New attachment through periodontal treatment and orthodontic intrusion

Periodontal considerations during orthodontic intrusion and extrusion in healthy and reduced periodontium

In patients with advanced periodontal disease, pathological tooth migration may occur, which may require subsequent orthodontic treatment for both aesthetic and functional purposes. When planning orthodontic treatment mechanics, intrusive or extrusive forces are frequently indicated. Understanding tissue reactions during these movements is essential for clinicians when devising a comprehensive orthodontic-periodontal treatment plan. This knowledge enables clinicians to be fully aware of and account for the potential effects on the surrounding tissues. The majority of our understanding regarding the behavior of periodontal tissues in both healthy and compromised periodontal conditions is derived from animal studies. These studies offer the advantage of conducting histological and other assessments that would not be feasible in human research. Human studies are nevertheless invaluable in being able to understand the clinically relevant response elicited by the periodontal tissues following orthodontic tooth movement. Animal and human data show that in dentitions with reduced periodontal support, orthodontic intrusion of the teeth does not induce periodontal damage, provided the periodontal tissues do not have inflammation and plaque control with excellent oral hygiene is maintained. On the contrary, when inflammation is not fully controlled, orthodontic intrusion may accelerate the progression of periodontal destruction, with bacterial plaque remnants being displaced subgingivally, leading to further loss of attachment. Orthodontic extrusion, on the other hand, does not seem to cause further periodontal breakdown in dentitions with reduced periodontal support, even in cases with deficient plaque control. This is attributed to the nature of the tooth movement, which directs any plaque remnants coronally (supragingivally), reducing the risk of adverse effects on the periodontal tissues. This specific type of tooth movement can be leveraged to benefit periodontal conditions by facilitating the regeneration of lost hard and soft periodontal tissues in a coronal direction. As a result, orthodontic extrusion can be employed in implant site development, offering an advantageous alternative to more invasive surgical procedures like bone grafting. Regardless of the tooth movement prescribed, when periodontal involvement is present, it is essential to prioritize periodontal therapy before commencing orthodontic treatment. Adequate plaque control is also imperative for successful outcomes. Additionally, utilizing light orthodontic forces is advisable to achieve efficient tooth movement while minimizing the risk of adverse effects, notably root resorption. By adhering to these principles, a more favorable and effective combined orthodontic-periodontal approach can be ensured. The present article describes indications, mechanisms, side effects, and histological and clinical evidence supporting orthodontic extrusion and intrusion in intact and reduced periodontal conditions.

Biomechanical Considerations in the Orthodontic Treatment of a Patient with Stabilised Stage IV Grade C Generalised Periodontitis: A Case Report

Orthodontic treatment of periodontally compromised patients presents unique challenges, including controlling periodontal inflammation, applying appropriate force, designing an effective dental anchorage, and maintaining treatment results. Deteriorated periodontal support leads to alterations in the biological responses of teeth to mechanical forces, and thus orthodontists must take greater care when treating patients with periodontal conditions than when treating those with a good periodontal status. In this article, we report the case of a 59-year-old woman with stabilised Stage IV grade C generalised periodontitis characterised by pathological tooth migration (PTM). The assessment, planning, and treatment of this patient with orthodontic fixed appliances is described. Moreover, the anchorage planning and biomechanical considerations are detailed. Specific orthodontic appliances were employed in this case to produce force systems for achieving precise tooth movement, which included a cantilever, mini-screws, and a box loop. Careful application of those appliances resulted in satisfactory aesthetic and functional orthodontic outcomes in the patient. This case highlights the importance of multidisciplinary collaboration in the treatment of patients with severe periodontitis and the potential for tailored biomechanical approaches in orthodontic treatment to furnish good outcomes.

To intrude or not to intrude? A systematic review of the controversy surrounding orthodontic intrusion on reduced periodontium

OBJECTIVE

The main objective of this review was to evaluate the effects of orthodontic intrusion on patients with reduced periodontium. Additionally, this review aims to explore the potential for attachment gain and tissue regeneration in these patients and identify optimal therapeutic conditions to mitigate any negative effects of intrusion.

METHODS

A systematic review was conducted according to the PRISMA 2020 statement. Duplicate electronic searches of the PubMed, Cochrane, EMC Premium, and Science Direct databases were performed by two independent reviewers. Data extraction and quality assessments, including risk of bias evaluation using the Cochrane and ROBINS-I tools were conducted.

RESULTS

From an initial pool of 418 articles, 29 were selected after title and abstract screening for full-text review. Following thorough full-text reading, 15 studies were ultimately included in the analysis. The total number of patients included in the studies is 528, who underwent orthodontic intrusion on reduced periodontium. Studies indicated a decrease in periodontal pocket depth and an increase in clinical attachment with ortho-periodontal treatment. Alveolar bone level outcomes varied, showing both increases and losses. Authors generally observed improved papillary regeneration and reduced gingival recessions.

CONCLUSION

Clinical studies involving combined ortho-periodontal treatment showed that orthodontic intrusion on a reduced but healthy periodontium can be considered a beneficial treatment for the periodontium, provided that potential adverse effects are carefully monitored.

