Surgically facilitated orthodontic therapy

Surgically Facilitated Orthodontic Therapy (SFOT) is a multidisciplinary approach that combines orthodontic treatment with selective surgery to enhance the effectiveness and efficiency of orthodontics. This method is particularly beneficial for adult patients with complex dental and skeletal discrepancies that cannot be adequately addressed through traditional orthodontics alone. SFOT aims to improve the periodontal health, aesthetics, and function of the dentition by creating a more favorable bone environment for tooth movement.

Overview

SFOT involves a collaborative effort between orthodontists, oral and maxillofacial surgeons, and sometimes periodontists to plan and execute a treatment that combines surgical procedures with conventional or accelerated orthodontic techniques. The surgical aspect of SFOT typically involves alveolar bone modifications, such as corticotomy, osteotomy, or alveolar distraction osteogenesis, which are designed to facilitate or expedite tooth movement. These procedures can reduce treatment time significantly and can improve outcomes in cases with severe malocclusion or where substantial bone augmentation is required.

Indications

SFOT is indicated for adult patients with:

• Moderate to severe malocclusion that cannot be corrected by orthodontics alone.
• Insufficient alveolar bone volume or density.
• Need for rapid orthodontic treatment due to personal or clinical reasons.
• Desire to improve periodontal health and aesthetics.

Procedure

The SFOT procedure typically follows these steps:

1. Initial Assessment: Comprehensive evaluation of the patient's dental, skeletal, and periodontal status to determine the feasibility of SFOT.
2. Treatment Planning: Collaborative planning among the orthodontist, surgeon, and other involved specialists to outline the orthodontic and surgical phases of treatment.
3. Orthodontic Phase: Pre-surgical orthodontic treatment to align the teeth and create a stable environment for the upcoming surgical procedure.
4. Surgical Phase: Execution of the planned surgical interventions to modify the alveolar bone and facilitate tooth movement.
5. Post-surgical Orthodontics: Final orthodontic adjustments to refine occlusion and aesthetics after the surgical modifications have healed.
6. Retention: Use of retainers to maintain the results achieved through SFOT.

Benefits

• Reduced treatment time compared to traditional orthodontics.
• Improved periodontal outcomes due to better bone support and easier hygiene.
• Enhanced aesthetic results by addressing skeletal discrepancies and soft tissue contours.
• Increased feasibility of treating complex cases that would otherwise be untreatable or require more invasive surgery.

Risks and Considerations

As with any surgical procedure, SFOT carries potential risks, including:

• Post-operative discomfort and swelling.
• Risk of infection or poor healing.
• Possible need for additional procedures if the desired movement is not achieved.
• Financial cost, as SFOT can be more expensive than traditional orthodontic treatment.

Conclusion

Surgically Facilitated Orthodontic Therapy represents a significant advancement in the field of orthodontics and oral surgery, offering a powerful tool for treating complex cases with improved efficiency and outcomes. However, careful patient selection, thorough planning, and close collaboration among the dental care team are essential to maximize the benefits and minimize the risks associated with this innovative approach.