The Intertwined Relationship Between Orthodontics And Periodontology
Patients with severe chronic periodontitis, often accompanied by bone loss, early tooth loss, stage 1 or stage 2 tooth trauma caused by pathological tooth displacement and often severe malocclusion and incorrect tooth position, are more likely to cause patient teeth Column further deteriorated.
Under such circumstances, corrective treatment is a necessary condition for reconstructing the patient’s functional dentition.
The treatment of these patients requires close coordination and cooperation between orthodontists, periodontists and denture doctors (sometimes two or three are the same doctor) to achieve better treatment results.
Clinical benefits of orthodontics for patients with periodontal disease
- Arrange the crowded or misaligned anterior teeth of the upper and lower jaws to make it easier for patients to fully clean all surfaces of their teeth. This is undoubtedly a huge benefit for patients who are prone to have periodontal bone loss or are unable to fully maintain oral hygiene proficiently.
- Vertical orthodontic tooth repositioning can improve the defect of certain bones in patients with periodontal disease, and can usually eliminate the need for alveolar bone resection.
- Correction can improve the aesthetic relationship of the gum position before the anterior teeth of the upper jaw make dentures.
- Patients with severely broken maxillary incisors can use forced eruption to make the root dentures with sufficient resistance shape and retention.
- Corrective treatment can open the gingival wedge gap to correct the reconstruction of the lost mastoid.
- Orthodontic treatment can improve the position of adjacent teeth before implants or dentures. Some patients lose their teeth for many years will cause the adjacent dentition to move or fall.
Some periodontal risk factors that must be controlled before adult correction begins
- Local periodontal risk factors: loss of alveolar bone, invasion of periodontal pockets, root bifurcation, sensitive dentin, excessive shaking, periodontal abscess.
- Risk factors of the host: bacteria under the gums, susceptibility of the patient, environmental factors (smoking, stress).
- Contraindications for orthodontic treatment: active periodontitis, third-degree shaking: but there are exceptions, temporarily used as anchoring teeth, or aesthetic reasons, a history of invasive periodontitis accompanied by poor oral hygiene, Irregular periodontal treatment also has an important factor: long-term smoking.
Treatment plan: considerations for orthodontics
Correctly correcting the movement of the teeth will not cause the gums to shrink. However, in the thin buccal gingival tissue or very few keratinized gums, the movement of the teeth on the lips will cause the bones to crack and cause plaque accumulation and toothbrush damage. Formation of local gum atrophy.
In thick gum tissue, even moving to the teeth on the lips will not cause the gums to shrink. In the case of thin lip gum tissue or lack of keratinized gums, if the correction plan is to move the teeth to the lip side, we can use appropriate gum mucosa surgery to improve the gums before correction.
Once orthodontic treatment is started, patients with periodontal disease should closely monitor any symptoms of periodontal pathological recurrence, and they must frequently refer back for professional infection control.
After the correction treatment is completed, once the final tooth position is reached, a permanent fixation is recommended for patients with reduced periodontal tissue. Usually, the tongue-side fixed maintainer is used to avoid the use of movable maintainers, in order to prevent pathological swaying movement of periodontal disease teeth.
Special orthodontic movement
Teeth extrusion can be expected to align the edges of the bones flat, or when the teeth break under the alveolar bone, the clinical crown can be lengthened to facilitate the production of dental braces. In the case of sub-bone defects, extrusion movement can remove angled bone defects without changing the position of the periodontal attachment.
The unsaved teeth can also be squeezed out with rectification before implantation, and the bone can be moved to the crown to improve the amount of the alveolar bone. It is also a bone enhancement option in areas where the bone is insufficient.
Research recommendations:
(1) Use light and constant extrusion force, 15g for front teeth and 50g for posterior teeth.
(2) The initial rate should be maintained at a slow and stable level, not more than 2mm a month.
(3) The volume of alveolar buccal and lingual side can be increased at the same time.
(4) Before tooth extraction, there should be a fixed and stable period of not less than one month after the initiative of each month.
(5) An overlying orthodontic wire can be used to strengthen the anchoring to prevent adjacent teeth from falling to the teeth being extruded.
Large molar centralization
Straightening the inclined large molars can improve the periodontal pocket depth and the crown root ratio. In the absence of inflammation of periodontal tissue, plaque control is also very good, even if the periodontal tissue support is reduced, you can try to press in.
Orthodontics for periodontal disease patients will cause changes in bacterial flora. Therefore, periodontal disease patients with orthodontic devices must have strict periodontal care to maintain periodontal health. The movement of the orthodontic tooth must be in the absence of inflammation, so during the orthodontic treatment, the accumulation of tooth film must be avoided and strictly monitored.
In some patients with poor oral hygiene, fixed orthodontic devices often promote gum growth, especially in the anterior jaw area. In this case, the inflammation needs to be lifted before corrective treatment can continue. Usually the orthosis is removed and appropriate periodontal treatment is given.
If periodontal inflammation cannot be fully controlled during corrective treatment, these inflammation processes may accelerate the destruction of periodontal tissues, causing more loss of attachment. Orthodontic patients must be checked every two months, including a complete periodontal examination, encouragement and re-education, tooth cleaning, treatment of reinfected teeth, and polishing.
In the correction treatment, if the periodontitis becomes worse, the correction treatment should be stopped immediately, and the teeth washing and root planing should be done. It is best to wait 40 to 60 days before starting corrective treatment.
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