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Stähli A, Orishko A, Imber JC, Roccuzzo A, Sculean A, Kloukos D, Salvi GE. Supportive periodontal care during active orthodontic therapy in patients with history of stage IV periodontitis: A narrative review. Periodontol 2000 2025. [PMID: 40256787 DOI: 10.1111/prd.12627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 02/24/2025] [Accepted: 02/25/2025] [Indexed: 04/22/2025]
Abstract
The present narrative review aims to summarize the existing literature on recommendations for supportive periodontal care (SPC) in patients undergoing combined periodontal-orthodontic treatment. It outlines a comprehensive step-4 treatment sequence in patients diagnosed with stage IV periodontitis and concurrent orthodontic problems. The delivery of SPC characterizes step 4 of the comprehensive treatment sequence, focusing on the prevention of bacterial re-infection and the recurrence of the disease. Step 4 includes repeated assessments of residual probing pocket depths (PPD) greater than 5 mm, bleeding on probing (BoP) and/or suppuration around teeth and implants, as well as evaluation of furcation involvement. Extensive evidence indicates the efficacy of rigorous self-performed plaque control and adherence to regular SPC following active periodontal therapy as vital for managing caries and periodontitis, thereby reducing possible tooth loss. Current evidence indicates that patients with stage IV periodontal disease can safely proceed with orthodontic treatment following active periodontal therapy. Nonetheless, it is the authors' recommendation for patients undergoing periodontal-orthodontic treatment to participate in an SPC program scheduled every 3-4 months.
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Affiliation(s)
- Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anastasiya Orishko
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Periodontology Unit, Eastman Dental Institute, University College London, London, UK
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Shanghai Perio-Implant Innovation Center, Institute for Integrated Oral, Craniofacial and Sensory Research, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Oral Diseases, and National Center of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Zhong W, Zhou C, Yin Y, Feng G, Zhao Z, Pan Y, Bai Y, Jin Z, Xu Y, Fang B, Liu Y, He H, Chen F, Li W, Ge S, Li A, Ding Y, Chen L, Yan F, Song J. Expert consensus on orthodontic treatment of patients with periodontal disease. Int J Oral Sci 2025; 17:27. [PMID: 40175337 PMCID: PMC11965299 DOI: 10.1038/s41368-025-00356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 02/14/2025] [Accepted: 02/18/2025] [Indexed: 04/04/2025] Open
Abstract
Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health, function, and aesthetics, ensuring both patient satisfaction and long-term stability. Managing these patients involving orthodontic tooth movement can be particularly challenging due to compromised periodontal soft and hard tissues, especially in severe cases. Therefore, close collaboration between orthodontists and periodontists for comprehensive diagnosis and sequential treatment, along with diligent patient compliance throughout the entire process, is crucial for achieving favorable treatment outcomes. Moreover, long-term orthodontic retention and periodontal follow-up are essential to sustain treatment success. This expert consensus, informed by the latest clinical research and practical experience, addresses clinical considerations for orthodontic treatment of periodontal patients, delineating indications, objectives, procedures, and principles with the aim of providing clear and practical guidance for clinical practitioners.
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Affiliation(s)
- Wenjie Zhong
- College of Stomatology, Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Chenchen Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuanyuan Yin
- College of Stomatology, Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Ge Feng
- College of Stomatology, Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Zhihe Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yaping Pan
- Department of Periodontics, Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Yuxing Bai
- Department of Orthodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zuolin Jin
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, Air Force Medical University, Xi'an, China
| | - Yan Xu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Bing Fang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Liu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong He
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Faming Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Weiran Li
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shaohua Ge
- Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration and Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Ang Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yi Ding
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lili Chen
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
| | - Fuhua Yan
- Department of Periodontology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China.
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical Engineering, Chongqing, China.
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Xin TY, Zhu ZL, Chen LJ, Han B, Yang RL, Shi J. Profile of Inflammatory Cytokines in Gingival Crevicular Fluid and Plasma in Patients With Grade C Periodontitis During Orthodontic Treatment: A Longitudinal Case Series Report. Orthod Craniofac Res 2025; 28:324-335. [PMID: 39589230 DOI: 10.1111/ocr.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 10/25/2024] [Accepted: 11/14/2024] [Indexed: 11/27/2024]
Abstract
AIM To examine the immune responses in patients diagnosed as grade C periodontitis during orthodontic treatment. MATERIALS AND METHODS Our study included seven orthodontic patients with grade C periodontitis and measured their levels of inflammatory cytokines in gingival crevicular fluid and plasma before orthodontic treatment, during the alignment and levelling phase, and during the detailing and finishing phase. The key signal pathways in the orthodontic process of patients with periodontitis were detected by KEGG analysis. RESULTS Studies have shown that orthodontic treatment brings great improvement to patients with grade C periodontitis, and most of the local/systemic inflammatory cytokines can be reduced after orthodontic treatment. Simultaneously, orthodontic treatment can reduce the percentage of IFN-γ+ Th1 cells in patients with grade C periodontitis. Through KEGG analysis, the IL-17 signalling pathway and TNF signalling pathway are closely interrelated in the orthodontic treatment of patients diagnosed with grade C periodontitis (p-value < 0.001). CONCLUSION Orthodontic treatment can effectively control the local and system levels of inflammation in patients with grade C periodontitis, with IL-17A and TNF-α as potential distinctive inflammatory markers for orthodontic-periodontal combined treatment in individuals with periodontitis.
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Affiliation(s)
- Tian-Yi Xin
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
- Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Zi-Lu Zhu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
- Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Liu-Jing Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
- Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Bin Han
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
- Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Rui-Li Yang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
- Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Jie Shi
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
- Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
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Li Y, Huang J, Fan Z, Han M, Gu Y, Li D, Li Y, Li L. Changes in alveolar bone remodeling after maxillary anterior retraction using fixed appliances with different periodontal conditions: A retrospective study based on cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2025:S0889-5406(25)00100-3. [PMID: 40119866 DOI: 10.1016/j.ajodo.2025.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 02/12/2025] [Accepted: 02/12/2025] [Indexed: 03/24/2025]
Abstract
INTRODUCTION This study aimed to compare changes in maxillary anterior alveolar bone remodeling and complication rates in adult patients with different periodontal conditions after maxillary anterior tooth retraction using fixed appliances. In addition, this study analyzed potential factors affecting alveolar bone thickness in patients with periodontitis. METHODS A total of 55 adult patients (mean age, 23.53 ± 4.55 years) with Angle Class I or II Division 1 malocclusion with maxillary protrusion were recruited and categorized into the healthy control group (n = 23), stage I periodontitis (P-I) group (n = 17), and stage II periodontitis (P-II) group (n = 15). The maxillary anterior teeth were retracted using a fixed appliance. Cone-beam computed tomography was used to measure the thickness, height, and density of the alveolar bone in the maxillary anterior region before (T1) and after (T2) treatment. The incidences of bone dehiscence and fenestration were documented. Statistical analysis was conducted to evaluate intergroup and intragroup differences. Clinical and cephalometric data were collected to identify factors affecting the changes in alveolar bone thickness using multivariate linear regression analysis. RESULTS The labial alveolar bone thickness increased significantly after treatment in all groups, but no differences were observed among the groups. In contrast, the palatal alveolar bone thickness decreased, particularly in the P-I and P-II groups, at the midroot and apical levels (P <0.05). A significant decrease in alveolar bone height was observed in the P-I and P-II groups (P <0.05). The incidence of palatal bone dehiscence was higher in the P-II (84.44%) and P-I (69.61%) groups. Multivariate linear regression analyses revealed that sex, treatment duration, periodontal treatment, changes in tooth inclination, and initial thickness significantly affected palatal alveolar bone thickness changes in patients with periodontitis. CONCLUSIONS After retraction of the maxillary anterior teeth with a fixed appliance, the labial alveolar bone of the maxillary anterior teeth thickened, whereas the palatal bone exhibited thinning in adults with periodontitis. The reduction in palatal bone height was more significant in this population than in healthy subjects, along with a higher incidence of palatal bone dehiscence. Bone morphology must be carefully assessed, considering these relevant factors before and during orthodontic treatment.
