Combined orthodontic-periodontal treatment in periodontal patients with anteriorly displaced incisors

To intrude or not to intrude? A systematic review of the controversy surrounding orthodontic intrusion on reduced periodontium

OBJECTIVE

The main objective of this review was to evaluate the effects of orthodontic intrusion on patients with reduced periodontium. Additionally, this review aims to explore the potential for attachment gain and tissue regeneration in these patients and identify optimal therapeutic conditions to mitigate any negative effects of intrusion.

METHODS

A systematic review was conducted according to the PRISMA 2020 statement. Duplicate electronic searches of the PubMed, Cochrane, EMC Premium, and Science Direct databases were performed by two independent reviewers. Data extraction and quality assessments, including risk of bias evaluation using the Cochrane and ROBINS-I tools were conducted.

RESULTS

From an initial pool of 418 articles, 29 were selected after title and abstract screening for full-text review. Following thorough full-text reading, 15 studies were ultimately included in the analysis. The total number of patients included in the studies is 528, who underwent orthodontic intrusion on reduced periodontium. Studies indicated a decrease in periodontal pocket depth and an increase in clinical attachment with ortho-periodontal treatment. Alveolar bone level outcomes varied, showing both increases and losses. Authors generally observed improved papillary regeneration and reduced gingival recessions.

CONCLUSION

Clinical studies involving combined ortho-periodontal treatment showed that orthodontic intrusion on a reduced but healthy periodontium can be considered a beneficial treatment for the periodontium, provided that potential adverse effects are carefully monitored.

Orthodontic treatment in patients with periodontitis - a narrative literature review

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.

Three-dimensional evaluation of a virtual setup considering the roots and alveolar bone in molar distalization cases

We aimed to evaluate root parallelism and the dehiscence or fenestrations of virtual teeth setup using roots isolated from cone beam computed tomography (CBCT) images. Sixteen patients undergoing non-extraction orthodontic treatment with molar distalization were selected. Composite teeth were created by merging CBCT-isolated roots with intraoral scan-derived crowns. Three setups were performed sequentially: crown setup considering only the crowns, root setup-1 considering root alignment, and root setup-2 considering the roots and surrounding alveolar bone. We evaluated the parallelism and exposure of the roots and compared the American Board of Orthodontics Objective Grading System (ABO-OGS) scores using three-dimensionally printed models among the setups. The mean angulation differences between adjacent teeth in root setups-1 and -2 were significantly smaller than in the crown setup, except for some posterior teeth (p < 0.05). The amount of root exposure was significantly smaller in root setup-2 compared to crown setup and root setup-1 except when the mean exposure was less than 0.6 mm (p < 0.05). There was no significant difference in ABO-OGS scores among the setups. Thus, virtual setup considering the roots and alveolar bone can improve root parallelism and reduce the risk of root exposure without compromising occlusion quality.

Association between alveolar bone height changes in mandibular incisors and three-dimensional tooth movement in non-extraction orthodontic treatment with Invisalign

OBJECTIVE

The purpose of this study was to investigate associations between alveolar bone height changes on the labial and lingual sides in mandibular incisors and three-dimensional orthodontic tooth movement, involving apex displacement, tooth inclination, and angulation.

MATERIALS AND METHODS

The samples consisted of 43 adult patients treated with Invisalign aligners. All subjects were skeletal Class I patients without extraction in mandible. Pre-treatment and post-treatment cone-beam computed tomographic images were obtained to measure labial and lingual alveolar bone height and bone thickness at apex level in four mandibular incisors. An x, y, z coordinate system, superimposing on mandibular body, was established to analyse three-dimensional apex movement and tooth inclination and angulation changes. Multiple linear regression was applied to identify the determining factors of marginal bone changes during orthodontic treatment.

RESULTS

Three directions of apex movement (anteroposterior, vertical, transverse) significantly associated with alveolar bone height changes. Inclination changes had a strong effect on lingual marginal bone, while tooth angulation had no significant effect on alveolar bone height. Incisors with lingual bodily movement were more susceptible to lingual marginal bone recession compared with lingual tipping movement.

CONCLUSIONS

Alveolar bone height changes on the labial and lingual sides were associated with three-dimensional apex movement, inclination changes, and movement patterns. Appropriate tooth movement should be considered to avoid excessive marginal bone loss around mandibular incisors.

