interdisciplinary treatment in orthodontics dr olivier sandid orthodontist

158-Interdisciplinary Treatment: Integrating
Orthodontics with Restorative Dentistry and
Periodontics, Endodontics.
Mohamad ABOULNASER- Orthodontist, BAU,
Connecticut, USA.
Oussama SANDID- Orthodontist, D.C.D., D.U.O,
C.E.S.B.B, C.E.S.O.D.F ,
S.Q.O.D.F, Paris. France.

Plan
• Part 1 A-Orthodontics and Restorative Dentistry
• 1- Consequences of tooth loss
• 2- Space management of Microdontia
• 3- Implant site preparation
• 4-Orthodontic Intrusion
• 5-Orthodontic Extrusion
• 6-Crown lengthening
• =================================================
• Part 2 B-Orthodontics with Oral Surgery
• Part 3 C-Orthodontics with Periodontics
• Part 4 D-Orthodontics with Pediatric dentistry
• Part 5 E-Orthodontics with Endodontics

PART 1 A-Orthodontics and
Restorative Dentistry
• 1 - Consequences of tooth loss
• 2- Space management of Microdontia
• 3- Implant site preparation
• 4-Orthodontic Intrusion
• 5-Orthodontic Extrusion
• 6-Crown lengthening

1a-Consequences of tooth loss
=
http://www.columbia.edu/itc/hs/dental/D5300/Lecture%2012.DDS.Class200
8.20050622.Principles%20of%20Molar%20Uprigh_BW.pdf
Mohamad ABOULNASER- Oussama SANDID
Orthodontics and restorative dentistry
1- Loss of a lower molar can lead to tipping and drifting of adjacent teeth.
2- Poor interproximal contacts.
3- Poor gingival contour.
4-Reduced interradicular bone.
5- Supra-eruption of opposed teeth.
6- Loss of alveolar bone in the area where a mandibular first molar was extracted
7-Exaggerated curve of Spee

1b-Consequences of tooth loss
- Gingival tissues become folded, and pockets form in the area
- Accumulation of plaque in pockets leads to periodontal damage, with loss of
gingival attachment and alveolar bone loss
Orthodontics and restorative dentistry Mohamad ABOULNASER- Oussama SANDID

1c-Consequences of tooth loss
This photo shows a lower ridge that has lost 60% of its width following an
extraction and normal healing. The black arrows indicate where bone is
located (compare the width to the adjacent molar). The red arrows
indicate the normal width that should be there.
http://www.pittsburghdentalimplants.com/dental-implants/effects-of-tooth-loss/

1d-Consequences of tooth loss
Occlusal Interferences and Temporomandibular Joint Disorders
http://www.dr-adrianbecker.com/page.php?pageId=281&nlid=50

1e-Managing the orthodontic-restorative patient
Early Tooth Loss and Space Maintenance Space regaining: Molar Uprighting and Distalization
Early tooth loss can be a result of traumatic avulsion or extraction of carious or infected
teeth, Premature loss of primary teeth can result in a loss of arch length and have a
negative effect on occlusion and alignment, often increasing the need for orthodontic
treatment.
Orthodontics and restorative dentistry M. ABOULNASER- O SANDID

1f-Uprighting the dental axes
http://pocketdentistry.com/18-special-considerations-in-treatment-for-adults/

Interdisciplinary Treatment.
Tooth loss Space maintainer Molar uprighting Intrusion of Overerupted Molars
Implants Microdontia

2-Multi-disciplinary approach for
space management of Microdontia
- A minimal reduction was needed for lateral incisors.
- Veneers cemented on lateral incisors.
- Definitive composite restorations after finishing and
polishing procedures.

2a-Anterior Space Management
Additional orthodontic treatment is initiated to improve the dental midline and
evenly distribute the space around the microdontic lateral incisors
Management of 'peg laterals'or other diminutive teeth

3a- Implant site preparation
Yvon Roberge, Sylvain Gagnon, Orthod Fr 2008;79:55–57
Implant site preparation : Open Space, Root proximity, Bone quality, implant types…

3b-Missing upper lateral incisors
Kazemi, https://www.facialart.com
IMPLANT SITE PREPARATION

3-Implant site preparation
Move the roots from implant site, To create space priorimplant placement, the
roots of the adjacent teeth should be upright and parallel
Dr Jebin
M. ABOULNASER- O SANDID

3a- Implant site peparation
Dr LEMAY-@ortholemay.com
Molar Uprighting, with space creation

3b-Implant site preparation
Root parallelism

3d-Implant site preparation

3c-Missing upper lateral incisors Closure space
LEMAY J - https://www.orthodontisteenligne.com
The upper canines were modified and brought closer to close the anterior spaces
and thus replace the missing lateral incisors (arrows). This approach avoids having
to use bridges, implants, etc. to replace the lateral incisor

4-Orthodontic extrusion
Orthodontic extrusion uses “orthodontic forces”.
The PDL including alveolar bone follows the extruding tooth
Rapid extrusion uses heavier forces, more frequent activations and results in extruding
the tooth beyond the PDL – lengthen clinical crown
Retention period
Dr Jebin