Comparative evaluation of treatment of angular bone defect related to over-erupted tooth using guided tissue regeneration (GTR) followed by orthodontic intrusion (OI) versus OI followed by GTR: a controlled clinical trial

BACKGROUND

Prematurity resulted from pathological migration of periodontally involved teeth with the loss of vertical stopping points between teeth, which can lead to teeth over eruption with dimensional changes favoring occlusal discrepancies. Therefore, evaluating and comparing the effect of guided tissue regeneration followed by orthodontic intrusion as opposed to orthodontic intrusion tracked by guided tissue regeneration in the treatment of an over-erupted tooth with angular bone loss.

METHODS

Twenty teeth in ten cases were selected with at least two teeth with vertical over-eruption and angular bone loss with the presence of their opposing. In group one, ten teeth over-erupted were treated by guided tissue regeneration followed by orthodontic intrusion, whereas, in group two, ten teeth over-erupted were treated by orthodontic intrusion followed by guided tissue regeneration. They were evaluated clinically for pocket depth, bleeding on probing, and tooth mobility. Radiographical evaluation assessed by cone beam computed tomography.

RESULTS

Clinically, there existed a statistically significant difference (P value ≤ 0.05) in favor of group one at six months post and in favor of group two at one year from re-evaluation regarding pocket depth and tooth mobility. Radiographically, in group one, there was a statistically significant improvement (P value ≤ 0.05) at six months post-guided tissue regeneration or orthodontic intrusion regarding defect depth and dimensional changes of the defect area, with a statistically significant difference (P value ≤ 0.05) in favor of group two at one year from re-evaluation phase regarding defect depth and defect area dimensional changes.

CONCLUSION

There was a short-term improvement in group one, which deteriorated over a long period compared with group two, so it is preferable to start orthodontic intrusion before guided tissue regeneration.

Clinical crown height changes in adult patients after non-extraction, orthodontic treatment: a retrospective cohort study

OBJECTIVE

To assess changes in clinical crown height (CCH) in adult orthodontic patients treated by fixed appliances to distalise the molars.

DESIGN

Retrospective case series study.

SETTING AND PATIENTS

A total of 30 adults with healthy periodontal tissues who received orthodontic treatment at the Department of Orthodontics, Yokohama, Japan and its related orthodontic clinic were assessed.

METHODS

CCH was measured as the distance from the gingival margin to the crown plane perpendicular to the tooth axis. Treatment changes of CCH of each tooth were examined on the labial/buccal and lingual/palatal side.

RESULTS

In the upper dentition, on the labial/buccal side, the CCH of the lateral incisors, canines, first premolars, first molars and second molars were increased significantly (P < 0.01), with a median value of 0.41 mm, 0.43 mm, 0.28 mm, 0.43 mm and 0.55 mm, respectively. In contrast on the palatal side, the CCH of the central incisors, first molars, and second molars decreased significantly (P < 0.01), with a median value of -0.41 mm, -0.30 mm and -0.20 mm, respectively. In the lower dentition on the labial/buccal side, the CCH of the first premolars, second premolars and first molars were increased significantly, with a median value of 0.39 mm (P < 0.01), 0.43 mm (P < 0.01) and 0.19 mm (P < 0.05), respectively. The second molars exhibited a significant decrease in CCH with a median value of -0.26 mm (P < 0.05). On the lingual side, the CCH of the central incisors, lateral incisors, canines, first premolars, second premolars and first molars were increased significantly (P < 0.01), with a median value of 0.28 mm, 0.22 mm, 0.31 mm, 0.37 mm, 0.26 mm and 0.28 mm, respectively.

CONCLUSION

Significant differences were observed in CCH before and after treatment for many teeth, the average change was less than 0.5 mm. The impact on the long-term health of the periodontal tissue is unknown.

Orthodontic treatment in patients with periodontitis - a narrative literature review

Patients with periodontitis often require an inter-disciplinary approach, including orthodontic treatment, for effective rehabilitation of masticatory function, aesthetics and quality of life. The aim of this narrative review was to comprehensively discuss literature focusing on the biology, indications and inter-disciplinary connections related to the orthodontic approach in patients with periodontitis and to present clinical concepts in accordance with valid guidelines. The outcomes of the experimental studies indicate that orthodontic tooth movement (OTM) can be performed safely for teeth with reduced periodontium, provided infection and inflammation are controlled. Orthodontic treatment can correct pathological tooth migration, is not associated with deterioration of clinical periodontal parameters and improves aesthetics. Intrusion is safe when performed with light forces and under a strict oral hygiene regimen. Teeth can be moved either towards or away from the intrabony defect previously subjected to regenerative procedures, and research suggests that OTM has the potential to enhance bone formation after regenerative therapy. The data on orthodontic movement of teeth with furcation involvement are very scarce. The improvement in furcation involvement following either combined periodontal and orthodontic treatment was only documented in animal model studies. Due to bone and tooth loss, special consideration should be given to orthodontic treatment mechanics. © 2023 Australian Dental Association.

Periodontal status following orthodontic mini-screw insertion: A prospective clinical split-mouth study

BACKGROUND

Anchorage control is one of the most important determinants of orthodontic treatments. Mini-screws are used to achieve the desired anchorage. Despite all their advantages, there is a possibility that treatment will not be successful due to conditions related to their interaction with the periodontal tissue.

OBJECTIVE

To evaluate the status of the periodontal tissue at the sites adjacent to the orthodontic mini-implants.

