PeriOrtho-dontics: Together We Succeed!

Innovative Publication, 2017

Harmonious cooperation of the general dentist, the periodontist and the orthodontist offers great possibilities for the treatment of combined orthodontic–periodontal problems. Orthodontic treatment along with patient's compliance and absence of periodontal inflammation can provide satisfactory results without causing irreversible damage to periodontal tissues. Orthodontic treatment carries with it the risks of tissue damage, treatment failure and an increased predisposition to dental disorders. The dentist must be aware of these risks in order to help the patient make a fully informed choice whether to proceed with orthodontic treatment. The aim of this study is to discuss the principles of orthodontic treatment in patients with reduced periodontium, its indications and limitations, as well as current views concerning retention of orthodontic result.

IOSR Journals , 2019

With a number of patients opting for orthodontic therapy for esthetic reasons, it becomes necessary to evaluate the resulting effects of orthodontic treatment on the periodontal tissues. In many cases, orthodontic tooth movement improves the periodontal conditions, and also, periodontal therapy often facilitates orthodontic tooth movement. The orthodontic treatment for the patients need to be carefully planned and carried out in order to prevent unwanted effects on the periodontium. So it is of great importance to determine the need and consequences of interdisciplinary periodontal-orthodontic approach in order maintain harmonious periodontal and orthodontic relation and bring out the best results for the patient. Thus, the aim of this review is to discuss in detail the effects of various orthodontic forces on the periodontal tissues.

2019

The interrelation between orthodontics and periodontics is evident. In daily practice is common to meet patients with periodontal disease associated with dental malpositions. In addition, it is also common to observe dental migrations secondary to periodontal disease. In this context, the dentist may have to question the possibility and the necessity of orthodontic treatment. The question is if orthodontic treatment improves the existing periodontal situation and if is possible to perform orthodontic treatment on a reduced periodontium without causing other complications. This review highlights three most important periodontal complications of the orthodontic treatment and it assesses the necessity of the periodical periodontal controls and treatments before, during and after the orthodontic treatment.

'fhe aim of this review is to provide the general dental practitioner with an understanding of the relationship between periodontal health and orthodontic therap,v. Specific areas reviewed, are how periodon-. tal tissue reacts to orthodontic forces, intluence of tooth lnovement on the periodontiunt, effect of orlhodontic bands on the periodontium, and time relationship between orthodontic treatment and periodontal therapy. In addition! some focus rvill give on the relationship between orthodontics and irnplant restorations (e.g., using dental implants as orthodontic anchorage).

2018

The number of adults with malocclusions and periodontal disease seeking orthodontic treatment is increasing. Therefore, it is important to examine benefits and risks of such treatment. Periodontal disease is a complex chronic inflammatory disease, affecting toothsupporting (periodontal) tissues, which results from imbalance between oral biofilm and the host's response. The result of the persisting inflammation and disease progression is the destruction of the periodontal tissues and loss of alveolar bone. Due to reduced periodontal attachment, teeth become mobile and migrate in the dental arch, resulting in malocclusions and further aggravation of the disease. If not treated, periodontal disease may finally result in loss of multiple teeth. Impaired function and poor dental aesthetics due to the disease lead to poor quality of life in terms of physical as well as psychosocial well-being, and are the primary reasons for seeking treatment. Treatment of periodontal disease is complex and often includes multidisciplinary teamwork. Aims: The overall aim of this thesis was to explore the effects, risks and benefits of periodontal-orthodontic treatment on periodontal tissues in subjects with periodontal disease. Methods: A systematic literature review was conducted which aimed to provide scientific evidence on the effects of orthodontic treatment on periodontal tissues in subjects with periodontal disease (Study 1). The clinical part of the thesis was designed as a randomised clinical trial, which aimed to compare two periodontal treatment timing strategies regarding the effect of orthodontic treatment on periodontal status (Study 2). Fifty subjects with periodontal disease were randomly assigned either to the test (periodontal treatment simultaneous to orthodontic treatment) or control group (periodontal treatment before the start of orthodontic treatment). Initial treatment included oral hygiene instruction, supra-and sub-gingival debridement and was performed for all study patients. Nonsurgical and subsequent surgical periodontal treatment was performed at different time points for the test and control groups. Orthodontic treatment was performed with a straight-wire appliance. Intrusion and retroclination together with space closure were used for flared cases and were the most used orthodontic movements for maxillary and/or mandibular anterior teeth. Micro-screws or implants were used for anchorage in the posterior segments where needed. Clinical attachment level (CAL) change was chosen as a primary outcome variable. All patients were examined by cone beam computed tomography (CBCT) before and after orthodontic treatment to explore the extent of external apical root resorption (EARR) (Study 3) and changes in alveolar bone levels (ABL) (Study 4). EARR and change in ABL of the most proclined maxillary incisor were also studied and related to the orthodontic movements such as intrusion and change in inclination angle. Results: The findings in the systematic literature review yielded absence of randomized controlled trials or controlled clinical trials on comprehensive orthodontic treatment in patients with periodontal disease. No difference in CAL change, EARR and ABL was found whether orthodontic treatment was performed simultaneously with (test group patients) or after (control group patients) periodontal treatment. 0.19, 0.61). Gain in clinical attachment level was observed in 22 (88%) patients in both treatment groups. CAL remained unchanged in an average of 3/4 of the sites; CAL gain was observed in an average of 1/4 of the sites. Root lengths were shortened in a median of 80.7% (Q1, Q3: 68.0, 90.0) of orthodontically moved teeth with a mean EARR of 1.2 mm (SD 0.44). EARR of <2 mm was observed in 82% of teeth. ABL levels remained unchanged on a mean of 69.3% (SD 8.8) of surfaces, ABL improved on a mean of 15.6% (SD 7.4) of surfaces, more on the mesial and distal, and ABL decreased on a mean of 15.1% (SD 7.5) of surfaces, more on the buccal and lingual. Amount of intrusion as well as amount of retroclination influenced extent of EARR and ABL changes of the most proclined maxillary incisors. Conclusions: Based on the results of the present research it can be concluded that periodontal-orthodontic treatment under optimal conditions (experienced clinicians and patients with excellent oral hygiene routines over time), if needed, could be included in the rehabilitation of patients with periodontal disease without deleterious effects. Orthodontic treatment, performed simultaneously with periodontal treatment, could be used in the routine treatment of patients with periodontal disease. However, there are two important prerequisites: meticulous personal oral hygiene of the patient and optimal sub-gingival control of inflammation before and throughout the combined treatment.

