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Tietmann C, Jepsen S, Kauer R, Jepsen K. Clinical effectiveness of regenerative periodontal surgery and orthodontic tooth movement with clear aligners in stage IV periodontitis: a case series. Quintessence Int 2024; 0:0. [PMID: 38619257 DOI: 10.3290/j.qi.b5213521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVES To evaluate the clinical effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic therapy (OT) with clear aligners in stage IV (type 2) periodontitis. METHOD AND MATERIALS Ten patients with a total of 103 intra-bony defects were analyzed after regenerative surgery using collagen-deproteinized bovine bone mineral with or without collagen membrane or enamel matrix derivative followed by OT with clear aligners. Changes in radiographic bone level (rBL) and probing pocket depths (PPD) were evaluated after 1 year (T1) and at final splinting (T2) after orthodontic tooth movement. RESULTS Mean rBL gain was significant with 2.13 mm (±1.64 mm) after 1 year (T1) and 3.02 mm (±2.00mm) at final splinting (T2). Mean PPD was significantly reduced from 5.40 mm (±1.80 mm)at baseline to 3.78 mm (±1.73 mm) at T1 and remained stable with 3.73 mm (±1.70 mm)at T2. Pocket closure (PPD< 4mm) was accomplished in 76% of all defects. Tooth loss amounted to 2.9%. CONCLUSION Within the limitations of the retrospective study design, the findings suggest that the interdisciplinary treatment of periodontitis stage IV by regenerative periodontal surgery and consecutive OT with clear aligners can lead to favorable results.
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Georgantza A, Manasse M, Tupinambá R, Nobrega C, Pigliacelli S, Cheng Paul Yu Y, Starace J, Palomo L. Saving teeth: Revisited. Esthetic improvement and long-term periodontal stability of a pathologic tooth migration case: An 84-month follow-up. Clin Adv Periodontics 2023; 13:258-265. [PMID: 37126210 DOI: 10.1002/cap.10244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Advances in implant dentistry, often influence our clinical treatment planning and steer us as periodontists from our fundamental values of preserving teeth. Pathologic tooth migration (PTM) of maxillary anterior teeth is a common sequela of periodontitis in patients and results in significant esthetic and functional problems. Patients' growing concern about the esthetics of their teeth and their fears of losing teeth are often reasons for them to seek treatment. We commonly assign a hopeless prognosis to these pathologically migrated teeth because of the significant loss of periodontal support and go with the "safer" choice of replacing them with implants. The purpose of this case report is to present the long-term (7-year) periodontal stability of compromised teeth and to emphasize the successful outcomes achieved when orthodontics, non-surgical periodontal, and restorative treatments are combined. METHODS AND RESULTS A 38-year-old, otherwise healthy male with compromised function and esthetics, PTM, periodontal disease, and missing teeth presented to our clinic. Primary treatment objectives were to 1) eliminate the periodontal inflammation and 2) restore and stabilize the occlusion by employing non-surgical periodontal treatment, adult orthodontics, and prosthodontics. Following interdisciplinary treatment, clinical and radiographic re-evaluation revealed significant clinical attachment gain, reduction in tooth mobility, favorable esthetics, and better overall prognosis. At an 84-month follow-up, the patient was periodontally healthy and retained his natural dentition. CONCLUSIONS Interdisciplinary collaboration along with patient compliance may increase the longevity of periodontally compromised teeth and improve esthetics for periodontitis patients who suffer from PTM. Such long-term favorable outcomes reaffirm the value of classic periodontal treatment and the success of multidisciplinary treatment to save teeth as a viable alternative to the extraction of teeth and the placement of implant retained restorations.
