List of Contributors xiii Introduction xiv 1 Orthodontic Tissue Engineering: A 20-Year Retrospective and Philosophical Polemic 1 Neal C. Murphy Dedication 1 Introductory Rationale 1 Topical Issues 4 The Alveolus Bone Is Not a Process 7 Epigenetics and the Waddington Landscape 8 From Osteotomy to Corticotomy to Tissue Engineering 10 Farrar Revisited: Bending Bone and CPO 11 Histophysiology of Orthodontically Driven Osteogenesis 14 Cell-Level Orthodontics 15 Timid Surgery and Its Consequences 15 Conceptual Foundation Through Historical Evolution 16 German Roots 16 The Introduction Into English 17 Suya and the Asian Connection 18 1980s: Anholm and the Loma Linda Investigation 18 A 20th Century Summary 20 21st Century Pioneers 21 The Entry of Academics 21 "Wilckodontics," PAOO/AOO, and Tissue Engineering 21 The Small Window Myth 24 The "Need" for Extraction Myth 24 On Beauty 25 From PAOO to SCAT; Dead Cells to Living Tissue 29 Beyond the Ligament with Mechano-biology 31 The Mechanosome 33 Enter the Exosome 35 TMP and MOP Nonsurgical Alternatives 35 The Problems with Orthodontics 38 Papillary Slough as a Troubling Complication 38 Managing Periodontal Infection 39 PAOO and SCAT Step-by-Step 40 Ortho-Infection 44 Oral Hygiene - A Pragmatic Imperative 46 Compliance Dialogue 47 Enhanced Bass Technique 47 Effective Oral Health Techniques 49 A Heretical Dehiscence Theory 49 How Fast is "Fast"? - A 4-Day Treatment 51 Conclusions 52 Afterword for Academic Leaders 54 Acknowledgments 55 References 55 Recommended Reading 59 2 From Acceleration to Osteogenesis 60 Federico Brugnami Accelerated Tooth Movement 60 Corticotomy 61 Accelerated Tooth Movement in Laboratory Animals 61 Accelerated Tooth Movement in the Canine Laboratory Model 62 Canine Study Description and Design 62 Canine Tooth Movement Data 68 Tooth Movement Paradigms: PDL Cell-Mediated versus Spongiosa Osteopenia 71 From Corticotomy to Grafting with Decortication (From Acceleration to Osteogenesis) 72 Histologic and Long-Term CBCT Evaluation 74 Conclusions 81 Acknowledgments 82 References 82 3 From Corticotomy to Orthodontically Driven Osteogenesis: Surgical Considerations 87 Alfonso Caiazzo and Federico Brugnami Introduction 87 Historical Background 88 Biophysiologic Considerations 89 Indications for SAD or Corticotomy Alone 89 Contraindications 90 Advantages 90 Surgical Technique 90 Preoperative Considerations 90 Incision Design 91 Flap Reflection and Exposure 91 Corticotomy/Surgical Decortication 92 Bone Grafting 92 Suturing 94 Postsurgical Considerations 94 Single Flap Regenerative Corticotomy (SFRC) 95 Case 1 (SFRC) 96 Tunnel Regenerative Corticotomy (TURC) 96 Case 2 100 Conclusions 103 Acknowledgments 108 References 110 4 Orthodontically Driven Osteogenesis (ODO) Indications and Applications in Orthodontics 111 Simonetta Meuli, Federico Brugnami, and Gianfranco Giordano Introduction 111 The Basic Concepts 113 Orthodontic Implications of Bone Injury: The RAP 114 From Corticotomy to Grafting with Decortication 115 Practical Applications and Indications 117 Maximizing the Window of Opportunity 120 Contraindications 120 Applications 121 Segmental Alveolar Decortication 121 Decortication Procedures with Clear Aligners 121 Interprofessional Communication 121 Conclusion 122 Cases Presentation 122 Introductory Note 122 Case 1 123 Case 2 124 3D Digital Planning and Clear Aligner Treatment 124 Case 3 124 Case 4 136 Conclusion 151 Acknowledgments 151 References 163 5 Three-dimensional Digital Planning of Orthodontic Treatment: A Powerful Tool in Understanding, Communicating, and Planning Orthodontically Driven Osteogenesis 167 Simonetta Meuli Introduction 167 Virtual Orthodontic Treatment 167 Potential of Virtual Three-dimensional 169 Traditional Versus Printing Technology 169 Imaging 171 Digital Models 171 Virtual Three-dimensional Orthodontic Planning Models 172 Integration of CBCT Into the Digital Orthodontic Treatment Flow 174 "ClinCheck" and CBCT Integration as a Planning Tool for ODO 176 References 176 6 From Orthodontically Driven Corticotomy to Orthodontically Driven Osteogenesis: Tissue Engineering to Enhance Orthodontic Treatment, Guided by the Orthodontist 178 