ortho-perio Flashcards
what time period is preventative ortho?
primary - early mixed
what time period is interceptive ortho?
mixed
what time period is corrective ortho?
permanent dentition
adult and geriatric ortho is considered
limited treatment
need healthy perio and no bisphosponates
adult patient characteristics
no growth
aging of maxillofacial structures
bone biology
dental status
chief complaint
aging of adult geriatric maxillofacial structures
small skeletal modifications
nose tip, chin and ears keep growing
resorption at basal bone (holding teeth), anterior areas
point A and B move somewhat back
geriatric patient dental consequence
reduced inter-canine distance (why we dont try to do this in general)
increased crowding (lower more likely)
increased Overbite
class II and III tend to worsen with time
soft tissue changes in adult / geratirc patient
nose and chin increase
retrusion of lips - flatten profile
loss of muclscle tone
less U incisor - more lower incical display
bone biology in this patient population
no growth
less growth factors
periodontal disease
diminished attachment apparatus
flaring of teeth
*always a continue of bone remodeling though
detnal status of older
dentiiton alterations
- wear sgns and irreeuluar pattern
loss of some VDO
tx goals in adult patients
prepate mouth for complex restorative treatment
minimum tx duration
improve periodontal prognosis
ortho - perio diagnosis
perio diagnosis
orrtho diagnosis
perio basic therapy – need to be addressed before ortho
perio surgery could be before during or after
- NEED TO BE ON 3 MONTH RECALL
ORTHO BEFORE PERIO?
no — paper did say ortho tx can only be truly considered to improve perio health in those relatively rare cases where treatment corrects an occlusal relationship causing traumatic injury to the periodonta tissue
improving oral hygeine
something we can do as ortho for our perio patients
- crowding and tipping make it more difficult to maintain periodontal health
- resolve crowding
- proper alignment
- stabilization of teeth with mobility with fixed lingual retainer, maintenance of results long term
plan of action with perio ortho patients
consults (perio, resto, ortho)
basic perio therapy and restorative therapy and surgical SRP if needed
extractions if needed
ortho intervention
gingivoplasty - grafts if needed
maintenance (perio and ortho)
breakdown of improve smile esthetics
- gummy smile
- gingival architecture
- black triangles
- recession
causes of gummy smile
skeletal
- vertical maxillary excess
perio
- altered passive eruption
skeletal cause of gummy smile
tx?
teeth normally shaped, with an increased lower anterior facial height with vertical maxillary excess, all maxillary teeth seem over erupted
tx
- combo ortho and orthgnathi surgery
or plastic surgery
NEW tx: botox upper lip
perio cause of gummy smile
altered passive eruption
- NONE OR REDUCED gingival margin after active eruption phase – late adolescence
so thick fibrotic tisssue migrates slower
teeth seem square and short, margin > 1 mm from CEJ
thick fibrotic gingiva
APICAL migration did not occur normally
tx
- perio surgery to normalize contours
perio surgery timing with gummy smile
if incisal edges are intact, surgery can be delayed until after orthodontic tx is complete and teeth are aligned
in some areas might be necessary to position brackets properly
teeth look short and square
altered passive eruption
perio due to gummy smile
when to do perio surgery DURING ortho?
if incisal edges are abraded – CEJ might not be leveled within the teeth
surgery during
- to allow corrections of discrepencies with intrusion - extrusion or restoration
gingival margin on centrals and cuspids position
1 mm apical than on the lateral incisor
altered architecture causes
altered passive eruption - localized
supra or infraeruption of teeth - loo incisal edges / wear pattern
recession
altered passive eruption with gingival architecture discrepencies
more localized
- teeth are in normal position, CEJ in correct relatino, excessive soft tissue present
gingival recontouring after ortho if needed– gingivectomy /CLP
supra or infraeruption of teeth with gingival architecture
causes altered arhitecture
either uneven or if even, abnormally worn
CEJ position is ALTERED
tx intrude / extrude tooth in worst relation and restore tooth structure
- composite, veneer, crown
bone defects that can be treated with ortho
hemiseptal osseous defects
1 or 2 walled
craters and 3 wall defects DO NOT IMPROVE WITH ORTHO
root proximity that improves perio health
2-3 mm of root separattion improves perio health in the area
furcation involvment with ortho?
furcations tend to WORSEN with ortho - class 3 might need hemisection and crowns (think implant maybe)
if ortho is choses FIRST address the perio tx and follow up closely with perio recalls
often seen in tipped or supraerupted teeth?
hemisectal osseous defects - 1 or 2 wall defects
hemisectal
osseous defects
1 or 2 wall defects that are often seen in tipped or supra-erupted teeth
tx - address perio treatment
extrude / upright teeth and stabilize for months
move teeth closer to THE TREATED DEFECT
ortho with recesssin?
either generalized or local recesssion –> basic perio therapy BEFORE ortho
ortho should , minimize expansion to avoid worsening recession
gingival grafting can be used
Interdental papilla missing b/c?
tx with ortho?
due to
- advanced perio disease
- loss of attachment, w/ or w/out flaring teeth
- divergent roots
- abnormal tooth shape
tx - ADDRESS PERIO FIRST – then ortho tx to close spaces
might NOT correct black triangles - IPR may improve appearance
fixed on may be needed
divergent root effects
can be cause of interdental papilla missing
- on incisors, positioning of contact is too incisasal but shape of tooth can be normal
tx - upright incisors and close space
NO firther perio involvment needed - might require incisal restoration if edges is worn
effect of abnormal tooth shape
can make interdental papilla be missing
- triangular central incisors make contact too small (less than 1 mm long) located in ot close to the incisal edge
perio health?
tx - reshape teeth removing .25 to .75 mm of enamel and close the space - no further perio needed