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Affiliation(s)
- Aikaterini Georgantza
- Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Maryse Manasse
- Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | | | - Celestino Nobrega
- Department of Orthodontics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Steven Pigliacelli
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
| | - Yung Cheng Paul Yu
- Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Jason Starace
- Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Leena Palomo
- Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
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Kudo M, Shirakata Y. Multidisciplinary approach involving strategic implant placement before orthodontic (SIMBO) treatment for generalized stage IV grade C periodontitis: A case report with 10-year follow-up. J ESTHET RESTOR DENT 2023; 35:1171-1185. [PMID: 37350421 DOI: 10.1111/jerd.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE The aim of this case report was to demonstrate the long-term effects of a multidisciplinary approach involving periodontal reconstructive surgery and strategic implant placement before orthodontic (SIMBO) treatment in a patient with severe periodontitis (e.g., stage IV/grade C). CLINICAL CONSIDERATIONS The patient presented with severe periodontitis and pathologic tooth migration (PTM) without stable occlusion or occlusal support. After performing cause-related therapy, periodontal regenerative surgery, pre-orthodontic posterior implant placement, and orthodontic treatment involving anterior implant placement with papilla reconstruction, the patient achieved full-mouth rehabilitation and improvement of dental and smile esthetics. The clinical and radiographic results obtained were maintained over a 10-year period. CONCLUSION Within the limits of this as a single case, multidisciplinary treatment involving the SIMBO approach appeared to allow long-term improvement of periodontal condition, stability of the dental arches and occlusion, and esthetics in a patient with severe periodontitis, PTM and posterior bite collapse. Future studies with more subjects are needed to evaluate and validate this approach. CLINICAL SIGNIFICANCE When addressing periodontal disease, SIMBO approach-based multidisciplinary treatment appears safe and effective as a clinical protocol for establishing esthetic and functional rehabilitation in generalized stage IV/grade C periodontitis.
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Affiliation(s)
| | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Oruba Z, Gibas-Stanek M, Pihut M, Cześnikiewicz-Guzik M, Stós W. Orthodontic treatment in patients with periodontitis - a narrative literature review. Aust Dent J 2023; 68:238-246. [PMID: 37688346 DOI: 10.1111/adj.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
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.
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Affiliation(s)
- Z Oruba
- Faculty of Medicine, Department of Periodontology, Preventive Dentistry and Oral Pathology, Institute of Dentistry, Jagiellonian University Medical College, Kraków, Poland
| | - M Gibas-Stanek
- Faculty of Medicine, Institute of Dentistry, Jagiellonian University Medical College, Chair of Prosthodontics and Orthodontics, Kraków, Poland
| | - M Pihut
- Faculty of Medicine, Institute of Dentistry, Jagiellonian University Medical College, Chair of Prosthodontics and Orthodontics, Kraków, Poland
| | - M Cześnikiewicz-Guzik
- Faculty of Medicine, Department of Periodontology, Preventive Dentistry and Oral Pathology, Institute of Dentistry, Jagiellonian University Medical College, Kraków, Poland
| | - W Stós
- Faculty of Medicine, Institute of Dentistry, Jagiellonian University Medical College, Chair of Prosthodontics and Orthodontics, Kraków, Poland
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Tietmann C, Jepsen S, Heibrok H, Wenzel S, Jepsen K. Long-term stability of regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: 10-year data of a retrospective study. J Periodontol 2023; 94:1176-1186. [PMID: 37010261 DOI: 10.1002/jper.23-0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the long-term effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic therapy (OT) in stage IV periodontitis. METHODS Twenty-two patients with a total of 256 intra-bony defects were analyzed after regenerative surgery followed by OT initiated 3 months later. Changes in radiographic bone level (rBL) and probing pocket depths (PPD) were evaluated after 1 year (T1), final splinting (T2), and 10 years (T10). RESULTS Mean rBL gain was significant with 4.63 mm (±2.43 mm) after 1 year (T1), 4.19 mm (±2.61 mm) at final splinting (T2), and 4.48 mm (±2.62 mm) after 10 years (T10). Mean PPD was significantly reduced from 5.84 mm (±2.05 mm) at baseline to 3.19 mm (±1.23 mm) at T1, to 3.07 mm (±1.23 mm) at T2, and to 2.93 mm (±1.24 mm) at T10. Pocket closure (PPD ≤ 4 mm) was achieved in 90% of all defects. Tooth loss amounted to 4.5%. CONCLUSIONS Within the limitations of this retrospective study design, these 10-year findings suggest that in motivated and compliant patients with stage IV periodontitis and in need of OT an inter-disciplinary treatment can lead to favorable and stable long-term results.
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Affiliation(s)
- Christina Tietmann
- Private Practice for Periodontology, Aachen, Germany
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | | | - Sven Wenzel
- Private Practice for Periodontology, Aachen, Germany
| | - Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Jepsen K, Tietmann C, Martin C, Kutschera E, Jäger A, Wüllenweber P, Gaveglio L, Cardaropoli D, Sanz-Sánchez I, Fimmers R, Jepsen S. Synergy of Regenerative Periodontal Surgery and Orthodontics Improves Quality of Life of Patients with Stage IV Periodontitis: 24-Month Outcomes of a Multicenter RCT. Bioengineering (Basel) 2023; 10:695. [PMID: 37370626 PMCID: PMC10295428 DOI: 10.3390/bioengineering10060695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany; (C.T.)
| | - Christina Tietmann
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany; (C.T.)