METHODS

A total of 34 teeth (17 case and 17 control) in 17 orthodontic patients requiring a mini-screw in the buccal area to proceed with their treatment were included in the study. Oral health instruction was provided to the patients prior to the intervention. In addition, scaling and root planing of the root surface were done using manual instruments and ultrasonic instruments if needed. For tooth anchorage, a mini-screw with Elastic Chain or Coil Spring was used. The following periodontal indices were examined in the mini-screw receiving tooth and the contralateral tooth: plaque index, pocket probing depth, attached gingiva level (AG), and gingival index. Measurements were made before the placement of the mini-screws and 1, 2, and 3 months following that.

RESULTS

The results revealed a significant difference only in the amount of AG between the tooth with mini-screw and the control tooth (p = 0.028); for other periodontal indices, there were no significant differences between the two groups.

CONCLUSION

This study showed that periodontal indices in adjacent teeth of the mini-screws do not change significantly compared to other teeth and mini-screws can be used as a suitable anchorage without posing a threat to the periodontal health. Using mini-screws is a safe intervention for orthodontic treatments.

Orthodontic treatment in periodontally compromised patients: a systematic review

OBJECTIVES

The aim of this systematic review was to examine the literature on aggressive and chronic periodontitis and orthodontics to clarify the therapy-relevant aspects of orthodontic treatment with altered biomechanics in periodontally compromised dentition.

MATERIALS AND METHODS

Literature searches were conducted in the electronic databases "PubMed" and "DIMDI" using the keywords "aggressive periodontitis AND ortho*," "aggressive periodontitis AND orthodontics," "chronic periodontitis AND ortho*," and "chronic periodontitis AND orthodontics" for the publication period from January 1990 to July 2022. In addition, a manual search was carried out in the selected trade journals "Community Dental Health," "European Journal of Oral Sciences," and "Parodontologie." Human clinical trials were included, whereas animal experimental studies, case reports, and reviews were generally excluded. The appropriate studies were selected, and the relevant data was tabulated according to different parameters, regarding the study design, the study structure, and the conduct of the study.

RESULTS

A total of 1067 articles were found in the preliminary electronic search. The manual search and review of all related bibliographies resulted in an additional 1591 hits. After the first screening, 43 articles were classified as potentially relevant and reviewed in their original form. After the suitability test, 5 studies with a total of 366 participants were included in the final evaluation. These included one randomized controlled trial and four low-evidence intervention studies. The studies were conducted in two university hospitals and three private practices. All participants underwent scaling and root plaining and periodontal surgery before the orthodontic treatment started. Mean probing pocket depth reduction before and after the interdisciplinary treatment was analyzed in all the included studies; mean difference in clinical attachment level in four of the studies was also included. All participants were enrolled in a continuous recall system. In all studies, orthodontic therapy in periodontally compromised patients improved function and esthetics, resulting in lower probing depths and clinical attachment gains.

CONCLUSIONS

Orthodontic treatment can be used for patients with reduced periodontal support to stabilize clinical findings and improve function and esthetics. The prerequisite for this is a profound knowledge of altered biomechanics and an adapted interdisciplinary treatment approach. Due to the large heterogeneity of the included studies and their limited methodological quality, the results obtained in this review must be considered critically. Further randomized controlled long-term studies with comparable study designs are necessary to obtain reliable and reproducible treatment results.

CLINICAL RELEVANCE

Patients with periodontal impairment can be successfully treated with orthodontics as part of interdisciplinary therapy. Orthodontic treatment has no negative impact on the periodontium; if minimal, controlled forces are used under non-inflammatory conditions.

Periodontal and Orthodontic Synergy in the Management of Stage IV Periodontitis: Challenges, Indications and Limits

This retrospective study described the clinical and radiographic long-term outcomes of combined periodontal and orthodontic treatment (OT) with fixed appliances in patients with Stage IV periodontitis and pathologic tooth migration (PTM) in the anterior sextants. OT was performed in either one or both arches, using tooth-supported or skeletal anchorage, following completion of active periodontal treatment and accurate planning of tooth movement biomechanics. Twenty-nine patients were identified and retrospectively examined when presenting for a supportive periodontal care (SPC) appointment. The mean SPC duration was 8.9 years (range 5 to 12 years). All anterior-migrated teeth showed statistically significant periodontal improvement compared to baseline values and stable radiographic bone levels at the final follow-up. Residual probing depths were 2.9 ± 0.5 mm at the end of active periodontal treatment, and they remained stable at the completion of OT (2.9 ± 0.6 mm) and at the last follow-up visit (2.8 ± 0.5 mm). These findings suggest that OT is a safe and effective treatment in improving the long-term prognosis of teeth with PTM in Stage IV periodontitis provided that periodontal health has been re-established and maintained with individualized SPC sessions.

Clear Aligner Treatments in Orthoperio Patients

Introduction. Orthodontic treatment is a recognized approach to support specific periodontal issues thanks to its capability to manipulate periodontal tissues. This concept is certainly not new, but the use of aligners in certain clinical conditions can be considered as being innovative when a multidisciplinary treatment is necessary. Moreover, aligners enable to plan 3D tooth movements, root placement, staging, and range of dental movements, alongside the improvement of oral hygiene. Thus, aligners can be suitable for the treatment of periodontal issues. In this article, the authors present two clinical cases with different periodontal issues: one with superficial periodontal problems and the other with a deep one. Both cases were successfully treated with aligners, highlighting how this invisible and comfortable tool can simplify the management of complex adult treatments. Conclusion. Digital workflow is the key for success in the aligner technique. The possibility to design a virtual plan of treatment and to transfer it in the real clinical world represents a way to limit errors and to reduce the time of orthodontic therapy.

