Academia.eduAcademia.edu

Figure 14 – uploaded by Nabil Bissada

See full PDFdownloadDownload figure
FIGURE 14. A, After full-thickness flap reflection and before bone activation at the time of the AOO surgery, note the dehiscence on the facial of the lower right canine that extends almost to the apex of the root. B, Re-entry at 7.5 years of retention, the bony dehis- cence on the facial of the lower right canine has been completely repaired. A core of bone has been removed facially, where there had originally been no bone due to the dehiscence that almost reached the apex of the root.

Figure 14 A, After full-thickness flap reflection and before bone activation at the time of the AOO surgery, note the dehiscence on the facial of the lower right canine that extends almost to the apex of the root. B, Re-entry at 7.5 years of retention, the bony dehis- cence on the facial of the lower right canine has been completely repaired. A core of bone has been removed facially, where there had originally been no bone due to the dehiscence that almost reached the apex of the root.

Related Figures (13)

FIGURE 1. Patient 1, male, age 23 years. A, Before treatment, anterior view. B, After treatment, total AOO treatment time 6 months 2 weeks, anterior view.
FIGURE 1. Patient 1, male, age 23 years. A, Before treatment, anterior view. B, After treatment, total AOO treatment time 6 months 2 weeks, anterior view.
FIGURE 2. A, After bone activation using circumscribing corti- cotomy cuts and intramarrow penetrations, left lateral view. B, Bone grafting mixture placed over the activated bone, left lateral view.
FIGURE 2. A, After bone activation using circumscribing corti- cotomy cuts and intramarrow penetrations, left lateral view. B, Bone grafting mixture placed over the activated bone, left lateral view.
FIGURE 3. Patient 1 (A) 4, (B) 8, (C) 11, and (D) 16 weeks after AOO surgery. A treatment plan is developed by the orthodontist/ surgeon team to determine the teeth that will un- dergo bone activation, the teeth that will be used for
FIGURE 3. Patient 1 (A) 4, (B) 8, (C) 11, and (D) 16 weeks after AOO surgery. A treatment plan is developed by the orthodontist/ surgeon team to determine the teeth that will un- dergo bone activation, the teeth that will be used for
FIGURE 4. Patient 1. A, Pretreatment surface computed tomographic scan, right oblique view of lower arch. B, Pretreatment surface computed tomographic scan, lingual view of lower arch.
FIGURE 4. Patient 1. A, Pretreatment surface computed tomographic scan, right oblique view of lower arch. B, Pretreatment surface computed tomographic scan, lingual view of lower arch.
FIGURE 5. A, Post-treatment surface computed tomographic scan, right oblique view of lower arch. B, A 2.5-years posttreatment surface computed tomographic scan, lingual view of lower arch. Typically, the orthodontic brackets are placed and a light wire engaged sometime during the week be- fore the surgery with the subsequent orthodontic adjustments being made at 2-week intervals. A full case in which upper and lower arches are treated surgically can require 3 to 4 hours to complete and is usually performed under intravenous or oral sedation. In general, full-thickness flaps are reflected labially and lingually using a sulcular releasing incision. The interdental papillae can be reflected with the flaps or left in place.'* Our preference is to reflect the inter- dental papillae with the full-thickness flaps except After bone activation the resorbable particulate bone grafting material is layered over the activated bone. This bone grafting material is typically first wet with a clindamycin phosphate/bacteriostatic water solution of approximately 5 mg/mL. Wetting the graft- ing material facilitates the ease of placement. The particulate bone grafting material can also be wet
FIGURE 5. A, Post-treatment surface computed tomographic scan, right oblique view of lower arch. B, A 2.5-years posttreatment surface computed tomographic scan, lingual view of lower arch. Typically, the orthodontic brackets are placed and a light wire engaged sometime during the week be- fore the surgery with the subsequent orthodontic adjustments being made at 2-week intervals. A full case in which upper and lower arches are treated surgically can require 3 to 4 hours to complete and is usually performed under intravenous or oral sedation. In general, full-thickness flaps are reflected labially and lingually using a sulcular releasing incision. The interdental papillae can be reflected with the flaps or left in place.'* Our preference is to reflect the inter- dental papillae with the full-thickness flaps except After bone activation the resorbable particulate bone grafting material is layered over the activated bone. This bone grafting material is typically first wet with a clindamycin phosphate/bacteriostatic water solution of approximately 5 mg/mL. Wetting the graft- ing material facilitates the ease of placement. The particulate bone grafting material can also be wet
FIGURE 6. The original alveolus was 5.6 mm in width. The grafting created 2.4 mm of additional labial bone at B-point and 3.6 mm of new bone lingually. A composite shows the dentoalveolar defecting that has been filled with new bone.
FIGURE 6. The original alveolus was 5.6 mm in width. The grafting created 2.4 mm of additional labial bone at B-point and 3.6 mm of new bone lingually. A composite shows the dentoalveolar defecting that has been filled with new bone.
