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Antonarakis GS, Zekeridou A, Kiliaridis S, Giannopoulou C. Periodontal considerations during orthodontic intrusion and extrusion in healthy and reduced periodontium. Periodontol 2000 2024. [PMID: 38831560 DOI: 10.1111/prd.12578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024]
Abstract
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.
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Affiliation(s)
- Gregory S Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alkisti Zekeridou
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stavros Kiliaridis
- Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland
| | - Catherine Giannopoulou
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Periodontal and Orthodontic Synergy in the Management of Stage IV Periodontitis: Challenges, Indications and Limits. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122131. [PMID: 36556496 PMCID: PMC9782082 DOI: 10.3390/life12122131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
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.
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Tu CC, Lo CY, Chang PC, Yin HJ. Orthodontic treatment of periodontally compromised teeth after periodontal regeneration: A restrospective study. J Formos Med Assoc 2022; 121:2065-2073. [DOI: 10.1016/j.jfma.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022] Open
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Clear Aligner Treatments in Orthoperio Patients. Case Rep Dent 2022; 2022:8932770. [PMID: 35198252 PMCID: PMC8860530 DOI: 10.1155/2022/8932770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/08/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Kloukos D, Roccuzzo A, Stähli A, Sculean A, Katsaros C, Salvi GE. Effect of combined periodontal and orthodontic treatment of tilted molars and of teeth with intra-bony and furcation defects in stage-IV periodontitis patients: A systematic review. J Clin Periodontol 2021; 49 Suppl 24:121-148. [PMID: 34761413 DOI: 10.1111/jcpe.13509] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023]
Abstract
AIM To assess the effect of combined periodontal and orthodontic treatment (OT) in stage-IV periodontitis patients. MATERIALS AND METHODS Three focused questions were addressed using the Population, Intervention, Comparison, Outcome, and Study Design criteria. Randomized controlled trials (RCTs), controlled clinical trials, follow-up studies, case series, and controlled/uncontrolled before/after studies were assessed for inclusion. Primary outcomes included mean changes in pocket probing depth (PPD) and clinical attachment level (CAL). Qualitative synthesis of results was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Out of 916 records, 1 retrospective case series study reported the effect of OT of tilted molars, 2 RCTs and 10 prospective and 2 retrospective case series studies reported the effect of OT of treated intra-bony defects and 0 articles reported the effect of OT of treated furcation defects. Mean PPD changes were reported in 14 articles, and mean CAL changes were reported in 8 articles. Risk of bias was high in both included RCTs, critical in nine articles, and serious in four articles. No articles included patient-reported outcomes, and three articles reported harms/adverse effects. CONCLUSIONS Evidence is limited by (i) the lack or low number of included studies, (ii) the apparent methodological and clinical heterogeneity, and (iii) the high risk of bias of the retrieved studies. No solid conclusions could be drawn concerning OT in stage-IV periodontitis patients with respect to tilted molars, teeth with treated intra-bony defects, and teeth with treated furcation defects.
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Affiliation(s)
- Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Christos Katsaros
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Frias Cortez MA, Bourauel C, Reichert C, Jäger A, Reimann S. Numerical and biomechanical analysis of orthodontic treatment of recovered periodontally compromised patients. J Orofac Orthop 2021; 83:255-268. [PMID: 34269825 DOI: 10.1007/s00056-021-00324-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 05/01/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
| | | | | | - Andreas Jäger
- Department of Orthodontics, University of Bonn, Bonn, Germany
| | - Susanne Reimann
- Oral Technology, University of Bonn, Bonn, Germany. .,Medical Engineering, University of Applied Sciences Bremerhaven, An der Karlstadt 8, 27568, Bremerhaven, Germany.
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Pini Prato GP, Chambrone L. Orthodontic treatment in periodontal patients: The use of periodontal gold standards to overcome the “grey zone”. J Periodontol 2019; 91:437-441. [DOI: 10.1002/jper.19-0306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 12/15/2022]
Affiliation(s)
| | - Leandro Chambrone
- School of DentistryIbirapuera University (Unib) São Paulo Brazil
- Unit of Basic Oral Investigation (UIBO)School of DentistryUniversidad El Bosque Bogota Colombia
- Department of PeriodonticsCollege of Dentistry and Dental ClinicsThe University of Iowa Iowa City IA USA
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Bai SY, Chen Y, Dai HW, Huang L. [Effect of sclerostin on the functions and related mechanisms of cementoblasts under mechanical stress]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:162-167. [PMID: 31168982 DOI: 10.7518/hxkq.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate the potential effects of sclerostin (SOST) on the biological funtions and related mechanisms of cementoblasts under mechanical stress. METHODS OCCM-30 cells were treated with varying doses of SOST (0, 25, 50, and 100 ng·mL⁻¹) and were loaded with uniaxial compressive stress (2 000 μ strain with a frequency of 0.5 Hz) for six hours. Western blot was utilized to detect the expressions of β-catenin, p-smad1/5/8, and smad1/5/8 proteins. Alkaline phosphatase (ALP) activity was determined, and reverse transcription polymerase chain reaction was used to measure the expressions of runt-related transcription factor 2 (Runx-2), osteocalcin (OCN), bone sialoproteins (BSP), receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG) mRNA. RESULTS The expression of p-smad
1/5/8 was significantly downregulated with increasing SOST. β-catenin and smad1/5/8 exhibited no difference. ALP activity decreased under mechanical compressive stress with increasing SOST concentrations. Runx-2 expression was reduced with increasing SOST concentrations, and a similar trend was observed for the BSP and OCN expressions. When the SOST concentration was enhanced, RANKL expression gradually increased, whereas the expression of OPG decreased. CONCLUSIONS Under mechanical comprehensive stress, SOST can adjust the bone morphogenetic protein (BMP) /smad signal pathway. Osteosclerosis inhibits the mineralization of cementoblasts under mechanical compressive stress, which may be achieved by inhibiting the expressions of osteogenesis factors (Runx2, OCN, BSP, and others) and by promoting the ratio of cementoclast-related factors (RANKL/OPG) through BMP signal pathways.
