Modern science is making disruptive advancements in medicine and dentistry. Medical breakthroughs such as gene therapy in the treatment of different forms of cancer directly address the underlying problems (i.e., mutated genes) versus compromising results by treating the symptoms or overtreating other issues and masking the disease. In dentistry, Surgically Facilitated Orthodontic Therapy (SFOT) is an advanced procedure that pinpoints the underlying problems of insufficient alveolar bone and compromised arch forms to optimally enhance functional and esthetic concerns. In the past, these issues were frequently ignored, inappropriately treated to lifelong iatrogenic consequences, camouflaged through extraction orthodontics and compensated restorations, or overtreated through orthognathic surgery when it wasn’t a true skeletal problem.
Nearly two-thirds of the US population have malocclusions of unknown etiology; however, insufficient alveolar bone is a common finding. Malocclusions with insufficient alveolar bone have traditionally been treated orthodontically by removal of permanent teeth. This doesn’t address the constricted arch form that can negatively affect function, esthetics, and the critically important airway.
Many complex interdisciplinary problems and malocclusions involve alveolar bone discrepancies in the dentoalveolar complex and/or the relationship of the dentoalveolar complex on the skeletal base. These issues can complicate therapy, prolong treatment time, and lead to disappointing results. The greatest limitation to orthodontically resolving these problems is the cortical plate of the alveolar bone. After teeth erupt, the cortical plates establish the boundaries for orthodontic development of the dental arches (6). Some refer to the cortical plates buccal and lingual to the apices of the teeth as “orthodontic walls”. Encroaching on these walls during traditional orthodontic tooth movement not only can lead to unstable results, but also iatrogenic tissue loss of the involved teeth, bone, and periodontium.
Surgically facilitated orthodontic therapy addresses the real, underlying problem of insufficient alveolar bone and expands the traditional “orthodontic walls.” It can reduce the need for extraction therapy, enable more ideal function and esthetics, enlarge arch form, decrease morbidity, increase predictability, enhance long-term stability, and significantly shorten treatment times. These SFOT advantages combined with clear aligner therapy creates a highly acceptable, cost-effective patient option for optimal interdisciplinary care.