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Affiliation(s)
- Yao Li
- Department of Periodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China; State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Jiaxin Huang
- Department of Periodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China; State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Zixin Fan
- Department of Periodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China; State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Minxuan Han
- State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China; Department of Orthodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Gu
- State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China; Department of Orthodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
| | - Dandan Li
- State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China; Department of Orthodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
| | - Yuan Li
- State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China; Department of Orthodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Li
- Department of Periodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China; State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China.
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Hashim NT, Dasnadi SP, Ziada H, Rahman MM, Ahmed A, Mohammed R, Islam MS, Mascarenhas R, Gismalla BG, Abubakr NH. Orthodontic Management of Different Stages and Grades of Periodontitis According to the 2017 Classification of Periodontal Diseases. Dent J (Basel) 2025; 13:59. [PMID: 39996933 PMCID: PMC11853809 DOI: 10.3390/dj13020059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 01/19/2025] [Accepted: 01/26/2025] [Indexed: 02/26/2025] Open
Abstract
Background/Objectives: The 2017 Periodontal Classification offers a comprehensive framework for the diagnosis and management of periodontitis based on staging and grading criteria. Orthodontic therapy is increasingly incorporated into the management of periodontitis to rectify malocclusion, pathological tooth migration, and occlusal stability. Nonetheless, few data directly correspond with this revised classification scheme. The objective of this systematic review is to figure out the influence of orthodontic therapy on periodontal outcomes in patients with Stage III and IV periodontitis, as categorized by the 2017 framework. Methods: A systematic review was performed in accordance with the PRISMA 2020 principles. The databases examined were PubMed, Web of Science, Scopus, and Google Scholar. The evaluation focuses on research published from 2012 to 2024. Seventeen studies were assessed after the application of the inclusion criteria. Key outcomes included clinical attachment level (CAL) improvement, probing depth (PD) decrease, and radiographic bone fill. Results: The integration of orthodontic treatment with periodontal therapy markedly enhanced CAL (mean gain: 4.35-5.96 mm), decreased PD (mean reduction: 3.1-6.3 mm), and facilitated radiographic bone regeneration (mean vertical fill: 4.89 mm). Patients with Stage IV Grade C periodontitis had the most significant improvement, especially with early orthodontic intervention subsequent to regenerative treatment. Prolonged follow-ups (up to 10 years) validated consistent results. Conclusions: Orthodontic intervention, as a supplementary measure to periodontal therapy, improves results in severe periodontitis, especially in Stage III and IV patients. These results underscore the need for multidisciplinary teamwork and defined protocols for including orthodontics in periodontitis therapy.
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Affiliation(s)
- Nada Tawfig Hashim
- Periodontics Department, RAK College of Dental Sciences, RAK Medical & Health Sciences University, Ras-AlKhaimah 12973, United Arab Emirates;
| | - Shahistha Parveen Dasnadi
- Orthodontics Department, RAK College of Dental Sciences, RAK Medical & Health Sciences University, Ras-AlKhaimah 12973, United Arab Emirates;
| | - Hassan Ziada
- Clinical Science Department, School of Dental Medicine, University of Nevada, Las Vegas, NV 89106, USA;
| | - Muhammed Mustahsen Rahman
- Periodontics Department, RAK College of Dental Sciences, RAK Medical & Health Sciences University, Ras-AlKhaimah 12973, United Arab Emirates;
| | - Ayman Ahmed
- Periodontics Department, College of Dentistry, Nile University, Khartoum 1847, Sudan;
| | - Riham Mohammed
- Oral Surgery Department, RAK College of Dental Sciences, RAK Medical & Health Sciences University, Ras-AlKhaimah 12973, United Arab Emirates;
| | - Md Sofiqul Islam
- Operative Department, RAK College of Dental Sciences, RAK Medical & Health Sciences University, Ras-AlKhaimah 12937, United Arab Emirates;
| | - Rohan Mascarenhas
- Orthodontics Department, Yenepoya Dental College, Mangaluru 575018, India;
| | - Bakri Gobara Gismalla
- Oral Rehabilitation Department, Faculty of Dentistry, University of Khartoum, Khartoum 11115, Sudan;
| | - Neamat Hassan Abubakr
- Biomedical Science Department, School of Dental Medicine, University of Nevada, Las Vegas, NV 89106, USA;
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Viglianisi G, Polizzi A, Lombardi T, Amato M, Grippaudo C, Isola G. Biomechanical and Biological Multidisciplinary Strategies in the Orthodontic Treatment of Patients with Periodontal Diseases: A Review of the Literature. Bioengineering (Basel) 2025; 12:49. [PMID: 39851323 PMCID: PMC11760482 DOI: 10.3390/bioengineering12010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 12/09/2024] [Accepted: 01/07/2025] [Indexed: 01/26/2025] Open
Abstract
Orthodontic treatment aims to correct malocclusions and ensure the overall health and stability of the periodontium. The relationship between orthodontic therapy and periodontal health is intricate and multifaceted, and a comprehensive approach is often required to achieve optimal outcomes. Firstly, this article delves into the impact of orthodontic mechanics on periodontal tissues, emphasizing the importance of minimizing iatrogenic effects such as root resorption and gingival recession. Understanding the biomechanical principles allows for the development of treatment plans that mitigate these risks while achieving the desired tooth movement. Effective communication and coordinated treatment protocols are essential for managing periodontal issues before, during, and after orthodontic intervention. To optimize outcomes, periodontal considerations such as gingival biotype, attachment levels, and bone support must be integrated into treatment planning. Additionally, adjunctive periodontal therapies such as selective alveolar decortication and regenerative procedures are explored as valuable tools to enhance periodontal support and optimize treatment outcomes. This narrative review explores strategies to attain periodontal goals in orthodontic patients, thereby facilitating successful treatment. Furthermore, the review examines the role of interdisciplinary collaborations between orthodontists and periodontists. In conclusion, achieving periodontal goals in orthodontic patients requires a comprehensive approach that addresses biomechanical principles, interdisciplinary collaboration, patient education, and adjunctive periodontal therapies. By integrating periodontal considerations into orthodontic treatment planning and execution, clinicians can ensure straight teeth and a healthy and stable periodontium, ultimately leading to successful treatment outcomes and long-term oral health.
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Affiliation(s)
- Gaia Viglianisi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (G.V.); (A.P.); (M.A.); (G.I.)
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (G.V.); (A.P.); (M.A.); (G.I.)
| | - Teresa Lombardi
- Department of Health Sciences, University Magna Græcia, 88100 Catanzaro, Italy;
| | - Mariacristina Amato
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (G.V.); (A.P.); (M.A.); (G.I.)
| | - Cristina Grippaudo
- UOC di Clinica Odontoiatrica, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (G.V.); (A.P.); (M.A.); (G.I.)
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Dung SZ, Tzeng IS, Li CS. Immediate orthodontic treatment after regeneration of periodontal intrabony defects: A long-term retrospective study. J Dent Sci 2025; 20:417-427. [PMID: 39873065 PMCID: PMC11762914 DOI: 10.1016/j.jds.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/03/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND/PURPOSE Orthodontic movement is often necessary for periodontally compromised patients to enhance esthetics, function, and long-term occlusal stability. However, the impact of orthodontic treatment immediately following the regeneration of intrabony defects on periodontal healing remains a topic of debate. The objective of this long-term case series study was to test the hypothesis that orthodontic treatment performed immediately after regenerative procedures for periodontal intrabony defects did not adversely affect periodontal healing. MATERIALS AND METHODS This case series study involved nine periodontally compromised subjects with a total of 17 intra-bony defects. Orthodontic brackets were applied immediately before surgery. Flaps were raised, and diseased roots were debrided. All intra-bony defects were filled with alloplastic bone grafts and covered with resorbable membranes, except for one defect treated with Emdogain. All patients initiated orthodontic treatment immediately after periodontal regenerative surgery. Clinical parameters, including probing depth, attachment level, and bone fill, were assessed at baseline and during final maintenance therapy. RESULTS The mean follow-up duration was 12.8 years. None of the 17 surgically regenerated teeth were lost. The mean reduction in probing depth was 3.94 mm (95% confidence level, 3.19-4.68; P < 0.001), with a mean clinical attachment gain of 3.47 mm (95% confidence level, 2.90-4.03; P < 0.001). The mean radiographic bone fill was 4.89 mm (P < 0.001). CONCLUSION Based on the findings of this long-term case study, it can be concluded that immediate orthodontic treatment does not adversely affect the maturation process of periodontal regeneration outcomes and can be maintained for more than ten years.
