Local Applications of Corticotomy and Bone Grafting for Difficult Orthodontic Tooth Movement

Local and timely application of corticotomy with bone grafting creates many opportunities to facilitate adult orthodontics. Controlled surgical trauma induces a regional burst of bone remodeling and decreases the resistance of the alveolar bone to favor root torque and bodily tooth movement, which is a biological approach to enhance orthodontic biomechanics. Corticotomy-facilitated orthodontics can be applied locally to facilitate difficult orthodontic tooth movement such as molar intrusion, molar distalization, extraction space closure, exposing high impacted canine, or correcting severely rotated tooth. Usually, the extent of the regional acceleratory phenomenon is proportional to the amount of surgical trauma, thus the approach can be customized in each case. Corticotomy is part of the routine steps in bone grafting procedures to provide blood supply to the regenerative scaffold. Bone grafting can reconstruct deficient alveolar ridge dimension to overcome the resistance from the cortical bone and expanding orthodontic boundaries. Thin periodontal phenotypes can also be augmented to strengthen tooth-supporting tissue and avoid future gingival recession. Local application of corticotomies and bone grafting can be very practical in an interdisciplinary collaborative approach with high patient acceptance.