by Lynn S.
– also known as Accelerated Osteogenic Orthodontics (AOO)TM
– is a relatively new treatment in the orthodontic realm. It
promises to radically shorten your time in braces with a
dental surgical procedure. This technique has roots in
orthopedics, dating back to the early 1900s. Only recently was
it modified to assist in straightening teeth and fix bites.
This article will help you understand what AOO is, how it is
done, and the pros and cons of the procedure. While
researching and writing this article, I tried to remain as
objective as possible to give you a clear picture of
you read this article, you may also want to read Patients'
Experiences with AOO Surgery.
website can help you find a doctor in your area that
does AOO surgery. The site also has information and video, but
it is mainly marketing-oriented.
AOO procedure was developed by Drs. Thomas and William Wilcko,
Thomas Wilcko is a Periodontist in practice for 25 years, and
his brother, William Wilcko, is an Orthodontist in practice
for 18 years. Both were interested in methods of growing bones
called Distraction Osteogenesis and Regional Accelerated
Phenomenon (RAP), and modified these methods to work
orthodontically with limited trauma to the surgical site.
Brief History of the Technique
osteogenesis was first used in orthopedic medicine in the
early 1900s, but the method wasn’t widely employed until the
1950s, when Russian orthopedic surgeon Dr. Gabriel Ilizarov
perfected the technique. Dr.
Ilizarov often did bone surgery to correct deformities and
repair defects in arms and legs. While treating a patient with
a short amputation stump, Dr. Ilizarov performed an osteotomy
– that is, he cut the bone, intending to lengthen it with a
bone graft in the middle. He then put a metal frame around the
stump, creating a gap (technically called a “distraction
gap.” By chance, he discovered that new bone grew in the
distraction gap, eliminating the need for the bone graft.
Intrigued, Dr. Ilizarov researched the phenomenon and proved
that stressing a bone increases metabolic activity and
cellular generation, also known in orthopedic science as
"bone remodeling," resulting in growth of new bone. The
phenomenon was named Distraction Osteogenesis (DO) – growth
of new bone by means of surgically "distracting" the
the early 1960s, craniofacial surgeons began using DO
techniques to rapidly expand palates in growing patients. In
the 1970s, the technique was introduced to jaw surgery. During
the next two decades, interest in craniofacial distraction
grew slowly and sporadic experiments were performed, mainly on
dogs. In the early 1990s, the technique began to be more
widely used on human patients with jaw defects. Meanwhile,
distinguished orthopedist Harold Frost realized that there was
a direct correlation between the degree of injuring a bone and
the intensity of its healing response. He called this the Rapid
Acceleratory Phenomenon (RAP). In RAP, there is a
temporary burst of localized soft and hard tissue remodeling
(i.e., regeneration) which rebuilds the bone back to its
early as the 1950s, periodontists began using a corticotomy
technique to increase the rate of tooth movement. An oral
corticotomy is surgical procedure where cuts are made in the Aveolar
bone (the bone surrounds and supports your teeth). In
the 1990s, the Drs. Wilcko, using computed tomography,
discovered that reduced mineralization of the Alveolar bone
was the reason behind the rapid tooth movement following
used their knowledge of corticotomy, and their observations of
RAP, to develop their patented AOO technique in 1995.
Does AOO Work?
a usual corticotomy, AOO doesn’t just cut into the bone, but
decorticates it – that is, some of the bone’s
external surface is removed. The bone then goes through a
phase known as osteopenia, where its mineral content is
temporarily decreased. The tissues of the Alveolar bone
release rich deposits of calcium, and new bone begins to
mineralize in about 20 to 55 days.
While your Aveolar bone is in this transient state,
braces can move your teeth very quickly, because the bone is
softer and there is less resistance to the force of the
has shown that after the Aveolar bone heals and the teeth are
in their new desired positions, additional Aveolar bone has
formed. The Drs. Wilcko, and other researchers have proven
that the aftermath of AOO is as stable and long-lasting as
conventional orthodontic braces. (A dental student named S.S.
Hajji did his Masters thesis at
comparison of the techniques and found that results were
statistically identical between AOO subjects and the
conventional orthodontic treatment group).
after AOO, the Aveolar bone is apparently not only as strong
as it was before the procedure (and your teeth held in it just
as well), but there is actually more of it-- which is
advantageous if your profile needs to be built up to improve
your facial aesthetics.
Long Does Total Treatment Take?
people who have undergone AOO surgery are in braces from three
to nine months. Afterward, they are in retainers for at least
six months, or longer.
Much Does AOO Cost – and Is It Covered by Insurance?
is typically about double the cost of a traditional
orthodontic treatment. So, if traditional braces cost you
$5,000 for two years of treatment, AOO would cost around
$10,000 for a three to nine month treatment. Some fees go as
high as $15,000. Those
costs include the anesthesia, the surgery, and the orthodontic
dental insurance plans don’t cover AOO surgery, because, at
the moment, it is viewed as a cosmetic surgery. For example,
Delta Dental, one of the largest dental insurers in the US, does not
cover AOO. However, you should check with your insurance plan
before you make your final decision. Be sure to check your
medical plan as well as your dental plan, because some types
of dental surgeries or anesthesias are covered under medical
your dental plan covers braces, the orthodontic portion of the
procedure (which is roughly half of the total cost) may be
Type of Doctor Does AOO?
AOO surgery can be done by an oral surgeon, a periodontist, an
orthodontist, or any dental professional who is versed in oral
surgery and has attended the two-day Wilckodontics course.
Currently, approximately 300 dental professionals around the
world are qualified to do the procedure; about 270 of them are
in the US.
is AOO Surgery Done?
is an outpatient procedure done in the office of an oral
surgeon or other dental professional trained in the technique.
