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Figure 1
Case 1: (A) A 43-year-old male patient with skeletal Class II relationship, hyperdivergent long-face pattern, retrognathic chin, and lip protrusion. Missing right and left mandibular first molars with an atrophic ridge. (B) Bilateral zygomatic mini-screws were inserted for anterior retraction and posterior intrusion. Space closure of the right mandibular first molar area, and uprighting of the right mandibular second and third molars after PAOO. (C) Patient after 3 years of treatment. (D) Patient 1 year 11 months after debonding.
Figure 2
In Case 1, PAOO was performed 1 year after the start of orthodontic treatment. (A) Intraoperative photos. The surgical cuts created vertical grooves and a circular corticotomy was performed with high speed piezoelectric tools to join the vertical cuts. Selective medullary penetration was performed to enhance bleeding. Later, freeze-dried bone allografts were placed in the areas that had undergone corticotomy to increase alveolar bone thickness. (B) After the PAOO. (C) One year and 10 months after PAOO.
Figure 3
Post-treatment CBCT: (A) In Case 1, the mandibular right second premolar had minor buccal dehiscences. However, the mandibular right second molar had no areas of bone dehiscence/fenestration. (B) In Case 2, the mandibular left second premolar had no areas of bone dehiscence/fenestration and had favourable alveolar continuity over the mandibular left protracted molars in the axial direction. However, thin bone covering of the buccal surface was noted in the coronal section and small root resorption lacunae were observed in the mesial aspect of the root surface in the molar sagittal view.
Figure 4
Case 2: (A) 37-year-old female patient with a skeletal Class III relationship, hypodivergent face pattern, anterior crossbite, and insufficient tooth display. Missing bilateral mandibular first molars with an atrophic ridge. (B) Space closure of the mandibular first molar areas, and bilateral uprighting of the mandibular second and third molars after GBR with an autogenous bone block (C) Patient after 28 months of treatment. (D) One year follow up records showed stable results without space re-opening.
Figure 5
Case 2: (A) The image shows the bone block temporarily fixed with tenting screws for stabilisation (Image shown here was from a similar intra-operative view to our patient's surgical procedure, courtesy of Dr. Chou). (B–E) Sequential panoramic radiographs of the lower left molars after GBR surgery.
Pre-treatment and post-treatment cephalometric measurements.