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Affiliation(s)
- Si-Yu Bai
- Dept. of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - Yue Chen
- Dept. of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - Hong-Wei Dai
- Dept. of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
| | - Lan Huang
- Dept. of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
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Bare-Welchel B, Campbell PM, Gonzalez M, Buschang PH. Effects of bone grafting, performed with corticotomies and buccal tooth movements, on dehiscence formation in dogs. Am J Orthod Dentofacial Orthop 2017; 151:1034-1047. [DOI: 10.1016/j.ajodo.2016.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/01/2016] [Accepted: 10/01/2016] [Indexed: 12/26/2022]
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Antoun JS, Mei L, Gibbs K, Farella M. Effect of orthodontic treatment on the periodontal tissues. Periodontol 2000 2017; 74:140-157. [DOI: 10.1111/prd.12194] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/30/2022]
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Kirschneck C, Fanghänel J, Wahlmann U, Wolf M, Roldán JC, Proff P. Interactive effects of periodontitis and orthodontic tooth movement on dental root resorption, tooth movement velocity and alveolar bone loss in a rat model. Ann Anat 2016; 210:32-43. [PMID: 27838559 DOI: 10.1016/j.aanat.2016.10.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/05/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Many adult orthodontic patients suffer from chronic periodontitis with recurrent episodes of active periodontal inflammation. As their number is steadily increasing, orthodontists are more and more frequently challenged by respective treatment considerations. However, little is currently known regarding interactive effects on undesired dental root resorption (DRR), tooth movement velocity, periodontal bone loss and the underlying cellular and tissue reactions. MATERIAL AND METHODS A total of 63 male Fischer344 rats were used in three consecutive experiments employing 21 animals each (A/B/C), randomly assigned to 3 experimental groups (n=7, 1/2/3), respectively: (A) CBCT; (B) histology/serology; (C) RT-qPCR-(1) control; (2) orthodontic tooth movement (OTM) of the first/second upper left molars (NiTi coil spring, 0.25N); (3) OTM with experimentally induced periodontitis (cervical silk ligature). After 14days of OTM, we quantified blood leukocyte level, DRR, osteoclast activity and relative gene expression of inflammatory and osteoclast marker genes within the dental-periodontal tissue as well as tooth movement velocity and periodontal bone loss after 14 and 28 days. RESULTS The experimentally induced periodontal bone loss was significantly increased by concurrent orthodontic force application. Periodontal inflammation during OTM on the other hand significantly augmented the extent of DRR, relative expression of inflammatory/osteoclast marker genes, blood leukocyte level and periodontal osteoclast activity. In addition, contrary to previous studies, we observed a significant increase in tooth movement velocity. CONCLUSIONS Although accelerated tooth movement would be favourable for orthodontic treatment, our results suggest that orthodontic interventions should only be performed after successful systematic periodontal therapy and paused in case of recurrent active inflammation.
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Affiliation(s)
- Christian Kirschneck
- Department of Orthodontics, University Medical Centre of Regensburg, Franz-Josef-Strauß-Allee 11, D-93053 Regensburg, Germany.
| | - Jochen Fanghänel
- Department of Orthodontics, University Medical Centre of Regensburg, Franz-Josef-Strauß-Allee 11, D-93053 Regensburg, Germany.
| | - Ulrich Wahlmann
- Department of Maxillofacial Surgery, University Medical Centre of Regensburg, Franz-Josef-Strauß-Allee 11, D-93053 Regensburg, Germany.
| | - Michael Wolf
- Department of Orthodontics, Rheinische Friedrich Wilhelm University of Bonn, Welschnonnenstraße 17, D-53111 Bonn, Germany.
| | - J Camilo Roldán
- Director of the Division of Pediatric Facial Plastic Surgery and Craniofacial Anomalies, Catholic Children's Hospital Wilhelmstift, Liliencronstraße 130, D-22149 Hamburg, Germany; Lecturer at the Department of Cranio-Maxillofacial Surgery, University Medical Centre of Regensburg, Franz-Josef-Strauß-Allee 11, D-93053 Regensburg, Germany.
| | - Peter Proff
- Department of Orthodontics, University Medical Centre of Regensburg, Franz-Josef-Strauß-Allee 11, D-93053 Regensburg, Germany.
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Maeda S, Sasaki T. Modality and risk management for orthodontic extrusion procedures in interdisciplinary treatment for generating proper bone and tissue contours for the planned implant: a case report. Int J Implant Dent 2016; 1:26. [PMID: 27747648 PMCID: PMC5005618 DOI: 10.1186/s40729-015-0028-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/29/2015] [Indexed: 11/16/2022] Open
Abstract
In adult interdisciplinary treatments with using dental implants, limited orthodontic treatment, especially orthodontic extrusion (OE), offers many benefits by both correcting teeth alignment and by contributing to the regeneration of periodontal tissues. However, orthodontic procedures carry some risks and unpredictabilities that might compromise tooth and/or periodontal tissue health. Especially in complex cases, it is difficult to decide which orthodontic treatment modalities should be combined, in what sequences they should be applied, and what their force systems and treatment times are. To achieve optimum results, some cases require two or more OEs to the same site being carried out at different times while taking the treatment effects into consideration. Such staged OE offers minimum intervention and maximum efficiency. In this case report, OE was first applied for orthodontic extraction. After bone regeneration followed by an implant placement and another surgical operation, a second OE was applied to align the inclination of an adjacent tooth. As a result, a predictable prognosis of implants as well as greatly improved esthetics and periodontal tissue health were achieved.
