Tooth movement in the periodontally compromised patient

Question 1

What is the main difference in orthodontic therapy between children /adolescents and adults?

Answer 1

• Adults: Only dentoalveolar tooth movement. The bone growth is complete.
• Children/Adolescents: Both dentoalveolar tooth movement and guidance of bone growth - jaw relationship

Question 2

How can the jaw relationship/tooth occlusion be corrected in adults?

Answer 2

Orthognathic surgery

Question 3

Can orthodontic therapy alone induce or aggravate periodontal disease?

Answer 3

No

• Insufficient plaque control is necessary to cause periodontal disease

Question 4

What can occur if a tooth is orthodontically moved labially?

Can this be repaired by returning the tooth to lingual position?

Answer 4

What can occur if a tooth is orthodontically moved labially?

• Gingival recession, facial bone dehiscence or fenestration
• Thin biotype most sensitive to recession

Can this be repaired by returning the tooth to lingual position?

• Yes, but not always.
• Surgical correction may be necessary in some cases

Question 5

Would you change the frequency of your recall appointments in periodontal patients that are receiving orthodontic treatment?

Answer 5

As a rule:

• During orthodontic treatment, clinical periodontal evaluation (including periodontal probing) should be performed every 6 months.

Patient-tailored frequency (increased frequency):

• Plaque control
• Risk factors
• Disease severity (= Loss of tooth support)
• Phase of therapy

The role of the orthodontist:

• Careful continuous evaluation. If signs of periodontal pathology, referral to the periodontist.
• Measures dependent on the condition

Question 6

Is the history of aggressive periodontitis a contraindication for orthodontic tooth movement?

Answer 6

No. But: Careful monitoring to avoid relapse during treatment

Question 7

Which periodontal findings will result to discontinuation of an on-going orthodontic treatment?

Answer 7

• Non-adherence to the oral hygiene protocol - Uncontrolled gingival inflammation.
• PD>5 mm with BL

Question 8

Does orthodontic movement affect the inflammatory status of the periodontium?

Answer 8

• Epidemiological studies: Increased prevalence of inflammation [Retention sites, Difficult plaque control]
• Experimental studies: Orthodontic tooth movement can enhance bacteria induced periodontal inflammation