Surgical Considerations and Decision Making in Surgically Facilitated Orthodontic Treatment/Periodontally Accelerated Osteogenic Orthodontics

Sequential soft- and hard-tissue augmentation after clear aligner-mediated adjustment of traumatic occlusion: A case report

BACKGROUND

Oral health and esthetic concerns have increasingly motivated adults with periodontitis to seek orthodontic care. Patients with periodontitis often have other dental complications that can make treatment more challenging or less likely to be successful. The predictability of multidisciplinary regenerative and orthodontic treatment approaches in a patient with periodontitis, thin periodontal phenotype, and anterior crossbite is described.

CASE DESCRIPTION

A 35-year-old man was designated as having a high risk of experiencing soft-tissue recession owing to his thin periodontal phenotype. After the initial periodontal therapy, clear aligners were used to eliminate the anterior crossbite that was causing traumatic occlusion. In addition, a subepithelial connective tissue graft was used to alter the thin periodontal phenotype. Three months later, guided bone regeneration with corticotomy was performed to increase bone mass, and orthodontic traction was used at 2 weeks after surgery. Orthodontic treatment was continued until all the spaces had been closed. Clinical and radiographic evaluations conducted at the 6-month follow-up revealed substantial improvements in both the soft- and hard-tissue phenotypes.

PRACTICAL IMPLICATIONS

Outcomes in this case indicate that sequential soft- and hard-tissue augmentation, after eliminating traumatic occlusion via using a clear aligner, may be a valuable approach for improving soft- and hard-tissue support in patients with periodontitis.

Endodontic and periodontal treatment of complete buccal root and apex exposition: A challenging case report with 17 months follow-up

INTRODUCTION

This case report demonstrated a challenging clinical case addressed within a multidisciplinary approach to achieve its maintenance, even though had a poor prognosis. It was associated with the endodontic treatment with mucogingival techniques, including periodontal microsurgery and connective tissue graft.

CASE PRESENTATION

A patient presented a deep gingival recession with the apex-exposed non-vital tooth with interproximal bone loss (RT2) and without mobility. The treatment involved an initial endodontic approach and periodontal therapy (scaling and root planing), microsurgical techniques with coronally advanced flap, root preparation with PrefGel (24% EDTA), enamel matrix derivatives (Emdogain), and connective tissue graft. As a clinical result, it was verified an increase of keratinized tissue width and gingival thickness, and root coverage (RC), reaching good esthetics and a stable result after 17 months.

CONCLUSION

The correct diagnosis and technique selection may affect directly the outcome, especially in challenging cases. Even though there was a poor prognosis, an adequate treatment plan, patient cooperation, and technique mastery help to achieve a high level of RC, esthetic recovering, and successful outcome.