Dysbiotic changes of periodontal pathogens in patients wearing conventional and self-ligating orthodontic appliances

Objective: This study aimed to analyse dysbiotic changes of periodontal pathogenic bacteria and their relationship with different types of fixed orthodontic appliances in a population located in Northwestern Mexico.

Methods: Three groups of patients were identified: a control group without orthodontic appliances (C), a conventional-ligating appliance group (CLA), and a self-ligating appliance group (SLA). Periodontal biofilm samples were collected for DNA extraction to identify the presence and load of Treponema denticola, Prevotella intermedia, and Fusobacterium nucleatum, using a quantitative real-time PCR technique.

Results: A total of 92 patients were included. The results showed that F. nucleatum was present in all groups including the control patients (C 96%, CLA 100%, and SLA 67%, respectively). Female participants displayed a higher frequency of periodontal pathogens than males, but males were more affected by F. nucleatum. In addition, the presence of T. denticola and P. intermedia was time-dependent, being more frequent in patients in treatment for longer than 12 months whereas CLA showed 74% and 78% of positive samples and SLA showed 78% and 89%, respectively. F. nucleatum was present in 100% of CLA samples before and after 12 months of treatment and its load was higher in the SLA group after 12 months.

Conclusions: Dysbiotic changes that could affect the periodontal tissues were seen in patients wearing orthodontic appliances. The frequency of F. nucleatum was significantly higher in CLA and noted with a greater load in SLA. In addition, female participants showed a higher frequency of periodontal pathogens while male subjects were more affected by F. nucleatum. As expected, treatment for longer than 12 months correlated with a higher frequency of all periodontal pathogens. The results support the concept that dysbiosis leading to periodontal disease can be caused by the rise of a dominant species, instead of the appearance of a new species.

Study on the Effects of Orthodontics on Anterior Tooth Displacement in Patients

Objective

The purpose of this study was to investigate the therapeutic effect of orthodontic treatment on anterior tooth displacement caused by periodontal disease.

Methods

A prospective study was performed in 86 patients with anterior tooth displacement caused by periodontal disease. These patients were divided into the experimental group and the control group according to the intervention methods. For the control group, patients were treated with conventional therapy. The experimental group used straight wire orthodontic technique for orthodontic treatment on the basis of conventional treatment. Comparisons were performed between two groups in term of bleeding index, alveolar bone height, anterior tooth coverage, periodontal pocket depth, probing depth, clinical crown length, tooth root length, inflammatory cytokines levels, and orthodontic satisfaction.

Results

Comparison of bleeding index, alveolar bone height, anterior tooth coverage, periodontal pocket depth, probing depth, clinical crown length, tooth root length, and inflammatory cytokines levels between two groups before treatment indicated that there were no statistical differences (all P > 0.05). After treatment, bleeding index, alveolar bone height, anterior tooth coverage, periodontal pocket depth, probing depth, clinical crown length, and serum levels of IL-6 and TNF-α in the experimental group were lower than those in the control group (all P < 0.05), while the serum level of IL-2 in the experimental group was more than that in the control group (P < 0.05). Also, there was no difference for tooth root length between two groups. Moreover, compared with the control group, orthodontic satisfaction in the experimental group was significantly increased.

Conclusion

The efficacy of orthodontic treatment in patients with anterior tooth displacement caused by periodontal disease is higher than that of only using conventional therapy, as it helps improve their periodontal health, alveolar bone height, clinical crown length, inflammatory factor levels, and orthodontic satisfaction of patients.

Knowledge, attitudes and professional practices of ortho-periodontal care of adults: a cross-sectional survey in France

BACKGROUND

Due to increasing numbers of adult patients, orthodontists are being confronted more and more with periodontal problems. Coordination amongst orthodontists, periodontists and general dentists is useful in preventing and stopping periodontal disease. The main objectives of this survey were to evaluate the technical knowledge, techniques and attitudes employed by French orthodontists, periodontists and general dentists in adult dental care.

METHODS

A cross-sectional online survey was distributed to French dentists. The questionnaire, consisting of 30 questions, was divided into six sections covering treatment programs and the forensic environment.