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Affiliation(s)
- Shing-Zeng Dung
- Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- Department of Surgery, College of Medicine, Tzu Chi University, Hualien, Taiwan
- College of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Cheng-Shan Li
- Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
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Camelin F, Saade A, El Helou M. To intrude or not to intrude? A systematic review of the controversy surrounding orthodontic intrusion on reduced periodontium. Int Orthod 2024; 22:100841. [PMID: 38215683 DOI: 10.1016/j.ortho.2023.100841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE The main objective of this review was to evaluate the effects of orthodontic intrusion on patients with reduced periodontium. Additionally, this review aims to explore the potential for attachment gain and tissue regeneration in these patients and identify optimal therapeutic conditions to mitigate any negative effects of intrusion. METHODS A systematic review was conducted according to the PRISMA 2020 statement. Duplicate electronic searches of the PubMed, Cochrane, EMC Premium, and Science Direct databases were performed by two independent reviewers. Data extraction and quality assessments, including risk of bias evaluation using the Cochrane and ROBINS-I tools were conducted. RESULTS From an initial pool of 418 articles, 29 were selected after title and abstract screening for full-text review. Following thorough full-text reading, 15 studies were ultimately included in the analysis. The total number of patients included in the studies is 528, who underwent orthodontic intrusion on reduced periodontium. Studies indicated a decrease in periodontal pocket depth and an increase in clinical attachment with ortho-periodontal treatment. Alveolar bone level outcomes varied, showing both increases and losses. Authors generally observed improved papillary regeneration and reduced gingival recessions. CONCLUSION Clinical studies involving combined ortho-periodontal treatment showed that orthodontic intrusion on a reduced but healthy periodontium can be considered a beneficial treatment for the periodontium, provided that potential adverse effects are carefully monitored.
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Affiliation(s)
- François Camelin
- Service d'odontologie, CHU de Clermont-Ferrand, Université de Clermont Auvergne, CROC, 63000 Clermont-Ferrand, France
| | - Aline Saade
- Private Practice, Abu Dhabi, United Arab Emirates
| | - Marwan El Helou
- Service d'odontologie, CHU de Clermont-Ferrand, Université de Clermont Auvergne, CROC, 63000 Clermont-Ferrand, France.
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9
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Ronsivalle V, Malara C, Cicciù M, Venezia P, Lo Giudice A. Digital orthodontic setup and clear aligners system for treating adult patients with periodontitis: a descriptive case report. FRONTIERS IN DENTAL MEDICINE 2024; 5:1353114. [PMID: 39917643 PMCID: PMC11797835 DOI: 10.3389/fdmed.2024.1353114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2025] Open
Abstract
This case report describes the treatment of an adult female patient with a history of periodontitis (Stage 3 -Grade B) and presenting significant crowding in both maxillary and mandibular arches. After periodontal stabilization, the patient underwent orthodontic treatment with clear aligners (CAT) for less than one year. CAT provided an effective quantitative and qualitative control of the forces applied to resolve the malocclusion. This case report provides a detailed description of the clinical strategy and features associated with the clear aligners system which were considered ideal tools for treating periodontal patients during the decisional workflow. The orthodontic treatment goals have been successfully achieved considering functional, periodontal, and aesthetic expectations. Several characteristics of clear aligners could support the recurrence of this orthodontic system for treating patients with a history of periodontitis or at risk of periodontal damage.
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Affiliation(s)
- Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, Dental Clinic - Unit of Oral Surgery, University of Catania, Catania, Italy
| | - Claudia Malara
- Department of General Surgery and Medical-Surgical Specialties, Dental Clinic - Unit of Orthodontics, University of Catania, Catania, Italy
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, Dental Clinic - Unit of Oral Surgery, University of Catania, Catania, Italy
| | - Piero Venezia
- Department of General Surgery and Medical-Surgical Specialties, Dental Clinic - Unit of Orthodontics, University of Catania, Catania, Italy
| | - Antonino Lo Giudice
- Department of General Surgery and Medical-Surgical Specialties, Dental Clinic - Unit of Orthodontics, University of Catania, Catania, Italy
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10
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Jepsen K, Sculean A, Jepsen S. Complications and treatment errors involving periodontal tissues related to orthodontic therapy. Periodontol 2000 2023; 92:135-158. [PMID: 36920050 DOI: 10.1111/prd.12484] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/25/2022] [Accepted: 01/04/2023] [Indexed: 03/16/2023]
Abstract
In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT). Special considerations are given for various clinical scenarios, such as the patient presenting in periodontal health, with periodontitis, or with mucogingival conditions. While some of the complications are seen as common side effects of OT, other, more severe, problems that could have been avoided may be viewed as treatment errors. Recommendations are made on how to prevent these complications, based on the currently available evidence, on clinical practice guidelines, and on expert opinion. In conclusion, while there are several areas in which OT can have unwanted adverse effects on periodontal/mucogingival conditions, there is also great potential for synergies, offering opportunities for close cooperation between the two specialties (periodontics and orthodontics) for the benefit of patients affected by tooth malpositioning and/or periodontal or mucogingival problems.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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11
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Navarrete C, Riquelme A, Baksai N, Pérez R, González C, Michea M, von Mühlenbrock H, Cafferata EA, Vernal R. Levels of Pro-Inflammatory and Bone-Resorptive Mediators in Periodontally Compromised Patients under Orthodontic Treatment Involving Intermittent Forces of Low Intensities. Int J Mol Sci 2023; 24:ijms24054807. [PMID: 36902236 PMCID: PMC10002573 DOI: 10.3390/ijms24054807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
During orthodontic treatment, diverse cytokines, enzymes, and osteolytic mediators produced within the teeth surrounding periodontal tissues determine the rate of alveolar bone remodeling and consequent teeth movement. In patients with teeth presenting reduced periodontal support, periodontal stability should be ensured during orthodontic treatment. Thus, therapies based on the application of low-intensity intermittent orthodontic forces are recommended. To determine if this kind of treatment is periodontally well tolerated, this study aimed to analyze the production of receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG), interleukin (IL)-6, IL-17A, and matrix metalloproteinase (MMP)-8 in periodontal tissues of protruded anterior teeth with reduced periodontal support and undergoing orthodontic treatment. Patients with periodontitis-associated anterior teeth migration received non-surgical periodontal therapy and a specific orthodontic treatment involving controlled low-intensity intermittent orthodontic forces. Samples were collected before periodontitis treatment, after periodontitis treatment, and at 1 week to 24 months of the orthodontic treatment. During the 2 years of orthodontic treatment, no significant differences were detected in the probing depth, clinical attachment level, supragingival bacterial plaque, and bleeding on probing. In line with this, the gingival crevicular levels of RANKL, OPG, IL-6, IL-17A, and MMP-8 did not vary between the different evaluation time-points of the orthodontic treatment. When compared with the levels detected during the periodontitis, the RANKL/OPG ratio was significantly lower at all the analyzed time-points of the orthodontic treatment. In conclusion, the patient-specific orthodontic treatment based on intermittent orthodontic forces of low intensities was well tolerated by periodontally compromised teeth with pathological migration.
