Am I a Candidate for Accelerated Orthodontics? (Wilckodontics/PAOO)

If you're an adult looking at orthodontic treatment and the phrase "eighteen to thirty months" makes you want to close the browser tab, I understand. The timeline is the single biggest reason adults either delay straightening their teeth or never start. And it's the reason I became a certified Wilckodontics provider back in 2016—because the technique genuinely delivers what it promises: orthodontic results in roughly one-third to one-half the conventional time, with stronger bone around the teeth when it's done.

But accelerated orthodontics is not for everyone. The procedure involves periodontal surgery, bone grafting, and close coordination with an orthodontist, which means the candidacy bar is higher than for braces or aligners alone. In this article I'll walk through who benefits most, what disqualifies you, and exactly what the evaluation looks like in my office so you can figure out whether this is a realistic option before you commit to a consultation.

What Wilckodontics Actually Is—A Quick Overview

Wilckodontics, formally called Periodontally Accelerated Osteogenic Orthodontics (PAOO), combines conventional orthodontic treatment with a minor periodontal surgical procedure. I perform small, precise modifications to the bone surrounding the teeth—a technique called selective alveolar decortication—and place bone graft material over those areas. This triggers a temporary regional acceleratory phenomenon (RAP) in the bone, essentially a controlled healing response that temporarily softens the surrounding bone and allows teeth to move through it much faster than they normally would.

The orthodontist then takes advantage of this biological window, adjusting braces or aligners on a compressed schedule. Treatment that would take two years can often be completed in six to nine months. And because bone graft material is added during the procedure, patients frequently end up with thicker bone around their teeth than they started with—a benefit that conventional orthodontics simply cannot offer. For a detailed comparison of how this differs from other acceleration methods, see our article on Wilckodontics versus Propel accelerated orthodontics.

The Ideal Candidates

After performing this procedure for a decade, I've seen clear patterns in who benefits the most. The best candidates share some combination of these characteristics:

What Disqualifies You

Not every adult who wants faster orthodontics is a candidate for the procedure. These are the factors that rule it out or require treatment first:

Active Periodontal Disease

This is the most common disqualifier I see. Wilckodontics involves surgically modifying bone and grafting around the teeth—performing that in a mouth with active gum disease would be introducing a surgical procedure into tissue that is already infected and inflamed. The results would be unpredictable at best and harmful at worst. If you have periodontal disease, it must be treated and stabilized first. In many cases, once the gums are healthy and stable, we can revisit accelerated orthodontics as an option.

Severe Bone Loss

Some bone loss can actually be improved by the grafting component of Wilckodontics—that's one of its advantages. But there's a threshold. If the bone loss around your teeth is so advanced that the teeth themselves have questionable long-term prognosis, accelerating their movement through compromised bone is not appropriate. We need enough healthy bone architecture to work with. This is determined precisely with a 3D CBCT scan during your evaluation.

Certain Medical Conditions

Because the technique relies on a healthy bone healing response, conditions or medications that impair bone metabolism can be disqualifying. These include long-term use of bisphosphonate medications (often prescribed for osteoporosis), uncontrolled diabetes, certain autoimmune conditions, active radiation therapy to the head and neck region, and heavy smoking. Some of these are absolute contraindications; others are relative, meaning we evaluate them case by case.

Very Mild Misalignment

If your teeth need only minor cosmetic adjustments—a slight rotation, a small gap—then clear aligners alone can typically handle the correction in a few months without any surgical component. The PAOO procedure is a real surgery with a real recovery, and it's not justified when the problem can be solved with a less involved approach. Part of an honest evaluation is telling you when you don't need the bigger procedure.

The Evaluation Process: What to Expect

The consultation for accelerated orthodontics in my practice is more thorough than a standard orthodontic evaluation, because we're assessing both your orthodontic needs and your periodontal and surgical readiness simultaneously. Here's what it involves:

Step 1: Comprehensive Periodontal Examination

Before we discuss tooth movement, I need to know the condition of the foundation. This means a full periodontal probing of every tooth, assessing gum tissue health, measuring attachment levels, and checking for any active infection or inflammation. If periodontal disease is present, we address it first—there are no shortcuts here.

Step 2: 3D CBCT Imaging

A cone-beam CT scan gives us a three-dimensional view of your bone, roots, and surrounding anatomy. I use this to measure bone thickness around each tooth, identify any areas of existing bone loss, check root length and morphology, and map the surgical plan. This scan is essential—two-dimensional X-rays don't show bone thickness, which is the single most important measurement for this procedure.

Step 3: Orthodontic Records and Treatment Planning

Working with your orthodontist—or with the orthodontic team in our practice—we establish the specific tooth movements needed, the sequence, and the realistic timeline with acceleration. This is a collaborative plan: the orthodontist designs the tooth movement, and I design the surgical and grafting approach to support it.

Step 4: Medical History Review

We review your full medical history, current medications, and any conditions that might affect bone healing. If there's a question about a specific medication or condition, I'll coordinate with your physician before proceeding.

Step 5: Honest Conversation About Expectations

I show you the scan on screen, walk you through the surgical plan, explain exactly what recovery involves, and give you a realistic timeline. If I think conventional orthodontics would serve you just as well, I'll say so. If I think another approach—like aligners alone for a mild case—makes more sense, I'll tell you that too. The goal is the right treatment, not the most treatment.

What Happens After You're Approved

Once we've confirmed you're a candidate, the typical sequence looks like this: your orthodontist places braces or begins aligner treatment. After a short initial alignment phase—usually a few weeks—I perform the PAOO surgery. The procedure takes about one to two hours under local anesthesia with sedation available, and most patients return to work within two to four days. From that point, the orthodontist adjusts your braces on a compressed schedule, often every two weeks instead of every four to six weeks, to take full advantage of the accelerated bone response.

The total treatment time from start to finish is typically six to nine months for cases that would otherwise take eighteen to twenty-four months. The exact timeline depends on the complexity of your case and how your biology responds.

The Bottom Line

Accelerated orthodontics with Wilckodontics is a powerful option for the right patient—typically an adult who needs meaningful tooth movement, has healthy or stabilized periodontal conditions, has adequate bone to work with, and is motivated by a timeline significantly shorter than conventional orthodontics allows. It is not a shortcut for everyone, and the evaluation is appropriately thorough because the procedure involves real surgery and real biology.

If you're considering it, the first step is finding out whether you qualify. That starts with a periodontal evaluation, a 3D scan, and an honest conversation about what your teeth need and whether acceleration genuinely makes sense for your situation. If it does, the results—straighter teeth in a fraction of the time, with stronger bone to hold them there—speak for themselves.