An Innovative Approach of Skeletal Maxillary Bilateral Posterior Crossbite Correction with Decortication and Bone Autograft Augmentation

Context: Deliberate periodontium damage caused by either corticotomy, piezocision or microosteoperforation causes increased remodelling of the alveolar bone due to regional acceleratory phenomena leading to rapid movement of the tooth. Periodontal bone graft augmentation provides the periodontium with structural integrity, reducing tell-tale relapse incidence. The procedures advocated for the accelerated correction of the skeletal maxillary bilateral posterior crossbite and open bite malocclusion were selective decortication and bone autograft augmentation in the case mentioned. A -18-year-old female patient with moderate Class III skeletal malocclusion, increased bimaxillary dento-alveolar protrusion, anterior open bite, forward tongue position, and maxillary bilateral posterior crossbite imbricated and rotated mandibular incisors. A protocol for non-extraction care has been recommended. Methods: Full thickness mucoperiosteal flaps were mirrored in the maxillary oral regions one week after strapping of the pre-adjusted edgewise appliance, MBT prescription (0.022 x 0.028-inch slot) and Hyrax unit. With surgical perforations, decortication was performed and supplemented with bone autograft taken from the patient’s symphyseal area. The activation of the Hyrax system two weeks later was conducted twice daily, with the other orthodontic changes conducted fortnightly before completion of treatment. Results: 2.5 months of accelerated correction of the skeletal maxillary bilateral posterior crossbite and 7 months of care of full malocclusion were achieved. Conclusion: The accelerated malocclusion correction could be attributed to the regional acceleration phenomenon induced by the deliberate surgical insult induced by the decortication procedure and the stable outcome thus observed was attributed to the bone autograft periodontal augmentation. In one-third to one-fourth of the treatment necessary for traditional malocclusion correction, the selective decortication procedure accelerated the correction of the maxillary bilateral posterior crossbite and open bite malocclusion and the augmented bone autograft provided excellent bone volume for the much needed post-treatment stability results in these cases.

Author (s) Details

Dr. R. Rajesh Murugan
Department of Orthodontics and Dentofacial Orthopedics, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

Dr. A. Arif Yezdani
Department of Orthodontics and Dentofacial Orthopedics, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

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