- Private Practice for Periodontology, Krefelder Strasse 73, 52070 Aachen, Germany
| | - Conchita Martin
- BIOCRAN Research Group, University Complutense of Madrid, 28040 Madrid, Spain
| | - Eric Kutschera
- Department of Orthodontics, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany
| | - Andreas Jäger
- Department of Orthodontics, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany
| | - Peter Wüllenweber
- Private Practice for Orthodontics, Theaterstraße 98-102, 52062 Aachen, Germany
| | - Lorena Gaveglio
- Private Practice, Corso Galileo Ferraris 148, 10129 Turino, Italy
| | | | | | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, 53127 Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnenstrasse 17, 53111 Bonn, Germany; (C.T.)
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Garbo D, Aimetti M, Bongiovanni L, Vidotto C, Mariani GM, Baima G, Romano F. Periodontal and Orthodontic Synergy in the Management of Stage IV Periodontitis: Challenges, Indications and Limits. Life (Basel) 2022; 12. [PMID: 36556496 DOI: 10.3390/life12122131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Jepsen K, Tietmann C, Kutschera E, Wüllenweber P, Jäger A, Cardaropoli D, Gaveglio L, Sanz Sanchez I, Martin C, Fimmers R, Jepsen S. The effect of timing of orthodontic therapy on the outcomes of regenerative periodontal surgery in patients with stage IV periodontitis: A multicenter randomized trial. J Clin Periodontol 2021; 48:1282-1292. [PMID: 34312872 DOI: 10.1111/jcpe.13528] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/29/2022]
Abstract
AIM To compare the outcomes after early (4 weeks post surgery) or late (6 months post surgery) orthodontic therapy (OT) following regenerative surgery of intra-bony defects (IDs). MATERIALS AND METHODS In a multi-center, parallel-group, randomized clinical trial, 43 patients with stage IV periodontitis were randomized to receive either early (n = 23) or late OT (n = 20) following regenerative surgery of IDs. Primary outcome was change in clinical attachment level (CAL) in one target ID at 12 months after surgery. Secondary outcomes were changes of probing pocket depth (PPD), bleeding on probing (BOP), and frequency of pocket closure. RESULTS No statistically significant differences between groups could be observed for CAL gain (5.4 mm [±2.1 mm] for early; 4.5 mm [±1.7 mm] for late OT). PPD was reduced by 4.2 mm (±1.9 mm) in the early group and by 3.9 mm (±1.5 mm) in the late group (p > .05). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects in early compared to 85% in late OT. CONCLUSION In the inter-disciplinary treatment of periodontitis stage IV, OT can be initiated already 4 weeks after regenerative surgery of IDs with favourable results, thus reducing the overall treatment time.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital of Bonn, Bonn, Germany
| | | | - Eric Kutschera
- Department of Orthodontics, University of Bonn, Bonn, Germany
| | | | - Andreas Jäger
- Department of Orthodontics, University of Bonn, Bonn, Germany
| | | | | | | | - Conchita Martin
- BIOCRAN Research Group, University Complutense of Madrid, Madrid, Spain
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital of Bonn, Bonn, Germany
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Iwata M, Saito A, Kuroda Y, Shinohara T, Arai D, Horie H, Tanaka E. Comprehensive treatment for severe periodontitis with pathologic tooth migration-related bimaxillary protrusion: A case report with 3-year follow-up. J Am Dent Assoc 2021; 152:471-482.e2. [PMID: 34044978 DOI: 10.1016/j.adaj.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OVERVIEW Patients with severe periodontitis often experience pathologic tooth migration (PTM), which impairs esthetics and leads to occlusal disharmony (for example, premature contacts and traumatic occlusion) that can further exacerbate periodontitis. The authors describe a patient who exhibited severe periodontitis with PTM-related bimaxillary protrusion. This report includes 3-year clinical outcomes after periodontal regenerative therapy, implant-anchored orthodontic therapy, and implant prosthodontics intended to achieve both functional and esthetic improvements. CASE DESCRIPTION A 63-year-old woman sought treatment with the chief complaint of maxillary anterior tooth mobility. Clinical examination revealed excessive tooth mobility, deep periodontal pockets, and infrabony defects in all teeth. All teeth exhibited PTM; the mandibular anterior teeth exhibited marked protrusion caused by the progression of periodontitis. After initial periodontal therapy, periodontal regenerative therapy was performed in all molar regions. At 6 and 9 months postoperatively, comprehensive orthodontic treatment was initiated for the mandible and maxilla, respectively, using orthodontic anchorage devices to achieve acceptable functional occlusion. After orthodontic treatment, staged guided bone regeneration was performed and dental implants were placed in the severely resorbed maxillary anterior ridge. This comprehensive treatment yielded favorable periodontal conditions, stable occlusion, and good esthetic outcomes. CONCLUSIONS AND PRACTICAL IMPLICATIONS Favorable esthetics, stable occlusion, and highly cleansable periodontal tissues were achieved with well-planned interdisciplinary and comprehensive treatment, although the patient had severe periodontitis and PTM-related bimaxillary protrusion.