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Affiliation(s)
- Sachiko Maeda
- Private practice limited to orthodontics, 8F Hankyu-Terminal-Bldg. 1-1-4 Shibata, Kitaku, Osaka, 530-0012, Japan.
| | - Takeshi Sasaki
- Private practice in general practice, 9F Nissei-Shinosaka-Bldg. 3-4-30 Miyahara, Yodogawa-ku, Osaka, 532-0003, Japan
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Cao T, Xu L, Shi J, Zhou Y. Combined orthodontic-periodontal treatment in periodontal patients with anteriorly displaced incisors. Am J Orthod Dentofacial Orthop 2016; 148:805-13. [PMID: 26522041 DOI: 10.1016/j.ajodo.2015.05.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Flared and elongated incisors are associated with different types of periodontal bone defects, usually horizontal. Combined orthodontic-periodontal treatment is being used in periodontal patients with anterior displacement of the incisors. The purpose of this study was to investigate the changes in periodontal health and the shape of bone defects in the incisors after such combined treatment. METHODS Fourteen adults were included in the study. In total, 56 elongated maxillary incisors with horizontal bone defects received orthodontic-periodontal treatment with circumferential supracrestal fibrotomy. To improve bone morphology, periodontal regenerative surgery and guided tissue regeneration were performed on the anterior teeth with angular bone defects after orthodontic treatment. Cone-beam computed tomography scans were taken before treatment (T0), at the end of the orthodontic intrusion (T1), and 6 months after the guided tissue regeneration surgery (T2). Probing pocket depth and clinical attachment loss were examined at T0, T1, and T2. The data were analyzed using paired t tests. RESULTS From T0 to T1, clinical attachment loss decreased significantly by 0.29 mm (P <0.05). The distance from the cementoenamel junction to the marginal bone crest decreased by 0.66 mm (P <0.05). The labial side of alveolar bone thickness increased by 0.54 mm (P <0.05), and the lingual side of alveolar bone thickness decreased by 0.46 mm (P <0.05). The shape of the bone defect was changed from horizontal to vertical on some teeth. From T1 to T2, both probing pocket depth and clinical attachment loss improved significantly, and the radiographic examinations showed bone redepositions of 2.15 ± 0.68 mm (P <0.05) vertically and 1.44 ± 0.92 mm (P <0.05) horizontally. The distance from the most apical point of the bone defect to the cementoenamel junction after combined treatment decreased by 2.11 ± 1.30 mm (P <0.05). CONCLUSIONS Combined orthodontic-periodontal treatment improved the periodontal conditions of the defective bone sites. Bone morphology, altered by orthodontic intrusion with fibrotomy, can improve the results of subsequent guided tissue regeneration.
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Affiliation(s)
- Tian Cao
- Postgraduate student, Department of Orthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Li Xu
- Professor, Department of Periodontics, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Jie Shi
- Orthodontist, Department of Orthodontics, School and Hospital of Stomatology, Peking University, Beijing, China.
| | - Yanheng Zhou
- Professor and director, Department of Orthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
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Impact of Orthodontic Treatment on Periodontal Tissues: A Narrative Review of Multidisciplinary Literature. Int J Dent 2016; 2016:4723589. [PMID: 26904120 PMCID: PMC4745353 DOI: 10.1155/2016/4723589] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 12/07/2015] [Accepted: 12/13/2015] [Indexed: 11/25/2022] Open
Abstract
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.
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Hochman MN, Chu SJ, Tarnow DP. Orthodontic extrusion for implant site development revisited: A new classification determined by anatomy and clinical outcomes. Semin Orthod 2014. [DOI: 10.1053/j.sodo.2014.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cardaropoli D, Gaveglio L, Abou-Arraj RV. Orthodontic movement and periodontal bone defects: Rationale, timing, and clinical implications. Semin Orthod 2014. [DOI: 10.1053/j.sodo.2014.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Geisinger ML, Abou-Arraj RV, Souccar NM, Holmes CM, Geurs NC. Decision making in the treatment of patients with malocclusion and chronic periodontitis: Scientific evidence and clinical experience. Semin Orthod 2014. [DOI: 10.1053/j.sodo.2014.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nakamura Y, Gomi K, Oikawa T, Tokiwa H, Sekiya T. Reconstruction of a collapsed dental arch in a patient with severe periodontitis. Am J Orthod Dentofacial Orthop 2013; 143:704-12. [DOI: 10.1016/j.ajodo.2012.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/01/2012] [Accepted: 04/01/2012] [Indexed: 10/26/2022]
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Ghezzi C, Viganò VM, Francinetti P, Zanotti G, Masiero S. Orthodontic Treatment After Induced Periodontal Regeneration in Deep Infrabony Defects. Clin Adv Periodontics 2013. [DOI: 10.1902/cap.2012.110085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Reichert C, Hagner M, Jepsen S, Jäger A. Interfaces between orthodontic and periodontal treatment: their current status. J Orofac Orthop 2012; 72:165-86. [PMID: 21744196 DOI: 10.1007/s00056-011-0023-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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An interdisciplinary treatment to manage pathologic tooth migration: A clinical report. J Prosthet Dent 2011; 106:153-8. [DOI: 10.1016/s0022-3913(11)60114-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dannan A. An update on periodontic-orthodontic interrelationships. J Indian Soc Periodontol 2011; 14:66-71. [PMID: 20922083 PMCID: PMC2933533 DOI: 10.4103/0972-124x.65445] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/25/2009] [Accepted: 09/16/2009] [Indexed: 11/17/2022] Open
Abstract
Talking about periodontic-orthodontic interrelationships is related primarily to the 1960s, where a generalized increase in salivary bacterial counts, especially Lactobacillus, had been shown after orthodontic band placement. The purpose of this article is to provide the dental practitioner with basic understanding of the interrelationship between periodontics and orthodontics by means of representing classical studies, and, to give an update on this topic by demonstrating the most recent opinions concerning periodontic-orthodontic interrelationships. Specific areas reviewed are the ability of orthodontic treatment to afford some degree of protection against periodontal breakdown, short-term and long-term effects of orthodontic treatment on the periodontium, and some mucogingival considerations. Topics considering orthodontic treatment in periodontally compromised patients were not included in this review. While past studies have shown that orthodontic treatment can positively affect the periodontal health, recent reviews indicate an absence of reliable evidence for the positive effects of orthodontic therapy on patients’ periodontal status. Periodontic-orthodontic interrelationships are still controversial issues. However, a standard language between the periodontist and the orthodontist must always be established to eliminate the existing communications barrier, and to improve the outcomes of the whole treatment.