Numerical and biomechanical analysis of orthodontic treatment of recovered periodontally compromised patients

OBJECTIVE

Generate a finite element (FE) model to simulate space closure and retraction mechanics for anterior maxillary teeth in periodontally compromised dentition, and compare the biomechanical effect of initial force systems with varying magnitude.

MATERIALS AND METHODS

The geometry of an idealized finite element model (FEM) of a maxilla was adapted such that the teeth showed reduced periodontal support together with extruded and flared incisors. In a first step, leveling and alignment of the front teeth were simulated. In a second step, force systems for orthodontic space closure of residual spaces on both sides distal to the lateral incisors were simulated. A combined intrusion and retraction cantilever was modeled, to simulate en masse retraction mechanics with segmented arches and elastic chains. A commercial FE system was used for all model generations and simulations.

RESULTS

Results of the simulations indicated that a force of 1.0 N is too high for space closure of flared front teeth in periodontally damaged dentition, as extreme strains may occur. En masse retraction using cantilever mechanics with lower forces showed a uniform intrusion and retraction movement and thus proved to be a better option for treating patients with a periodontally compromised dentition.

CONCLUSION

The outcome of this study indicates that increased periodontal stresses resulting from severe attachment loss should be seriously considered by careful planning of the orthodontic mechanics and reduction of the applied forces is suggested. The presented cantilever mechanics seems to be an appropriate means for en masse retraction of periodontally compromised extruded front teeth.

Change in clinical crown height in adult patients treated by means of the multi-bracket appliance with extraction of four first premolars

OBJECTIVE

To evaluate the gingival condition due to adult orthodontic treatment using the clinical crown height (CCH) as an index.

DESIGN

Retrospective study.

SETTING

Department of Orthodontics at a university.

PARTICIPANTS

A total of 21 adult female patients with healthy periodontal tissue were treated by means of the multi-bracket appliance with extraction of four first premolars.

METHODS

Three-dimensional (3D) digital dental models were reconstructed to assess the vertical movement of the free gingival margin caused by adult orthodontic treatment. Pre- and post-treatment CCH were measured, and changes in CCH due to treatment were examined.

RESULTS

The change in CCH by orthodontic treatment was able to be assessed objectively using 3D digital models of the dental casts. In the upper dentition, a significant reduction in CCH was found on the labial and lingual sides of the central incisor, with a mean of -0.28 mm and -0.34 mm, respectively (P < 0.001). In contrast, a significant increase in CCH was found on the labial side of the lateral incisor with a mean of 0.75 mm (P < 0.001). In the lower dentition, CCH on the lingual side of the canine, the second premolar and the first molar increased significantly (P < 0.001), with a mean of 0.41 mm, 0.45 mm and 0.50 mm, respectively. For the buccal side, the second premolar showed a significant increase in CCH with a mean of 0.61 mm (P < 0.001).

CONCLUSION

By using the CCH as an index, it was possible to assess the gingival condition after active orthodontic treatment.

The Incidence and Nature of Malpractice Claims against Dentists for Orthodontic Treatment with Periodontal Damage in Israel during the Years 2005-2018-A Descriptive Study

In recent years, dental malpractice claims have increased dramatically worldwide. The purpose of the present study is to analyze claims related to orthodontic treatment involving periodontal problems that resulted in legal decisions in Israel. This study analyzed legal claims registered by Medical Consultants International (MCI) between 2005 and 2018. Only closed cases of orthodontic claims involving periodontal problems in which a decision was made were included. The parameters studied included patients' demographic data, the main reasons of the claim, and complications. Statistical significance was found for aesthetic damage, which was more common in claims of females (p = 0.035) and in older claims (p = 0.004); tooth damage was more common in claims of older patients (p = 0.032); violation of autonomy was higher in private practice (p = 0.047) and in more recent claims (p = 0.001). As orthodontic treatment is becoming more popular in older patients, and as lawsuit claims become more common in recent years, the orthodontists should always analyze and document the periodontal status of their patients before and during treatment in order to maintain professional practice and avoid future claims.

Orthodontic treatment of periodontal patients: challenges and solutions, from planning to retention

Introduction:

There is an increasing number of adult patients with sequelae of periodontal diseases seeking orthodontic treatment to improve their occlusion and quality of life. However, it is important to highlight that the patient who has vertical bone loss has unique needs, arising from the frequent related pathological migrations. Therefore, it requires an individualized orthodontic treatment in terms of anchorage, biomechanics, and multidisciplinary planning, which raises doubts in the hierarchy of priorities and organization of the treatment plan.

Objectives:

It was proposed a stratified hierarchy of the needs of orthodontic-periodontal treatment in six levels, which were illustrated with examples of clinical cases in which biomechanical planning and a multidisciplinary approach made it possible to obtain a balanced occlusion, aesthetic improvement and stabilization of the results.

