Treatment of Class III malocclusion using platelet-rich fibrin in periodontally accelerated osteogenic orthodontics – An ortho–perio interdisciplinary approach

The treatment of borderline Class III cases is always a challenge as surgery or orthodontic camouflage. In the present-day, scenario as the number of adult patients presenting with severe malocclusion has outcomes. Platelet-rich fibrin (PRF), a second-generation platelet concentrate, has the potential to accelerate the healing process due to release of significant amount of growth factors. Periodontally accelerated osteogenic orthodontics (PAOO), a surgically assisted orthodontic procedure, which combines the use of corticotomy along with bone grafts, has been used to hasten the clinical results. This case report aimed to demonstrate the efficacy of PRF on soft-tissue outcomes when used as an adjunct to a variation of PAOO technique and assess the time duration to achieve complete space closure in a Class III malocclusion treated with orthodontic camouflage. Case 1: a 22-year-old male patient presented himself to the Outpatient Department of Government Dental Hospital, India, with a chief complaint of protruded lower anterior teeth. The patient had been diagnosed with Class III division malocclusion with Class III molar relation and reverse overjet of 3 mm. The patient was started on fixed mechanotherapy and was referred to the Department of Periodontology for PAOO procedure after 6 months of orthodontic treatment after leveling and alignment. Therapeutic extraction of lower first premolars was performed to facilitate lower anterior retraction along with PAOO procedure with PRF as a membrane, and the clinical outcomes were assessed at the end of 6 months. Case 2: A 19-year-old male patient sought orthodontic treatment with the complaint of crowding in the upper arch, a blocked-out canine 13, and dissatisfied with his smile. The patient was started on fixed mechanotherapy and was referred to the Department of Periodontology for PAOO procedure after 6 months of orthodontic treatment after leveling and alignment. Therapeutic extraction of upper second premolars was carried out to correct the crowding in the upper arch, and therapeutic extraction of lower first premolars was performed to facilitate lower anterior retraction along with PAOO procedure with PRF as a membrane. A combination of PAOO with PRF has shown beneficial therapeutic outcomes, better patient acceptance, and enhanced soft-tissue healing. Clinical significance: PAOO when combined with PRF not only improves postoperative healing but also expedites retraction of teeth and space closure. Increase in the gingival thickness is an added benefit of using PRF. The modality is a viable option to treat mild Class III malocclusion and gives the desired results within a shorter time frame.