
securing the plate at the zygomatic buttress. The
plate can then be rotated on that screw to point
directly at the first molar. The plate can then be
stabilized with 2 additional screws. The intraoral
component of the plate can be cut to the appro-
priate length to allow both for tooth attachment
and adequate extension into the vestibule. In addi-
tion, the plate can be modified over time by
removing holes and creating new notches for
continued occlusal traction at the posterior region.
Supplemental grafting and platelet-rich plasma
are then applied to the facial surface. The tissue
is closed with interdental 3-0 chromic sutures
and elastic traction is placed from the zygomatic
Fig. 15. (A) Before treatment. (B) Lateral cephalometric radiograph. (C) Panoramic radiograph.
plate to the maxillary molars. A transpalatal arch
wire had previously been applied to prevent
buccal tipping and intentionally left off the palatal
surface to allow room for impaction of the molars
(Fig. 9). Once appropriate molar intrusion is
accomplished, the transpalatal arch wire can be
used and the still-active segments can be ortho-
dontically expanded to improve the transverse
dimension. Treatment of the case was ultimately
completed in approximately 6 months (Fig. 10).
Case Number 3
A 35-year-old female professional presents with
an open bite, maxillary transverse deficiency, and
severe maxillary and mandibular crowding
(Fig. 11). Because of her career, the downtime
associated with orthognathic surgery was not

Fig. 16. Surgical plan.
feasible and she was hopeful for correction with as
short a recovery as possible. Based on her clinical,
radiographic, and model examination, it was
decided that she would benefit from surgically as-
sisted osteogenic orthodontics to include maxil-
lary and mandibular interdental osteotomies
without premolar extraction, as well as zygomatic
skeletal anchorage with supplemental grafting
(Fig. 12). As in the previous cases, intrasulcular in-
cisions were made with release incisions at the
maxillary tuberosities and in the mandibular obli-
que ridge. Mucoperiosteal flaps were elevated
and interdental corticotomies and osteotomies
were performed as previously described. Excep-
tions were made in the regions of severe tooth
crowding, such as the lower anterior where corti-
cotomies alone were used to prevent dental root
Fig. 17. (A) Surgical access. (B) Osteotomies. (C) Zygomatic anchorage. (D) Three days after surgery. (E) Three days
after surgery. (F) Three weeks after surgery. (G) Ten weeks after surgery. (H) Completed.
Surgical Assistance 549
injury. Maxillary zygomatic plates were adapted
and secured, and supplemental grafting was per-
formed with the use of particulate bone and
platelet-rich plasma (Fig. 13). Significant improve-
ment in dental alignment and skeletal discrep-
ancies were noted in the first 3 months.
Treatment of the case was completed at approxi-
mately 10 months (Fig. 14). Note that preparation
alone for orthognathic surgery is likely to have
taken the same amount of time or longer.
Case Number 4
A 57-year-old woman presents with significant
anterior open bite as well as a maxillary transverse
discrepancy secondary to previous maxillary and
mandibular trauma with inadequate management
of the maxillary fracture. She is noted additionally
to have severe vertical deficiency of the anterior
segment combined with posterior vertical maxil-
lary excess (Fig. 15). Based on her clinical, radio-
graphic, and model examination it is decided that
she would benefit from maxillary full-arch inter-
dental osteotomies with mandibular and zygo-
matic anchorage to accomplish a clockwise
rotation of the maxillary segment (Fig. 16). This
treatment would improve the vertical position of
the anterior teeth as well as allow for posterior
impaction to close the open bite and improve
her transverse dimension. After some orthodontic
leveling and aligning of her dental arches, her sur-
gical procedure included an intrasulcular incision
550 Finn
of the maxillary arch with vertical releases in the
tuberosity region. Interdental osteotomies were
then performed per protocol. Maxillary zygomatic
anchorage was placed with supplemental facial
grafting. In addition, temporary anchorage de-
vices were placed in the anterior mandible to
allow for both posterior maxillary impaction and
anterior maxillary vertical enhancement (Fig. 17).
The maxillary dentition was noted to be leveled
and the open bite closed in approximately
3 months. Additional orthodontic detailing
completed treatment of the case in approximately
6 months.
SUMMARY
Surgically assisted osteogenic orthodontics is a
departure from earlier described techniques
such as accelerated osteogenic orthodontics in
that multiple modalities are combined not only
to shorten treatment time but to accomplish re-
sults that cannot be achieved with orthodontics
alone. Accelerated osteogenic orthodontics sim-
ply improves treatment time of otherwise regularly
performed orthodontics, whereas surgically assis-
ted osteogenic orthodontics can replace proce-
dures such as orthognathic surgery or facilitate
otherwise improbable orthodontic mechanics.
When appropriately used, surgically assisted
osteogenic orthodontics can be a useful surgical
option. There is a significant reduction in cost to
the patient, especially when there is a lack of in-
surance coverage for orthognathic techniques.
Patient recovery is usually no more than a long
weekend and overall treatment time is greatly
reduced. In addition, surgeons are able to work
in the comfortable environment of their own of-
fices. Decreased cost, recovery time, and treat-
ment time, and an in-office environment all
increase patient acceptance and allow surgeons
to provide treatment to patients who might other-
wise have no options.
REFERENCES
1. Kole H. Surgical operations of the alveolar ridge to
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2. Lines PA. Adult rapid maxillary expansion with corti-
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3. Bell WH, Epker BN. Surgical-orthodontic expansion
of the maxilla. Am J Orthod 1976;70:517.
4. Kraut RA. Surgically assisted rapid maxillary expan-
sion by opening the midpalatal suture. J Oral Maxil-
lofac Surg 1984;42:651–5.
5. Frost HM. The regional acceleratory phenomenon: a
review. Henry Ford Hosp Med J 1983;31:3–9.
6. Wilcko WM, Wilcko MT, Bouquot JE, et al. Rapid or-
thodontics with alveolar reshaping: two case reports
of decrowding. Int J Periodontics Restorative Dent
2001;21:9.
7. Wilcko MT, Wilcko WM, Pulver JJ, et al. Accelerated
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