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ePaper created 2018-03-13, 09:28:55 | version 1.38.0
| research Fig. 7 Fig. 8 Fig. 9 cedure and the precautions are similar to the insertion of mini-screws. Orthodontists can easily create MOPs at the chairside, and the cost is a great deal more afford- able for the patient. Finally, they can easily be repeated during treatment if additional bone stimulation is needed. No packing and no sutures are necessary after MOP. The limit is that no grafting can accompany MOP. Whenever possible and desirable, grafting may accompany alveolar corticotomy. The grafting is usu- ally planned before surgery, based upon initial clinical and radiographic evaluation, the desired OTM, and the short- and long-term periodontal considerations. In situ- ations of thin bone and a thin gingival biotype, with risky movements like expansion, labial proclination or antero - posterior movements in reduced bone volumes, grafting may be indicated to reduce/eliminate fenestrations and dehiscences, produce additional support for the roots, and improve final aesthetics and stability. Grafting may include hard-tissue, soft-tissue and autol- ogous growth factors. Quality and quantity may be mod- ulated at the surgery depending on the clinical condi- tions of the surgical site. As a general rule, composite bone grafts where allogeneic bone (bone from human cadavers that is freeze-dried to reduce antigenicity and demineralised to expose the underlying collagen and its growth factors, like bone morphogenetic protein) with osteoinductive properties, is mixed with xenogenic bone (bone usually from bovine animals that provides a physi- cal matrix or scaffold suitable for deposition of new bone and that prevents its rapid resorption) with osteoconduc- tive properties are preferred (Fig. 10). Soft-tissue grafts are added to bone graft when a thin biotype or gingival recession is present. If the area to be regenerated is small, an autologous connective tissue graft is the gold standard procedure. Large areas may be man- aged with allogenic human acellular dermal matrices, that are available in different sizes and thicknesses (Fig. 11). case of injury and healing processes. Studies have shown that growth factors from platelet- concentrated plasma (platelet- derived growth factor, vascular endo- thelial growth factor, transforming growth factor beta 1 and 2) may rapidly increase the number of the avail- able stem cells, stimulate their activity, as well as reduce inflammation and pain during the healing processes.36 Platelet- rich fibrin (PRF) 37, 38 and the platelet rich in growth factors (PRGF) 39, 40 are prepared via two differ- ent protocols in which blood centrifugations allow sep- aration of the plasma platelets from the white and red cells. PRF contains leucocytes and the process for its preparation produces membranes with a light compres- sion of the centrifuged fraction. The process for preparing PRGF allows the separa- tion of three fractions with different concentrations of platelets. They may be mixed with bone grafts (increas- ing the graft’s viscosity and adherence to the surgi- cal site, thus facilitating its application) and soft -tissue grafts. Activating and heating the PRGF fraction pro- duces clots/membranes of fibrin that are placed on the bone grafts, stabilising their position (Fig. 12). When using grafts along with alveolar corticotomy, a tension-free flap closure must be achieved at the end of the surgery, to provide optimal coverage of the decorti- cated area and the grafted material, and to enhance final soft-tissue healing. Non-resorbable sutures are left for at least 14–21 days. 5. Proper orthodontic management after corticotomy must be performed Orthodontic treatment associated with periodontally facilitated orthodontics may be carried out with any fixed or removable appliances. It is the clinician’s choice to combine periodontally facilitated orthodontic procedures with fixed, active self-ligating appliances (In-Ovation) with the new prescription of the CCO System (GAC-Dentsply Sirona; Fig. 13).41 Soft-tissue grafts are sutured with resorbable sutures. Both bone and soft-tissue grafts are coupled with autol- ogous growth factors. With ageing, the number of stem cells rapidly decreases. These cells are important in The management and wire changes are similar to those of any orthodontic case. No initial heavy force is necessary. There is no rule regarding timing of the bond- 24 ortho 1 2018