Ortho-Perio Risk Assessment and timing flowchart for lingual orthodontics in an interdisciplinary adult ortho-perio patient: A case report of ``Perio-Guided'' Orthodontic treatment

INTRODUCTION

The treatment of ortho-perio patients is a challenge for the interdisciplinary team. Not only are adult patients with overt perio pathology involved, but any ortho patient, even young ones, can be a perio patient and vice versa. Diagnosis and risk assessment of every ortho-perio patient is essential to establish a correct treatment plan, schedule and prognosis. Orthodontics becomes a ``Perio-Guided" Orthodontic Treatment and Periodontics a "Ortho-Guided Periodontal Treatment".

MATERIAL AND METHODS

This case report presents a man with a very compromised dentition asking for a complete interdisciplinary rehabilitation treated with a combined ortho-perio treatment in lingual mechanics. The periodontal evaluation confirmed the possibility of performing orthodontic treatment after active periodontal treatment. Treatment objectives were the resolution of the crowding, the correction of the levels of the gingival margin, the bone levelling, the preparation for restorative spaces; the objectives of the latter prior to implant placement were: redistribution of space, optimization of the position of adjacent teeth and their parallelism, exploitation of edentulous sites to correct dental class II and placement of the least number of implants possible. After integrating the conventional perio risk assessment with a new Ortho-Perio Risk Assessment (OPRA), a lingual fixed appliance was applied with the help of miniscrews to correct class II division 2 by substituting the upper right first premolar into a canine and retracting the entire upper arch, while correcting the deep bite and optimising the occlusion.

RESULTS

At the end of the treatment, the patient had molar relationships of class II on the right and class I on the left with a class I canine and the 14 in the position of 13. Incisal relationships were corrected, the position of the incisors was optimized, the spaces in the upper arch were fully resolved by orthodontics. During the treatment, orthodontics corrected the uneven gingival margin of the anterior teeth and levelled the bone.

CONCLUSIONS

Correct ortho-perio risk assessment (OPRA) is necessary to plan the risk of expression of the periodontal phenotype in ortho-patient. OPRA and the lingual mechanics allowed an orthodontic resolution of the malocclusion and an enhancement of the perio-implant-restorative contributions. OPRA followed by periodontal therapy and lingual mechanics resolved the malocclusion by improving the restorative peri-implant conditions. Orthodontists and periodontists should be aware of the characteristics of the individual expression of the periodontal phenotype at the beginning of treatment and involve patients in the outcome, sequencing of combined treatments, ortho-perio retention and stability.

Lingual orthodontics in an adult patient with upper premolar extraction: Case report

OBJECTIVE

To show with this case report that lingual orthodontics can be a solution in complex adult situation and with interdisciplinary approach.

MATERIALS AND METHODS

The patient presented a dental and skeletal high angle class II division 1 with a previous extraction of one mandibular incisor. The strategy of treatment was upper first premolar-extraction to obtain a correction of the incisal-class II relationship with a normal lip function, a class II molar relationship on the right side and a class I on the left side. A lingual appliance and miniscrews were used.

RESULTS

The lingual orthodontic treatment with miniscrews responded to the occlusal objectives with a good upper incisors torque and retraction control.

DISCUSSION

Limits and advantages of lingual orthodontics were discussed.

CONCLUSION

Lingual mechanics can provide good results from both an aesthetic and function point of view in adult complex extractions case. It ensures aesthetics during treatment, incisor control during retraction. Miniscrews were also useful to overcome the periodontal limits and enhance the anchorage.

Orthodontic-periodontal interactions: Orthodontic extrusion in interdisciplinary regenerative treatments

Orthodontics is a periodontal treatment. "Guided orthodontic regeneration" (GOR) procedures use orthodontic movements in perio-restorative patients. The GOR technique includes a guided orthodontic "soft tissue" regeneration (GOTR) and a guided orthodontic "bone" regeneration (GOBR) with a plastic soft tissue approach and a regenerating reality. The increased amount of soft tissue gained with orthodontic movement can be used for subsequent periodontal regenerative techniques. The increased amount of bone can as well improve primary implant stability and, eventually, simplify a GTR technique to regenerate soft tissues, to restore tooth with external resorption in aesthetic zone or to extract a tooth to create new hard-soft tissue for adjacent teeth.