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Tietmann C, Bröseler F, Axelrad T, Jepsen K, Jepsen S. Regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: A retrospective practice-based cohort study. J Clin Periodontol 2021; 48:668-678. [PMID: 33555608 DOI: 10.1111/jcpe.13442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/23/2020] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
AIM Evaluation of the effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic tooth movements in stage IV periodontitis. MATERIAL AND METHODS A total of 526 intra-bony defects in 48 patients were analysed after regenerative therapy using collagen-deproteinized bovine bone mineral with or without collagen membrane or enamel matrix derivative followed by orthodontic tooth movement initiated 3 months after surgery. Changes in radiographic bone levels (BL) and probing pocket depths (PPD) were evaluated after 1 year and up to 4 years. RESULTS Tooth loss amounted to 0.57%. Mean BL gain was 4.67 mm (±2.5 mm) after 1 year and 4.85 mm (±2.55 mm) after up to 4 years. Mean PPD was significantly reduced from 6.00 mm (±2.09 mm) at baseline to 3.45 mm (±1.2 mm) after 1 year, and to 3.12 mm (±1.36 mm) after 2-4 years. Pocket closure (PPD ≤4 mm) was accomplished in 87% of all defects. Adjunctive antibiotic therapy did not show any statistically significant impact on treatment outcomes. CONCLUSIONS Within the limits of this retrospective study design, the findings suggest that the combination of regenerative treatment and consecutive orthodontic tooth movements resulted in favourable results up to 4 years.
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Affiliation(s)
| | | | | | - Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Karthikeyan BV, Khanna D, Prabhuji ML. Repositioning of a pathologically migrated tooth using autologous platelet-rich plasma: a case report with 3-year follow-up. Gen Dent 2017; 65:e17-e21. [PMID: 28068276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An intricate balance between the periodontal tissues and the forces of occlusion, tongue, and lips helps to maintain a tooth in its physiologic position within the dental arch. Disturbances in the equilibrium can cause a tooth to migrate pathologically, often requiring multidisciplinary treatment approaches. The present case demonstrates, for the first time, the use of autologous platelet-rich plasma to aid in tooth repositioning after pathologic tooth migration. A 25-year-old woman presented with extrusion and labial migration of the maxillary left central incisor, a diastema of 3 mm, and grade II mobility. Radiographic evaluation showed a deep, angular bone defect, extending to the apical third of the root, on both the mesial and distal aspects of the maxillary left central incisor. Comprehensive treatment consisted of nonsurgical and surgical periodontal therapy with autologous platelet-rich plasma. Without orthodontic intervention, the unesthetic diastema had completely closed by the end of 3 months postoperatively, and the results were stable at a 3-year follow-up examination. This successful, novel approach can be adopted as a conservative and time-efficient modality for management of unesthetic spaces caused by pathologic tooth migration.
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12
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Khorshidi H, Moaddeli MR, Golkari A, Heidari H, Raoofi S. The prevalence of pathologic tooth migration with respect to the severity of periodontitis. J Int Soc Prev Community Dent 2016; 6:S122-5. [PMID: 27652243 PMCID: PMC5022388 DOI: 10.4103/2231-0762.189738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: Pathologic tooth migration (PTM) has been defined as tooth displacement that occurs when the balance among the factors that maintain physiologic tooth position is disturbed by periodontal disease. The aim of this cross-sectional epidemiological study was to determine the prevalence of pathologic tooth migration among patients with periodontitis. Materials and Methods: Recorded documents of 370 patients (72.4% females, 27.6% males) within the age range of 17 to 70 years (mean 37.77 ± 11.46) were studied. Statistical analysis was carried out using t-test and Chi-square test. Results: Pathologic migration prevalence was 11.4% (35/314 patients), however, there was no pathologic migration in patients with mild chronic periodontitis. The Chi-square test showed that there was no statistically significant difference between males and females. Conclusions: The results of this study confirm that pathologic tooth migration is relatively common among periodontal patients and its prevalence is increased by the severity of periodontal disease.
