Alveolar corticotomy: Are we looking at it in the right way?

Alveolar corticotomy (AC) is advocated to accelerate orthodontic tooth movement and reduce treatment time. It has been clearly demonstrated in both clinical patients and experimental animals that after a surgical insult to the alveolar bone a regional acceleratory phenomenon (RAP) reaction and a temporary increase of the speed of tooth movement follow. Reduction of treatment time is still a discussed topic: it is still unclear in which clinical situations AC is more effective, the extent of treatment reduction, and how it influences the quality of end result and patient’s satisfaction. So far, integration of AC in an orthodontic treatment with the simple intention of reducing the length of the treatment of just few months seems not to justify the risk and the cost. Differently, AC may be associated to orthodontic treatments to reduce tooth resistance to orthodontic forces and simplify complex biomechanical situations. In this paper, a distinct perspective of the biological, biomechanical, and therapeutic advantages of this surgical periodontal procedure is described. Six rules, based on current clinical and experimental research, to be effective, efficient, and patient-friendly are advised.