Conclusion:

Orthodontic treatment of periodontal patients with a multidisciplinary approach is increasingly frequent and should be planned individually, considering bone losses suffered by each patient. Respecting some limitations, it is possible to improve the level of bone insertion, smile aesthetics and masticatory function, to facilitate oral hygiene through the orthodontic treatment of adult patients with little bone support. It is also important to highlight that there are unique aspects in the orthodontic retention in these cases.

Esthetic Indication for Dental Implant Treatment and Immediate Loading (3). Case Report and Considerations Regarding the Aspect of the Patient's Right to Self-Determination in Medical Decision-Making

The technology of the Strategic Implant^® has expanded the indications for tooth and bone removal. This case report shows what kind of results are possible and how much the appearance of a patient can be changed within a few days if both teeth and bone are removed. The treatment option explained here could be considered by patients with a gummy smile. This treatment conflicts with the traditional thinking of dentists, who are educated to keep and maintain teeth. This can be compared to other fields of esthetic surgery where the patient's right to self-determination in medical decision-making has been established for a considerable period of time and is more frequent than in dentistry.

Orthodontic Management of a Migrated Maxillary Central Incisor With a Secondary Occlusal Trauma

INTRODUCTION

Normal or excessive occlusal forces exerted on teeth with a reduced periodontal support might result in a secondary occlusal trauma. This type of injury is diagnosed based on histological changes in the periodontium. Multiple clinical and radiographic indicators are, therefore, required as surrogates to assist the presumptive diagnosis of a (secondary) occlusal trauma.

CASE PRESENTATION

In this case report, the diagnosis, management, and the 1-year follow-up of a secondary occlusal trauma of a maxillary central incisor are described. The occlusal relationship was rehabilitated with fixed orthodontic appliances and was further stabilized with both fixed and removable retainers.

CONCLUSIONS

A combined periodontal-orthodontic approach for a secondary occlusal trauma allows the rehabilitation of periodontal, occlusal, and esthetic parameters. Twelve months after the end of the active orthodontic treatment, a combination of fixed and removable retainers showed to be effective in retaining the treatment outcome.

Stable deep bite correction with true mandibular incisor intrusion in a late adolescent patient with skeletal deep bite: A case report

The treatment of skeletal deep bite does not remain stable. The patient was a Japanese woman aged 16 years and 10 months. Her chief complaint was maxillary protrusion. The degree of overjet was + 10.5 mm and overbite was + 5.0 mm; the intermolar relationship was Angle Class II. An excessive curve of Spee was observed in the mandibular arch. A hypodivergent skeletal pattern was indicated by a small mandibular plane angle and gonial angle. The maxillary incisors were proclined and the mandibular incisors were retroclined. Based on the above findings, the patient was diagnosed with Angle Class II maxillary protrusion and deep bite with hypodivergency. Both maxillary first premolars were extracted and orthodontic treatment was performed using multi-bracket appliances. A proper overbite was achieved by 5.0 mm intrusion of the mandibular incisors. The maxillary incisors were retracted by 11.2 mm and a proper overjet was achieved. Good treatment results were obtained without apical root resorption. After 2 years of retention, the occlusion has been well maintained. This report may constitute a remarkable suggestion for treatment of an unstable deep bite.

Periodontal and root changes after orthodontic treatment in middle-aged adults are similar to those in young adults

INTRODUCTION

The goal of this study was to compare the outcomes and amount of change in periodontal health of anterior teeth in young versus middle-aged adults, who were treated to improve anterior alignment and occlusion.

METHODS

Pre- and posttreatment records including orthodontic casts, cephalograms, and standardized periapical radiographs were retrospectively collected from young adults (aged 19-30 years; n = 12) and middle-aged adults (aged ≥40 years; n = 27). Following the American Board of Orthodontics criteria, discrepancy index (DI), cast-radiograph evaluation (CRE), treatment duration (TD), marginal bone loss (MBL), and tooth length (TL) were measured, and with the use of periapical radiographs, changes in the level of marginal bone (MBC) and the amount of root resorption (RR) after orthodontic treatment were calculated.

RESULTS

DI, MBL, and TD were significantly higher in the middle-aged adults than in the young adults (P < 0.05). However, CRE and MBC after treatment were similar between the 2 groups (P > 0.05). The mean amount of RR following treatment was -0.6 ± 0.44 mm and -1.0 ± 0.61 mm in young and middle-aged adults, respectively. The degree of RR after compensating for treatment complexity and TD was similar between the 2 groups (P > 0.05).

CONCLUSIONS

Although the initial malocclusion and periodontal conditions were unfavorable for the middle-aged adults, the overall treatment and periodontal outcomes after orthodontic treatment of the anterior teeth were similar to those for young adults. It appears that older adults tolerate orthodontics to improve the appearance of the anterior teeth as well as younger adults, with no additional burden because of their increased age.

Combined Periodontal-Orthodontic Treatment of Pathologic Tooth Migration: A Case Study with 10-Year Follow-Up

Pathologic tooth migration is a change in tooth position resulting from disruption of the forces that maintain teeth in a normal position in relation to their arch. The disruption of the equilibrium in tooth position may be caused by various etiologic factors. Loss of attachment apparatus along with a non periodontal related condition such as excess occlusal force, a progressive migration of tooth may take place. Mostly this migration can be associated with aesthetic damage of the smile line. To solve these issues, a combination of periodontal and orthodontic treatment is often needed. In this presentation a 23-year-old, systemically healthy, non-smoking female presented with the complaint of bleeding gums, mobility and increased space between upper and lower front teeth causing un-aesthetic appearance and low self esteem. She was treated with interdisciplinary approach of orthodontic and periodontal intervention. Improvement of facial esthetics contributed to the self-confidence of an adult periodontal patient with pathologic tooth migration. Follow up at 10 years post treatment confirmed the good choice of treatment planning and the tendency to improve the results over time. Periodontally compromised orthodontic patients can be satisfactorily treated, achieving correction of the malocclusion and a marked improvement in esthetics when an interdisciplinary approach is used.