Interdisciplinary approach helps the specialists of contributing disciplines immensely in diagnosis, treatment planning, execution of planned treatment and problem solving for any untoward complication. Orthodontic treatment may be adjunctive to periodontal therapy or vice versa. Periodontal problems might lead to occlusal abnormalities which may require orthodontic correction. Also orthodontic treatment of adult patients is most frequently just one component of a more complex treatment involving several dental disciplines. Various orthodontic treatments also may precipitate some periodontal problems which frequently require periodontal management. This report discusses, through representative cases, potential periodontal problems and their management encountered before, during and after orthodontic treatment.

Orthodontics: Current Principles and Techniques. 6th ed. In: Graber LW, Vanarsdall RL, Vig KWL, Huang GJ, editors. Elsevier., 2017

As we see more adults entering comprehensive orthodontic treatment, we must be more attuned to the implications of periodontal issues. In this updated chapter, Robert Vanarsdall, Ignacio Blasi and Antonino Secchi review periodontal issues that impact orthodontic tooth movement. They describe periodontal "high risk" factors, mucogingival considerations, and problems with ectopic as well as ankylosed teeth. A new section on alveolar decortication and augmentation grafting has been added to address the increased use of these procedures designed to develop the alveolar housing and potentially increase the speed of tooth movement. Excellent clinical examples are pictured throughout the chapter.

Journal of Clinical Periodontology, 2017

Aim: To compare two treatment strategies regarding the effect of orthodontic treatment on periodontal status in patients with plaque-induced periodontitis. Subjects and Methods: This was a randomized clinical trial. Fifty periodontal patients were randomly assigned to the test or control groups according to periodontal treatment timing. All patients received supra-and subgingival debridement following baseline examination. Control group patients received cause-related periodontal treatment before the start of orthodontic treatment and which was performed simultaneous to orthodontic treatment for the test group patients. Results: No difference between the test and control groups was found regarding change of clinical attachment level (CAL) after periodontal-orthodontic treatment. Fewer sites with initial pocket depth (PD) of 4-6 mm healed after periodontal-orthodontic treatment in the test group (20.5%, IQR = 11.9%) in comparison with controls (30.4%, IQR = 27.1%) (p = .03). Anterior teeth [OR 2.5] and teeth in male patients [OR 1.6] had a greater chance for PD improvement ≥2 mm. Total periodontal-orthodontic treatment duration was significantly longer for the control group (p < .01). Conclusions: Both groups showed a gain of CAL and a reduction in sites with PD ≥ 4 mm. Orthodontic treatment, simultaneously to the periodontal treatment, could be used in the routine treatment of patients with plaque-induced periodontitis.

Current Trends in Orthodontics, 2021

The force applied by the orthodontist to facilitate the orderly movement of teeth to their new position may have deleterious effects on the most important structure involved in the procedure—the periodontium. This chapter endeavors to provide an overview of the biological processes that play a role in achieving the patient’s as well as the orthodontist’s objective.

Periodontology 2000, 1995