Corticotomy-assisted decompensation for augmentation of the mandibular anterior ridge

Abstract

Introduction: This article introduces a technique combining corticotomy and orthodontic forces, or accelerated osteogenic orthodontics, for use in patients with a Class III occlusion and a thin alveolus who will undergo orthognathic surgery.

Methods: Two adults with Class III malocclusion undergoing anterior decompensation for mandibular setback surgery were selected. The first patient was treated with accelerated osteogenic orthodontics and conventional decompensation. The second patient was treated with accelerated osteogenic orthodontics and decompensation with a temporary skeletal anchorage device in concert with guided tissue regeneration. Decortication of bone was performed to the mandibular teeth with a low-speed round bur and piezosurgery. After hemostasis, bone graft material was placed into the decorticated area. In the severely thin alveolar ridge, a rigid scaffold was applied for immobilization of graft material. After approximation of the flap, an immediate orthodontic force was applied to the teeth to initiate rapid tooth movement.

Results: Rapid tooth movement into predetermined positions for orthognathic surgery was accomplished in all mandibular anterior teeth. Preoperative 3-dimensional imaging showed dehiscences on the facial aspects of the mandibular anterior teeth. Postoperative imaging demonstrated coverage of the denuded roots with radiodense material.

Conclusions: The accelerated osteogenic orthodontic technique is a safe and effective treatment option for mandibular anterior decompensation treatment of these patients. When combined with a temporary skeletal anchorage device and bone augmentation, this technique facilitated the decompression of the mandibular anterior teeth in severely compromised dentitions.