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Affiliation(s)
- Aous Dannan
- Department of Periodontology, Faculty of Dental Medicine, Witten/Herdecke University, Witten, Germany
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Deepa D, Mehta DS, Puri VK, Shetty S. Combined periodontic-orthodonticendodontic interdisciplinary approach in the treatment of periodontally compromised tooth. J Indian Soc Periodontol 2011; 14:139-43. [PMID: 21691554 PMCID: PMC3110470 DOI: 10.4103/0972-124x.70837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 03/09/2010] [Indexed: 11/25/2022] Open
Abstract
Orthodontic treatment in adult patients is one of the most frequently encountered components involving multidisciplinary approaches. In the present report, a 28-year-old male patient was treated for localized chronic periodontitis with pocket formation, mobility, pathologic migration and malalignment of maxillary left lateral incisor tooth #22. The periodontal therapy included motivation, education and oral-hygiene instructions (O.H.I.), scaling and root planing and periodontal flap surgery. Subsequently on resolution of periodontal inflammation, orthodontic therapy was carried out using the orthodontic aligner for a period of 6 months. Post-treatment (3 years) results showed complete resolution of infrabony pocket with significant bone fill, reduced tooth mobility and complete alignment of the affected maxillary left lateral incisor, thus restoring the esthetics and function.
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Affiliation(s)
- D Deepa
- Department of Periodontics, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
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Rotundo R, Bassarelli T, Pace E, Iachetti G, Mervelt J, Pini Prato G. Orthodontic treatment of periodontal defects. Part II: A systematic review on human and animal studies. Prog Orthod 2011; 12:45-52. [PMID: 21515231 DOI: 10.1016/j.pio.2011.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 02/02/2011] [Accepted: 02/04/2011] [Indexed: 11/29/2022] Open
Abstract
Several studies have been published focusing on the possibility to treat patients affected by periodontal defects by means of orthodontic treatment. The aim of this systematic review is to evaluate the efficacy of the orthodontic treatment applied to the therapy of infraosseous defects, gingival recessions, and furcation lesions. An electronic and a manual search were performed based on a PICO assessment worksheet. Both human and animal studies were selected for this review. The electronic search (from January 1966 to December 2009) and the hand search (from January 1988 to December 2009) were conducted by 3 independent reviewers. A total of 197 articles were found and only 29 were considered eligible for this review. In particular, 22 studies dealing with infrabony defects, 1 gingival recession, and 6 furcation defect treatments. Due to the weak evidence and the controversial and unclear results, it appears important to encourage the researchers to produce Randomized Controlled clinical Trials aimed to investigate the efficacy of the orthodontic treatment for the correction of periodontal defects.
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Affiliation(s)
- Roberto Rotundo
- Department of Periodontology, University of Florence, Florence, Italy.
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25
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Orthodontic treatment of periodontal defects. A systematic review. Prog Orthod 2010; 11:41-4. [DOI: 10.1016/j.pio.2010.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 04/20/2010] [Indexed: 11/30/2022] Open
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GKANTIDIS N, CHRISTOU P, TOPOUZELIS N. The orthodontic-periodontic interrelationship in integrated treatment challenges: a systematic review. J Oral Rehabil 2010; 37:377-90. [DOI: 10.1111/j.1365-2842.2010.02068.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Ngom PI, Benoist HM, Soulier-Peigue D, Niang A. [Reciprocal relationships between orthodontics and periodontics: relevance of a synergistic action]. Orthod Fr 2010; 81:41-58. [PMID: 20359448 DOI: 10.1051/orthodfr/2010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The aim of this article is to review evidence on the reciprocal relationships between orthodontics and periodontics. Normal intra-arch and inter-arch relationships have long been considered as an anatomic prerequisite for the preservation of dental health and function. Certain malocclusion traits are associated with difficulties in maintaining good oral hygiene and as a consequence to poor periodontal condition. Therefore, proper alignment of the teeth provided by orthodontic treatment may promote good control of soft deposit and calculus and subsequent periodontal inflammation. The tendency of orthodontic appliances, particularly the brackets and bands to promote the accumulation of plaque and thus increasing the risk of developing localized periodontal disease must however be constantly emphasized. Periodontitis involves progressive loss of the alveolar bone around the teeth, pathological tooth migration and gingival recession with pathological tooth migration and gingival recession as a possible outcome. The effectiveness of orthodontics in conjunction with periodontics in the management of these esthetic and functional defects is highlighted in this review.
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Affiliation(s)
- Papa Ibrahima Ngom
- Département d'Odontologie, Faculté de Médecine, Pharmacie et Odontologie, Université Cheikh Anta Diop Dakar, Sénégal.