It takes between three and four hours, and is considered a
minor periodontic plastic surgery.
your braces are put on a few days before you undergo the AOO
After receiving anesthesia, (either general or local,
depending on you and the surgeon), the oral surgeon cuts flaps
along the surface of your gums and behind your teeth, exposing
the bone adjacent to your teeth. Using a surgical bur, the
bone is scored. The surgeon then places a bone graft over the
bleeding area. The
grafting material is mixed with antibiotics to help prevent
infection. According to Dr. Thomas Wilcko, who I interviewed
as part of my research for this article, the surgery is not
difficult for the periodontist or surgeon, but is a bit
tedious, as repositioning of the soft tissue can be
is not as invasive as taking out teeth," Dr. Wilcko said.
"There is some swelling and very little bleeding
After the procedure is done, you are usually given a narcotic
pain reliever or told to take acetaminophen (i.e., Tylenol).
According to Dr. Wilcko, pain relievers like Ibuprofen (i.e.,
Advil) are not recommended, since they are NSAIDs (Non-Steroid
Anti-Inflammatory Drugs). NSAIDs can interfere with the
production of prostaglandin hormone in your body and slow down
the bone growth process which is vital to AOO. In addition,
NSAIDs given during the first 24 hours following trauma
(surgical or otherwise) inhibit clotting. Therefore, you
should not take NSAIDs on a regular basis before or after
undergoing AOO surgery.
After the surgery, you will probably be in no shape to drive,
so arrange for someone to pick you up at the surgeon’s
office and take you home.
from AOO Surgery
Total recovery from the procedure takes seven to 10 days. You
will probably experience some swelling and need to use ice
packs. If you are
given a narcotic pain killer, you can take it for up to a week
post-surgery. The surgery usually does not result in facial
During this time, you also use a special prescription
mouthwash, because you can’t brush your teeth. Most
people get the surgery done on Thursday, and take Friday and
the weekend to recover before considering going back to work
or school. However, you may want to schedule an entire week
off (or do it during vacation time), to ensure that you will
be most comfortable. After all, if complications (such as
infection) do occur, you probably won’t be able to go to
work or classes. And you certainly can’t work, study, or
drive if you’re taking a narcotic pain killer.
Adjustments After the Surgery
you have fully recovered from the procedure, your orthodontist
adjusts your braces about every two weeks. Depending on your
case, you will wear braces from 3 months up to about 9 months.
After the braces are removed, you must wear a retainer for at
least six months (although longer is usually recommended).
same types of braces and retainers are used in AOO as in
traditional orthodontics, so you will have your choice of
metal or ceramic brackets.
orthodontist named Albert H. Owen III researched Invisalign
treatment in conjunction with AOO surgery. He had some minor
crowding in his mouth and had the procedure done on himself
(how’s that for dedicated research?!)
surgery, he used Invisalign appliances to move his teeth. He
reported his findings in the Journal of Clinical Orthodontics
in June, 2001. Of
course, the aligners were changed much more quickly than
traditional Invisalign treatment (every 3 to 4 days instead of
every two weeks). Dr. Owen was pleased with the result. He
concluded that because the aligners had to be worn full-time,
this technique required a high degree of patient compliance.
He also said that because he didn’t have the AOO surgery
done on his entire mouth (only on the areas adjacent to the
crowded teeth), the "non-surgery" teeth hurt a lot
more than the "surgery" teeth because of the force
applied by the aligners. According to officials at Align
Technolgies, Dr. Owen is the only dental professional (to
their knowledge) that has used Invisalign after AOO surgery.
Qualifications for AOO Treatment
AOO can be done on people of any age, as long as they have a
healthy periodontal situation. According to Dr. Wilcko, the
technique has been done on children as young as age 11 and on
senior citizens as old as 77 (mainly as preparation for dental
implants or devices).
You are not a candidate
for this procedure if you have dental bone loss, periodontal
disease, root damage or poor roots. In addition, if you have a
disease such as Rheumatoid Arthritis which requires you to
take regular doses of NSAIDs, you may not be a good candidate
Dr. Wilcko says that the AOO technique can correct most of the
orthodontic problems that are treated with traditional
long-term braces. The only exception is a Class III condition,
in which the lower jaw is too long relative to the rest of the
face, and the chin protrudes. Class III cases have many
physical constrains which may not lend themselves to AOO
and Cons of AOO Surgery
are in braces less time than traditional orthodontics
is less likelihood of root resorption
AOO, there is more bone to support your teeth and facial
of relapse has been very low
is less need for appliances and headgear (depending on the
the eight years since AOO was first applied, the
patients’ outcomes were good and have remained stable
technique has its roots in proven orthopedic research and
can wear either metal or ceramic brackets
is an expensive procedure, often not covered by insurance
is a mildly invasive surgical procedure, and like all
surgeries, it has its risks
will experience some pain and swelling, and the
possibility of infection
is not for you if you take NSAIDs on a regular basis or
have other chronic health problems
form of anesthesia must be used
will probably miss a week of school or work
does not lend itself to Class III malocclusion cases
is not "pain free;" your teeth will still hurt
when the braces begin to move them
following references were used in writing this article:
Orthodontics by Altering Alveolar Bone Density,”
and Wilcko, Good Practice Newsletter, V.2 No.2
Treatment”, Owen, Journal of Clinical Orthodontics, June
(for access go to Archives - Free Access- 2001-June)
Osteogenesis of the Mandible,” Baur, emedicine.com
Distraction Osteogenesis", Martin Chin, DDS
thanks also to Kevin DuPre
and to Adrian Vogt, DDS, MSD