With an increasing number of adult patients coming to the orthodontic clinic, the orthodontic professional is constantly looking for ways to accelerate tooth movement. Surgical intervention to affect the alveolar housing and tooth movement has been described in various forms for over a hundred years. However, it is the spirit of interdisciplinary collaboration in orthodontics has expanded the realm of traditional orthodontic tooth movement protocols. Periodontal accelerated osteogenic orthodontics (PAOO) is a clinical procedure that combines selective alveolar corticotomy, particulate bone grafting, and the application of orthodontic forces. This procedure is theoretically based on the bone healing pattern known as the regional acceleratory phenomenon (RAP). PAOO results in an increase in alveolar bone width, shorter treatment time, increased post treatment stability, and decreased amount of apical root resorption. Tooth movement can be enhanced and cases completed with increased alveolar volume providing for a more intact periodontium, decreased need for extractions, degree of facial remodeling and increased bone support for teeth and overlying soft tissues, thereby augmenting gingival and facial esthetics.The purpose of this article is to describe the history, biology, clinical surgical procedures, indications, contraindications and possible complications of the PAOO procedure.