Mandibular response and directional forces with a new functional orthopedic appliance - A clinical case treated with a "Paolone-Kaitsas (PK) appliance"

Class II/1 malocclusion needs strict vertical control in order to obtain a mandibular response and correction of the sagittal discrepancy. These objectives can be achieved not only in one-stage treatments but also in two stages, when clinicians decide to perform functional therapy for psychological, traumatological or social reasons. This paper reports on expression of mandibular response and directional forces in a two-stage class II/1 malocclusion using a new functional appliance. The Paolone-Kaitsas (PK) appliance provides vertical control and occlusal plane management during the very first phases of treatment. It prepares the anchorage of the denture used in the second phase of treatment.

Guided orthodontic regeneration: A tool to enhance conventional regenerative techniques in implant surgery

A hopeless upper central incisor was subjected to forced eruption before implant substitution to improve and develop the amount of soft tissue. This involved a GBR to insert the implant and a GTR to regenerate the tissue around the dehiscence of the nearby lateral using a "Guided Orthodontic Regeneration" (GOR) approach. The extrusion was performed esthetically in lingual orthodontics. The GOR technique included a Guided Orthodontic "Bone" Regeneration (GOBR) and a Guided Orthodontic "Soft Tissue" Regeneration (GOTR). This developed a 3D implant site while correcting the osseous defects and increasing the amount of soft tissue, which was used for a subsequent regenerative technique.

Tensile test and interface retention forces between wires and composites in lingual fixed retainers

INTRODUCTION

In daily orthodontic clinical practice retention is very important, and lingual retainers are part of this challenge. The failure of lingual retainers may be due to many factors. The aim of this study was to assess the retention forces and mechanical behavior of different types of wires matched with different kinds of composites in lingual retainers.

METHODS

A tensile test was performed on cylindrical composite test specimens bonded to orthodontic wires. The specimens were constructed using four different wires: a straight wire (Remanium .016×.022″ Dentaurum), two round twisted wires (Penta One .0215″ Masel, Gold Penta Twisted .0215″ Gold N'braces) and a rectangular braided wire (D-Rect .016×.022″ Ormco); and three composites: two micro-hybrids (Micro-Hybrid Enamel Plus HFO Micerium, and Micro-Hybrid SDR U Dentsply) and a micro-nano-filled composite (Micro-Nano-Filled Transbond LR 3M). The test was performed at a speed of 10mm/min on an Inström device. The wire was fixed with a clamp.

RESULTS

The results showed that the bonding between wires and composites in lingual fixed retainers seemed to be lowest for rectangular smooth wires and increased in round twisted and rectangular twisted wires where the bonding was so strong that the maximum tension/bond strength was greater than the ultimate tensile strength of the wire. The highest values were in rectangular twisted wires. Concerning the composites, hybrid composites had the lowest interface bonding values and broke very quickly, while the nano- and micro-composites tolerated stronger forces and displayed higher bonding values. The best results were observed with the golden twisted wire and reached 21.46 MPa with the Transbond composite. With the rectangular braided wire the retention forces were so high that the Enamel Plus composite fractured when the load exceeded 154.6 N/MPa. When the same wire was combined with the Transbond LR either the wire or the composite broke when the force exceeded 240 N.

CONCLUSIONS

The results of this study show that, when selecting a lingual retainer in daily clinical practice, not only must the patient's compliance and dependability be considered but also the mechanical properties and composition of different combinations of composites and wires.

Lingual orthodontics and forced eruption: a means for osseous and tissue regeneration

An hopeless upper central incisor was subjected to forced eruption in order to improve and develop the implant site by distraction of the periodontal ligament-alveolar bone complex. The orthodontic extrusion was carried out with two aesthetic approaches: lingual orthodontics and a composite resin 2-2 veneer pontic. The first part of the extrusion was realized with lingual orthodontics alone, then, when the crown had been remodelled in its greatest part and the aesthetics was no more acceptable to the patient a composite resin 2-2 veneer pontic was bonded to the vestibular side of the other three incisors to mimetise the extruded tooth and to be anchorage to the lingual mechanics. The orthodontic preparation of the implant site allowed the correction of the periodontal defect due to the fracture, the enhancement of the alveolar bone and the soft tissue remodelling.