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Periodontally accelerated osteogenic orthodontics (PAOO) combines alveolar decortication plus augmentation grafting
technique to accelerated orthodontic tooth movement. Fixed orthodontic appliances are placed followed within 1 week
by full thickness flap surgery and scaring of facial-lingual alveolar cortices. The patient is seen every 2 weeks following the
procedure. Rapid tooth movement results from the transient demineralization-remineralization (osteopenia) produced within
the alveolus, i.e., increased bone turnover. Benefits of PAOO therapy include: 1) active orthodontic treatment times averaging
6 months, 2) greater scope of malocclusion treatment, 2) greater stability of clinical outcomes and less relapse, and 3) increased
alveolar volume and enhanced periodontal health. Tensional integrity or “prestress” keeps hydrostatically contained dentoalveolar
tissues sensitive to and prepared for changes in the biomechanical environment. Sustained orthodontic forces translated
at nano-level in the multiple microenvironments involved in tooth movement are reflected at all length scales including the
organ-level. The biomechanical stresses introduced by intentional wounding in PAOO technique “tricks” the body by signaling
local micro-fracture level microstrain and regional acceleratory phenomena (increased turnover and demineralization, i.e.,
transient osteopenia) is initiated. In other words, PAOO patient tissues go into hyper-activity in order to bring excessive
microstrain back to steady state homeostatic levels which provide the orthodontist with the golden opportunity to accelerated
tooth movement. The lesson learned from wound healing is that tensional readiness and the remarkable ability for maxillofacial
tissue to accommodate changes in tissue tension can be used to accelerate tooth movement. The host response is remarkably
local and so PAOO surgery is used strategically to move certain teeth or tooth groups. Applying tensional integrity concept
explains all variations in individual patient response to treatment and all experimental data from accelerated tooth movement
investigations. The prevailing pressure-tension concept does not clearly explain the tooth movement phenomena and a PDL
cell-mediated focus needs revisiting.
Donald J Ferguson is a Professor of Orthodontics and Dean, European University College at Dubai Healthcare City, United Arab Emirates. He is formerly Professor and Chair of Orthodontics at Boston University and has held the positions of Executive Director, Center for Advanced Dental Education and Associate Dean for Dental Education, Saint Louis University, and Chair of Orthodontics and Director, Advanced Orthodontic Training Program, Marquette University. He is a Diplomate of the American Board of Orthodontics (ABO) and past-President of the EH Angle Society, Midwest Component. He served as a Senior Fulbright Scholar (a US National Scholar Award) at Alexandria University, Egypt, and has lectured extensively at university, regional, national and international forums. He received all of his professional dental degrees in the USA. His research interests include accelerated tooth movement. He has authored over 100 articles and abstracts for professional journals and publications as well as contributed chapters to several textbooks.