Rapid orthodontics with alveolar reshaping: Two case reports of decrowding

Two case reports demonstrate a new orthodontic method that offers short tre atment times and the ability to simultaneously reshape and increase the buc colingual thickness of the supporting alveolar bone. A 24-year-old man with a Class I severely crowded malocclusion and an overly constricted maxilla with concomitant posterior crossbites and a 17-year-old female with a Class I moderately to severely crowded malocclusion requested shortened orthodon tic treatment times. This new surgery technique included buccal and lingual full-thickness flaps, selective partial decortication of the cortical plat es, concomitant bone grafting/augmentation, and primary flap closure. Follo wing the surgery, orthodontic adjustments were made approximately every 2 w eeks. From bracketing to debracketing, both cases were completed in approxi mately 6 months and 2 weeks. Posttreatment evaluation of both patients reve aled good results. At approximately 15 months following surgery in one pati ent, a full-thickness flap was again reflected. Visual examination revealed good maintenance of the height of the alveolar crest and an increased thic kness in the buccal bone. The canine and premolars in this area were expand ed buccally by more than 3 mm, and yet there had actually been an increase in the buccolingual thickness of the overlying buccal bone. Additionally a preexisting bony fenestration buccal of the root of the first premolar was covered. Both of these findings lend credence to the incorporation of the b one augmentation procedure into the corticotomy surgery because this made i t possible to complete the orthodontic treatment with a more intact periodo ntium. The rapid expansive tooth movements with no significant apical root resorption may be attributed to the osteoclastic or catabolic phase of the regional acceleratory phenomenon. Instead of bony "block" movement or resor ption/apposition, the degree of demineralizaiton/remineralization might be a more accurate explanation of what occurs in the alveolar bone during phys iologic tooth movement in these patients.