Cone-beam computed tomographic evaluation of changes in maxillary alveolar bone after orthodontic treatment

This study examined the relationship of vertical and horizontal changes in the alveolar bone crest with upper incisor movement after orthodontic treatment. Tooth movement was measured on lateral cephalograms. Vertical and horizontal changes in the median alveolar crest and distance from the cementoenamel junction and anterior nasal spine to the alveolar crest were measured with cone-beam computed tomography. The incisal edge moved distally, and the cervical point intruded significantly and moved distally. The median alveolar crest decreased by 3.80 ± 2.05 mm. The distance from the labial cementoenamel increased significantly, by 0.35 ± 0.38 mm. The vertical distance from the anterior nasal spine decreased significantly, and the alveolar crest moved distally. Vertical tooth movement was positively associated with change in the distance from the labial cementoenamel junction and inversely associated with vertical change in the distance from the anterior nasal spine on the labial and palatal sides. Lingual tooth movement was positively and negatively correlated with horizontal changes in the labial and palatal alveolar crest and vertical change in the palatal alveolar crest. The lingual movement of incisors was related to labial bone resorption. Greater lingual and extrusive movement of incisors led to a greater decrease in the alveolar bone crest.

Comparison between Two Radiological Methods for Assessment of Tooth Root Resorption: An In Vitro Study

Purpose

This study aims to verify the validity of the radiographic image and the most effective radiological techniques for the diagnosis of root resorption to prevent, cure, and reduce it and to verify if radiological images can be helpful in medical and legal situations.

Methods

19 dental elements without root resorption extracted from several patients were examined: endooral and panoramic radiographs were performed, with traditional and digital methods. Then the root of each tooth was dipped into 3-4 mm of 10% nitric acid for 24 hours to simulate the resorption of the root and later submitted again to radiological examinations and measurements using the same criteria and methods.

Results

For teeth with root resorption the real measurements and the values obtained with endooral techniques and digital sensors are almost the same, while image values obtained by panoramic radiographs are more distorted than the real ones.

Conclusions

Panoramic radiographs are not useful for the diagnosis of root resorption. The endooral examination is, in medical and legal fields, the most valid and objective instrument to detect root resorption. Although the literature suggests that CBCT is a reliable tool in detecting root resorption defects, the increased radiation dosage and expense and the limited availability of CBCT in most clinical settings accentuate the outcome of this study.

Orthodontic treatment in periodontitis-susceptible subjects: a systematic literature review

The aim is to evaluate the literature for clinical scientific data on possible effects of orthodontic treatment on periodontal status in periodontitis-susceptible subjects. A systematic literature review was performed on studies in English using PubMed, MEDLINE, and Cochrane Library central databases (1965-2014). By manually searching reference lists of selected studies, we identified additional articles; then we searched these publications: Journal of Periodontology, Periodontology 2000, Journal of Clinical Periodontology, American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, International Journal of Periodontics & Restorative Dentistry, and European Journal of Orthodontics. Search terms included randomized clinical trials, controlled clinical trials, prospective and retrospective clinical studies, case series >5 patients, periodontitis, orthodontics, alveolar bone loss, tooth migration, tooth movement, orthodontic extrusion, and orthodontic intrusion. Only studies on orthodontic treatment in periodontally compromised dentitions were included. One randomized controlled clinical trial, one controlled clinical trial, and 12 clinical studies were included. No evidence currently exists from controlled studies and randomized controlled clinical trials, which shows that orthodontic treatment improves or aggravates the status of periodontally compromised dentitions.

Impact of Orthodontic Treatment on Periodontal Tissues: A Narrative Review of Multidisciplinary Literature

The aim of this review is to describe the most commonly observed changes in periodontium caused by orthodontic treatment in order to facilitate specialists' collaboration and communication. An electronic database search was carried out using PubMed abstract and citation database and bibliographic material was then used in order to find other appropriate sources. Soft and hard periodontal tissues changes during orthodontic treatment and maintenance of the patients are discussed in order to provide an exhaustive picture of the possible interactions between these two interwoven disciplines.

A comparative study of combined periodontal and orthodontic treatment with fixed appliances and clear aligners in patients with periodontitis

Purpose

With the increasing prevalence of orthodontic treatment in adults, clear aligner treatments are becoming more popular. The aim of this study was to evaluate the effect of orthodontic treatment on periodontal tissue and to compare orthodontic treatment with fixed appliances (FA) to clear aligner treatment (CAT) in periodontitis patients.

Methods

A total of 35 patients who underwent orthodontic treatment in the Department of Periodontology were included in this study. After periodontal treatment with meticulous oral hygiene education, patients underwent treatment with FA or CAT, and this study analyzed patient outcomes depending on the treatment strategy. Clinical parameters were assessed at baseline and after orthodontic treatment, and the duration of treatment was compared between these two groups.

