Perio and Endo Considerations (Lindauer)

Question 1

When does orthodontic treatment occur during a multidisciplinary case?

Answer 1

After ODCT but before definitive Perio surgery and Pros

Question 2

What are periodontal issues that must be addressed prior to orthodontic treatment?

Answer 2

1. Mucogingival defects

2. Control of periodontitis

Question 3

What are teeth being flared during orthodontic treatment at increased risk of developing?

Answer 3

Recession

Question 4

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?

Answer 4

Gingival grafting

Question 5

When would a gingival graft be indicated prior to orthodontic treatment even when there is enough attached keratinized tissue?

Answer 5

The patient has a thin biotype (can see the probe tip when placed in the sulcus)

Question 6

Can an adult with previous periodontitis be safely treated if perio is controlled?

Answer 6

Yes

Question 7

What is the perio maintenance schedule for a stable perio patient receiving ortho treatment?

Answer 7

Twice the normal maintenance schedule

Question 8

Tooth movement in ortho occurs because of what process in the bone?

Answer 8

Bone remodeling

Question 9

What will occur if bone resorption exceeds bone deposition in the remodeling process?

Answer 9

Bone Loss

Question 10

What is the average bone loss in ortho treatment?

Answer 10

Less than 0.5mm

Question 11

Bone follows what in ortho treatment?

Answer 11

Tooth movement

Question 12

When does bone not follow tooth movement in ortho?

Answer 12

Non-physiologic fast movements

Question 13

Why is definitive perio surgery (bony recontouring) done after ortho treatment?

Answer 13

Because intrusions and extrusions of teeth will change bony architecture and only want perio to do their bony recontouring once

Question 14

Is PDL widening and tooth mobility normal and expected during ortho treatment?

Answer 14

Yes

Question 15

What would be the ideal ortho materials used on an adult perio patient to decrease plaque retention and make access for gingival cleaning easier?

Answer 15

1. Bonded brackets (allow gingival access)

2. Steel ligatures (retain less plaque)

Question 16

Do endodontically treated teeth move any different than vital teeth during ortho treatment?

Answer 16

No, they respond just like vital teeth

Question 17

Why is it thought that endo treated teeth experience a higher rate of root resorption than vital teeth during ortho treatment?

Answer 17

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

Question 18

Should a properly endo treated tooth be expected to experience more root resorption than vital teeth being moved orthodontically(?

Answer 18

No

Question 19

Can an ankylosed tooth be moved orthodontically?

Answer 19

No

Question 20

What does an ankylosed tooth lack that is required for the bone remodeling for ortho?

Answer 20

PDL

Question 21

What are 2 options for an ankylosed tooth in ortho treatment?

Answer 21

EXT and replace with implant or FPD after ortho. Move segment of bone with ankylosed tooth into new position with distraction

Question 22

What are the most common teeth to experience orthodontic root resorption?

Answer 22

Maxillary central and lateral incisors (most)
Mandibular incisors (second most)
Mandibular first molars (third most)

Question 23

When will resorption of the root occur in ortho treatment?

Answer 23

When active force is present

Question 24

Is the loss of the root apex during ortho treatment reversible?

Answer 24

No

Question 25

If even severe root resorption occurs in ortho, will the teeth most likely remain vital?

Answer 25

Yes

Question 26

What are 4 patient factors to consider when looking at the risk for root resorption during ortho treatment?

Answer 26

1. Ethnic predisposition(? )/ systemic factors
2. Conical roots with pointed apices (pipette shaped)
3. Dilacerated roots
4. Teeth with history of trauma

Question 27

What are 3 treatment factors thought to cause root resorption, but not supported by literature?

Answer 27

1. Heavy forces during treatment
2. Longer treatment times
3. Movement of roots into lingual cortical plate

Question 28

Do children generally get periodontal disease?

Answer 28

No. Usually just gingivitis.

Question 29

What regulates tooth movement?

Answer 29

PDL response