Surgery vs Non-surgery

Creative Non-Surgical Bone Augmentation in the Treatment of Ankylosis and Deep Impaction

Kee-Joon Lee

Dr. Kee-Joon Lee is a professor of the Department of Orthodontics, Yonsei University College of Dentistry, Seoul, Korea. He received DDS and PhD degree from Graduate school, College of Dentistry, Yonsei University. He completed the orthodontics specialty training in Yonsei University. He was a visiting scholar at the Department of Biochemistry, University of Pennsylvania School of Dental Medicine in 2002-2004 and at the Division of Plastic Surgery, the Children's Hospital of Philadelphia in 2010-2011. He was an adjunct professor at the Department of Orthodontics, University of Pennsylvania between 2016 and 2019. He has contributed many book chapters on biomechanics of miniscrew-driven orthodontics, non-extraction treatment in adults, up-to-date lingual orthodontic mechanics and surgery-first approached using TADs. He is the first who demonstrated the miniscrew-assisted rapid palatal expander (MARPE) for adults in AJO-DO, which was cited by many other authors. He has published many articles and case reports regarding the treatment of non-eruption, and total arch movement for hyperdivergent face in orthodontic journals including two cover issues in AJO-DO. His fields in research include clinical biomechanics regarding TADs application and the suture and bone responses to orthodontic stimulus. He has served as a reviewer in major orthodontic journals, including AJO-DO, Angle Orthodontists and European Journal of Orthodontics. He has been invited to many international orthodontic conferences around the world.
E-mail: orthojn@yuhs.ac

Lecture Description

Conventional biomechanical principles mainly focused on how to move tooth/teeth that are already erupted, which normally requires two-dimensional tooth movement in each spatial plane. In contrast, pathologic conditions during the formation and development of dentition such as impaction and/or non-eruption may lead to various three-dimensional tooth and alveolar bone relationships due to the undesired migration of adjacent teeth, when left untreated. Surgical exposure and orthodontic forced eruption has been a routine practice for impacted tooth. However, the forced eruption of impacted tooth may demand biological consideration, because the eruption of a tooth, unlike the regular tooth movement, is under stage-specific regulation. Hence a strategic and individualized treatment planning is crucial, starting from the differential diagnosis of ankyloses. Using the bone-borne miniscrews, one may try therapeutic diagnosis whether it is indeed ankylosed. Then the 'best' treatment plan may be found based on 'game theory' considering the individual conditions. This presentation is aimed to propose and summarize essential factors for the predictable treatment of ankylosed and/or impacted tooth with clinical significance, with attention to the (1) biologic factors - depth, angulation, root maturity and age (2) biomechanical factors - three-dimensional localization and application of TADs according to the force-driven approach. The orthodontic treatment overall should be considered a process which facilitate the underlying osteogenic potential of the peri-dental tissue and thereby restore the undesirable alveolar structure during and after the formation of dentition.