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Affiliation(s)
- Cristian Navarrete
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Alejandro Riquelme
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Natalia Baksai
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Romina Pérez
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Claudia González
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - María Michea
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Hans von Mühlenbrock
- Orthodontics-Periodontics Center, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Emilio A. Cafferata
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Lima 15067, Peru
- Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Rolando Vernal
- Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
- Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
- Correspondence:
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12
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Zasčiurinskienė E, Šidlauskas A, Kavaliauskienė A, Vazgytė J, Matuzas A, Zaborskis A. Reliability and Validity of a Lithuanian Version of the Oral Health Impact Profile-A Study in Patients with Stage III-IV Periodontitis. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010069. [PMID: 36676693 PMCID: PMC9867273 DOI: 10.3390/medicina59010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 12/30/2022]
Abstract
Background and Objectives: The study aimed to translate the original English version of Oral Health Impact Profile (OHIP) into Lithuanian and to assess reliability and validity of the translated instrument (OHIP-Lt) in patients with advanced stages of periodontitis. Materials and Methods: Subjects (N = 67) with stage III-IV periodontitis aged 30-63 years were surveyed by questionnaire and examined clinically. Psychometric analysis included explanatory (EFA) and confirmatory (CFA) factor analyses and psychometric tests. Results: Cronbach's alpha of the translated OHIP was 0.96. EFA revealed four dimensions which Cronbach's alpha ranged from 0.75 to 0.96. Construct validity of the four-factor model derived from the OHIP-Lt was supported by findings of CFA (RMSEA = 0.077). The total OHIP-Lt and its subscale scores increased as the patients' self-rated oral health status changed from healthy to unhealthy. Discriminative validity of the OHIP-Lt was confirmed by its higher scores among patients who had an increased spacing between the maxillary anterior teeth and increased clinical attachment level (CAL ≥ 5 mm) compared to those who did not. Conclusions: The translated Lithuanian version of OHIP-Lt was identified as four-dimension inventory. Good reliability and validity of the OHIP-Lt provide the evidence for its further use in study on advanced periodontal disease burden among Lithuanian patients.
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Affiliation(s)
- Eglė Zasčiurinskienė
- Department of Orthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
- Correspondence:
| | - Antanas Šidlauskas
- Department of Orthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Aistė Kavaliauskienė
- Department of Orthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Jurgita Vazgytė
- Department of Dental and Oral Pathology, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Agnius Matuzas
- Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Apolinaras Zaborskis
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
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13
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Periodontal and Orthodontic Synergy in the Management of Stage IV Periodontitis: Challenges, Indications and Limits. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122131. [PMID: 36556496 PMCID: PMC9782082 DOI: 10.3390/life12122131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
This retrospective study described the clinical and radiographic long-term outcomes of combined periodontal and orthodontic treatment (OT) with fixed appliances in patients with Stage IV periodontitis and pathologic tooth migration (PTM) in the anterior sextants. OT was performed in either one or both arches, using tooth-supported or skeletal anchorage, following completion of active periodontal treatment and accurate planning of tooth movement biomechanics. Twenty-nine patients were identified and retrospectively examined when presenting for a supportive periodontal care (SPC) appointment. The mean SPC duration was 8.9 years (range 5 to 12 years). All anterior-migrated teeth showed statistically significant periodontal improvement compared to baseline values and stable radiographic bone levels at the final follow-up. Residual probing depths were 2.9 ± 0.5 mm at the end of active periodontal treatment, and they remained stable at the completion of OT (2.9 ± 0.6 mm) and at the last follow-up visit (2.8 ± 0.5 mm). These findings suggest that OT is a safe and effective treatment in improving the long-term prognosis of teeth with PTM in Stage IV periodontitis provided that periodontal health has been re-established and maintained with individualized SPC sessions.
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14
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Satomi K, Nishimura K, Igarashi K. Semaphorin 3A protects against alveolar bone loss during orthodontic tooth movement in mice with periodontitis. J Periodontal Res 2022; 57:991-1002. [PMID: 35899793 DOI: 10.1111/jre.13038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE This study investigated the effect of local semaphorin 3A (Sema3A) administration on alveolar bone loss during OTM in a mouse model of periodontitis. BACKGROUND Orthodontic tooth movement (OTM) for patients with periodontal disease is known to increase the risk of exacerbating alveolar bone loss due to inflammation of the periodontal tissue. However, its mechanism of action and prevention remains unclear. METHODS Mice (male 7-8 weeks old, C57BL/6J, n = 12) were divided into six groups: untreated group (control), without OTM and recovered from induced periodontitis (RP), with OTM and administered PBS or Sema3A to the gingiva after induced periodontitis (VehPO, SemaPO), with OTM and administered PBS or Sema3A to the gingiva without periodontitis induction (VehNO, SemaNO). Samples were collected on 14 days, and bone loss, histological analysis, cytokine production level, and tooth movement were assessed. Cultured human periodontal ligament (hPDL) cells were stimulated with lipopolysaccharide (LPS) and compressive force (CF), and mRNA expression levels of Sema3A and its receptors were analyzed. RESULTS The bone loss was significantly lower in the SemaPO group than in the VehPO group. The number of TRAP-positive cells in the SemaPO group was significantly lower than that in the VehPO group and was at the same level as that in the control group. The receptor activator of nuclear factor (NF)-kB-ligand/osteoprotegerin (RANKL/OPG) ratio and the levels of proinflammatory cytokines, including interleukin (IL)-1β, IL-6, IL-17, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ, in the gingival tissues were significantly lower in the SemaPO group than in the VehPO group. Additionally, Sema3A mRNA expression in hPDL cells was significantly decreased by co-stimulation with LPS and CF compared with that in the control group. Finally, the distance moved (dist.) and the mesial tipping angle (θ) was significantly smaller in the SemaPO group than in the VehPO group and was not significantly different from that of VehNO. CONCLUSION Pathological alveolar bone loss exacerbated by OTM in periodontitis might be prevented by local administration of Sema3A without inhibiting OTM.
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Affiliation(s)
- Kazuki Satomi
- Division of Craniofacial Anomalies, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kazuaki Nishimura
- Division of Craniofacial Anomalies, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Department of Orthodontics and Speech Therapy for Craniofacial Anomalies, Tohoku University Hospital, Sendai, Japan
| | - Kaoru Igarashi
- Division of Craniofacial Anomalies, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Department of Orthodontics and Speech Therapy for Craniofacial Anomalies, Tohoku University Hospital, Sendai, Japan
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15
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Papageorgiou SN, Antonoglou GN, Michelogiannakis D, Kakali L, Eliades T, Madianos P. Effect of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis: A systematic review with meta-analysis. J Clin Periodontol 2022; 49 Suppl 24:102-120. [PMID: 34327710 PMCID: PMC9290963 DOI: 10.1111/jcpe.13529] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/25/2021] [Indexed: 12/28/2022]
Abstract
AIM To assess the beneficial and adverse effects on the dental and periodontal issues of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis. MATERIALS AND METHODS Nine databases were searched in April 2020 for randomized/non-randomized clinical studies. After duplicate study selection, data extraction, and risk-of-bias assessment, random-effect meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression analyses. RESULTS A total of 30 randomized and non-randomized clinical studies including 914 patients (29.7% male; mean age 43.4 years) were identified. Orthodontic treatment of pathologically migrated teeth was associated with clinical attachment gain (-0.24 mm; seven studies), pocket probing depth reduction (-0.23 mm; seven studies), marginal bone gain (-0.36 mm; seven studies), and papilla height gain (-1.42 mm; two studies) without considerable adverse effects, while patient sex, gingival phenotype, baseline disease severity, interval between periodontal and orthodontic treatment, and orthodontic treatment duration affected the results. Greater marginal bone level gains were seen by additional circumferential fiberotomy (two studies; MD = -0.98 mm; 95% CI = -1.87 to -0.10 mm; p = .03), but the quality of evidence was low. CONCLUSIONS Limited evidence of poor quality indicates that orthodontic treatment might be associated with small improvements of periodontal parameters, which do not seem to affect prognosis, but more research is needed.
