Decision making in the treatment of patients with malocclusion and chronic periodontitis: Scientific evidence and clinical experience☆☆
Section snippets
Background
With recent evidence indicating that up to 50% of American adults have chronic periodontitis1 and an increasing demand for orthodontic treatment in esthetic-conscious adults,2, 3 it is important to identify and properly treat patients with periodontitis who are undergoing orthodontic therapy. Previous reports have indicated that in the presence of plaque and gingival inflammation, orthodontic tooth movement can result in further periodontal disease progression and attachment loss.4, 5 Much
Factors affecting orthodontic and periodontal treatment outcomes
In clinical practice, achieving optimal oral health and esthetic results is dependent upon many patient and treatment factors.
Discussion
The existing scientific literature consistently emphasizes the importance of oral hygiene and periodontal maintenance visits during the orthodontic treatment phase of patients with chronic or aggressive periodontitis. However, differences in the treatment sequence of such cases have been noted due to multiple considerations.
Orthodontic movement per se has not been shown to accelerate the destruction of the connective tissue attachment on teeth with healthy periodontium8, 53 or in the presence
Clinical decision matrix
A decision tree is suggested when considering orthodontic therapy for patients with periodontal disease (Fig. 1).
Initial periodontal therapy is indicated in all patients with chronic periodontitis and inflammation prior to orthodontic tooth movement. Improved oral hygiene and nonsurgical or initial periodontal therapy allow for removal of etiologic factors and reduction of edema and erythema in the periodontal tissues.
If nonsurgical therapy alone allows for cleansable defects able to be
Conclusion
The recognition and identification of patients with periodontal disease in the orthodontic office remains key for a successful treatment and long-term maintenance of teeth. Similarly, it is essential for the periodontist to consider orthodontic treatment in combination with periodontal care for patients with periodontal disease, malocclusion, and optimal oral hygiene and compliance levels.
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Cited by (5)
Clear aligner treatment among patients with compromised periodontal tissue
2023, Seminars in OrthodonticsA conservative approach for an adult patient with a fractured tooth and crowding: Autotransplantation at the fracture site
2021, American Journal of Orthodontics and Dentofacial OrthopedicsCitation Excerpt :After several treatment alternatives were presented, this patient chose the option of extraction of the maxillary right side premolar and the autotransplantation of the extracted tooth to the hopelessly fractured site. In this adult patient with dental caries, a fractured tooth, and periodontitis, shorter treatment duration would be desirable while minimizing treatment time and optimizing oral health and esthetics.14 Therefore, the advantages of this treatment option were the less number of extracted teeth and less amount of tooth movement, and therefore, more efficient and practical treatment procedures.
Effect of orthodontic therapy in periodontitis and non-periodontitis patients: a systematic review with meta-analysis
2022, Journal of Clinical PeriodontologyIatrogenic damage to the periodontium caused by orthodontic treatment procedures: An overview
2015, Open Dentistry Journal
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Findings: The severity and morphology of periodontal attachment loss as well as the nature of the orthodontic tooth movement should be considered when determining the proper treatment sequence and procedures to be performed for patients with both malocclusion and periodontal diseases.