FIGURE 7. A, At 14.5 months after AOO surgery, the bone biopsy has been outlined on the facial of the upper left canine. B, The bone biopsy has been removed from the facials of the upper left canine and the upper left first bicuspid; there is now 3- to 4-mm ieloiees of bone over the root prominence of the upper left first bicuspid where there was litle or no one originally. releasing incision is used. When more than 0.5 cc of bone grafting material is used per tooth, the sutures are retained in place for 3 weeks. Premature suture removal can result in flap displacement, opening of
FIGURE 7. A, At 14.5 months after AOO surgery, the bone biopsy has been outlined on the facial of the upper left canine. B, The bone biopsy has been removed from the facials of the upper left canine and the upper left first bicuspid; there is now 3- to 4-mm ieloiees of bone over the root prominence of the upper left first bicuspid where there was litle or no one originally. releasing incision is used. When more than 0.5 cc of bone grafting material is used per tooth, the sutures are retained in place for 3 weeks. Premature suture removal can result in flap displacement, opening of
FIGURE 8. Histology of bone biopsy from the upper left first bicuspid. PDL (righ#), particle of un-resorbed bovine bone (lefi], and interspersed medullary bone with osteocytes in lacunae. Hematox- ylin and eosin, X200, routine light normal.
FIGURE 8. Histology of bone biopsy from the upper left first bicuspid. PDL (righ#), particle of un-resorbed bovine bone (lefi], and interspersed medullary bone with osteocytes in lacunae. Hematox- ylin and eosin, X200, routine light normal.
FIGURE 9. Patient 2, female, age 47 years. A, Before treatment, left lateral view. B, Eight years’ retention; total AOO treatment time had been 7 months.
FIGURE 9. Patient 2, female, age 47 years. A, Before treatment, left lateral view. B, Eight years’ retention; total AOO treatment time had been 7 months.
FIGURE 10. Bone activation from the lower right canine to the lower left canine using circumscribing corticotomy cuts and intra- marrow penetrations. A, Lower anterior facial view. B, Lower an- terior lingual view. C, Ostectomy at upper left second bicuspid site, upper left lateral view.
FIGURE 10. Bone activation from the lower right canine to the lower left canine using circumscribing corticotomy cuts and intra- marrow penetrations. A, Lower anterior facial view. B, Lower an- terior lingual view. C, Ostectomy at upper left second bicuspid site, upper left lateral view.
FIGURE 11. A, Orthopedic retractor inserted. B, One week after insertion. C, Two weeks after insertion. D, Three weeks after insertion, orthopedic retractor removed.
FIGURE 11. A, Orthopedic retractor inserted. B, One week after insertion. C, Two weeks after insertion. D, Three weeks after insertion, orthopedic retractor removed.
FIGURE 12. A, After fullthickness flap reflection and before bone activation, there is a fenestration on the facial of the lower left canine that extends almost to the apex of the root, lower left anterior view. B, Re-entry by a full-thickness flap 17 months after AOO surgery (10 months after de-bracketing); the bony fenestrations are filled in with new bone, lower left anterior view. C, After removal of cores of bone from the facials of the lower left canine and lower left lateral incisor, where there had originally been no bone due to the facial fenestrations, there is now 2- to 3-mm thickness of bone, lower left anterior view.
FIGURE 12. A, After fullthickness flap reflection and before bone activation, there is a fenestration on the facial of the lower left canine that extends almost to the apex of the root, lower left anterior view. B, Re-entry by a full-thickness flap 17 months after AOO surgery (10 months after de-bracketing); the bony fenestrations are filled in with new bone, lower left anterior view. C, After removal of cores of bone from the facials of the lower left canine and lower left lateral incisor, where there had originally been no bone due to the facial fenestrations, there is now 2- to 3-mm thickness of bone, lower left anterior view.
FIGURE 13. Histology of the demineralized core of bone removec from the facial of the lower left canine. Note that there are osteo: cytes in the lacunae. Hematoxylin and eosin, X200, routine light. The inclusion of bone augmentation with 1-stage corticotomy surgery and orthodontic tooth move- ment is a new concept®?'!4 and has made it possible to provide for an increased alveolar volume to help support the teeth in their straightened position. How- ever, bone induction techniques are not new and have evolved over the past 4 decades. Urist?? in 1965 was the first to demonstrate that decalcified bone matrix could induce new cartilage and bone forma- tion.
FIGURE 13. Histology of the demineralized core of bone removec from the facial of the lower left canine. Note that there are osteo: cytes in the lacunae. Hematoxylin and eosin, X200, routine light. The inclusion of bone augmentation with 1-stage corticotomy surgery and orthodontic tooth move- ment is a new concept®?'!4 and has made it possible to provide for an increased alveolar volume to help support the teeth in their straightened position. How- ever, bone induction techniques are not new and have evolved over the past 4 decades. Urist?? in 1965 was the first to demonstrate that decalcified bone matrix could induce new cartilage and bone forma- tion.
Related topics:
DentistrySurgeryOral and Maxillofacial SurgeryOsteogenesis distractionBone SubstitutesX ray Computed Tomography
580 California St., Suite 400
San Francisco, CA, 94104
© 2025 Academia. All rights reserved