Rapid orthodontics with alveolar reshaping: two case reports of decrowding

Two case reports demonstrate a new orthodontic method that offers short treatment times and the ability to simultaneously reshape and increase the buccolingual 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 orthodontic treatment times. This new surgery technique included buccal and lingual full-thickness flaps, selective partial decortication of the cortical plates, concomitant bone grafting/augmentation, and primary flap closure. Following the surgery, orthodontic adjustments were made approximately every 2 weeks. From bracketing to debracketing, both cases were completed in approximately 6 months and 2 weeks. Posttreatment evaluation of both patients revealed good results. At approximately 15 months following surgery in one patient, a full-thickness flap was again reflected. Visual examination revealed good maintenance of the height of the alveolar crest and an increased thickness in the buccal bone. The canine and premolars in this area were expanded 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 bone augmentation procedure into the corticotomy surgery because this made it possible to complete the orthodontic treatment with a more intact periodontium. 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 resorption/apposition, the degree of demineralization/remineralization might be a more accurate explanation of what occurs in the alveolar bone during physiologic tooth movement in these patients.