Orthodontic extrusion
• (a) Buccal view of the fractured premolar, (b) Occlusal view, (c) Initial radiographic appearance, (d) Initial
orthodontic root extrusion of the premolar, (e) Buccal view of the orthodontic apparatus, (f)
Stabilization of the orthodontic extrusion over 5 months
http://www.jidonline.com/viewimage.asp?img=JInterdiscipDentistry_2012_2_3_221_113270_u1.jpg

Combined endodontic-orthodontic and prosthodontic
treatment of fractured teeth
• Fractured teeth- Orthodontic extrusion

5-Orthodontic intrusion
• intrusion

5-Orthodontic intrusion
• Patient with advanced periodontitis and migration of the maxillary left central
incisor,
• Clinical view after the end of the orthodontic treatment the teeth are retained by
means of a resin-bonded splints
• Biomechanics used to intrude and move the central incisor into the defect

Orthodontic Treatment in Periodontally Compromised
Patients
• Radiographic view of the osseoous defect ,
• Radiographic wiew at the end of the treatment with reduction of the defect
Stefanis Re, Giuseppe CorrenteIJP and DR
Orthodontic treatment - Periodontal pocket reduction

Orthodontic Treatment in Periodontally Compromised
Patients
Orthodontic treatment - Periodontal pocket reduction

6-Crown lengthening
• Crown lengthening is as a viable procedure that enables to restore teeth
having a short clinical crown,
• extensive subgingival caries, subgingival tooth fractures at dentogingival
junction, when performed in ideal clinical conditions…
Before crown lengtheninig After crown lengtheninig

Crown lengthening
Orthodontic Forced Eruption Combined with
Circumferential Fiberotomy
http://drromanmelnyk.com/crown-lengthening/

References
• http://www.dentistrytoday.com/orthodontics?start=20
• http://www.slideshare.net/almuzian/orthodontics-and-restorative-dentistry-by-almuzian-36418366
• http://www.semortho.com/article/S1073-8746(97)80034-5/abstract
• https://www.orthodontisteenligne.com/cas-traites-2/multidisciplinaire/
• http://pocketdentistry.com/11-interdisciplinary-orthodontics/

Oral Surgery and Orthodontics
M. ABOULNASER- Orthodontist, BAU, Connecticut, USA.
O. SANDID- Orthodontist, D.C.D., D.U.O, C.E.S.B.B, C.E.S.O.D.F ,
S.Q.O.D.F, Paris. France
Contact: dr.aboualnaser@hotmail.com

1-Orthodontic Exposure of Impacted Teeth for Orthodontics
2b-Gummy Smile
3c-Operculectomy /Excision of pericoronal gingiva
4a-Maxillary Frenectomy
5-Soft Tissue Grafting
6-Esthetic Crown Lengthening
7-Odontoma-associated with tooth impaction
8-Repositioning - impacted lower second molar
9-Tooth impaction- Extraction
10-Gingivectomy

Exposure of Impacted Canine Gummy smile - recontouring Operculectomy I
Teeth Repositioning Removal of Impacted Teeth Odontoma
Frenectomy Soft tissue grafting Esthetic Crown Lengthening

1a-Exposure of Impacted Canine
Oral Surgery and Orthodontics M ABOULNASER- O SANDID
http://forum.dentalxp.com
http://www.drhungvu.com/impacted_canines
The orthodontic-surgical management of impacted canines requires accurate diagnosis and
precise location of the impacted canine and the surrounding structures.

1b-Exposure of Impacted mandibular 2nd Molar
http://www.fwperio.com/procedures.asp
Sometimes teeth do not erupt through the gum tissue on their own and they need to be exposed as part of
orthodontic treatment
Impacted tooth was exposed Orthodontic bracket placed 1 year later
Impacted mandibular 2nd molar

http://pocketdentistry.com/9-impacted-teeth-in-the-adult-patient/
1c-Exposure of Impacted Maxillary Central Incisor

2a-Gummy Smile
http://www.traceyortho.com/Treatment/LaserTreatment/tabid/190/Default.aspx
Before Laser Recontouring After
http://www.gummysmile.com/braces.html
M ABOULNASER- O SANDID
Gingival Sculpting - Reshaping Gum Tissue

3a-Operculectomy/Excision of pericoronal gingiva
Pericoronal gingiva that was removed with a combination of surgical
excision and laser.
Pain, Infection, discomfort.
Before After

3b-Laser recontouring
Laser Recontouring -Partially Impacted Canine
http://www.traceyortho.com/Treatment/LaserTreatment/tabid/190/Default.aspx
Before Laser Recontouring Braces in Place

4a-Frenectomy Maxillary -midline Diastemas
Lasers and Orthodontics
http://www.sarkissiandds.com/services/laser-frenectomy.html

5-Soft Tissue Grafting
Before After

6-Esthetic Crown Lengthening
http://pocketdentistry.com/esthetical-clinical-crown-lengthening-lip-repositioning-and-gingival-depigmentation/