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Affiliation(s)
- Hooman Khorshidi
- Department of Periodontology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad R Moaddeli
- Department of Periodontology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Golkari
- Department of Oral Health and Community Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Heshmatollah Heidari
- Department of Oral Health and Community Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Raoofi
- Department of Periodontology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Gupta S, Deshmukh J, Khatri R, Kulkarni VK, Karthik B. From hopeless to good prognosis: journey of a failing tooth. J Int Oral Health 2015; 7:53-7. [PMID: 25859109 PMCID: PMC4377152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/03/2014] [Indexed: 11/02/2022] Open
Abstract
Chronic periodontitis, along with associated clinical findings such as pathologic tooth migration, diastema, functional and aesthetic aberrations, poses an immense challenge to a dental professional. These findings convert clinical decision making into a daunting task and adversely affect the prognosis and the treatment plan for the presenting clinical problem. An interdisciplinary approach aimed at restoring functional and aesthetic needs of the affected individual within the limitations of such a compromised clinical scenario may be a viable alternative to any radical treatment causing loss of natural tooth structure such as extraction. This article reports the usefulness of the interdisciplinary route for managing an otherwise hopeless clinical situation of chronic periodontitis complicated with extreme mobility and pathologic tooth migration, which resulted in compromised function and aesthetics.
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Affiliation(s)
- Saurabh Gupta
- Reader, Department of Periodontology, Rishi Raj College of Dental Sciences & Research Centre, Bhopal, Madhya Pradesh, India
| | - Jeevanand Deshmukh
- Professor & Head, Department of Periodontology, Rishi Raj College of Dental Sciences & Research Centre, Bhopal, Madhya Pradesh, India,Correspondence: Dr. Deshmukh J. Department of Periodontology, Rishi Raj College of Dental Sciences & Research Centre, Gandhinagar, Bhopal - 462 036, Madhya Pradesh, India. Phone: +91-9806088606.
| | - Richa Khatri
- Postgraduate Student, Department of Periodontology, Rishi Raj College of Dental Sciences & Research Centre, Bhopal, Madhya Pradesh, India
| | - Vinaya Kumar Kulkarni
- Professor, Department of Pedodontics, Modern Dental College & Research Centre, Indore, Madhya Pradesh, India
| | - B Karthik
- Senoir Lecturer, Department of Oral Pathology, Rishi Raj College of Dental Sciences & Research Centre, Bhopal, Madhya Pradesh, India
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Panwar M, Jayan B, Arora V, Singh S. Orthodontic management of dentition in patients with periodontally compromised dentition. J Indian Soc Periodontol 2014; 18:200-4. [PMID: 24872629 PMCID: PMC4033887 DOI: 10.4103/0972-124x.131325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 10/11/2013] [Indexed: 11/13/2022] Open
Abstract
Background: An increasing number of adult patients are seeking orthodontic treatment to improve their dental appearance. However, special attention must be given to the periodontal status of the adults as periodontal disease and its sequel, such as pathologic migration of anterior teeth, result in esthetic and functional problems. In such adult patients, an interdisciplinary approach often offers the best option for achieving a predictable outcome to solve complex clinical problems. Materials and Methods: A prospective study was carried out on 20 adult patients [mean age = 33.3 ± 4.52 (SD), 11 females and nine males] with periodontally compromised and malaligned dentition. Loe and Silness Gingival Index (GI), Ramfjord's Periodontal Disease Index (PDI) and Dental Aesthetic Index (DAI) were recorded at the start and after completion of treatment. Results: Comparison of GI, PDI and DAI before and after completion of treatment showed statistically significant differences, indicating the relevance of combined orthodontic–periodontic treatment in periodontally compromised dentition (P < 0.01). Conclusion: The outcome of the study showed that an interdisciplinary approach is a simple solution for complex clinical problems arising as a sequel to periodontitis, such as pathological tooth migration, restoring function, esthetics and periodontal health.
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Affiliation(s)
- Mohinder Panwar
- Adjutant General's Branch, IHQ, MOD (Army), New Delhi, India
| | - B Jayan
- Department of Dentistry, AFMC, Pune, Maharashtra, India
| | - Vimal Arora
- Adjutant General's Branch, IHQ, MOD (Army), New Delhi, India
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