Results

The overall plaque index, the gingival index, and probing depth improved after orthodontic treatment (P<0.01). The overall bone level also improved (P=0.045). However, the bone level changes in the FA and CAT groups were not significantly different. Significant differences were found between the FA and CAT groups in probing depth, change in probing depth, and duration of treatment (P<0.05). However, no significant differences were found between the FA and CAT groups regarding the plaque index, changes in the plaque index, the gingival index, changes in the gingival index, or changes in the alveolar bone level. The percentage of females in the CAT group (88%) was significantly greater than in the FA group (37%) (P<0.01).

Conclusions

After orthodontic treatment, clinical parameters were improved in the FA and CAT groups with meticulous oral hygiene education and plaque control. Regarding plaque index and gingival index, no significant differences were found between these two groups. We suggest that combined periodontal and orthodontic treatment can improve patients’ periodontal health irrespective of orthodontic techniques.

The role of orthodontics in the regeneration of the degenerated dentition

The demand for regeneration of a degenerated dentition has been increasing as a result of the development of societies, where the life expectancy is increasing and fighting age-related changes is in focus. Whereas removable dentures were acceptable and considered a norm earlier, patients do, to an increasing degree,demand fixed prosthetics; consequently, the development of implants has had an important impact. The balance in the chewing organ will change with time, due to age-related changes within the bone and the loss of teeth due to caries or periodontal disease, and malocclusions may develop or aggravate. The re-establishment of an aesthetical and functional satisfactory solution cannot be reached by replacing teeth by fixed prosthodontics and implants. The aim of this update was threefold: firstly, to demonstrate that age-related changes, often unnoticed by both the patient and the general dentist, can lead to degeneration of the dentition; secondly, to explain how an interdisciplinary approach can make regeneration of even severe degeneration possible; and finally, to show the importance of the general dentist in the maintenance of the obtained results. Treatments should not aim for short-term results but focus on maintainable results.

Curve of Spee - from orthodontic perspective

The presence of a curve of Spee (COS) of variable depth is common finding in the occlusal arrangement and is sixth key of occlusion The understanding of COS in the field of orthodontics is very important as orthodontists deal with it in virtually every patient they treat. An excessive COS is a common form of malocclusion that may be addressed in many ways, including posterior extrusion, anterior intrusion, and incisor proclination. The specific approach to leveling of COS should be selected based on each patient's needs. Soft tissue, crown–gingival relations, occlusal plane, and skeletofacial concerns are among the special considerations for treatment planning for leveling of COS.

Periodontal changes following molar intrusion with miniscrews

BACKGROUND

With the introduction of skeletal anchorage system, recently it is possible to successfully intrude molar teeth. On the other hand, there have been concerns about periodontal changes associated with intrusion and there are few studies on this topic, especially for posterior teeth.

MATERIALS AND METHODS

Ten female patients were enrolled in this study. Maxillary molar intrusion was achieved by inserting two miniscrews and a 17 × 25 titanium molybdenum alloy spring. Crestal height changes were evaluated at three intervals including: Baseline (T0), end of active treatment (T1) and 6 months after retention (T2). Other variables including probing depth, gingival recession, attachment level and bleeding on probing were evaluated by clinical measurements in the three above mentioned intervals. One-sample Kolmogrov-Smirnov test ascertained the normality of the data. For all patients, the changes in tooth position and crestal height were evaluated using one-sample t-test. (P < 0.05).

RESULTS

Supra-erupted molars were successfully intruded a mean of 2.1 ± 0.9 mm during active treatment (T0-T1). A mean bone resorption of 0.9 ± 0.9 mm in mesial crest and 1 ± 0.8 mm in distal crest had occurred in total treatment (T0-T2). A mean of 0.6 ± 1.4 mm bone was deposited on mesial crest during the retention period (T1-T2) following tooth relapse. On average, 0.8 ± 0.4 mm attachment gain was obtained. Gingival margin coronalized a mean of 0.8 ± 0.6 mm throughout the entire treatment. Probing depth showed no significant change during treatment.

CONCLUSION

Within the limitations of this study, these results suggest that not only periodontal status was not negatively affected by intrusion, but also there were signs of periodontal improvement including attachment gain and shortening of clinical crown height.

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Dr Birte Melsen est née à Aabenraa, au Danemark, le 9 Juin 1939.

Elle fait ses études dentaires au Royal Dental College à Aarhus, Danemark (1964).

Elle est professeur et chef du Département d’Orthodontie à l’Université dentaire, à Aarhus, depuis 1975 et traite exclusivement des adultes en pratique privée à Lübeck, en Allemagne (temps partiel depuis 1986).

Birte Melsen est l’auteur de plus de 350 articles et publications, dans des domaines aussi variés que la croissance et le développement cranio-facial (recherches sur cadavres humains), la biologie osseuse et les réactions tissulaires, la distraction osseuse, les implants dentaires, les traitements adultes, les asymétries, la stabilité à long terme, sans oublier les mini-vis orthodontiques d’ancrage temporaire, les attaches auto-ligaturantes et l’imagerie.

Aggressive periodontitis diagnosed during or before orthodontic treatment

OBJECTIVE

The aim was to review the literature on aggressive periodontitis diagnosed during or before the initiation of orthodontic treatment and to propose preventive recommendations before, during and after orthodontic treatment.