RESULTS

One thousand one hundred twenty-two complete answers were recorded. Adults undergoing orthodontic treatment represented 19.9% of the orthodontists' patients, but only 2.67% of the general dentists' patients. Communication between clinicians was rated as good, greater than 3 out of 5. Before treatment, orthodontists were less alarmed than generalists regarding bleeding, recessions, increased probing depths, halitosis and hyperplasia. During treatment, orthodontists never or only occasionally performed palpation or probing in 54.2% and 84.6% of cases. Gingivitis and recessions were the main reasons for consultations for 22.0% and 20.1% of general dentists and periodontists after orthodontic treatment. Of the practitioners surveyed, 43% felt that they experienced a setback in the ortho-periodontal treatment.

CONCLUSIONS

This study revealed discrepancies in the knowledge and attitudes of practitioners. Therapeutic management remains one of the major challenges of multidisciplinary treatments. Continuing education needs to be further developed in this field.

Effect of orthodontic treatment on periodontal health of periodontally compromised patients: A randomized controlled clinical trial

OBJECTIVES

To evaluate the effect of fixed orthodontic treatment on periodontal parameters in periodontally compromised adult orthodontic patients.

MATERIALS AND METHODS

This was a prospective, randomized, controlled clinical trial. Thirty-six periodontally compromised adult patients (mean age: 29.67 ± 4.8 years) were randomly allocated to either test (perio-ortho) or control group (perio). After periodontal stabilization in both groups, orthodontic treatment was started in the test group, whereas the control group remained on periodontal maintenance only. Evaluation and comparison of clinical parameters (plaque index [PI]; gingival index [GI]; bleeding on probing [BOP]; probing depth [PD]; clinical attachment level [CAL]) of both groups was assessed at three time intervals: T0 (base line), T1 (at start of orthodontic treatment), and T2 (1 year after start of orthodontic treatment). Radiological parameters (alveolar bone levels [ABL]) were recorded using CBCT at T1 and T2.

RESULTS

Intragroup analysis showed statistically significant improvement in all clinical and radiological periodontal parameters in both groups (P ≤ .05). Intergroup comparison revealed improvement in the periodontal parameters was not statistically significant between the groups (P ≥ .05). Subgroup analysis showed reduction in the number of moderate and severe periodontitis sites in both groups with significant more gains in ABL in the test group compared to the control group.

CONCLUSIONS

Orthodontic treatment after periodontal stabilization does not have any detrimental effect on periodontal health in adult periodontally compromised orthodontic patients and may add to the benefits achieved by periodontal treatment alone.

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

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.

Interaction of periodontitis and orthodontic tooth movement-an in vitro and in vivo study

OBJECTIVES

The aim of this in vitro and in vivo study was to investigate the interaction of periodontitis and orthodontic tooth movement on interleukin (IL)-6 and C-X-C motif chemokine 2 (CXCL2).

MATERIALS AND METHODS

The effect of periodontitis and/or orthodontic tooth movement (OTM) on alveolar bone and gingival IL-6 and CXCL2 expressions was studied in rats by histology and RT-PCR, respectively. The animals were assigned to four groups (control, periodontitis, OTM, and combination of periodontitis and OTM). The IL-6 and CXCL2 levels were also studied in human gingival biopsies from periodontally healthy and periodontitis subjects by RT-PCR and immunohistochemistry. Additionally, the synthesis of IL-6 and CXCL2 in response to the periodontopathogen Fusobacterium nucleatum and/or mechanical strain was studied in periodontal fibroblasts by RT-PCR and ELISA.

RESULTS

Periodontitis caused an increase in gingival levels of IL-6 and CXCL2 in the animal model. Moreover, orthodontic tooth movement further enhanced the bacteria-induced periodontal destruction and gingival IL-6 gene expression. Elevated IL-6 and CXCL2 gingival levels were also found in human periodontitis. Furthermore, mechanical strain increased the stimulatory effect of F. nucleatum on IL-6 protein in vitro.

CONCLUSIONS

Our study suggests that orthodontic tooth movement can enhance bacteria-induced periodontal inflammation and thus destruction and that IL-6 may play a pivotal role in this process.

CLINICAL RELEVANCE

Orthodontic tooth movement should only be performed after periodontal therapy. In case of periodontitis relapse, orthodontic therapy should be suspended until the periodontal inflammation has been successfully treated and thus the periodontal disease is controlled again.

