More recently, orthodontics has been used as an adjunct to periodontics to This definition is applicable to the classic relationship between orthodontic and. correlation between Orthodontics and. Periodontics. After regenerative periodontal therapy healing period of months is . create a structural relationship. Deepthi P K, Kumar P A, Nalini H E, Devi R. Ortho-perio relation: A . for crater, hemiseptal defect, three-wall defect, and furcation lesion.
Does this mean that we are going to deny orthodontic treatment for those adults whose number is rising, more often secondary to periodontal deterioration and pathological migration of teeth resulting in aesthetic and functional problems?
Need of the hour is to have an integrated approach where in periodontal treatment precedes orthodontic treatment to restore periodontal health. Orthodontic treatment should be performed under strict plaque control measures to place the teeth in a structurally balanced and functionally efficient position. Aim of this article is to familiarize the practicing clinicians both in the field of orthodontics and periodontics with current thoughts and successful clinical techniques used in the field of periodontology to regenerate lost periodontal structures.
Furthermore, it aims to integrate such techniques into the orthodontic treatment of patients with severe bone loss. Orthodontic treatment is based on the principle that if prolonged pressure is applied to a tooth, it will move as the surrounding bone remodels. Bone is selectively removed in some areas and added in others.
In essence, the tooth moves through the bone carrying its attachment apparatus with it, as the socket of the tooth migrates. Since this response is mediated by the periodontal ligament, tooth movement is primarily a periodontal ligament phenomenon.
Ortho-perio integrated approach in periodontally compromised patients
It could be an oral prophylactic procedure in adolescent patients or advanced periodontal treatment in adults so as to eliminate the presence of inflammation in the presence of which carrying out orthodontic treatment will have deleterious effect.
The orthodontic literature has presented different treatment modalities for the management of adult orthodontic patients with mild to moderate bone loss. However, the management of adult orthodontic patients with severe bone loss continues to present a challenge. None, Conflict of Interest: These movements are specifically related to interactions of the teeth with their supportive periodontal tissues. Periodontic and orthodontic interactions usually deal with the establishment of an appropriate diagnosis and the treatment planning needed to enable coordinated periodontic-orthodontic therapy.
A harmonious cooperation of the periodontist and the orthodontist offers great possibilities for the treatment of various orthodontic-periodontal problems. The present discussion focused on the effects of a combined periodontal and orthodontic treatment on the periodontal health and dentofacial aesthetics, and the mode that each field can contribute to optimize treatment of combined orthodontic-periodontal clinical problems. Adult orthodontics tooth movement, interdisciplinary approach, orthodontic therapy, periodontics How to cite this article: The combined approach can greatly enhance the periodontal health and dentofacial aesthetics in many situations.
The main aim of periodontal therapy is to restore and maintain the health and integrity of the attachment apparatus of teeth. These movements are strongly related to the interactions of teeth with their supportive periodontal tissues. The applied force causes remodeling changes in the dental and periodontal tissues. Orthodontic force application results in compression of the alveolar bone and the periodontal ligament on one side while the periodontal ligament is stretched on the opposite side.
The bone is selectively resorbed on the compressed side and deposited on the tension side.
Moderate orthodontic forces, i. Various orthodontic treatments such as uprighting, intrusion, and rotation are performed to correct the pathologically migrated teeth that control further periodontal breakdown, improve oral function, and provide acceptable aesthetics. These procedures should be performed only after controlling the periodontal disease. Although there is no consistent relation between malocclusion and periodontal disease, certain characteristics of malocclusion can promote a pathologic environment and hinder periodontal therapy.
Ortho-perio integrated approach in periodontally compromised patients
Food impactions are also reduced or eliminated by the creation of proper arch form and proximal contact. The distal movement tooth allows the deposition of alveolar bone on the mesial defect. This also eliminates the gingival folding and plaque retentive area on the mesial side.
Extrusion results in coronal positioning of intact connective tissue attachment along the tooth and also the bone deposition. The intrusion of plaque-infected teeth may lead to apical displacement of supragingival plaque, which results in periodontal destruction. Furcation defects require special attention during orthodontic treatment. They are difficult to maintain and can worsen during orthodontic treatment.
- Orthodontic–periodontics interdisciplinary approach
In Class III furcation cases, a possible method for treating the furcation is by hemisecting the crown and root and pushing the roots apart may be advantageous. This could improve adjacent tooth position before placement of implant or tooth replacement. However, it is widely believed that insufficient width of the attached gingiva predisposes the development of recession. To maintain proper gingival health, a 2-mm width of keratinized gingiva is adequate.
To maintain adequate width of the attached gingiva in these conditions, mucogingival surgery may be advised during the course of orthodontic treatment. The abnormal frenum prevents mesial migration of the central incisor and the aberrant fiber increases the relapse tendency after orthodontic space closure. Surgical removal of the frenum is usually advised in these situations and it should be performed after the completion of orthodontic treatment unless the frenum prevents space closure or become painful or traumatized.
Proper exposure of the impacted tooth and preservation of the keratinized tissue are important to avoid loss of attachment after orthodontic treatment. Apically or laterally positioned pedicle graft is usually advised in this situation. In order to prevent orthodontic relapse and to achieve proper rearrangement of the supporting tissues, the teeth must be retained. However, Sharpey's fibers of the newly formed bundle bone as well as supraalveolar and transseptal fibers undergo rearrangement even after months of retention, especially after the correction of rotation.
Hence, the teeth must be retained for at least 12 months to allow time for complete remodeling of these fibers.
Circumferential supracrestal fiberotomy is usually advised to reduce this relapse tendency. Fiberotomy is usually performed toward the end of the active orthodontic therapy, i. Crown lengthening is usually performed by gingivectomy or an apically repositioned flap in combination with gingivectomy prior to orthodontic bonding procedures. Osseous craters are interproximal, two-wall defects that do not improve with orthodontic therapy alone. Some shallow craters i.
Large craters can be eliminated by reshaping the bony defect. This enhances the patient's ability to maintain these interproximal areas during orthodontic treatment. Bone grafts are usually advised to fill these defects.