MATERIALS AND METHODS

Literature searches of free text and MeSH terms were performed by using PubMed, Embase and the Cochrane Library and the appropriate studies were selected. The retrieved articles were analyzed and the relevant data was tabulated according to different parameters.

RESULTS

A total of 220 articles were found in the preliminary search. Eighteen studies, all case reports, describing 21 cases from this search met all the criteria. The mean age of the reported cases was 21.12 years, all treated with combined periodontal and orthodontic modalities. Most of the reported cases were female.

CONCLUSION

An interdisciplinary dental team must approve the periodontal health prior to and during the course of the orthodontic therapy. In subjects with periodontal pathology, a periodontal consultation and interceptive/corrective therapy should be performed prior to commencing with orthodontic treatment. Orthodontic treatment should be postponed or replanned in order to shorten treatment duration and reduce the orthodontic forces exerted on the aggressive periodontitis involved dentition.

Surgical-orthodontic treatment of patients suffering from severe periodontal disorders - a clinical case study

INTRODUCTION

Orthodontic or, more precisely, surgico-orthodontic treatment of patients suffering from periodontal disorders generally requires a multidisciplinary approach by a qualified dental team. Periodontal bone healing is an essential factor for successful orthodontic treatment in a compromised periodontal situation.

CLINICAL CASE

We report on the case of an adult patient suffering from severe chronic periodontitis; he was a hyperdivergent skeletal Class III with dento-alveolar compensation, esthetic problems and a significant lack of dental material. A multidisciplinary approach was adopted. First of all, periodontal treatment was undertaken (root scaling and planing) accompanied by appropriate medical treatment and a bone graft to strengthen the area of the lower incisors. After that, surgical and orthodontic treatment to correct the malocclusion was begun. The difficulty lay in the significant absence of dental material to ensure proper intercuspation. A surgical repositioning splint was constructed on an articulator to ensure adequate mandibular retraction after maxillary advancement surgery. After treatment, the missing teeth were replaced by a prosthesis.

RESULTS AND DISCUSSION

Following treatment, the periodontal bone resorption was stabilized; the bone deficit was improved and the malocclusion had been corrected; the missing teeth were replaced by appropriate dentures. Short- and medium-term follow-up confirmed the stability of the results obtained, which will be discussed.

CONCLUSION

The right combination of properly managed orthodontic, periodontal and prosthetic treatment can contribute to effective elimination of chronic periodontitis, even at an advanced stage in an adult patient, while at the same time improving esthetic and functional parameters.

Three-dimensional analysis of tooth movement after intrusion of a supraerupted molar using a mini-implant with partial-fixed orthodontic appliances

Objective:

To evaluate three-dimensional (3D) positional changes of an intruded tooth, a neighboring tooth, and a tooth connected to a mini-implant following intrusion of a single supraerupted molar, using a mini-implant with partial-fixed orthodontic appliances.

Materials and Methods:

The study consisted of 14 adult patients (two males and 12 females, mean age 41.9 years) with a supraerupted molar due to loss of an antagonist. Intrusion was performed using a mini-implant with a partial strap-up. The mean treatment time was 11.9 months, and the mean retention time was 23.3 months. To quantify the positional changes of the teeth, 3D models using a laser-based, dental scanning system and 3D software at pretreatment, posttreatment, and retention were oriented in a coordinate system and superimposed using nonmoved teeth as references. The changes on the x-, y-, and z-axes were measured at the tip of each cusp in the involved teeth.

Results:

A supraerupted molar was intruded by a mean amount of 1.35 ± 0.48 mm and was well maintained during the retention period. The overall change in the neighboring tooth was insignificant, although it showed opposite movement compared to the intruded tooth during the intrusion. The tooth connected to a mini-implant exhibited a secure anchorage.

Conclusion:

3D analysis showed the detailed positional changes of each tooth, and the involved molars were well maintained after intrusion.

Significance of curve of Spee: An orthodontic review

Exaggerated curve of Spee is frequently observed in dental malocclusions with deep overbites. Such excessive curve of Spee alters the muscle imbalance, ultimately leading to the improper functional occlusion. It has been proposed that an imbalance between the anterior and the posterior components of occlusal force can cause the lower incisors to overerupt, the premolars to infraerupt, and the lower molars to be mesially inclined. This altered condition requires specialized skills for the practitioner. It would be useful if we have a thorough knowledge of how and when this curve of Spee develops, so that it will aid us in our treatment. The understanding of why the curve of Spee develops is limited in literature. The purpose of this article is to increase our knowledge regarding the development and its effect on dentition and its treatment in exaggerated cases.

Interfaces between orthodontic and periodontal treatment: their current status

The contextual relationships between orthodontics and periodontology are diverse and complex. While the consequences of orthodontic tooth movements are discussed in terms of possible damage and improvements in the long-term health of periodontal tissues orthodontic treatment of adults is a routine clinical procedure nowadays, even in patients presenting already-damaged periodontal tissues. As developments in both fields have been so rapid, there is a constant need for evidence-based concepts in this interdisciplinary field. The goal of this review was to discuss the latest aspects of interdisciplinary treatment and to reflect on the latest developments in research. A treatment scheme is also presented which aims to facilitate coordination of the orthodontic treatment of patients with periodontal diseases.