Federico Brugnami and Alfonso Caiazzo Introduction 178 Surgical Techniques: The Beginning of Tissue Engineering in Orthodontics 178 Surgical Strategies: Single Flap Corticotomy (SFC) and Tunnel Regenerative Corticotomy (TURC) 179 The Concept of Orthodontically Driven Corticotomy (ODC): From ODC to ODO 185 Surgical Strategies in ODO: Segmental, Sequential, Segmental, and Sequential Approaches 185 Segmental Approach 185 Sequential Approach 190 What is ODC? 190 Case Presentation 191 Case 1 191 Case 2 194 Case 4 197 Conclusions 203 References 206 7 Orthodontic Treatment and Periodontal Side Effects: Orthodontically Driven Osteogenesis to Stretch the Limits of a Safe Orthodontic Treatment 208 Federico Brugnami and Alfonso Caiazzo Introduction 208 Radiographic Evaluation of Orthodontic Side Effects 210 Research Experience 214 Material and Methods 216 Results 218 Conclusions 218 Dehiscences and Fenestrations 220 Indications of Use for ODO 225 Case Presentation 225 Conclusions and Recommendations 230 Acknowledgments 234 References 234 8 Orthodontically Driven Osteogenesis: Tissue Engineering to Enhance Adult and Multidisciplinary Treatment 237 Federico Brugnami and Alfonso Caiazzo ODO in Multidisciplinary Treatment 237 Orthodontics for Prosthetic 238 Periodontics and Orthodontics Synergy: The Two Dental Specialties that Need a Healthy Periodontium 238 Case Presentation 238 Case 1 Mutilated Dentition #1: Orthodontics and Prosthodontics Connection, Enhancing the Periodontal Outcome 238 Technical Procedure 240 Case 2 The Summer Break Case: An Alternative to Veneers to Correct Esthetics in the Anterior Area 243 Case Management 243 Clinical Outcomes 244 Case 3 Mutilated dentition #2: Adjunctive Corticotomy-enhanced Segmental Orthodontics to Intrude Over-erupted Molars and Allow Teeth Replacement in the Opposite Arch 244 One-shot Surgical Procedure Combining Corticotomy with Anchorage Plate Positioning, Wisdom Extraction, and Periodontal Surgeries 244 Case 4 Mutilated Dentition #2. Adjunctive Corticotomy-facilitated Segmental Orthodontics to Enhance Periodontics and Prosthodontics 246 Case 5 Mutilated Dentition #3: Segmental Corticotomy to Treat Unilateral Crossbite with Crowding, Rotations, and Missing Dentition 249 Case 6 Corticotomy in Periodontal Patients: Enhancing Orthodontic Treatment to Facilitate Periodontal Maintenance 249 Case 7 Malocclusion and Mutilated Detention in a Periodontally Compromised Patient: The Perfect Storm 261 Conclusions 268 References 276 9 Clear Aligners and Orthodontically Driven Osteogenesis: Boosting Treatment in the Gray Areas Between the Straightforward and the Orthognathic Cases 277 Simonetta Meuli and Federico Brugnami Introduction 277 Birth and Development of the Invisalign Technique 277 Treatment Phases and Characteristics Peculiar to the Invisalign System 278 Advantages of the Invisalign System 279 Regenerative Corticotomy and Bone Engineering in Orthodontics with a Digital Approach 280 Orthodontics and Its "Limitations" 280 Orthodontically Driven Osteogenesis in Orthodontic Treatment Planning 281 Presentation of Clinical Cases 282 Case 1 282 Case 2 283 Conclusions 287 Modifying the Lower Third of the Face 289 References 293 10 Orthognathic Surgery and Orthodontically Driven Osteogenesis 295 Simonetta Meuli, Federico Brugnami, Sergio Marrocco, Giulia Amodeo, and Domenico Scopelliti Introduction 295 Diagnosis and Treatment Planning 296 Case 1 297 Therapy Protocol 299 Discussion 302 Case 2 303 Conclusions 307 References 309 11 Understanding the Etiological Relationship Between Orthodontic Tooth Crowding and Mucogingival Pathologies, "Big Teeth in Small Jaws" 312 Colin Richman Introduction 312 Fundamental Etiological Factors Associated with Orthodontic Tooth Crowding 312 Anthropological Factors 312 Genetic Factors 312 Dietary Factors 314 Comparative Anatomical Observations Relative to Other Mammalian Species Nurtured and Living in Their Natural Habitats 314 Vasculature of the Gingival Tissues 314 The Clinical Significance of Dehiscences and Fenestrations 316 Tooth Eruption Patterns 318 Consequences and Management Strategies, Including Phenotype Modification 319 References 323 Index 325.