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Okamoto A, Ohnishi T, Bandow K, Kakimoto K, Chiba N, Maeda A, Fukunaga T, Miyawaki S, Matsuguchi T. Reduction of orthodontic tooth movement by experimentally induced periodontal inflammation in mice. Eur J Oral Sci 2009; 117:238-47. [PMID: 19583750 DOI: 10.1111/j.1600-0722.2009.00625.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Orthodontic therapy is known to have an aggravating effect on the progression of destructive periodontitis if oral hygiene is not maintained. However, it is largely unknown how active periodontitis affects the velocity of orthodontic tooth movement. In this study, we examined the effect of periodontal inflammation on orthodontic tooth movement using a mouse model. Orthodontic force was applied on the maxillary first molar of mice, with or without ligature wire to induce experimental periodontitis. The distance moved by the first molar was significantly reduced by the ligature-induced experimental periodontitis. Tartrate-resistant acid phosphatase staining revealed that the number of osteoclasts present during orthodontic treatment was lower in the pressure zone of alveolar bone in the presence of periodontal inflammation. Consistently, the expression level of receptor activator of nuclear factor-kappaB ligand (RANKL) in the pressure zone was decreased in the ligature group. By contrast, experimental periodontitis increased the expression of cyclooxygenase-2 mRNA in the periodontal tissues, while in vitro treatment with prostaglandin E(2) decreased extracellular signal-regulated kinase phosphorylation and RANKL expression induced by mechanical stress in osteoblasts. Taken together, these results suggest that the orthodontic force-induced osteoclastogenesis in alveolar bone was inhibited by the accompanying periodontal inflammation, at least partly through prostaglandin E(2), resulting in reduced orthodontic tooth movement.
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Affiliation(s)
- Atsuko Okamoto
- Department of Orthodontics, Kagoshima University, Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
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Medill S, Derocher AE, Stirling I, Lunn N, Moses RA. Estimating Cementum Annuli Width in Polar Bears: Identifying Sources of Variation and Error. J Mammal 2009. [DOI: 10.1644/08-mamm-a-186.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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30
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Medill S, Derocher AE, Stirling I, Lunn N. Reconstructing the reproductive history of female polar bears using cementum patterns of premolar teeth. Polar Biol 2009. [DOI: 10.1007/s00300-009-0689-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Mechanical responses to orthodontic loading: A 3-dimensional finite element multi-tooth model. Am J Orthod Dentofacial Orthop 2009; 135:174-81. [PMID: 19201323 DOI: 10.1016/j.ajodo.2007.03.032] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Revised: 03/01/2007] [Accepted: 03/01/2007] [Indexed: 11/24/2022]
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da Silva VC, Cirelli CC, Ribeiro FS, Leite FRM, Benatti Neto C, Marcantonio RAC, Cirelli JA. Intrusion of teeth with class III furcation: a clinical, histologic and histometric study in dogs. J Clin Periodontol 2008; 35:807-16. [DOI: 10.1111/j.1600-051x.2008.01293.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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34
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Passanezi E, Janson M, Janson G, Sant'Anna AP, de Freitas MR, Henriques JFC. Interdisciplinary treatment of localized juvenile periodontitis: A new perspective to an old problem. Am J Orthod Dentofacial Orthop 2007; 131:268-76. [PMID: 17276870 DOI: 10.1016/j.ajodo.2005.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Revised: 03/21/2005] [Accepted: 03/21/2005] [Indexed: 10/23/2022]
Abstract
What can be done for a 17-year-old girl with localized juvenile periodontitis, a Class II malocclusion, and flared teeth? Is it possible to regain epithelial attachment and rebuild the bone architecture? Is it possible to achieve good esthetics and occlusion with conventional orthodontic treatment, or is an interdisciplinary approach needed? What sequence should be followed? What is the prognosis for the affected teeth in the long term? Our aim in this article was to review the literature and present a clinical case to shed more light on the subject.
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Affiliation(s)
- Euloir Passanezi
- Department of Periodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
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37
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da Silva VC, Cirelli CC, Ribeiro FS, Costa MR, Comelli Lia RC, Cirelli JA. Orthodontic movement after periodontal regeneration of class II furcation: a pilot study in dogs. J Clin Periodontol 2006; 33:440-8. [PMID: 16677334 DOI: 10.1111/j.1600-051x.2006.00920.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The effect of orthodontic movement on the periodontal tissues of maxillary second pre-molars, after regenerative treatment for class II furcations, was evaluated in four mongrel dogs. MATERIAL AND METHODS Class II furcation lesions were created. After 75 days they were treated with bovine bone mineral matrix and guided tissue regeneration with absorbable membrane. After 2 months of daily plaque control, each of the dog's furcation pre-molars was randomly assigned to a test or control group. Orthodontic appliances were placed on both sides of the maxilla using third pre-molars and canines as anchorages. In the test group, bodily orthodontic movement of the second pre-molars was performed in the mesial direction for 3 months while control pre-molars remained unmoved. The dogs were sacrificed for histometric and histologic analyses. RESULTS There were no statistically significant differences between the two groups in total bone and biomaterial areas or linear extension of periodontal regeneration on the radicular surfaces. In the test group, however, there was a tendency to a greater quantity of bone and a lesser quantity of biomaterial. CONCLUSION The orthodontic movement was not pre-judicial to the results obtained with the regenerative periodontal treatment.
