The Utilization of the PAOO™ Technique to Increase Oral Cavity Volume for OSA and Potential OSA Patients – (9-21-202)

Speakers: John Tucker, DMD; Tom Wilco, DMD

Time: 7:00PM-8:00PM

Course Description:  The PAOO™ can make it possible to complete most orthodontics treatments in 1/3rd to 1/4th the time of traditional orthodontic treatment.  However, the most POWER aspects of the PAOO™ technique in regards to OSA are the ability to:

A.     To move the teeth at least 2 to 3 times further than would be possible with traditional orthodontics alone and especially with anterior protraction for arch length increase and posterior expansion for arch width increase.

B.     To dramatically decrease the need for bicuspid extractions and to reopen spaces subsequent to previous bicuspid extractions.  Additionally, spaces can be opened for a third bicuspid in each quadrant to make it possible to increase the arch length beyond what would typically be possible with orthodontic treatment alone.

C.    To have the ability to sandwich the teeth between intact layers of facial and lingual alveolar bone to provide for an intact periodontium with a significant increase in long-term stability!  Additionally, the converse can also be addressed.  If there are extensive bony exostoses impinging on the tongue space these can be reduced.

There are also some concepts that at first will seem to contradict conventional thinking and it will take a little time to wrap your arms around them.  The increase in the rate of tooth movement is due to increased bone turnover that results from traumatizing the bone but to fully realize what the technique has to offer one must ensure that there is also a relatively thin layer of bone in the direction of the tooth movement.  This thin layer of bone will be augmented so that at the end of the treatment there are thicker cortical layers of bone to provide for an intact periodontium and increased stability.  Additionally, in contradiction to conventional thinking, the increase in the rate of tooth movement does not result in increased root resorption, in fact, quite the opposite.
The tooth movement utilizing the PAOO™ technique is 100% PDL mediated, tipping followed by up-righting.  There is no bony block movement of any significance.  Even bony sutures are not opened significantly.  For example, in palatal expansions, the orthopedic devices are typically tooth-borne and even in adolescents, there is seldom more than a millimeter or so of sutural opening.  This translates to minimal relapse but also does not address an increase in the width of the floor of the nose.  If an increase in the floor of the nose is needed a TAD-borne appliance may also be needed.

Objectives:  After taking the webinar one should have a basic understanding of the underlying physiology and anatomic considerations necessary to accomplish the enhanced tooth movement.  Perhaps most importantly one should have a better understanding of the potential that the PAOO™ technique has to offer their compromised patients in regards to providing for an adequate oral cavity volume.