Corticotomy and Tissue Engineering for Orthodontists: A Critical History and Commentary

Twenty-first century discoveries in cellular and molecular biology have explained how clinicians in medicine and dentistry can engineer tissue regeneration in a way that makes room for orthodontists. This presumes that they define themselves as dentoalveolar orthopedists and restrict corticotomy procedures to “selective alveolar decortication,” with or without grafting. With a new vision (orthodontic tooth movement, through a healing wound), orthodontists can modulate physiological internal strains—similar to those of distraction osteogenesis in long bones—to define novel and more stable alveolus phenotypes, reducing the need for bicuspid extractions and minimizing orthognathic surgery morbidity. The aim of this treatise, using critical rationalism and analytical commentary, is to chronicle the historical techniques, which have evolved into orthodontic tissue engineering and stem cell therapy, and, first, synthesize redoubtable 21st century biology into a protocol that is compatible with any style of traditional biomechanics. This context of dialectical history abandons vestiges of 19th century eugenics, such as, “strong chin,” “weak chin,” and extends reductionist thought from gross anatomical orientations to tissue- and cell-level biology for a new generation of orthodontists. Thus, proffering a postmodern “NewThink” as a categorical imperative for our time, this proposal seeks to provide both an intellectual guide and practical justification for dentoalveolar orthopedics in clinical practice.