Effect of orthodontic therapy in periodontitis and non-periodontitis patients: a systematic review with meta-analysis

AIM

To answer these PICO questions: #1: In adult patients with malocclusion, what are the effects of orthodontic tooth movement (OTM) on clinical attachment level (CAL) changes in treated periodontitis patients with a healthy but reduced periodontium compared to non-periodontitis patients? #2: In adult patients with treated periodontitis and malocclusion, which is the efficacy of skeletal anchorage devices compared to conventional systems in terms of orthodontic treatment outcomes?

MATERIAL AND METHODS

Seven databases were searched until June 2020 looking for randomized, non-randomized trials and case series. Mean effects (ME) and 95% confidence intervals (CIs) were calculated.

RESULTS

Twenty-six studies with high risk of bias were included. PICO#1: In 26 patients without periodontitis and in 69 treated periodontitis patients, minimal changes in periodontal outcomes were reported after orthodontic therapy (p>0.05). A significant CAL gain (mm) (ME=3.523; 95% CI [2.353; 4.693]; p<0.001) was observed in 214 patients when periodontal outcomes were retrieved before a combined periodontal and orthodontic therapy. PICO#2: Orthodontic variables were scarcely reported and objective assessment of the results on orthodontic therapy were missing.

CONCLUSIONS

Based on a small number of low-quality studies, in non-periodontitis and in stable treated periodontitis patients, OTM had no significant impact on periodontal outcomes.

The adult orthodontic patient over 40 years of age: association between periodontal bone loss, incisor irregularity, and increased orthodontic treatment need

Objectives

Adult orthodontic treatment, especially in patients over 40 years, is steadily increasing. One causal factor for the treatment need in this age group is periodontal breakdown. The aim of this study was to detect correlations between periodontal problems and orthodontic parameters in interdisciplinary patients.

Methods

This observational, cross-sectional study included 118 patients over 40 years (51 men/67 women; mean age, 58.03 years) classified into three groups according to periodontal breakdown (group I, controls; group II, moderate periodontitis; group III, severe periodontitis). Clinical periodontal and orthodontic parameters as well as the index of orthodontic treatment need (IOTN) were assessed and compared between the groups.

Results

A gradual deterioration of all periodontal and orthodontic parameters according to periodontal bone loss (lowest values in group I; highest values in group III) was observed. Especially groups I and III differed significantly regarding the overjet (p < 0.001) and the little indices of the maxilla (p < 0.001) and mandible (p < 0.010). The IOTN was highest in group III: 90% of the patients with severe periodontitis were classified to have moderate to very great treatment need.

Conclusions

The higher the degree of periodontal breakdown was, the more severe were overjet, overbite, irregularity of the anterior teeth, and the orthodontic treatment need.

Clinical relevance

Adult patients over 40 years represent a challenge for an orthodontic/periodontal treatment approach with high incidence of pathologic tooth migration, orthodontic treatment need, and periodontal breakdown. Therefore, this special patient collective requires a focus in clinical orthodontics and research.

Orthodontic Treatment of Periodontally Compromised Teeth After Laser Periodontal Therapy: A Case Report

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.

Rotational relapse of anterior teeth following orthodontic treatment and circumferential supracrestal fiberotomy

Background/purpose

Several factors cause relapse of orthodontically de-rotated teeth after appliance removal. Circumferential supracrestal fiberotomy (CSF) may release the tension on the supra-alveolar fibers following tooth de-rotation, thereby reducing the relapse risk. However, careful identification of the amount and location of relapse enables proper clinical evaluation. We aimed to determine the amount of orthodontic relapse following CSF for de-rotated anterior teeth.

Materials and methods

Eleven patients with 90 orthodontically de-rotated anterior teeth were enrolled. CSF was performed after orthodontic treatment, during fixed retainer placement. Rotational correction and relapse were measured on three casts (preorthodontic treatment, cast 1; postorthodontic treatment + CSF, cast 2; and 12-month follow-up, cast 3). The Wilcoxon test was used to assess significant differences in the tooth rotation angles between casts 1 and 2 and casts 2 and 3. The relationship between the magnitude of relapse and pretreatment severity of rotation was assessed by the point biserial correlation test. The Mann-Whitney U test helped in identifying significant differences in the amount of relapse between maxillary and mandibular teeth.

Results

The mean amount of rotational correction was 14.05°, while the mean amount and percentage of relapse were 1.1° and 10.8%, respectively [0.81° (8%) and 1.44° (14%) for maxillary and mandibular teeth, respectively]. The relapse amount was proportional to the pretreatment rotation severity, and it was larger for the mandibular canines. There was no significant difference in the amount of relapse between the maxillary and mandibular teeth (P = 0.07).