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Affiliation(s)
- Spyridon N. Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental MedicineUniversity of ZurichZurichSwitzerland
| | - Georgios N. Antonoglou
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Periodontology, Faculty of DentistryUniversity ComplutenseMadridSpain
| | - Dimitrios Michelogiannakis
- Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral HealthUniversity of RochesterRochesterNew YorkUSA
| | - Lydia Kakali
- Department of Orthodontics, School of DentistryNational and Kapodistrian University of AthensAthensGreece
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental MedicineUniversity of ZurichZurichSwitzerland
| | - Phoebus Madianos
- Department of Periodontology, School of DentistryNational and Kapodistrian University of AthensAthensGreece
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16
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NESTEROVA O, KRASILNIKOVA V, MARGARYAN E, LAZAREVA Y, NEMTYREVA L. Treatment of chronic generalized periodontitis in patients with underlying hypovitaminosis D: randomized comparative clinical trial. J Appl Oral Sci 2022. [DOI: 10.1590/1678-7757-2022-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Olga NESTEROVA
- I.M. Sechenov First Moscow State Medical University, Russian Federation
| | | | - Edita MARGARYAN
- I.M. Sechenov First Moscow State Medical University, Russian Federation
| | - Yuliya LAZAREVA
- I.M. Sechenov First Moscow State Medical University, Russian Federation
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17
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Zhang J, Xing J, Zheng M, Sheng J, Zhang K, Zhang B. Effectiveness of virtual simulation and jaw model for undergraduate periodontal teaching. BMC MEDICAL EDUCATION 2021; 21:616. [PMID: 34906125 PMCID: PMC8672555 DOI: 10.1186/s12909-021-03064-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/01/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND The current study explored the effect of virtual simulation and jaw model on development of preclinical periodontal skills in undergraduate students. The study also sought to explore effectiveness of VR in periodontal preclinical training and determine adequate performance mode in basic periodontal education to improve future preclinical training strategies. METHODS Sixty volunteer sophomores and juniors from the stomatology department in Lanzhou university were enrolled to the current study. Participants were randomly assigned into four groups (each group, n = 15) including the traditional jaw model group (Group J) which was the control group, virtual reality group (Group V), virtual-jaw group (Group V-J), and jaw-virtual group (Group J-V). Participants received training on uniform basic periodontal knowledge before completing the first theoretical assessment. Participants further underwent a total 8 h of operation training and completed a second theoretical assessment. Performance of participants was evaluated using the supragingival scaling processes, and clinical operation scores were graded by a blinded professional using an established standard scoring system. RESULTS The findings showed no significant difference in the first theoretical outcomes between the four groups (P > 0.05). The scores of the second theoretical assessment were significantly improved for the V-J and J-V groups (60.00 ± 4.47, 58.33 ± 4.35) compared with the scores of the first theoretical exam (49.67 ± 4.81, 48.00 ± 4.93, P < 0.05). The operation process scores of students in Group V-J and J-V (72.00 ± 5.92; 70.00 ± 3.05) were significantly higher compared with the scores in the other two groups (V: 61.67 ± 7.85; J: 60.67 ± 2.58). The scaling process performance of students in Group V-J and J-V (53.00 ± 3.05; 63.40 ± 4.39) was improved compared with that of students in the other two groups (V: 41.90 ± 5.23; J: 47.40 ± 4.31). CONCLUSION The findings show that combination of virtual reality and jaw model during periodontal preclinical training increases students' grades and improves acquiring of professional skills. Findings from the current study indicate that the jaw model should be applied prior to virtual reality to ensure high efficacy.
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Affiliation(s)
- Jie Zhang
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
- Hospital of Stomatology, Lanzhou University, Lanzhou, 730000, China
- Gansu Province Key Lab of Maxillofacial Reconstruction and Intelligent Manufacturing, Lanzhou, 730000, China
| | - Jiawei Xing
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Min Zheng
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Jie Sheng
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Kailiang Zhang
- School of Stomatology Lanzhou University, Lanzhou, 730000, China.
- Hospital of Stomatology, Lanzhou University, Lanzhou, 730000, China.
- Gansu Province Key Lab of Maxillofacial Reconstruction and Intelligent Manufacturing, Lanzhou, 730000, China.
- Gansu Province Clinical Research Center for Oral Diseases, Lanzhou, 730000, China.
| | - Baoping Zhang
- School of Stomatology Lanzhou University, Lanzhou, 730000, China.
- Hospital of Stomatology, Lanzhou University, Lanzhou, 730000, China.
- Gansu Province Key Lab of Maxillofacial Reconstruction and Intelligent Manufacturing, Lanzhou, 730000, China.
- Gansu Province Clinical Research Center for Oral Diseases, Lanzhou, 730000, China.
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18
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Gehlot M, Sharma R, Tewari S, Kumar D, Gupta A. Effect of orthodontic treatment on periodontal health of periodontally compromised patients: A randomized controlled clinical trial. Angle Orthod 2021; 92:324-332. [PMID: 34882193 DOI: 10.2319/022521-156.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the effect of fixed orthodontic treatment on periodontal parameters in periodontally compromised adult orthodontic patients. MATERIALS AND METHODS This was a prospective, randomized, controlled clinical trial. Thirty-six periodontally compromised adult patients (mean age: 29.67 ± 4.8 years) were randomly allocated to either test (perio-ortho) or control group (perio). After periodontal stabilization in both groups, orthodontic treatment was started in the test group, whereas the control group remained on periodontal maintenance only. Evaluation and comparison of clinical parameters (plaque index [PI]; gingival index [GI]; bleeding on probing [BOP]; probing depth [PD]; clinical attachment level [CAL]) of both groups was assessed at three time intervals: T0 (base line), T1 (at start of orthodontic treatment), and T2 (1 year after start of orthodontic treatment). Radiological parameters (alveolar bone levels [ABL]) were recorded using CBCT at T1 and T2. RESULTS Intragroup analysis showed statistically significant improvement in all clinical and radiological periodontal parameters in both groups (P ≤ .05). Intergroup comparison revealed improvement in the periodontal parameters was not statistically significant between the groups (P ≥ .05). Subgroup analysis showed reduction in the number of moderate and severe periodontitis sites in both groups with significant more gains in ABL in the test group compared to the control group. CONCLUSIONS Orthodontic treatment after periodontal stabilization does not have any detrimental effect on periodontal health in adult periodontally compromised orthodontic patients and may add to the benefits achieved by periodontal treatment alone.
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Kloukos D, Roccuzzo A, Stähli A, Sculean A, Katsaros C, Salvi GE. Effect of combined periodontal and orthodontic treatment of tilted molars and of teeth with intra-bony and furcation defects in stage-IV periodontitis patients: A systematic review. J Clin Periodontol 2021; 49 Suppl 24:121-148. [PMID: 34761413 DOI: 10.1111/jcpe.13509] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023]
Abstract
AIM To assess the effect of combined periodontal and orthodontic treatment (OT) in stage-IV periodontitis patients. MATERIALS AND METHODS Three focused questions were addressed using the Population, Intervention, Comparison, Outcome, and Study Design criteria. Randomized controlled trials (RCTs), controlled clinical trials, follow-up studies, case series, and controlled/uncontrolled before/after studies were assessed for inclusion. Primary outcomes included mean changes in pocket probing depth (PPD) and clinical attachment level (CAL). Qualitative synthesis of results was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Out of 916 records, 1 retrospective case series study reported the effect of OT of tilted molars, 2 RCTs and 10 prospective and 2 retrospective case series studies reported the effect of OT of treated intra-bony defects and 0 articles reported the effect of OT of treated furcation defects. Mean PPD changes were reported in 14 articles, and mean CAL changes were reported in 8 articles. Risk of bias was high in both included RCTs, critical in nine articles, and serious in four articles. No articles included patient-reported outcomes, and three articles reported harms/adverse effects. CONCLUSIONS Evidence is limited by (i) the lack or low number of included studies, (ii) the apparent methodological and clinical heterogeneity, and (iii) the high risk of bias of the retrieved studies. No solid conclusions could be drawn concerning OT in stage-IV periodontitis patients with respect to tilted molars, teeth with treated intra-bony defects, and teeth with treated furcation defects.
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Affiliation(s)
- Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Christos Katsaros
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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20
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Kaku M, Matsuda S, Kubo T, Shimoe S, Tsuga K, Kurihara H, Tanimoto K. Generalized periodontitis treated with periodontal, orthodontic, and prosthodontic therapy: A case report. World J Clin Cases 2021; 9:6110-6124. [PMID: 34368333 PMCID: PMC8316965 DOI: 10.12998/wjcc.v9.i21.6110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Generalized periodontitis is a severe periodontal disease characterized by rapid periodontal destruction in healthy persons. This case report describes the treatment of a severe crowding, large overjet, and occlusal collapse due to the loss of anterior guidance with generalized periodontitis.
CASE SUMMARY A 35-year-old female patient with a chief complaint of crowding and maxillary protrusion was diagnosed with generalized periodontitis by clinical and radiographic examinations. To improve crowding and overjet, orthodontic treatment was performed after basic periodontal therapy. Severely damaged upper right lateral incisor and left canine were extracted, and lower right first premolar and left second premolar were also removed to treat severe crowding. After orthodontic treatment, periodontal flap surgery for upper left molars and guided tissue regeneration for the lower left second molar was performed. Then, a dental implant was inserted in the upper left canine legion. The esthetics of the maxillary anterior tooth was improved by prosthetic restorations. The treatment result showed a well-improved occlusion with proper anterior guidance and healthy periodontal tissue after a retention period of 10 years.
