Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI.
Graduate Periodontics, University of Illinois, Chicago, IL.
Clin Adv Periodontics. 2020 Dec;10(4):213-223. doi: 10.1002/cap.10116. Epub 2020 Aug 27.
Surgically facilitated orthodontic treatment (SFOT)/periodontally accelerated osteogenic orthodontics (PAOO) has the potential of allowing safer orthodontic treatment in vulnerable periodontium with thin phenotypes. SFOT/PAOO is a phenotype modification therapy (PhMT) approach where thin bone morphotype and/or gingiva are surgically augmented to convert a fragile-thin to a robust-thick periodontal environment. This permits orthodontic treatment in these previously thin phenotype cases to proceed without iatrogenically-induced adverse effects. This is an infrequently performed procedure with few available clinical recommendations.
In this practical application paper, three clinicians with the collective clinical experience of over 1500 SFOT cases developed a clinical decision-making algorithm outlining the key steps for SFOT. A sample case is provided for clinical appreciation of the procedure. Lastly, this panel reviewed and detailed the critical decision making and surgical approaches associated with the use of SFOT. Though the basic decision making is consistent, individual variations on surgical management are compared. This is summarized in a clinical decision tree along with a sample clinical case. Additionally, the cumulative experience has been organized into tables that provide comparative decision and surgical approaches. There are similarities and differences. Lastly, strategies that have not been individually effective are also noted.
SFOT/PAOO is an effective PhMT approach whereby the bone and/or soft tissue phenotype can be surgically modified to permit orthodontic treatment in patients with thin phenotypes. The cumulative experience of three experienced clinicians provides clinical recommendations for SFOT management of PhMT for pre-orthodontic treatment.
正畸辅助外科治疗（SFOT）/牙周加速成骨正畸（PAOO）有可能使脆弱牙周组织中薄型表型的正畸治疗更安全。SFOT/PAOO 是一种表型修饰治疗（PhMT）方法，其中薄骨形态和/或牙龈通过手术增强，将脆弱-薄转化为强壮-厚的牙周环境。这允许在以前的薄表型病例中进行正畸治疗，而不会产生医源性不良反应。这是一种很少进行的手术，几乎没有可用的临床建议。
在这篇实用应用论文中，三位临床医生拥有超过 1500 例 SFOT 病例的集体临床经验，制定了一个临床决策算法，概述了 SFOT 的关键步骤。提供了一个案例供临床了解该程序。最后，该小组审查并详细说明了与 SFOT 使用相关的关键决策和手术方法。尽管基本决策是一致的，但手术管理的个体差异仍有所比较。这在一个临床决策树中进行了总结，并附有一个案例。此外，还将累积经验组织成表格，提供比较决策和手术方法。既有相似之处，也有不同之处。最后，还指出了个别无效的策略。
SFOT/PAOO 是一种有效的 PhMT 方法，通过该方法可以对骨和/或软组织表型进行手术修饰，从而允许在薄表型患者中进行正畸治疗。三位经验丰富的临床医生的累积经验为 SFOT 在 PhMT 治疗中的管理提供了临床建议。