Conclusion

Post-treatment rotational relapse of anterior teeth subjected to CSF was minimal and statistically insignificant after 1 year of follow-up. This validates the promising results of CSF when combined with appropriate mechanical retention for an adequate period.

Outcome of periodontal–orthodontic treatment in subjects with periodontal disease. Part II: a CBCT study of alveolar bone level changes

Aim

To examine alveolar bone level (ABL) changes before (T1) and after (T2) orthodontic treatment (OT) in subjects with periodontal disease.

Methods

The study included 50 subjects with periodontal disease. All patients received subgingival debridement following baseline examination. Control group patients received final periodontal treatment before the start of OT. For the test group patients final periodontal treatment was performed simultaneous to OT. OT was performed with a straight-wire appliance. Micro-implants or temporary crowns on implants were used for posterior anchorage when needed. ABL measurements of 3821 tooth surfaces were performed on cone beam computed tomography images.

Results

No difference was observed between mean ABL at T1 and T2. ABL remained unchanged on 69 per cent of surfaces. A mean of 15.6 (SD 7.4) per cent of surfaces experienced ABL gain, and a mean of 15.1 (SD 7.5) per cent was found with ABL loss. Small significant median ABL difference was observed on mesial and distal surfaces (P < 0.001). A significant difference was found between median ABL changes on mesial/distal in comparison to buccal/lingual surfaces (P < 0.01). Significantly more buccal (17.9 %) and lingual (18.5 %) surfaces experienced ABL loss when compared with mesial (11.3 %) and distal (12.0 %) surfaces (P < 0.001). Significant difference was found in the median ABL change of intruded (0.5 (IQR 0.94) mm) and non-intruded (−0.4 (IQR 1.07) mm) maxillary incisors (P = 0.04). Significant median ABL gain was found on the lingual surface of maxillary incisors, which were retroclined more than 8.6 degree and intruded more than 1.6 mm.

Conclusions

ABL changes after periodontal–orthodontic treatment in patients with periodontal disease were small. ABL gain was more observed on mesial and distal surfaces and ABL loss on buccal and lingual surfaces. Larger orthodontic movements of maxillary incisors influenced ABL gain.

Periodontal and root changes after orthodontic treatment in middle-aged adults are similar to those in young adults

INTRODUCTION

The goal of this study was to compare the outcomes and amount of change in periodontal health of anterior teeth in young versus middle-aged adults, who were treated to improve anterior alignment and occlusion.

METHODS

Pre- and posttreatment records including orthodontic casts, cephalograms, and standardized periapical radiographs were retrospectively collected from young adults (aged 19-30 years; n = 12) and middle-aged adults (aged ≥40 years; n = 27). Following the American Board of Orthodontics criteria, discrepancy index (DI), cast-radiograph evaluation (CRE), treatment duration (TD), marginal bone loss (MBL), and tooth length (TL) were measured, and with the use of periapical radiographs, changes in the level of marginal bone (MBC) and the amount of root resorption (RR) after orthodontic treatment were calculated.

RESULTS

DI, MBL, and TD were significantly higher in the middle-aged adults than in the young adults (P < 0.05). However, CRE and MBC after treatment were similar between the 2 groups (P > 0.05). The mean amount of RR following treatment was -0.6 ± 0.44 mm and -1.0 ± 0.61 mm in young and middle-aged adults, respectively. The degree of RR after compensating for treatment complexity and TD was similar between the 2 groups (P > 0.05).

CONCLUSIONS

Although the initial malocclusion and periodontal conditions were unfavorable for the middle-aged adults, the overall treatment and periodontal outcomes after orthodontic treatment of the anterior teeth were similar to those for young adults. It appears that older adults tolerate orthodontics to improve the appearance of the anterior teeth as well as younger adults, with no additional burden because of their increased age.

