Case Study #5

16 year old pre orthodontic and pre orthognathic surgical treatment. Note severe in the crowding mandibular anterior segment and class 3 skeletal jaw relationship. 

 

 

Intra-operative view at time of localized POPA treatment for teeth numbers 21-28, facial surface only. Note ultrathin facial bone with early dehiscences and fenestrations.

 

Four months post treatment (and preceding orthognathic treatment). Note robust muco-gingival periodontal health.



Pre Orthodontic Periodontal Augmentation (POPA) vs. Periodontally Accelerated Osteogenic Orthodontics (PAOO™)

1. POPA (Pre Orthodontic Periodontal Augmentation) is a periodontal surgical procedure to augment facially deficient alveolar bone (dehiscences and fenestrations) prior to initiation of orthodontic treatment. (Ref. Richman, Compendium 2011).
2. This treatment modality has been shown to minimize the risk of post orthodontic gingival recession and post orthodontic tooth relapse. 
3. If the patient or orthodontist is seeking accelerated tooth movement as well, lingual treatment (corticotomies) is electively provided. This typifies PAOO. However, if augmentation is the primary objective, only the facial aspects are treated. Pre-treatment CBCT is essential to facilitate the diagnosis and treatment plan.
4. POPA precisely defines what we are trying to achieve -- pre orthodontic periodontal augmentation. It is less confusing terminology than PAOO, Wilckodontics, SFOT, Piezocision, etc.
5. In summary, POPA addresses only the biological need for alveolar bone augmentation. In contrast, PAOO is a more aggressive surgical intervention which addresses both the biological need for augmentation of deficient bone sites as well as the elective lifestyle desires for accelerated orthodontic therapy.

 

 

 

 

 

Case Study #4

This case illustrates the need for POPA or PAOO™. At the time of PAOO™ surgery, note the severely deficient facial bony plates associated with teeth numbers 22-26 inclusive. Also note the CBCT scan demonstrating missing facial bone (RSBI C, Richman 2011).