Perio and Endo Considerations (Lindauer) Flashcards
When does orthodontic treatment occur during a multidisciplinary case?
After ODCT but before definitive Perio surgery and Pros
What are periodontal issues that must be addressed prior to orthodontic treatment?
- Mucogingival defects
2. Control of periodontitis
What are teeth being flared during orthodontic treatment at increased risk of developing?
Recession
What may be indicated prior to ortho treatment to give adequate thickness of attached gingiva to avoid risk of recession or dehiscence during tooth movement?
Gingival grafting
When would a gingival graft be indicated prior to orthodontic treatment even when there is enough attached keratinized tissue?
The patient has a thin biotype (can see the probe tip when placed in the sulcus)
Can an adult with previous periodontitis be safely treated if perio is controlled?
Yes
What is the perio maintenance schedule for a stable perio patient receiving ortho treatment?
Twice the normal maintenance schedule
Tooth movement in ortho occurs because of what process in the bone?
Bone remodeling
What will occur if bone resorption exceeds bone deposition in the remodeling process?
Bone Loss
What is the average bone loss in ortho treatment?
Less than 0.5mm
Bone follows what in ortho treatment?
Tooth movement
When does bone not follow tooth movement in ortho?
Non-physiologic fast movements
Why is definitive perio surgery (bony recontouring) done after ortho treatment?
Because intrusions and extrusions of teeth will change bony architecture and only want perio to do their bony recontouring once
Is PDL widening and tooth mobility normal and expected during ortho treatment?
Yes
What would be the ideal ortho materials used on an adult perio patient to decrease plaque retention and make access for gingival cleaning easier?
- Bonded brackets (allow gingival access)
2. Steel ligatures (retain less plaque)
Do endodontically treated teeth move any different than vital teeth during ortho treatment?
No, they respond just like vital teeth
Why is it thought that endo treated teeth experience a higher rate of root resorption than vital teeth during ortho treatment?
Thought to be due to tooth having previous trauma that led to the endo, not the endo itself. Traumatized teeth are more prone to resorption
Should a properly endo treated tooth be expected to experience more root resorption than vital teeth being moved orthodontically(?
No
Can an ankylosed tooth be moved orthodontically?
No
What does an ankylosed tooth lack that is required for the bone remodeling for ortho?
PDL
What are 2 options for an ankylosed tooth in ortho treatment?
EXT and replace with implant or FPD after ortho. Move segment of bone with ankylosed tooth into new position with distraction
What are the most common teeth to experience orthodontic root resorption?
Maxillary central and lateral incisors (most)
Mandibular incisors (second most)
Mandibular first molars (third most)
When will resorption of the root occur in ortho treatment?
When active force is present
Is the loss of the root apex during ortho treatment reversible?
No
If even severe root resorption occurs in ortho, will the teeth most likely remain vital?
Yes
What are 4 patient factors to consider when looking at the risk for root resorption during ortho treatment?
- Ethnic predisposition(? )/ systemic factors
- Conical roots with pointed apices (pipette shaped)
- Dilacerated roots
- Teeth with history of trauma
What are 3 treatment factors thought to cause root resorption, but not supported by literature?
- Heavy forces during treatment
- Longer treatment times
- Movement of roots into lingual cortical plate
Do children generally get periodontal disease?
No. Usually just gingivitis.
What regulates tooth movement?
PDL response