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Affiliation(s)
- Vanessa Camila da Silva
- Department of Periodontology, School of Dentistry at Araraquara, State University of São Paulo - UNESP, Araraquara, SP, Brazil
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Chan E, Darendeliler MA. Physical properties of root cementum: Part 7. Extent of root resorption under areas of compression and tension. Am J Orthod Dentofacial Orthop 2006; 129:504-10. [PMID: 16627176 DOI: 10.1016/j.ajodo.2004.12.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Revised: 12/15/2004] [Accepted: 12/15/2004] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of this article was to quantify the extent of root resorption in areas of compression or tension under light and heavy buccal tipping orthodontic forces. METHODS The sample consisted of 36 premolars in 16 patients. On 1 side, light (25 g) or heavy (225 g) buccal tipping orthodontic forces were activated for 28 days. The contralateral side in each patient served as the control (0 g). The teeth were extracted, disinfected, imaged under a scanning electron microscope, and analyzed with commercial stereo imaging computer software modified for this study. Buccal and lingual surfaces were divided into 3 equal regions: cervical, middle, and apical. The root surface areas of these regions were documented with straight-on images. Quantification of resorption craters by using volumetric analysis was performed from stereo images taken at +/-3 degrees. The degree of resorption was correlated to the amount of surface area under compression or tension. RESULTS AND CONCLUSIONS The buccal cervical region had 8.16-fold more root resorption in the heavy-force group compared with the light-force group (P <.01). The other regions did not seem to have significant differences in the force levels. In the experimental teeth, there was more root resorption in the high-compression regions than in the other regions (P <.01). There were similar amounts of resorption per unit area on the lingual apical and buccal cervical regions. Regions under compression had more root resorption than regions under tension. There was more resorption in regions under heavy compression than in regions under light compression (P <.01). There was also more root resorption in regions under heavy tension than in regions under light tension (P <.01).
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Affiliation(s)
- Eugene Chan
- Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, South West Area Health Services, Australia
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Cardaropoli D, Re S. Interdental papilla augmentation procedure following orthodontic treatment in a periodontal patient. J Periodontol 2005; 76:655-61. [PMID: 15857109 DOI: 10.1902/jop.2005.76.4.655] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The absence of the interdental papilla is a situation that may alter patients' esthetics. Recession of interproximal gingival tissues may be a consequence of periodontal disease, but in some cases it may also be a consequence of periodontal therapy, as a result of surgical or non-surgical procedures. METHODS The authors present a new multidisciplinary approach for the treatment of migrated maxillary incisors presenting infrabony defects, extrusion, and loss of the interdental papilla. RESULTS AND CONCLUSION The proposed clinical protocol may reconstruct the interproximal soft tissue, with esthetic improvement of the papillary level, together with resolution of the periodontal defects.
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Yamaoka M, Hashimoto M, Sugiura M, Matsuura T, Shiba T, Uematsu T, Furusawa K. Overeruption without root exposure of third molars and periodontal health in the mandible. Clin Oral Investig 2005; 9:192-6. [PMID: 15940543 DOI: 10.1007/s00784-005-0314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Accepted: 03/14/2005] [Indexed: 11/25/2022]
Abstract
Bone formation is seen around the third molar even when the tooth is exposed to the oral environment due to overeruption. To determine if overeruption of the third molar with or without root exposure is related to the status of the exposure of other teeth in the mandible, using orthopantomographs, 424 third molars were studied in 371 patients who were over 41 years of age. The rate of overeruption and root exposure in third molars was measured, and its relationship to the number of teeth lost and the rate of root exposure in other teeth in the mandible was analyzed. Tooth loss in the group of third molars with overeruption without root exposure was greater than in that without overeruption or root exposure in men, whereas the relationship was not seen in women. We found that root exposures of other teeth in the group of third molars with overeruption without root exposure were significantly smaller than in those with root exposure in both genders. Third molars with overeruption without root exposure, in which bone formation was easy to observe for radiographic diagnosis, were correlated with periodontal health in the mandible, suggesting a component of precision determination for predicting resistance to periodontitis.
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Affiliation(s)
- M Yamaoka
- Department of Oral and Maxillofacial Surgery, Matsumoto Dental University School of Dentistry, Shiojiri, Nagano 399-0781, Japan.
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Maeda S, Maeda Y, Ono Y, Nakamura K, Sasaki T. Interdisciplinary treatment of a patient with severe pathologic tooth migration caused by localized aggressive periodontitis. Am J Orthod Dentofacial Orthop 2005; 127:374-84. [PMID: 15775955 DOI: 10.1016/j.ajodo.2004.01.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An interdisciplinary approach was used to treat a patient with pathologic migration of teeth, with severe anterior proclination and molar mesial inclination due to localized aggressive periodontitis. The combination of regenerative periodontal therapy, prosthodontic rehabilitation, and orthodontic treatment greatly improved function and esthetics.
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Affiliation(s)
- Sachiko Maeda
- Fukoku Building Dental Clinic, 2-4 Komatsubara-cho, Kita-ku, Osaka, Japan.
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Nemcovsky CE, Beny L, Shanberger S, Feldman-Herman S, Vardimon A. Bone Apposition in Surgical Bony Defects Following Orthodontic Movement: A Comparative Histomorphometric Study Between Root- and Periodontal Ligament-Damaged and Periodontally Intact Rat Molars. J Periodontol 2004; 75:1013-9. [PMID: 15341361 DOI: 10.1902/jop.2004.75.7.1013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The influence of orthodontic tooth movement with diminished periodontal support is unclear. The aim of the present study was to evaluate bone healing in surgical defects following orthodontic tooth movement with and without periodontal ligament (PDL) and root surface damage. METHODS The study comprised 33 adult male Wistar rats, divided into two groups: group 1 (n = 14) with bony defect and no root damage and group 2 (n = 19) with periodontal bony defect including root/PDL damage on the mesial root of the maxillary first molar. One week after a surgical defect was created, orthodontic protraction of the right maxillary first molar was initiated in both groups. After 2 weeks of protraction, retention of 1 week was established; at the end of this period block sections were made. Histomorphometric analysis through light microscopy of decalcified tissue was performed. Results were statistically analyzed using independent samples t test and analysis of variance (ANOVA) with repeated measures. RESULTS Differences between groups in total area of bone defect and bone apposition were not statistically significant. Bone apposition calculated as percentage of the bone defect was significantly (t-test) greater (P = 0.002) in group 2 (46.21%) than in group 1 (24.95%). Within each group, area of bone apposition was significantly (ANOVA) greater in the distal than in the mesial quadrants of the bony defect (P = 0.006) and in the apical than the occlusal ones (P = 0.021). CONCLUSION Following orthodontic tooth movement, periodontal bony defects showed enhanced bony healing compared with alveolar bone defects with no direct association with the periodontal attachment apparatus.
