The clinical efficacy of periodontally accelerated osteogenic orthodontics in patients with bone fenestration and dehiscence: a retrospective study

Abstract

Purpose: The objective of the study was to explore the effect of periodontally accelerated osteogenic orthodontics (PAOO) in orthodontic patients with bone dehiscence and fenestration in the anterior alveolar region of the mandible.

Methods: A retrospective study was performed in 42 patients with bone dehiscence and fenestrations in the anterior alveolar region of the mandible who underwent the PAOO technique. The bleeding index (BI), probing depth (PD), keratinized gingiva width (KGW), gingival recession level (GRL), and gingival phenotype were recorded and assessed at baseline and 6 and 12 months postoperatively. Cone-beam computerized tomography was used to measure bone volume in terms of root length (RL), horizontal bone thickness at different levels, and vertical bone height at baseline and 6 months and 12 months after surgery.

Results: The sample was composed of 42 patients (22 males and 20 females; mean age, aged 25.6 ± 4.8 years) with 81 teeth showing dehiscence/fenestrations and 36 sites presenting gingival recessions. There was no significant difference in BI, PD, or KGW (between baseline and 6 or 12 months postoperatively) based on the clinical evaluations (P > 0.05). Gingival recession sites demonstrated a significant reduction in the GRL after surgery (P < 0.05). Furthermore, the proportion of teeth with a thick gingival phenotype increased from 33.61% at baseline to 53.13% at the end of the follow-up. In addition, the bone thickness measurements at the mid-root and crestal levels were markedly increased compared with the baseline values (P < 0.05), although the increase in thickness at the apical level was not statistically significant (P > 0.05).

Conclusions: Within the limitations of the study, the results show that the PAOO technique is beneficial to periodontal conditions in terms of soft and hard tissue augmentation. The PAOO procedure may represent a safe and efficient treatment for orthodontic patients with bone dehiscence and fenestration.

Trial registration: This study was approved by the ethics committee of the stomatological hospital affiliated with Xi'an Jiaotong University (xjkqll [2019] No. 016) and registered in the Chinese Clinical Trial Registry (ChiCTR2100053092).

Keywords: Bone fenestration and dehiscence; Gingival recession; Guided bone regeneration; Periodontal tissues; Periodontally accelerated osteogenic orthodontics.

Fig. 1

Flowchart

Fig. 2

Schematic diagram of radiographic measurements. (0- the root apex; 1- the intersection of the labial-lingual CEJ line and the long axis; 2- the intersection of the labial alveolar bone surface and the line perpendicular to the long axis through dot 0; 3- the mid-root point of the labial root surface; 4- the intersection of the labial alveolar bone surface and the line perpendicular to the long axis through dot 3; 5- the point 2 mm below the labial CEJ; 6- the intersection of the labial alveolar bone surface and the line perpendicular to the long axis through dot 5; 7- the labial CEJ; 8-the alveolar crest.)

Fig. 3

Surgical procedure of PAOO. (a) Presurgical treatment. (b) Full-thickness flap reflection (yellow dotted lines show bone dehiscence). (c) Performing corticotomies in the inter-radicular space. (d) Placement of grafting materials on the surface of alveolar bone. (e) Collagen membrane covering the grafting materials. (f) Interrupted sutures. (g) Six-month follow-up. (h) Twelve-month follow-up

Fig. 4

CBCT images of mandibular anterior teeth before surgery (baseline) and after surgery (6 months and 12 months)