SFOT (Surgically Facilitated Orthodontic Therapy)

This is an advanced procedure that addresses the underlying problem of tooth size relative to insufficient alveolar bone volume and associated compromised arch forms. To optimally enhance the functional outcome of your treatment. A major advantage of this procedure is the benefit it provides to the periodontal support of your teeth and the long term stability and retention of your orthodontic alignment in a decreased amount of treatment time.

This involves doing orthodontics with either clear aligner therapy or traditional braces in conjunction with minor oral surgery procedures to allow for softening of the bone, augmentation of the bony housing and improving the soft tissue covering.

In the past these issues were frequently ignored with long term outcomes resulting and recurrent crowding, gingival recession and even tooth loss. This modality also can have a significant positive effect on airway obstruction, breathing and sleep apnea.

Dr. Rimer is recognized as one of the few Oral and Maxillofacial with an expertise in SFOT.

Dentistry now understands that due to the hetrogenious mix in Human populations a significant discrepancy in tooth size and jaw size of both parents often results in a child with the underlying problem of insufficient alveolar bone volume to accommodate a certain size of teeth. This can result in crowding and or a malocclusion. This might be expressed early on or later in life as areas of gum recession, root exposure or tooth malposition. As a result of this mismatch between jawbone size and tooth size. In the past these issues were frequently ignored, resulting in lifelong consequences, camouflaged through extraction orthodontic and compensated restorations or with Jaw surgical procedures that might not have been necessary. 

Crowding of teeth with insufficient bone volume has traditionally been treated by removal of permanent teeth. This has resulted often in constricted arch forms that negatively affect function, airway and esthetics.

Many complex interdisciplinary problems and malocclusions involve alveolar bone discrepancies in the dentoalveolar complex and/or the relationship of the dentoalveolar complex on the skeletal base. These issues can complicate therapy, prolong treatment time, and lead to disappointing results. The greatest limitation to orthodontically resolving these problems is the cortical plate of the alveolar bone. After teeth erupt, the cortical plates establish the boundaries for orthodontic development of the dental arches. Some refer to the cortical plates buccal and lingual to the apices of the teeth as “orthodontic walls”. Encroaching on these walls during traditional orthodontic tooth movement not only can lead to unstable results, but also iatrogenic tissue loss of the involved teeth, bone, and periodontium.


SFOT addresses all of the above issues and has additional benefits:

  • Engineers new tissue to provide a more robust and expanded arch form for the teeth to reside instead of resorting to extractions of teeth to fit the existing compromised arch
  • Enables ideal tooth position for optimal occlusion
  • Enables ideal tooth position for optimal restorative dentistry (virtually planned)
  • Implant site development/planning through augmentation and tooth movement
  • Enhances esthetics through optimizing dental relationships and arch forms
  • Maximizes orthodontic possibilities
  • Minimizes the number of surgeries by combining:
  • Grafting of hard and soft tissue
  • Addressing altered eruption as performed in esthetic crown lengthening
  • Placing orthodontic anchorage
  • Correcting osseous defects
  • Removing tori and exostoses
  • May avoid extracting deciduous and permanent teeth
  • Extracting deciduous and permanent teeth
  • Reduces orthodontic treatment time
  • Establishes proper bone structure
  • Lowers incidences of relapse and crowding
  • Decreases likelihood of root breakdown
  • Reduces retards or eliminates gingival recession
  • Converts thin periodontal phenotypes to thick, reduces the incidence of bone loss influenced from tooth movement
  • Can be used with aligners as well as braces


Surgically facilitated orthodontic therapy addresses the real, underlying problem of insufficient alveolar bone and expands the traditional “orthodontic walls.” It can reduce the need for extraction therapy, enable more ideal function and esthetics, enlarge arch form, decrease morbidity, increase predictability, enhance long-term stability, and significantly shorten treatment times. These SFOT advantages combined you’re your orthodontic therapy and optimal interdisciplinary care provide for long term support, oral health and the optimal outcome.

Many adults in the past have declined orthodontic therapy due to the length of treatment, embarrassment and time commitment. As a ‘Bonus’

SFOT orthodontic cases typically are completed 3-4 times faster than conventional orthodontics. This due to the fact that these procedures soften the bone which accelerates the process of tooth movement.

Using these novel surgical techniques which our practice is recognized as a worldwide leader in SFOT may be used to prevent tooth extractions, periodontal defects the long term risk of gum recession and significantly change your oral airway.

These procedures will not only benefit adult patients but are also being applied with teenagers undergoing orthodontic therapy to prevent these now better understood anatomical issues.