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Affiliation(s)
- Carlos E Nemcovsky
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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Re S, Cardaropoli D, Abundo R, Corrente G. Reduction of gingival recession following orthodontic intrusion in periodontally compromised patients. Orthod Craniofac Res 2004; 7:35-9. [PMID: 14989753 DOI: 10.1111/j.1601-6343.2004.00277.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the role of orthodontic intrusion and alignment in the reduction of gingival recession (REC) around maxillary incisors of adult periodontal patients. Design - Prospective clinical study. SETTING AND SAMPLE POPULATION Twenty-eight consecutively treated adult patients, suffering from severe chronic periodontitis and with one upper central incisor extruded and infrabony defect on its mesial site. All patients were seen in a private practice in Turin, Italy. At baseline, all patients presented with REC on the buccal and mesial aspects of the treated teeth. MEASUREMENTS AND RESULTS For each patient probing pocket depth (PPD) and REC were assessed at baseline, at the end of treatment and 1-year after the end of treatment. REC was also evaluated independently in patients with narrow (NPB) or wide periodontal biotype (WPB). All parameters showed improvement between initial and final measurements statistically, and showed no changes between final and follow-up measurements. Mean mesial PPD decrease was 4.29 mm, with a residual PPD of 2.50 mm. Mean REC reduction was 0.96 mm on the buccal sites and 1.71 mm on the mesial. No statistical difference was recorded on REC values between groups NPB and WPB. CONCLUSION The presented clinical protocol resulted in improvement of all parameters examined. At the end of orthodontic treatment a predictable reduction of REC was reported, both in patients with thin or wide gingiva.
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Affiliation(s)
- S Re
- Private Practice, Turin, Italy
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Corrente G, Abundo R, Re S, Cardaropoli D, Cardaropoli G. Orthodontic Movement into Infrabony Defects in Patients with Advanced Periodontal Disease: A Clinical and Radiological Study. J Periodontol 2003; 74:1104-9. [PMID: 14514223 DOI: 10.1902/jop.2003.74.8.1104] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In cases of advanced periodontal disease with a pathologic flaring of frontal teeth, a combined periodontic-orthodontic therapy may be a reliable approach in order to solve both functional and esthetic problems. The aim of the present study was to evaluate the periodontal tissue alterations following periodontal surgery and orthodontic intrusion in migrated upper central incisors with intrabony defects. METHODS Ten patients with advanced periodontal disease and an extruded maxillary central incisor infrabony defect at its mesial aspect and probing depth (PD) > or = 6 mm were included in the present study. At baseline, PD and clinical attachment level (CAL) were measured. The vertical and horizontal dimensions of the defects were assessed on standardized radiographs. Seven to 10 days after surgery the active orthodontic treatment started using the segmented arch technique, in order to intrude and move the teeth into the defects. Maintenance therapy was performed every 2 to 3 months until the orthodontic treatment was completed. RESULTS At the end of treatment, mean PD reduction was 4.35 mm, with a residual mean PD of 2.80 mm. Mean CAL gain was 5.50 mm. The mean radiological vertical and horizontal bone fills were, respectively, 1.35 mm and 1.40 mm. All differences were of statistical significance (P<0.001). CONCLUSION The present study showed that the combined orthodontic and periodontic therapy performed resulted in the realignment of extruded teeth with infrabony defects, obtaining a significant probing depth reduction, clinical attachment gain, and radiological bone fill.
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Cirelli CC, Cirelli JA, da Rosa Martins JC, Lia RCC, Rossa C, Marcantonio E. Orthodontic movement of teeth with intraosseous defects: Histologic and histometric study in dogs. Am J Orthod Dentofacial Orthop 2003; 123:666-73; discussion 673-5. [PMID: 12806347 DOI: 10.1016/s0889-5406(03)00154-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to evaluate histologically, in dogs, the periodontal healing of 1-walled intraosseous defects in teeth that were subjected to orthodontic movement toward the defects. The defects were surgically created bilaterally at the mesial aspects of the maxillary second premolars and distal aspects of the mandibular second premolars of 4 mongrel dogs. One week after creating the defects, an orthodontic appliance was installed, and the teeth were randomly assigned to 1 of 2 treatment groups: those in the test group received a titanium-molybdenum alloy rectangular wire spring that performed a controlled tipping root movement, and those in the control group received a passive stainless steel wire. Active orthodontic movement of the test teeth lasted 2 months and was followed by a stabilization period of another 2 months, after which the animals were killed. Throughout the study, routine daily plaque control was performed on the dogs with a topical application of a 2% chlorhexidine gel. The results showed no difference between the groups, with some regularization of the defects and periodontal regeneration limited to the apical portion of the defects. Histometric analysis showed a significant difference in bone height; on average, it was 0.53 mm smaller in the test group. It was concluded that orthodontic movement does not interfere with the healing of 1-walled intraosseous defects, with the exception of the linear extent of new bone apposition.