CONCLUSION Periodontal, orthodontic, and prosthodontic treatments are extremely useful to improve function and stable periodontal tissue for generalized periodontitis.
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Affiliation(s)
- Masato Kaku
- Department of Anatomy and Functional Restorations, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima 734-8553, Japan
| | - Shinji Matsuda
- Department of Periodontal Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima 734-8553, Japan
| | - Takayasu Kubo
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima 734-8553, Japan
| | - Saiji Shimoe
- Department of Anatomy and Functional Restorations, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima 734-8553, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima 734-8553, Japan
| | - Hidemi Kurihara
- Department of Periodontal Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima 734-8553, Japan
| | - Kotaro Tanimoto
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima 734-8553, Japan
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21
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Rath-Deschner B, Nogueira AVB, Beisel-Memmert S, Nokhbehsaim M, Eick S, Cirelli JA, Deschner J, Jäger A, Damanaki A. Interaction of periodontitis and orthodontic tooth movement-an in vitro and in vivo study. Clin Oral Investig 2021; 26:171-181. [PMID: 34024010 PMCID: PMC8140908 DOI: 10.1007/s00784-021-03988-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/11/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this in vitro and in vivo study was to investigate the interaction of periodontitis and orthodontic tooth movement on interleukin (IL)-6 and C-X-C motif chemokine 2 (CXCL2). MATERIALS AND METHODS The effect of periodontitis and/or orthodontic tooth movement (OTM) on alveolar bone and gingival IL-6 and CXCL2 expressions was studied in rats by histology and RT-PCR, respectively. The animals were assigned to four groups (control, periodontitis, OTM, and combination of periodontitis and OTM). The IL-6 and CXCL2 levels were also studied in human gingival biopsies from periodontally healthy and periodontitis subjects by RT-PCR and immunohistochemistry. Additionally, the synthesis of IL-6 and CXCL2 in response to the periodontopathogen Fusobacterium nucleatum and/or mechanical strain was studied in periodontal fibroblasts by RT-PCR and ELISA. RESULTS Periodontitis caused an increase in gingival levels of IL-6 and CXCL2 in the animal model. Moreover, orthodontic tooth movement further enhanced the bacteria-induced periodontal destruction and gingival IL-6 gene expression. Elevated IL-6 and CXCL2 gingival levels were also found in human periodontitis. Furthermore, mechanical strain increased the stimulatory effect of F. nucleatum on IL-6 protein in vitro. CONCLUSIONS Our study suggests that orthodontic tooth movement can enhance bacteria-induced periodontal inflammation and thus destruction and that IL-6 may play a pivotal role in this process. CLINICAL RELEVANCE Orthodontic tooth movement should only be performed after periodontal therapy. In case of periodontitis relapse, orthodontic therapy should be suspended until the periodontal inflammation has been successfully treated and thus the periodontal disease is controlled again.
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Affiliation(s)
- Birgit Rath-Deschner
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany.
| | - Andressa V B Nogueira
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Svenja Beisel-Memmert
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany
| | - Marjan Nokhbehsaim
- Section of Experimental Dento-Maxillo-Facial Medicine, Center of Dento-Maxillo-Facial Medicine, University of Bonn, Bonn, Germany
| | - Sigrun Eick
- Department of Periodontology, Laboratory for Oral Microbiology, University of Bern, Bern, Switzerland
| | - Joni A Cirelli
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Sao Paulo State University, UNESP, Araraquara, Brazil
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Jäger
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany
| | - Anna Damanaki
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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22
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Martin C, Celis B, Ambrosio N, Bollain J, Antonoglou GN, Figuero E. Effect of orthodontic therapy in periodontitis and non-periodontitis patients: a systematic review with meta-analysis. J Clin Periodontol 2021; 49 Suppl 24:72-101. [PMID: 33998045 DOI: 10.1111/jcpe.13487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
AIM To answer these PICO questions: #1: In adult patients with malocclusion, what are the effects of orthodontic tooth movement (OTM) on clinical attachment level (CAL) changes in treated periodontitis patients with a healthy but reduced periodontium compared to non-periodontitis patients? #2: In adult patients with treated periodontitis and malocclusion, which is the efficacy of skeletal anchorage devices compared to conventional systems in terms of orthodontic treatment outcomes? MATERIAL AND METHODS Seven databases were searched until June 2020 looking for randomized, non-randomized trials and case series. Mean effects (ME) and 95% confidence intervals (CIs) were calculated. RESULTS Twenty-six studies with high risk of bias were included. PICO#1: In 26 patients without periodontitis and in 69 treated periodontitis patients, minimal changes in periodontal outcomes were reported after orthodontic therapy (p>0.05). A significant CAL gain (mm) (ME=3.523; 95% CI [2.353; 4.693]; p<0.001) was observed in 214 patients when periodontal outcomes were retrieved before a combined periodontal and orthodontic therapy. PICO#2: Orthodontic variables were scarcely reported and objective assessment of the results on orthodontic therapy were missing. CONCLUSIONS Based on a small number of low-quality studies, in non-periodontitis and in stable treated periodontitis patients, OTM had no significant impact on periodontal outcomes.
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Affiliation(s)
- Conchita Martin
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain.,BIOCRAN (Craniofacial Biology: Orthodontics and Dentofacial Orthopedics) Research Group, Complutense University of Madrid, Madrid, Spain
| | - Beatriz Celis
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain
| | - Nagore Ambrosio
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Complutense University of Madrid, Madrid, Spain
| | - Juan Bollain
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain
| | - Georgios N Antonoglou
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain
| | - Elena Figuero
- Department of Dental Clinical Specialties, Complutense University of Madrid, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Complutense University of Madrid, Madrid, Spain
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23
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Abstract
Periodontitis is one of the most prevalent epidemics affecting human health and life recently, and exploration of the pathogenesis and treatment of periodontitis has been valued by scholars. In recent years, sclerostin, a new factor on bone resorption and reconstruction caused by inflammation and mechanical stimulation, has been a research hotspot. This article summarizes the researches on sclerostin in periodontitis development in recent years. Among them, sclerostin has been shown to be a critical negative regulator of bone formation, thereby inhibiting bone remodeling in periodontitis development, and is closely associated with tooth movement. Besides, evidence indicates that the removal of sclerostin seems to reasonably protect the alveolar bone from resorption. Regulation of sclerostin expression is a novel, promising treatment for periodontitis and addresses several complications seen with traditional therapies; accordingly, many drugs with similar mechanisms have emerged. Moreover, the application prospect of sclerostin in periodontal therapy combined with orthodontic treatment is another promising approach. There are also a lot of drugs that regulate sclerostin. Anti-sclerostin antibody (Scl-Ab) is the most direct one that inhibits bone resorption caused by sclerostin. At present, drugs that inhibit the expression of sclerostin have been applied to the treatment of diseases such as multiple myeloma and osteoporosis. Therefore, the application of sclerostin in the oral field is just around the corner, which provides a new therapeutic bone regulation strategy in oral and general health.
