Pre Orthodontic Periodontal Augmentation (POPA) and Periodontically Accelerated Osteogenic Orthodontics (PAOO™) are advanced techniques that can straighten most patient's teeth within three to eight months. However, more importantly, substantial hard and soft tissue augmentation of deficient alveolar bone will minimize the risk of future gingival recession as well as improve and enhance post orthodontic treatment stability. This accelerated orthodontic treatment allows patients to get the beautiful, straight smile they want more quickly. This option is especially appealing to adult patients who do not want to spend years in braces and appliances. Younger patients also qualify for POPA and PAOO™ treatment.
POPA and PAOO™ allow the clinician to fast track orthodontic treatment by inducing the Regional Acceloratory Phenomenon (RAP) of Frost. While traditional orthodontic treatment focuses solely on the forces applied to teeth and tooth movement through hyaline necrosis, the RAP effect results in a dystraction based type of tooth movement. This is far more gentle in the long term to the periodontium.
Objectives of POPA and PAOO™
In the past, if a patient asked their orthodontist if it was possible to complete orthodontic treatment in 8 to 12 months, they would have been told that it would not be likely. However, research clearly demonstrates that patients prefer shorter treatment times. This objective is now easily realized through POPA or PAOO™ treatment.
Evidence is available that POPA and PAOO™ treatment provide:
- Enhanced muco-gingival complexes with decreased risk of subsequent gingival recession
- Increased post-treatment stability
- Less apical root resorption
- Decreased risk of white spot lesions
- Happier patients
The Procedure
Comprehensive records are obtained by the orthodontist and periodontist and an appropriate diagnosis and treatment plan is established. Orthodontic appliances are then placed 1-2 weeks prior to the surgical phase of treatment with orthodontic adjustments provided every 2 weeks until treatment is complete. The patient must be taught efficient interproximal plaque control measures. It is suggested that hygiene visits be completed every 3 months alternating between the periodontal or oral surgical office and the general dental office.
Comprehensive records are obtained by the orthodontist and periodontist and an appropriate diagnosis and treatment plan is established. Orthodontic appliances are then placed 1-2 weeks prior to the surgical phase of treatment with orthodontic adjustments provided every 2 weeks until treatment is complete. The patient must be taught efficient interproximal plaque control measures. It is suggested that hygiene visits be completed every 3 months alternating between the periodontal or oral surgical office and the general dental office.
Following appropriate sedation and local anesthesia, corticotomies and substantial bone grafting is completed. This results in a temporary conversion of the highly organized lamellar bone to highly cellular trabecular bone. This is known as a reversible osteopenic change of the bone surrounding the teeth which allows for rapid tooth movement. Traditional tooth movement involves hyaline necrosis at the pressure side and bone deposition at the tension side. With POPA and PAOO™, teeth move more rapidly in the surrounding demineralized bone matrix because the bone is more cellular and less mineralized. New bone begins to mineralize within 20-55 days.
After the surgery, the orthodontist adjusts the appliances in order to move the teeth to the desired position. These adjustments are made every two weeks because the teeth are moving 60-70% faster than traditional orthodontic tooth movement. After the teeth are repositioned, the surrounding bone regenerates back to highly mineralized lamellar bone.
