PAOO: Speedy Orthodontics
PAOO (Periodontally Accelerated Osteogenic Orthodontics) – Patient Story
AVOIDING EXTRATIONS IN ADULTS FOR TOOTH ALIGNMENT AND LEVELLING
Chief concerns: improving the aesthetic apperance of her smile:
Severe upper and lower crowding was a concern for Ms L. Main concern was: crowding severe maxillary/mandibular crowding. In the past, this patient was advised extraction of all four premolar teeth (this was not an option for the patient preferring different less invasive approach.
Our Aim: to improve the aesthetics: arch shape, teeth alignment and levelling. Provide optimal lip and facial support using minimal intervention.
We agreed to consider the best option: maxillary (upper jaw) arch expansion in combination with PAOO, TAD to create adequate space to level and align the teeth in both arches.
Therefore, I would like to set out the treatment I feel appropriate in this case.
Unacceptable tooth colour & wear: creating an aesthetic disturbance.
We agreed to consider the best option: maxillary (upper jaw) arch expansion in combination with PAOO, TAD to create adequate space to level and align the teeth in both arches.
Therefore, I would like to set out the treatment I feel appropriate in this case.
This study will show;
- Complexity of treatment.
- Hence special intervention is required as precise outcome is critical in this complex smile outline
- Treatment outcome
- Patient’s assessment
Crowded lower arch with spacing & wear. Note the blocked out upper left lateral incisor and lower right lateral incisor. The uneven gum levels and discrepancy between the dental and facial midline is quite obvious.
Diagnosis: Unacceptable tooth position and arch form: creating an aesthetic disturbance Diagnosis & Patient centred treatment planning Once we have determined their needs and expectations and when the patient is ready, we begin to restore their teeth to optimal function and aesthetics Summary of treatment plan Clinical examinations, x-rays, photos and study models confirmed the following: Cephalometric Facial analysis has confirmed the following:
- Skeletal class II base, dental molarI and anterior Div-1.
- Narrow upper arch with Crossbite 22/33.
- Bilateral cross bite and severe lower arch crowding.
- Profile straight/convex
- Symmetrical face, with slight chin deviation to the right. The upper jaw rotated to the left with midline shift 4mm.Due to high smile line and dental/facial midline discrepancy (to the left) this asymmetry is obvious.
- Optimal lip outline and thickness
- Dental and skeletal midlines: considerable discrepancy due to missing 4mm dental midline to the facial midline (left)
- Frontally it is evident that maxillomandibular complex is rotated within the facial frame. The ideal treatment is orthodontic and orthognathic surgical correction. However, since Ms L has multiple orthodontic consultations in the past, and time factors, therefore prolonged surgical-orthodontic treatment at this stage in her life is not an option. Hence the reason for choosing the treatment mainly related to upper arch to compensation the dental-skeletal correction.
- Periodontal health is mandatory and needs to be under control with good home care.
- We need space 8-10mm per arch, therefore some interproximal reduction would be required as discussed.
- We need TAD (temporary anchorage –mini implants) to distalise 43, 33, 13, 23
- PAOO to free up the system
- Initially developed the arches and retraction of 33, 43,
- Improve buccal corridor and correct anterior cross bite
Levelling and alignment with an orthodontic treatment. The primary aim is to correct the dental/facial midline, create space using small interproximal refinementsr canines for retracting canines and anterior crossbite 22/33 using TADs ( temporary anchorage device-miniimplant to be removed once the orthodontic treatment is completed).
The treatment will involve placement of clear orthodontic brackets, followed by forthnightly adjustment.
To “speed up the orthodontic treatment, the procedure is PAOO: Periodontally Accelerated Osteogenic Orthodontics is advised, which involved selective incisions on the bone between the teeth being moved orthodontically (selective alveolar decortications).
This concept is well tested. It improves the speed and result of orthodontic levelling and alignment.
Treatment time less than one year but usually in severe crowding we need up to 18 months.
When orthodontic treatment is complete we place permanent retention wire on the palatal aspect of upper front teeth as well as back of the lower front teeth, since we have better control with fixed compared to wearing removable retainers. Latest research suggests that retention should be as long as possible.
Should establish harmony and balance between dentition and surrounding soft tissues Final treatment outcome and we have a happy patient Final treatment outcome: we have restored aesthetics comfort & function However most importantly we have complemented our lovely patient’s facial aesthetics. Hence the term: dentofacial rejuvenation by Dr Sarkis Nalbandian Final treatment outcome and we have a confident and happy patient.
What our Clients Say!
I've been a customer of Designer Smiles for over 20 years and I cannot say enough good things about them! From the moment you walk into the office, you are greeted with a warm and friendly atmosphere that immediately puts you at ease. The staff is knowledgeable, professional, and caring. They use the latest technology and take the time to explain everything. I highly recommend them!
Dr Sarkis is the maestro of cosmetic dentistry….for years I suffered with 2 slightly darker front teeth due to a childhood accident. I’ve had composite veneers before but nothing compared to the composite veneers Dr Sarkis did……now I feel so confident smiling again……Dr Sarkis I can’t thank you enough…
Quite literally the best dentist I’ve been to in a lifetime. Dr Natasha Koelmeyer specifically is just a wonderfully kind and gentle Doctor. Must also mention that the head specialist here is also second to none. Their knowledge (goodness they know their stuff) their approach, their kind and gentle manner - my daughter actually enjoys going to the dentist. They’ve got a really considered patient centric mentality. I wouldn’t go anywhere else, every single person there including the reception staff is a star. Thank you Designer Smiles!
My journey with Dr Sarkis began about 10 years ago. I did not realise that I had lacked self confidence and shone away from "my true smile". Dr Sarkis was honest, reassuring and professional throughout my process and not only was he able to achieve that perfect smile but achieve same without compromising the health of my teeth and gums.The ongoing care at Designer Smiles is 5 star whether it is a routine check, clean minor or major dentistry. Thank you Dr Sarkis and also your team.
I found Designer Smiles from one of their YouTube videos showcasing the Icon treatment to fix white spots on teeth. Dr. Sarkis Nalbandian's consultation provided me with a thorough plan and showed me how their practise could give me predicable results for my concerns. I knew I was in safe hands. I had Kristy Gupta perform both of my procedures and she was very professional and so kind. I am very happy with my results!
I cannot express how grateful I am for Sarkis and the team at Designer Smiles. Around 11 years ago my life changed when Sarkis first transformed my smile with composite veneers. This month, with my original teeth in tact I returned to have my composite veneers upgraded to porcelain. I was amazed that Sarkis and his team could do this without an injections, no pain and whilst still keeping my original teeth in tact. I absolutely love the result and I would highly recommend that anyone that is unhappy with their smile in any way, must visit designer smiles
Started my treatment with the team at Designer Smiles in 2019. Had other dental treatments including Maxillofacial, expanders, straightening and gum grafting but out of all the procedures and surgeries Dr. Sarkis was the key as he was applying the ‘finishing product’ which included composite veneers. I am gobsmacked by the incredible job done. He talks the talk and definitely walks the walk. And his support team there are simply incredible and make you feel part of a family not just another dental clinic to take your money. Can not recommend highly enough. Customer for life here!!
Get In Touch
Mon to Fri: 8.00AM-5.00PM
Sat-Sun: Closed