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Sum FHKMH, Shan Z, Chan YHD, Chu RJDH, Pelekos G, She TT. Biomechanical Considerations in the Orthodontic Treatment of a Patient with Stabilised Stage IV Grade C Generalised Periodontitis: A Case Report. Bioengineering (Basel) 2024; 11:403. [PMID: 38671824 PMCID: PMC11048569 DOI: 10.3390/bioengineering11040403] [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: 03/26/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Orthodontic treatment of periodontally compromised patients presents unique challenges, including controlling periodontal inflammation, applying appropriate force, designing an effective dental anchorage, and maintaining treatment results. Deteriorated periodontal support leads to alterations in the biological responses of teeth to mechanical forces, and thus orthodontists must take greater care when treating patients with periodontal conditions than when treating those with a good periodontal status. In this article, we report the case of a 59-year-old woman with stabilised Stage IV grade C generalised periodontitis characterised by pathological tooth migration (PTM). The assessment, planning, and treatment of this patient with orthodontic fixed appliances is described. Moreover, the anchorage planning and biomechanical considerations are detailed. Specific orthodontic appliances were employed in this case to produce force systems for achieving precise tooth movement, which included a cantilever, mini-screws, and a box loop. Careful application of those appliances resulted in satisfactory aesthetic and functional orthodontic outcomes in the patient. This case highlights the importance of multidisciplinary collaboration in the treatment of patients with severe periodontitis and the potential for tailored biomechanical approaches in orthodontic treatment to furnish good outcomes.
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Affiliation(s)
| | | | | | | | | | - Tsang Tsang She
- Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR (000), China (Z.S.); (G.P.)
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Han SH, Ko Y, Ham LK, Park JH, Kim Y. Precautions and possibilities in orthodontic treatment of periodontally compromised patients: Current recommendations. J ESTHET RESTOR DENT 2024; 36:595-605. [PMID: 37994693 DOI: 10.1111/jerd.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE Orthodontic treatment plays a crucial role in achieving optimal dental esthetics and functional occlusion. However, when periodontally compromised patients are involved, additional precautions and considerations are critical. This article aims to provide up-to-date recommendations for the orthodontic treatment of periodontally compromised patients. CLINICAL CONSIDERATIONS Comprehensive diagnosis of the patient's periodontal status, inherent malocclusion, and secondary malocclusion resulting from periodontal disease are essential for achieving optimal esthetics and functional occlusion. This can be facilitated through the use of a simplified checklist. Prior to orthodontic treatment, pre-existing periodontal diseases should be managed. Light and controlled forces should be used to minimize the risk of adverse effects on the periodontium, and any potential traumatic occlusion during tooth movement should be minimized. Furthermore, careful anchorage management is required, and proper application of temporary anchorage devices can significantly expand the scope of orthodontic treatment. Finally, treatment results are maintained by ongoing supportive periodontal therapy even during the retention period. CONCLUSIONS This article presents clinical cases demonstrating the importance of accurate diagnosis in orthodontics and periodontics and the positive impact of orthodontic treatment on patients with pre-existing periodontal diseases. CLINICAL SIGNIFICANCE An up-to-date orthodontic treatment protocol for periodontally compromised patients is presented.