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24
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Meyer-Marcotty P, Klenke D, Knocks L, Santander P, Hrasky V, Quast A. The adult orthodontic patient over 40 years of age: association between periodontal bone loss, incisor irregularity, and increased orthodontic treatment need. Clin Oral Investig 2021; 25:6357-6364. [PMID: 33884503 PMCID: PMC8531047 DOI: 10.1007/s00784-021-03936-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
Objectives Adult orthodontic treatment, especially in patients over 40 years, is steadily increasing. One causal factor for the treatment need in this age group is periodontal breakdown. The aim of this study was to detect correlations between periodontal problems and orthodontic parameters in interdisciplinary patients. Methods This observational, cross-sectional study included 118 patients over 40 years (51 men/67 women; mean age, 58.03 years) classified into three groups according to periodontal breakdown (group I, controls; group II, moderate periodontitis; group III, severe periodontitis). Clinical periodontal and orthodontic parameters as well as the index of orthodontic treatment need (IOTN) were assessed and compared between the groups. Results A gradual deterioration of all periodontal and orthodontic parameters according to periodontal bone loss (lowest values in group I; highest values in group III) was observed. Especially groups I and III differed significantly regarding the overjet (p < 0.001) and the little indices of the maxilla (p < 0.001) and mandible (p < 0.010). The IOTN was highest in group III: 90% of the patients with severe periodontitis were classified to have moderate to very great treatment need. Conclusions The higher the degree of periodontal breakdown was, the more severe were overjet, overbite, irregularity of the anterior teeth, and the orthodontic treatment need. Clinical relevance Adult patients over 40 years represent a challenge for an orthodontic/periodontal treatment approach with high incidence of pathologic tooth migration, orthodontic treatment need, and periodontal breakdown. Therefore, this special patient collective requires a focus in clinical orthodontics and research.
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Affiliation(s)
- Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Daniela Klenke
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Larissa Knocks
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Petra Santander
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Valentina Hrasky
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Anja Quast
- Department of Orthodontics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
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25
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Ishii T, Goto H, Watanabe A, Yamamoto S, Onodera H, Yoshida S, Nishii Y. A Case of Mandibular Prognathism with Generalized Aggressive Periodontitis and Crowding. THE BULLETIN OF TOKYO DENTAL COLLEGE 2021; 62:27-39. [PMID: 33583878 DOI: 10.2209/tdcpublication.2020-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aggressive periodontitis during adolescence has a poor prognosis due to rapid alveolar bone resorption. Few studies have investigated long-term follow-up after surgical orthodontic treatment performed in conjunction with that for invasive periodontitis. Here, we report a case of mandibular prognathism accompanied by generalized aggressive periodontitis and crowding. A 31-year-old woman was referred to our department for treatment of masticatory dysfunction due to reverse overjet. The patient exhibited a class III molar relationship, protrusion of the ANB of －6.0°, and severe maxillary crowding. Initial periodontal examination revealed deep periodontal pockets and extensive inflammation. Mandibular prognathism accompanied by generalized aggressive periodontitis and crowding was diagnosed. Therefore, it was necessary to adopt an interdisciplinary approach involving surgical, orthodontic, and periodontal treatment. Prior to commencement of orthodontic treatment, plaque control, scaling, and root planing of all teeth were performed by a periodontist to suppress inflammation and reduce probing depth. During pre-surgical orthodontic treatment, the maxillary first premolars were extracted to reduce crowding of the maxillary incisors. To correct the mandibular prognathism, the mandible was repositioned by sagittal split ramus osteotomy. Proper occlusion of the incisors and maximum intercuspation were achieved by post-surgical orthodontic treatment. After completion of active orthodontic treatment, acceleration of inflammation was observed together with aggravated resorption of the alveolar bone surrounding the molars. However, reduction of probing depth and inflammation were observed after scaling and root planing. The surgical-orthodontic treatment time was 1 year and 11 months, which was followed by a 2-year retention period. There was no tooth loss due to periodontitis, and an overall satisfactory outcome was achieved.
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Affiliation(s)
| | | | - Akira Watanabe
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
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26
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Laviv A, Barnea E, Tagger Green N, Kadry R, Nassar D, Laviv M, Kolerman R. The Incidence and Nature of Malpractice Claims against Dentists for Orthodontic Treatment with Periodontal Damage in Israel during the Years 2005-2018-A Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238785. [PMID: 33256065 PMCID: PMC7731254 DOI: 10.3390/ijerph17238785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
In recent years, dental malpractice claims have increased dramatically worldwide. The purpose of the present study is to analyze claims related to orthodontic treatment involving periodontal problems that resulted in legal decisions in Israel. This study analyzed legal claims registered by Medical Consultants International (MCI) between 2005 and 2018. Only closed cases of orthodontic claims involving periodontal problems in which a decision was made were included. The parameters studied included patients' demographic data, the main reasons of the claim, and complications. Statistical significance was found for aesthetic damage, which was more common in claims of females (p = 0.035) and in older claims (p = 0.004); tooth damage was more common in claims of older patients (p = 0.032); violation of autonomy was higher in private practice (p = 0.047) and in more recent claims (p = 0.001). As orthodontic treatment is becoming more popular in older patients, and as lawsuit claims become more common in recent years, the orthodontists should always analyze and document the periodontal status of their patients before and during treatment in order to maintain professional practice and avoid future claims.
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Affiliation(s)
- Amir Laviv
- Department of Oral and Maxillofacial Surgery, the Maurice and Gabriela Goldschleger School of Dental Medicine Tel-Aviv University, Tel-Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3640-9434
| | - Eitan Barnea
- Prosthodontist, Private Practice, Tel-Aviv 6100000, Israel;
| | - Nirit Tagger Green
- Department of Periodontology and Implant Dentistry, the Maurice and Gabriela Goldschleger School of Dental Medicine Tel-Aviv University, Tel-Aviv 6997801, Israel; (N.T.G.); (R.K.)
| | - Rana Kadry
- Department of Orthodontics, the Maurice and Gabriela Goldschleger School of Dental Medicine Tel-Aviv University, Tel-Aviv 6997801, Israel;
| | | | - Meytal Laviv
- Department of Orthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 12272, Israel;
| | - Roni Kolerman
- Department of Periodontology and Implant Dentistry, the Maurice and Gabriela Goldschleger School of Dental Medicine Tel-Aviv University, Tel-Aviv 6997801, Israel; (N.T.G.); (R.K.)
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27
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Feu D. Orthodontic treatment of periodontal patients: challenges and solutions, from planning to retention. Dental Press J Orthod 2020; 25:79-116. [PMID: 33503129 PMCID: PMC7869805 DOI: 10.1590/2177-6709.25.6.079-116.sar] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: There is an increasing number of adult patients with sequelae of periodontal diseases seeking orthodontic treatment to improve their occlusion and quality of life. However, it is important to highlight that the patient who has vertical bone loss has unique needs, arising from the frequent related pathological migrations. Therefore, it requires an individualized orthodontic treatment in terms of anchorage, biomechanics, and multidisciplinary planning, which raises doubts in the hierarchy of priorities and organization of the treatment plan. Objectives: It was proposed a stratified hierarchy of the needs of orthodontic-periodontal treatment in six levels, which were illustrated with examples of clinical cases in which biomechanical planning and a multidisciplinary approach made it possible to obtain a balanced occlusion, aesthetic improvement and stabilization of the results. Conclusion: Orthodontic treatment of periodontal patients with a multidisciplinary approach is increasingly frequent and should be planned individually, considering bone losses suffered by each patient. Respecting some limitations, it is possible to improve the level of bone insertion, smile aesthetics and masticatory function, to facilitate oral hygiene through the orthodontic treatment of adult patients with little bone support. It is also important to highlight that there are unique aspects in the orthodontic retention in these cases.
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Affiliation(s)
- Daniela Feu
- Universidade Vila Velha, Departamento de Odontologia, Disciplina de Ortodontia (Vila Velha/ES, Brazil)
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28
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Pini Prato GP, Chambrone L. Orthodontic treatment in periodontal patients: The use of periodontal gold standards to overcome the “grey zone”. J Periodontol 2019; 91:437-441. [DOI: 10.1002/jper.19-0306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 12/15/2022]
Affiliation(s)
| | - Leandro Chambrone
- School of DentistryIbirapuera University (Unib) São Paulo Brazil
- Unit of Basic Oral Investigation (UIBO)School of DentistryUniversidad El Bosque Bogota Colombia
- Department of PeriodonticsCollege of Dentistry and Dental ClinicsThe University of Iowa Iowa City IA USA
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29
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Cagna DR, Donovan TE, McKee JR, Eichmiller F, Metz JE, Albouy JP, Marzola R, Murphy KR, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2019; 122:198-269. [PMID: 31405523 DOI: 10.1016/j.prosdent.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/13/2022]
Abstract
This comprehensive review of the 2018 dental literature is provided to inform busy dentists about progress in the profession. Developed by the Committee on Scientific Investigation of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to one of the 8 sections of the report including (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information that will likely influence day-to-day treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source materials if greater detail is desired. As the profession continues its march toward evidence-based clinical decision-making, an already voluminous library of potentially valuable dental literature continues to grow. It is the intention of this review and its authors to provide assistance in navigating the extensive dental literature published in 2018. It is our hope that readers find this work useful in the clinical management of patients moving forward.
