Surgically facilitated orthodontic therapy (SFOT) is a specialized treatment that merges minor oral surgery with conventional methods like braces or clear aligners. The objective is to shorten the time required to straighten teeth and align a patient’s bite, particularly when issues like insufficient jawbone complicate traditional work. The therapy prepares the jawbone to make it more receptive to tooth movement.
This procedure is a collaborative effort between an orthodontist and a surgical specialist, such as a periodontist or oral surgeon. By modifying the bone and surrounding tissues, SFOT can expand the range of possible tooth movement beyond what a patient’s existing anatomy might otherwise limit. This allows for more predictable and stable long-term results.
The Science of Accelerated Tooth Movement
The effectiveness of surgically facilitated orthodontic therapy is based on a biological process known as the Regional Acceleratory Phenomenon (RAP). This phenomenon is the body’s intensified healing response to a controlled surgical injury. When the bone supporting the teeth is stimulated, the body initiates cellular activities that accelerate tissue turnover and repair in that specific area.
This accelerated metabolic state is characterized by a temporary decrease in the mineral content of the alveolar bone, which is the part of the jaw that holds the tooth sockets. This reduction in bone density makes the jawbone softer for a limited period. This phase of increased bone plasticity allows orthodontic appliances to move teeth more quickly and with less resistance.
The process is similar to tilling a garden. By loosening compacted soil, a gardener makes it easier to move plants. In the same way, the surgical aspect of SFOT “tills” the bone, creating a temporary state that is highly conducive to the repositioning of teeth.
This induced healing response increases blood flow and the presence of cells responsible for breaking down and rebuilding bone tissue. The period of accelerated movement lasts for a few months, during which orthodontic appointments are scheduled more frequently to take full advantage of the RAP.
The Surgical Procedure
The surgical component of SFOT is a planned procedure involving collaboration between the patient’s orthodontist and a surgical specialist, typically a periodontist or an oral surgeon. This partnership ensures the surgical preparations align with the orthodontic treatment plan. Advanced 3D imaging is often used to map out the procedure and plan the necessary bone modifications.
On the day of the procedure, the patient is given local anesthesia to ensure the area is numb. The surgeon then makes small incisions in the gum tissue to expose the surface of the alveolar bone that surrounds the roots of the teeth. This provides direct access to the bone that needs to be modified.
With the bone exposed, the surgeon performs a corticotomy. This involves creating small, shallow perforations in the outer layer, or cortex, of the bone. These corticotomies are the stimulus that triggers the Regional Acceleratory Phenomenon (RAP), initiating the temporary demineralization and increased metabolic activity in the bone.
In many SFOT cases, the surgeon will also place bone grafting material over the areas where the corticotomies were made. This material serves to augment the thickness and volume of the jawbone. This is beneficial for patients who have thin bone, as it strengthens the foundation that will support the teeth in their new positions and enhances long-term stability. After the grafting material is placed, the gum tissue is repositioned and closed with small sutures.
Determining Candidacy for Treatment
Determining who is a suitable candidate for SFOT involves a thorough evaluation by the dental team. The treatment is most frequently recommended for adults who are seeking to reduce the duration of their orthodontic care. Many adults have denser jawbones, which can make tooth movement slower with traditional orthodontic forces.
The therapy is also well-suited for individuals with specific dental and skeletal conditions. Patients with moderate to severe tooth crowding can benefit, as SFOT allows for more effective arch expansion by remodeling the bone, often eliminating the need for tooth extractions. It is also a valuable tool for correcting issues like impacted teeth.
SFOT is often considered for complex orthodontic cases that might otherwise require more invasive orthognathic surgery. By enabling a greater range of tooth movement, SFOT can provide a less extensive alternative for correcting certain bite and alignment problems while reinforcing the bone structure.
The procedure is less commonly performed on younger adolescents. Their bones are still growing and are naturally more malleable, meaning their teeth respond more readily to conventional orthodontic treatment without the need for surgical facilitation.
Comparing Treatment Timelines and Outcomes
One of the most significant differences between SFOT and traditional orthodontics is the treatment duration. A complex orthodontic case treated with braces or clear aligners alone can take 18 to 36 months to complete. In contrast, a treatment plan incorporating SFOT can often be finished in 6 to 9 months.
This reduction is possible because the Regional Acceleratory Phenomenon creates a temporary period of heightened biological activity where teeth can be moved up to 50% faster.
Beyond speed, SFOT can expand the scope of what is achievable with orthodontics. The procedure can facilitate more significant and complex tooth movements than might be possible with traditional methods. In cases where the jawbone is narrow, bone augmentation creates a more robust foundation for arch expansions that might otherwise be considered unstable.
The final results are also impacted, particularly regarding long-term stability. The bone grafting component increases the volume of the alveolar bone that supports the teeth. This added bone mass provides enhanced support for the teeth in their final corrected positions, which may reduce the risk of relapse.
Patients must weigh these benefits against the associated considerations. The treatment involves an additional surgical procedure, which has its own recovery period and costs that are separate from the orthodontic fees.