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Affiliation(s)
- Carolina Chan Cirelli
- Department of Orthodontics, School of Dentistry at Araraquara, State University of São Paulo (UNESP), Brazil
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Carvalho RS, Nelson D, Kelderman H, Wise R. Guided bone regeneration to repair an osseous defect. Am J Orthod Dentofacial Orthop 2003; 123:455-67. [PMID: 12695774 DOI: 10.1067/mod.2003.59] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The ultimate goal of orthodontic therapy is to establish functional and esthetic dental relationships in a balanced facial pattern. In patients with compromised periodontal support, the use of multidisciplinary treatment plans is essential in attaining these goals. This case report includes a thorough documentation of the orthodontic and periodontal treatments to demonstrate the effectiveness of guided bone regenerative procedures combined with a bone allograft to aid in correcting a dental malocclusion.
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Affiliation(s)
- Roberto S Carvalho
- Department of Orthodontics, Boston University School of Dental Medicine, MA, USA
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Ogihara S, Marks MH. Alveolar bone upper growth in furcation area using a combined orthodontic-regenerative therapy: a case report. J Periodontol 2002; 73:1522-7. [PMID: 12546104 DOI: 10.1902/jop.2002.73.12.1522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This case report demonstrates orthodontic and regenerative combined therapy in a 49-year-old male whose right maxillary premolar furcation had a bony defect with poor biologic width resulting from extensive subgingival caries. In these advanced interdisciplinary cases, crown lengthening with periodontal surgery alone does not solve the complex clinical problems. We believe that a combined orthodontic and periodontal regenerative combination therapy offers the best option for achieving a predictable outcome. METHODS First, regenerative therapy by open debridement with a bioabsorbable synthetic bone graft, bioabsorbable membrane, and minocycline root conditioning was carried out. Eight weeks after initial surgery, orthodontic extrusion was initiated. RESULTS Radiographs and reentry documentation suggest that the furcation defect associated with poor biologic width was successfully treated. CONCLUSION This case report demonstrates that orthodontic-regenerative combined therapy can resolve complex clinical problems and enhance predictability.
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Affiliation(s)
- Shigeki Ogihara
- School of Dental Medicine, University of Pennsylvania, Philadelphia, USA
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Abstract
The purpose of this article is to provide an update of the interrelationship between periodontics and orthodontics in adults. Specific areas reviewed are the reaction of periodontal tissue to orthodontic forces, the influence of tooth movement on the periodontium, the effect of circumferential supracrestal fiberotomy in preventing orthodontic relapse, the effect of orthodontic treatment on the periodontium, microbiology associated with orthodontic bands, and mucogingival and esthetic considerations. In addition, the relationship between orthodontics and implants (eg, using dental implants for orthodontic anchorage) is discussed.
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Affiliation(s)
- Marianne M A Ong
- Periodontics Unit, Department of Restorative Dentistry, National Dental Centre, Singapore
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Cardaropoli D, Re S, Corrente G, Abundo R. Intrusion of migrated incisors with infrabony defects in adult periodontal patients. Am J Orthod Dentofacial Orthop 2001; 120:671-5; quiz 677. [PMID: 11742313 DOI: 10.1067/mod.2001.119385] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This report describes the orthodontic treatment of 10 adult patients who had severe periodontal disease, with migration and radiological evidence of an infrabony defect on a maxillary central incisor. Orthodontic tooth movement, using light and continuous forces, was initiated 7 to 10 days after periodontal surgical therapy. Mean orthodontic treatment time was 10 months. Before surgery and at the end of orthodontic treatment, the following parameters were registered clinically and with standardized intraoral radiographs: probing depth, clinical crown length, marginal bone level, bone defect radiological dimension, and root length. Comparison of pre- and posttreatment values showed a statistically significant improvement for all parameters without a remarkable decrease of root length. The mean residual probing depth was 2.80 mm, and the mean intrusion of the incisors was 2.05 mm. Moreover, radiographs showed a reduction of the infrabony defects. These results show the efficacy of a combined orthodontic-periodontal approach. Intrusive movement, after proper periodontal surgical therapy, can positively modify both the alveolar bone and the soft periodontal tissues.
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Affiliation(s)
- D Cardaropoli
- Dental Clinic, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, 10133 Turin, Italy
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Vardimon AD, Nemcovsky CE, Dre E. Orthodontic tooth movement enhances bone healing of surgical bony defects in rats. J Periodontol 2001; 72:858-64. [PMID: 11495132 DOI: 10.1902/jop.2001.72.7.858] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The question of whether the repair of an alveolar bony defect can be enhanced by orthodontic tooth movement was addressed. METHODS Alveolar bone defects were created in 52 Wistar male rats anterior to both maxillary first molars. After 1 week of healing, orthodontic protraction was applied for 2 weeks on the right side, resulting in mesial tipping and displacement movement. Subsequently, a retention appliance was inserted for 1 week. The left side served as the untreated (control) group. Vital bone staining (procion brilliant red H-8) was administered before and after orthodontic traction. Histomorphometric analysis was performed on 62 hemimaxillae using UV confocal microscopy and an imaging program. The total area of the bony defect was divided into 4 equal quadrants, and the area of bony apposition in each quadrant was measured. RESULTS The total area of bony apposition was 6.5-fold larger in the treated (26.41 x 10(4) +/- 28.92 x 10(4) microm2) than in the control group (4.07 x 10(4) +/- 2.82 x 10(4) microm2), approaching statistical significance (P = 0.065). The treated occlusal quadrants demonstrated highly significant (P= 0.010), greater bone apposition compared to the control group (13.8-fold) and to the treated apical quadrants (P= 0.04, 5-fold). CONCLUSIONS This study confirms that orthodontic tooth movement is a stimulating factor of bone apposition. A conversion in the repair pattern of the bony defect from apicoocclusal in the control group (no tooth movement) to occlusoapical in the treated group (with tooth movement) further supports the linkage between tooth movement and enhanced bone deposition. Clinical implication suggests incorporation of orthodontic tooth movement in regenerative therapy.
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Affiliation(s)
- A D Vardimon
- Department of Orthodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel.
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