perio and ortho interface

Question 1

What is the prevalence of perio as a function of age?

Answer 1

% of ortho pts w 5+mm pockets increases w age
But mucogingival problems peak and then decrease w age

Question 2

What is minimal perio involvement?

Answer 2

Before tx, OHI
Ortho pts need to take extra care
Hygiene aids often needed

Session 1-3 (plaque score, brushing technique, diet, floss)

Question 3

What are methods of plaque control?

Answer 3

Mesial and distal area between brackets
Gingival margin below bracket

Special aids-
1. Interproximal brushes
2. Standard interspace brush
3. Powered rotary brush
4. Superfloss/floss threader

However, standard tooth brush is adequate (special grooved no advantage)

Question 4

Can perio pts have ortho?

Answer 4

No contraindication as long as perio is under control before and during tx
Vigorous support plan and maintenance

Question 5

What are perio statistics?

Answer 5

Perio affects up to 40% of >40 years
Increased no of adult pts wanting ortho
Interface is significantly increasing

Question 6

What are the most common ortho problems in perio compromised pts?

Answer 6

Proclination of maxillary anteriors
Irregular interdental spacing
Rotation of teeth
Overeruption
Migration/loss of teeth
Traumatic occlusion

Question 7

Why does inflammation need to be under control?

Answer 7

If not, combination of inflam, ortho forces and occlusal trauma produced more rapid destruction

Question 8

How can you identify active disease?

Answer 8

Persistent BOP

Question 9

What are groups at risk?

Answer 9

1. Minimal disease and no progression despite gingival inflam (10%)
2. Moderate progression (80%)
3. Rapid progression (10%)

Question 10

How should you control moderate perio?

Answer 10

PMPR w/o surgical flaps (increased freq- depending)
Osseous surgery before/after ortho depending on condition

Period of observation following tx for complete healing and ensure control

Question 11

How can you reduce microorganisms in ortho?

Answer 11

Molar bonding over bands- marginal cleaning difficult

Wire ligatures/self ligating brackets over elastomeric rings- higher lvls of microbes

Question 12

Why might ortho lead to perio problems?

Answer 12

Enthusiastic arch expansion can lead to recession
Labial movement of lower anteriors can put supporting tissues at risk
Non passive retainer can acts as fulcrum

Question 13

What are perio indications for ortho tx?

Answer 13

Class II div 1-palatal trauma
Class II div 2-lower labial trauma