A corticotomy is a surgical procedure on the jawbone to accelerate the movement of teeth during orthodontic treatment. It is defined as a procedure that creates calculated surgical cuts into the cortical bone, the dense outer layer of the jaw. This is not a standalone method for straightening teeth, but an adjunctive procedure performed with braces or clear aligners to shorten treatment time.
The procedure is designed for specific situations, such as correcting severe dental crowding or complex bite issues. It is often considered for adult patients, whose denser bone can make traditional orthodontic movement a slower process.
The Goal of a Corticotomy
The goal of a corticotomy is to harness the body’s natural healing mechanisms to speed up tooth movement. Orthodontic appliances like braces work by applying steady pressure to teeth, which slowly causes the bone surrounding them to remodel. A corticotomy accelerates this process through a biological response known as the Regional Acceleratory Phenomenon (RAP).
This phenomenon is a temporary state of increased metabolic activity in the bone triggered by the surgical procedure. The shallow cuts made in the cortical bone act as a localized, controlled injury. This stimulates cellular activity that leads to a temporary demineralization and softening of the bone, making the jawbone more malleable for a limited time.
With the bone in this softened state, the forces applied by braces or aligners can move teeth into their correct positions much more quickly. This can reduce the total time spent in orthodontic treatment significantly, sometimes by as much as half.
The Surgical Process
The surgical process begins with collaborative planning between the orthodontist and a dental surgeon, such as a periodontist or oral surgeon. They will identify the specific areas of the jaw where tooth movement needs to be accelerated.
On the day of the procedure, local anesthesia is administered to numb the targeted areas of the mouth. The surgeon then makes small, precise incisions in the gum tissue to expose the underlying cortical bone.
With the bone exposed, the surgeon uses specialized instruments to make a series of shallow cuts or perforations into the dense outer layer of the bone. These cuts are strategically placed around the roots of the teeth that are slated for movement. The cuts are controlled to only affect the outer cortex, leaving the inner portion of the bone and the tooth roots unharmed.
Following the bone perforations, a bone grafting material is often placed over the surgical sites. This step helps to enhance the volume and strength of the bone after healing, providing better support for the teeth. Finally, the surgeon carefully repositions the gum tissue and secures it with small sutures.
Recovery and Orthodontic Follow-Up
Following corticotomy surgery, patients can expect mild to moderate swelling, bruising, and general discomfort. These symptoms are managed with over-the-counter pain relievers and the application of cold packs to the jaw.
A soft food diet is recommended for the first few days to a week to avoid putting pressure on the surgical sites. Patients will receive specific instructions on how to gently clean their mouth while avoiding direct contact with the sutured areas. The sutures themselves are often dissolvable, breaking down on their own within a week or two.
A unique aspect of this procedure is the need for prompt orthodontic follow-up. To capitalize on the temporary state of accelerated bone remodeling, orthodontic adjustments must begin within one to two weeks after the surgery. During this accelerated phase, orthodontic appointments may be scheduled more frequently to guide the teeth into place efficiently.
Determining Candidacy for the Procedure
Deciding whether a corticotomy is appropriate involves a careful evaluation of a patient’s health and orthodontic needs. Good candidates are adults hoping to significantly shorten the time they need to wear braces or aligners. They must have good overall systemic health and demonstrate excellent oral hygiene, as healthy gums and bone are necessary to ensure proper healing.
There are several factors that may make someone an unsuitable candidate for a corticotomy. These contraindications include:
- Active or uncontrolled periodontal (gum) disease, as the infection can compromise surgical outcomes
- Heavy smoking, because it impairs blood flow and can hinder the body’s ability to heal
- Systemic bone diseases
- Patients taking specific medications that affect bone metabolism, such as bisphosphonates
A thorough medical history review and dental examination are performed to ensure the procedure is a safe and effective option for the patient.