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Affiliation(s)
- Sung-Hoon Han
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Kore, Seoul, Republic of Korea
| | - Youngkyung Ko
- Department of Periodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Lyun Kwang Ham
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Kore, Seoul, Republic of Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA
- Graduate School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Yoonji Kim
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Kore, Seoul, Republic of Korea
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Deandra FA, Sulijaya B, Sudjatmika DA, Harsas NA. Selection of bone graft material and proper timing of periodontal surgery for orthodontic patients: A systematic review. Heliyon 2024; 10:e24201. [PMID: 38268591 PMCID: PMC10806355 DOI: 10.1016/j.heliyon.2024.e24201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Abstract
Introduction Bone loss progression due to periodontitis can lead to pathologic tooth migration, ultimately compromising the overall structure and function of the oral cavity. In pathologic tooth migration, a periodontal-orthodontic interdisciplinary approach is necessary. The combination of a bone graft and orthodontic treatment has shown promising results for periodontal regeneration. The treatment sequence and selection of a bone graft define the success of the therapy. Objective This study aims to discuss the protocol of the interdisciplinary approach to regenerative periodontal surgery in cases of intrabony defects requiring orthodontic treatment. Material & methods Literature searches were conducted on four online databases (PubMed, Wiley, ScienceDirect, and Google Scholar). The keywords used were (intrabony defect OR vertical bone defect) AND (bone graft OR periodontal regeneration) AND (orthodontic). Out of 1656 studies that were retrieved initially, 14 full-text articles were checked for eligibility assessment. Finally, a total of seven studies met all of the requirements for inclusion in this study. This study includes two randomized controlled trials (RCTs), which are considered the highest level of evidence, however it is important to note that the overall evidence base is heterogeneous, inclusive of various study designs. Discussion Periodontal tissue damage must be addressed before considering orthodontic therapy, including cases with intrabony defects. On the basis of the seven studies, orthodontic therapy can be initiated as early as four weeks after surgery or as late as one year after periodontal surgery. Different types of bone graft materials, such as autografts, allografts, xenografts, and alloplasts, are used in the included studies. Three out of seven studies used autogenous graft combined with xenograft or enamel matrix derivative as the graft material as it is osteoconductive, osteogenic, and osteoinductive. Regular periodontal tissue maintenance therapy should be performed every 2-6 months, before, during, and after orthodontic treatment. Conclusion Making a proper diagnosis and treatment sequence is key to the success of a periodontal-orthodontic treatment. In addition, identifying the appropriate timing between periodontal surgery and orthodontic movement, selecting the most suitable bone graft material, and ensuring regular maintenance of periodontal tissue are important considerations.
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Affiliation(s)
- Fathia Agzarine Deandra
- Postgraduate Program in Periodontology, Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Benso Sulijaya
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | | | - Nadhia Anindhita Harsas
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
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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] [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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Jepsen K, Sculean A, Jepsen S. Complications and treatment errors involving periodontal tissues related to orthodontic therapy. Periodontol 2000 2023; 92:135-158. [PMID: 36920050 DOI: 10.1111/prd.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/25/2022] [Accepted: 01/04/2023] [Indexed: 03/16/2023]
Abstract
In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT). Special considerations are given for various clinical scenarios, such as the patient presenting in periodontal health, with periodontitis, or with mucogingival conditions. While some of the complications are seen as common side effects of OT, other, more severe, problems that could have been avoided may be viewed as treatment errors. Recommendations are made on how to prevent these complications, based on the currently available evidence, on clinical practice guidelines, and on expert opinion. In conclusion, while there are several areas in which OT can have unwanted adverse effects on periodontal/mucogingival conditions, there is also great potential for synergies, offering opportunities for close cooperation between the two specialties (periodontics and orthodontics) for the benefit of patients affected by tooth malpositioning and/or periodontal or mucogingival problems.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Recombinant Irisin Protects Against Alveolar Bone Destruction During Orthodontic Tooth Movement. Inflammation 2023; 46:1106-1117. [PMID: 36918436 DOI: 10.1007/s10753-023-01797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 01/15/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
Patients with periodontitis have higher risk of alveolar bone loss when seek for orthodontic therapy. Inflammation and osteogenesis are key factors in alveolar bone destruction in periodontitis and orthodontic tooth movement (OTM). Here we evaluated the effects of irisin on alveolar bone destruction in rats with periodontitis and OTM. We isolated and cultured human periodontal ligament stem cells (PDLSCs). Irisin was administrated to PDLSCs. Cell proliferations, osteogenic differentiation, expression of RUNX2 and ALP, and the expression of OPG and RANKL were measured. We induced periodontitis and OTM in rats and treated rats with irisin. The alveolar bone loss, inflammatory cytokine levels, and expression of OPG and RANKL in gingival tissues were measured. Irisin promoted the cell proliferation and osteogenic differentiation of PDLSCs. Irisin elevated the expression of RUNX2, ALP, and OPG while decreased the expression of RANKL in PDLSCs. Irisin ameliorated the alveolar bone loss, suppressed cytokine levels, and increased OPG/RANKL expression ratio in rat with periodontitis and orthodontic tooth movement. Irisin prevented alveolar bone destruction during OTM in rats with periodontitis.
