Gingival recession and adult orthodontics: a clinical evidence-based treatment proposal

[Periodontal optimization of the smile: choosing the right moment to achieve a maximum esthetic result]

INTRODUCTION

Today, esthetic enhancement is one of the main reasons why patients seek orthodontic treatment. Governed by the canons of beauty dictated by our society, the smile is a key component in this quest for perfect beauty. Hence, the orthodontist is often the first specialist to be consulted by adolescents, but also, more and more, by adults as well. Using simple tools, the practitioner must be able to make a precise analysis of the patient combining both orthodontic and periodontal examinations with an esthetic periodontal diagnosis.

OBJECTIVES

Using this analysis, the orthodontist must be able to identify his/her patient's periodontal morphotype and assess whether there is a risk of complications during treatment. One of the main complications that may arise is periodontal recession, which can both impact the esthetic result and give rise to patient anxiety, very soon leaving the orthodontist at a loss. If in doubt, it is essential to refer one's patient to the general dentist or to the periodontist.

MATERIALS AND METHODS

In this paper, the authors will describe a didactic decision-making tree, which will assist practitioners in learning how to manage their patients.

DISCUSSION

A synergistic approach to global patient management will ensure an optimal outcome by providing the patient with an appropriate and individualized treatment procedure.

How to recognize the eight signs of periodontitis?

Orthodontics contributes to improving self-esteem and function. However, a common refrain in ortho-perio relationships states that orthodontics has no deleterious effects on the healthy or reduced and treated periodontium. Though supported for decades, this idea has now been heavily challenged by a recent systematic review of the literature. The conclusion of this article is unfortunately very clear. There is a lack of reliable evidence showing the beneficial effects of orthodontic treatment on periodontal health with, at best, mild adverse effects. How can we reduce the periodontal cost of orthodontic treatment to a minimum? How can we ensure that this "at best" does not turn into "at worst"? To minimize the adverse effects of orthodontic treatment on periodontal tissues, the orthodontist must be able to determine to which patients he/she can consider providing orthodontic treatment and those for whom prior periodontal treatment is mandatory. In addition to the items collected for an orthodontic diagnosis, the orthodontist must be able to recognize the eight signs of attachment loss.

Magnetic bead-based salivary peptidome profiling for periodontal-orthodontic treatment

Background

Patients with periodontitis seek periodontal-orthodontic treatment to address certain functional and aesthetic problems. However, little is known of the effect of periodontitis on orthodontic treatment. Thus, we compared the differences in peptide mass fingerprints of orthodontic patients with and without periodontitis by MALDI-TOF MS using a magnetic bead-based peptidome analysis of saliva samples. In this way, we aimed to identify and explore a panel of differentially-expressed specific peptides.

Results

Saliva samples from 24 patients (eight orthodontic patients without periodontitis, eight with periodontitis and another eight with periodontitis but no orthodontic treatment) were analyzed, and peptide mass fingerprints were created by scanning MS signals using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) combined with magnetic beads. Nine mass peaks showed significant differences. Orthodontic patients in the group without periodontal disease showed higher mass peaks for seven peptides of the nine, whereas the mass peaks for the other two peptides were higher in the periodontal-orthodontic patients. Besides, these differentially-expressed peptides were sequenced.

Conclusions

The elucidated candidate biomarkers indicated interactions between periodontal condition and orthodontic treatment and their contributions to the changes of saliva protein profiles. Our results provide novel insight into the altered salivary protein profile during periodontal-orthodontic treatment, and may lead to the development of a therapeutic monitoring strategy for periodontics and orthodontics.