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Affiliation(s)
- David R Cagna
- Professor, Associate Dean, and Residency Director, Department of Prosthodontics, University of Tennessee Health Sciences Center, College of Dentistry, Memphis, Tenn.
| | - Terence E Donovan
- Professor and Head of Biomaterials, Department of Restorative Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC
| | - James R McKee
- Private practice, Restorative Dentistry, Downers Grove, Ill
| | | | - James E Metz
- Private practice, Restorative Dentistry, Columbus, Ohio
| | - Jean-Pierre Albouy
- Assistant Professor, Department of Restorative Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC
| | | | - Kevin R Murphy
- Associate Clinical Professor, Department of Periodontics, University of Maryland College of Dentistry, Baltimore, MD; Private practice, Periodontics and Prosthodontics, Baltimore, MD
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Ristoska S, Dzipunova B, Stefanovska E, Rendzova V, Radojkova-Nikolovska V, Evrosimovska B. Orthodontic Treatment of a Periodontally - Affected Adult Patient (Case Report). Open Access Maced J Med Sci 2019; 7:2343-2349. [PMID: 31592049 PMCID: PMC6765088 DOI: 10.3889/oamjms.2019.629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND: The advanced periodontal disease is characterised by a strongly pronounced loss of attachment and reduction of the alveolar bone support, which leads to luxation, migration of the teeth, functional discomfort and poor facial aesthetics. CASE PRESENTATION: The aim of this paper is to present the case of a 26-year-old female patient, registered at the Clinic of Periodontology with highly expressed gingivitis, unsatisfactory periodontal status, presence of diastemas between the frontal teeth and attachment loss of 5-6 millimetres in different areas. We conducted a thorough classic periodontal treatment, as well as training for proper maintenance of oral hygiene, with frequent professional oral-prophylactic sessions, complemented with orthodontic treatment. Fixed orthodontic appliances were installed, and mild forces were applied for gradual levelling of the teeth, with constant control of the periodontal status. After 20 months of treatment, the patient was in retention. CONCLUSION: Orthodontic therapy of periodontally-affected teeth can begin only after exhaustive administration of a periodontal treatment. Orthodontic treatment as an addition to the periodontal restoration must be gradual with mild forces for an optimal dental response, thus helping to improve function, facial aesthetics and psychological confidence of adult patients.
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Affiliation(s)
- Stevica Ristoska
- Department of Oral Pathology and Periodontology, Faculty of Dental Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Biljana Dzipunova
- Department of Orthodontics, Faculty of Dental Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Emilija Stefanovska
- Department of Oral Pathology and Periodontology, Faculty of Dental Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Vasilka Rendzova
- Department of Restorative Dentistry, Faculty of Dental Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Vera Radojkova-Nikolovska
- Department of Oral Pathology and Periodontology, Faculty of Dental Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Biljana Evrosimovska
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Zasčiurinskienė E, Lund H, Lindsten R, Jansson H, Bjerklin K. Outcome of periodontal–orthodontic treatment in subjects with periodontal disease. Part II: a CBCT study of alveolar bone level changes. Eur J Orthod 2019; 41:565-574. [DOI: 10.1093/ejo/cjz039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
Aim
To examine alveolar bone level (ABL) changes before (T1) and after (T2) orthodontic treatment (OT) in subjects with periodontal disease.
Methods
The study included 50 subjects with periodontal disease. All patients received subgingival debridement following baseline examination. Control group patients received final periodontal treatment before the start of OT. For the test group patients final periodontal treatment was performed simultaneous to OT. OT was performed with a straight-wire appliance. Micro-implants or temporary crowns on implants were used for posterior anchorage when needed. ABL measurements of 3821 tooth surfaces were performed on cone beam computed tomography images.
Results
No difference was observed between mean ABL at T1 and T2. ABL remained unchanged on 69 per cent of surfaces. A mean of 15.6 (SD 7.4) per cent of surfaces experienced ABL gain, and a mean of 15.1 (SD 7.5) per cent was found with ABL loss. Small significant median ABL difference was observed on mesial and distal surfaces (P < 0.001). A significant difference was found between median ABL changes on mesial/distal in comparison to buccal/lingual surfaces (P < 0.01). Significantly more buccal (17.9 %) and lingual (18.5 %) surfaces experienced ABL loss when compared with mesial (11.3 %) and distal (12.0 %) surfaces (P < 0.001). Significant difference was found in the median ABL change of intruded (0.5 (IQR 0.94) mm) and non-intruded (−0.4 (IQR 1.07) mm) maxillary incisors (P = 0.04). Significant median ABL gain was found on the lingual surface of maxillary incisors, which were retroclined more than 8.6 degree and intruded more than 1.6 mm.
Conclusions
ABL changes after periodontal–orthodontic treatment in patients with periodontal disease were small. ABL gain was more observed on mesial and distal surfaces and ABL loss on buccal and lingual surfaces. Larger orthodontic movements of maxillary incisors influenced ABL gain.
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Affiliation(s)
- Eglė Zasčiurinskienė
- Department of Orthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Center for Oral Health, Jönköping University, Sweden
| | - Henrik Lund
- Department of Oral and Maxillofacial Radiology, Sahlgrenska Academy, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden
| | - Rune Lindsten
- Center for Oral Health, Jönköping University, Sweden
- Departments of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Henrik Jansson
- Center for Oral Health, Jönköping University, Sweden
- Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Krister Bjerklin
- Departments of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden
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Zasčiurinskienė E, Lund H, Lindsten R, Jansson H, Bjerklin K. Outcome of orthodontic treatment in subjects with periodontal disease. Part III: a CBCT study of external apical root resorption. Eur J Orthod 2019; 41:575-582. [DOI: 10.1093/ejo/cjz040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Summary
Background
No evidence is present on the risk for external apical root resorption (EARR) during orthodontic treatment (OT) of adult patients with periodontal disease.
Aim
To examine EARR after OT in subjects with periodontal disease and to analyse how intrusion and change in inclination of the most proclined maxillary incisors influence EARR.
Methods
The study included 50 patients with periodontal disease. Sub-gingival debridement by ultrasonic instrumentation supplemented with hand instruments was performed by experienced dental hygienist after baseline examination for all patients. For the control group, final periodontal treatment (PT) was performed before orthodontic tooth movement. For the test group patients, final PT was performed after levelling and alignment phases were finished, before the active space closure with elastic chain and/or inter-arch elastic traction for sagittal correction was started. OT was performed with a straight-wire appliance. Micro-implants or implants were used for posterior anchorage. Cone beam computed tomography examinations were performed before and after OT. EARR of all single-rooted teeth were measured. EARR of the most proclined maxillary incisor was related to intrusion and change in inclination angle.
Results
EARR after OT was observed in median 80.7 per cent (interquartile range 22.02) of single-rooted teeth [mean 1.2 (standard deviation 0.44) mm]. In 82.3 per cent of teeth, EARR was 2 mm or less. Severe EARR was found in 8 per cent of patients and five maxillary incisors (less than 1 per cent of all teeth). The amount of intrusion and change in inclination angle of the most proclined maxillary central incisor influenced the extent of EARR. Mean EARR was significantly higher when OT lasted more than 18 months (P = 0.02).
Conclusions
OT in conjunction with PT in periodontal patients resulted in EARR in 81 per cent of all single-rooted teeth. Intrusion and change in inclination angle of the most proclined maxillary central incisor influenced the extent of EARR, as did longer OT.
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Affiliation(s)
- Eglė Zasčiurinskienė
- Department of Orthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Center for Oral Health, Jönköping University, Jönköping, Sweden
| | - Henrik Lund
- Department of Oral and Maxillofacial Radiology, Sahlgrenska Academy, Institute of Odontology, University of Gothenburg, Sweden
| | - Rune Lindsten
- Center for Oral Health, Jönköping University, Jönköping, Sweden
- Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Henrik Jansson
- Center for Oral Health, Jönköping University, Jönköping, Sweden
- Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Krister Bjerklin
- Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden
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