Combined Periodontal-Orthodontic Treatment of Pathologic Tooth Migration: A Case Study with 10-Year Follow-Up

Pathologic tooth migration is a change in tooth position resulting from disruption of the forces that maintain teeth in a normal position in relation to their arch. The disruption of the equilibrium in tooth position may be caused by various etiologic factors. Loss of attachment apparatus along with a non periodontal related condition such as excess occlusal force, a progressive migration of tooth may take place. Mostly this migration can be associated with aesthetic damage of the smile line. To solve these issues, a combination of periodontal and orthodontic treatment is often needed. In this presentation a 23-year-old, systemically healthy, non-smoking female presented with the complaint of bleeding gums, mobility and increased space between upper and lower front teeth causing un-aesthetic appearance and low self esteem. She was treated with interdisciplinary approach of orthodontic and periodontal intervention. Improvement of facial esthetics contributed to the self-confidence of an adult periodontal patient with pathologic tooth migration. Follow up at 10 years post treatment confirmed the good choice of treatment planning and the tendency to improve the results over time. Periodontally compromised orthodontic patients can be satisfactorily treated, achieving correction of the malocclusion and a marked improvement in esthetics when an interdisciplinary approach is used.

Retrospective study of combined splinting restorations in the aesthetic zone of periodontal patients

Evaluates the clinical performance of of a fiber-reinforced, composite-resin bonded splint; a bridge; a fiber post; and/or a resin veneer for the restoration of periodontally-involved anterior teeth.

Shows that a combination of approaches is a good choice for minimally invasive prosthodontic treatment in the aesthetic zone in periodontal patients.

Aims This retrospective study evaluated the clinical performance of combining a fiber-reinforced, composite-resin (FRC) bonded splint; bridge; fiber post; and/or resin veneer for the restoration of periodontally-involved anterior teeth.

Methods Sixty-three patients with periodontally-involved anterior teeth each received one of the following splinting restorations: FRC-bonded splint-bridges (SB), a combination of an FRC-bonded splint and resin veneer (SV), or FRC-bonded splints (S). Six patients with healthy periodontal teeth received orthodontic retainers with FRC-bonded splints (OS) as a control. Modified USPHS criteria were used to evaluate the effects of rehabilitation, and the periodontal pocket depth (PPD) and clinical attachment level (CAL) of the natural teeth were measured.

Results All restorations resulted in good aesthetic outcomes. SV, S in combination with fiber posts and OS all resulted in 100% acceptable ratings for each category that was directly evaluated at each follow-up. The mean PPD was 3.5 ± 1.0 mm at baseline, decreased to 3.3 ± 1.0 mm after one year (p <0.05), and subsequently increased to 3.5±1.0 mm again after four years (p >0.05). These changes were similar to those in the mean CAL.

Conclusion A combination of a FRC-bonded splint, bridge, fiber post and/or resin veneer for minimally invasive prosthodontic treatment in the aesthetic zone is a good choice for periodontal patients.

Evaluation of the Stress Induced in Tooth, Periodontal Ligament & Alveolar Bone with Varying Degrees of Bone Loss During Various Types of Orthodontic Tooth Movements

INTRODUCTION

The force applied on to a tooth with periodontal bone loss may generate different magnitude and pattern of stresses in the periodontium when compared to a tooth with no bone loss & under the same force system. The intensity of the forces and moment to force ratios needed to be applied during an Orthodontic treatment must be adapted to obtain the same movement as in a tooth with a healthy periodontal support.

AIM

Evaluation and assessment of the stress distribution during various types of Orthodontic tooth movement on application of Orthodontic force, at various levels of alveolar bone loss; & determination of the most ideal force system producing the Optimum Stress (i.e., stress within optimum range), uniformly (conducive to bodily movement of maxillary canine with varying degrees of bone loss).

MATERIALS AND METHODS

A human maxillary canine tooth of right side was simulated by means of Finite Element Method (FEM). Five different models were constructed with bone loss ranging from 0mm in model 1, to 8mm in model 5 (progressing at 2mm per model). Ten different loading conditions were applied on these models and the stress generated was charted at various occluso-gingival levels and surfaces around the tooth. The evaluation and assessment of the stress distribution during various types of Orthodontic tooth movement on application of Orthodontic force, at various levels of alveolar bone loss was done.

RESULTS

The results showed that there was a high positive correlation between the increase in bone loss & the stress generated, suggesting an elevation in the stress with advancing bone loss. Additionally, the type of tooth movement was found to be changed with bone loss. During the determination of ideal force system it was found that the centre of resistance of the canine migrated apically with bone loss and an increase in the moment to force ratio (Mc:F) was required to control the root position in these cases.

CONCLUSION

A high positive correlation exists between the increase in bone loss and the stress generated. Suitable modification should be done in the force system under bone loss conditions.