Skeletal Maxillary Bilateral Posterior Crossbite Correction with Decortication and Bone Autograft Augmentation

Background: Intentional injury to the periodontium by either corticotomy, piezocision or microosteoperforations triggers increased alveolar bone remodelling due to the regional acceleratory phenomena leading to accelerated tooth movement. Periodontal augmentation with bone graft provides structural integrity to the periodontium minimising occurrence of tell-tale relapse. Selective decortication and bone autograft augmentation were the procedures advocated for the accelerated correction of the skeletal maxillary bilateral posterior crossbite and open bite malocclusion in the case reported.

A -18 - year-old female patient presented with a mild skeletal Class III malocclusion with increased bimaxillary dento-alveolar protrusion, anterior open bite, forward tongue posture and imbricated and rotated mandibular incisors with maxillary bilateral posterior crossbite. A nonextraction treatment plan was recommended.

Method: A week subsequent to strapping of pre-adjusted edgewise appliance, MBT prescription (0.022 x 0.028-inch slot) and Hyrax device, full thickness mucoperiosteal flaps were reflected in the maxillary buccal regions. Decortication was done with surgical perforations and augmented with bone autograft taken from the symphyseal region of the patient. Two weeks later activation of the Hyrax device was done twice daily with the other orthodontic adjustments performed fortnightly untill completion of treatment.

Results: Rapid correction of the skeletal maxillary bilateral posterior crossbite was achieved in 2.5 months and the complete malocclusion was treated in 7 months.

Conclusion: The accelerated correction of the malocclusion could be attributed to the regional acceleratory phenomenon triggered by the intentional surgical insult effected by the decortication procedure and the stable result thus observed was attributed to the periodontal augmentation by the bone autograft.