Faster tooth movement is the orthodontist's holy grail. Shorter treatment times would reduce costs and decrease the risks of gingival inflammation, decalcifica-tion, dental caries and root resorption. The idea of shortening treatment duration through surgical intervention was introduced first in the late 1800s; it resurfaced temporarily in the early to mid 1900s and reemerged in 2001. Interest increased dramatically after faster movements were linked to the biological process, the regional acceleratory phenomenon (RAP), which explained the response of bone to injury. Since then, a great deal of evidence has been accumulated showing that corticotomies-the most commonly used surgical intervention-increase rates of tooth movement approximately two-fold; however, the duration of the effect is limited. For humans, the orthodontist can expect the effect to last two to three months, during which the teeth can be moved 4 to 6 mm. There also is good evidence that the greater the injury, the greater the rate of tooth movement, but this does not affect the duration of the effect. While the evidence pertaining to less invasive, flapless, corticision procedures is controversial, more rapid tooth movements may be possible when the surgical cuts penetrate deeper into medullary bone. There is weak evidence supporting the efficacy of the least invasive flapless procedures involving limited numbers of 2 to 3 mm deep perforations into bone. Finally, there is limited evidence supporting the most invasive approaches that move teeth up to 1 mm/day by means of periodontal or dentoalveolar distraction osteogenesis. Although the evidence for some approaches may be limited, their potential is great. Surgical intervention presently provides the best means for orthodontists to accelerate tooth movement substantially and decrease treatment time. More experimental studies are needed to understand and eventually be able to control the biological events that occur with surgical intervention.
展开▼