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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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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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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] [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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Carvalho R, Botelho J, Machado V, Mascarenhas P, Alcoforado G, Mendes JJ, Chambrone L. Predictors of tooth loss during long-term periodontal maintenance: An updated systematic review. J Clin Periodontol 2021; 48:1019-1036. [PMID: 33998031 DOI: 10.1111/jcpe.13488] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the risk factors / predictors of tooth loss in patients with periodontitis who underwent periodontal therapy and long-term periodontal maintenance (PM). MATERIAL AND METHODS PubMed, CENTRAL, EMBASE, Web of Science, LILACS and Scholar were searched up to and including September 2020. Studies limited to periodontitis patients who underwent active periodontal therapy (APT) and followed a regular PM programme with 5 years follow-up minimum were eligible for inclusion in this review. Studies were included if they reported data on tooth loss during PM. Random effects meta-analyses of number of tooth loss per patient per year were conducted. RESULTS Thirty-six papers regarding thirty-three studies were included in this review, with three prospective 30 retrospective trials. Subgroup meta-analysis showed no differences between prospective and retrospective studies, with an average of 0.1 tooth loss per year per patient (p < 0.001). Maxillary and molar teeth were more susceptible to be extracted during long-term PM. Baseline characteristics (smoking, diabetes mellitus, cardiovascular disease, being male and teeth with furcation lesions) showed no significance as predictor of tooth loss through meta-regression. The percentage of tooth loss due to periodontal reasons ranged from 0.45% to 14.4%. The individual outcomes in each study evidenced different patient-related factors (age and smoking) and tooth-related factors (i.e. tooth type and location) were associated with tooth loss during PM. CONCLUSION The majority of patients undergoing long-term PM have not lost teeth. On average, long-term PM effectively causes the loss of 1 tooth per patient every 10 years. Additional prospective trials may confirm these results.
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Affiliation(s)
- Rui Carvalho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Paulo Mascarenhas
- Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Gil Alcoforado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Periodontology Department, Egas Moniz Dental Clinic (EMDC), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal
| | - Leandro Chambrone
- Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.,Graduate Dentistry Program, School of Dentistry, Ibirapuera University, São Paulo, Brazil.,Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia
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11
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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] [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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12
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Johnson TM, Bice RW, Gilbert WA. Orthodontic Treatment of Periodontally Compromised Teeth After Laser Periodontal Therapy: A Case Report. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:528-534. [PMID: 33493411 DOI: 10.1089/photob.2020.4910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: To assess stability of laser periodontal therapy (LPT) results after orthodontic tooth movement. Background: Periodontitis and malocclusion each exhibit high global prevalence. Thus, dentists inevitably face increasing demand for orthodontic treatment in patients with reduced periodontal support. Many of these patients benefit from orthodontic treatment, provided that periodontal inflammation is controlled. Materials and methods: We present a case demonstrating successful orthodontic treatment of periodontally compromised teeth after LPT. A patient with severe attachment and alveolar bone loss received orthodontic treatment 13 months after neodymium-doped: yttrium aluminum garnet LPT (1064 nm). We utilized three laser parameter sets for various purposes during the procedure-ablation of the periodontal pocket epithelium (2.8 W, 20 Hz, 100 μs), clot stabilization (2.8 W, 20 Hz, 550 μs), and photobiomodulation (2.8 W, 20 Hz, 100 μs, noncontact). Results: Treatment resulted in improved radiographic bone levels, clinical parameters consistent with periodontal health, and favorable occlusal relationships. Conclusions: In the presented case, we successfully treated a patient presenting with malocclusion and reduced periodontal support while avoiding the risk and morbidity of conventional periodontal surgery. Controlled clinical research to establish the predictability of the described approach appears warranted.
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Affiliation(s)
- Thomas M Johnson
- Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, Georgia, USA
| | - Ronald W Bice
- Department of Orthodontics, United States Army Dental Health Activity, Fort Gordon, Georgia, USA
| | - William A Gilbert
- Deputy Consultant to the Surgeon General for Periodontics, United States Army Dental Health Activity, Joint Base Lewis-McChord, Washington, USA
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