7-Odontoma-associated with tooth impaction and
suprnumerary teeth

8-Repositioning – impaction of lower second molar

9-Considerations For Removal Of Wisdom Teeth

10-Gingivectomy

REFERENCES
https://www.google.com.lb/?ion=1&espv=2#q=ORAL+SURGERY+AND+ORTHODO
NTICS+RELATIONSHIP
https://www.perio.org/consumer/plastic-surgery-procedures
https://loveperio.com/2013/03/26/exposure-impacted-canine/
http://www.jcda.ca/article/a147
http://www.exodontia.info/Expose_and_Bonding_of_Teeth_Example.html
http://www.drcawhite.com/orthodontic-procedures/tooth-exposures/

Periodontal Surgery for the
Orthodontic Patient
O.SANDID, SQODF
2007

Periodontal Surgery for the Orthodontic Patient
• 1. Pericision-Circumferential Supracrestal Fiberotomy
• 2. Frenectomy
• 3. Gingival Grafting
• 4-Surgical Exposure of Impacted Tooth For Orthodontics
• 5-Extraction supernumerary teeth mesiodens
• 6- Impacted Wisdom teeth
• 7-Repositioning - impaction lower second molar
• 8-Gummy smile
• 9- Mini-implant
• 10- Corticotomy
• 11-Orthodontics extractions – Space gaining
• 12- Black triangle

1- Pericision-Circumferential Supracrestal Fiberotomy
www.orthofree.com
Fiberotomy (CSF) Preventing Orthodontic Relapse
Relapse of severely rotated teeth due to rebound of elastic ﬁbres in the supracrestal tissues
can be reduced by pericision.
http://www.aso.org.au/members/NSW%20Brighter%20Futures/Brighter_Futures_002.pdf
www.orthofree.com

2- Frenectomy
www.orthofree.com
http://www.omahaperio.com/services/frenectomy.aspx
Closure of the maxillary midline
diastema , with frenectomy and
orthodontic treatment
Ankyloglossia: large frenulum can limit tongue
movement thereby cause eating problems and
interfering with speech.

3- Gingival Grafting
www.orthofree.com
http://www.mrzperio.com
Gingival Grafting: Orthodontic tooth movement may lead to gingival recession.
The treatment of gingival recession is to cover the exposed root surfaces to improve esthetics
and to reduce hypersensitivity, This treatment involves the utilization of a small piece of tissue
removed from the roof of the mouth and placed in an area of extremely weak, thin tissue to
prevent further recession.

4-Surgical Exposure of Impacted Tooth For Orthodontics
www.orthofree.com
O.SANDID- O.Migault
Canine Exposure: This procedure involves opening a flap and removing small amounts of
bone in order to bond an orthodontic “button” to a tooth that is not properly positioned in
the arch. Once the button is bonded to the tooth, the orthodontist can move this tooth into
the appropriate place.

5-Extraction supernumerary teeth- mesiodens
www.orthofree.com
O.SANDID

6- Impacted Wisdom teeth
www.orthofree.com
Impacted Wisdom teeth- Pericoronitis
www.orthofree.com

7-Repositioning - impaction lower second molar
www.orthofree.com

8-Interdisciplinary approach to improve smile esthetics
www.orthofree.com
http://www.gummysmile.com/
Gummy smile
The combination of the overgrown gum tissue and the high lip line are working together to
reduce the beauty of this smile.
Following minimally-invasive surgery, where the patient had no post-surgical pain, we can now
see the fullness of her smile. Her high lip line is not a severe problem and is less of a concern.

9-Mini-implant
www.orthofree.com
Mini-implant (Could eliminate need for Headgear):
Temporary anchorage devices are utilized in conjunction with orthodontics to assist in
moving teeth. This procedure involves placement of the TAD (titanium bone anchor) directly
through the gums into the bone, eliminating unwanted movement of anchorage teeth,
decreasing treatment time and making headgear a thing of the past for patients
L. Massif, L. Frapier, EMC
www.orthofree.com
.

10- Corticotomy facilitated orthodontics
www.orthofree.com
http://parkell.cdeworld.com/
Corticotomy, Periodontally Accelerated Osteogenic Orthodontics (PAOO): is ideal for patients
who want braces, but do not want the traditionally long treatment time. For this procedure,
the gum tissue is gently separated from the bone, making a “flap”. The bone is then activated
by creating small cuts into the bone to facilitate the orthodontic movement, and the sites are
then augmented with graft material. After this, orthodontic treatment begins. PAOO
significantly decreases the treatment time (1 year to 6 months, 2 years to 6-8 months),
enhances the range of movement, requires fewer permanent extractions, and less root
resorption has been reported

11-Orthodontics extractions – Space gaining

12- Black triangle
www.orthofree.com
http://www.oralhealthgroup.com/news/treating-the-dreaded-black-triangle/1002990029/?&er=NA
www.orthofree.com

Bibliography
• 1. Andlin-Sobocki A. Changes of facial gingival dimensions in children.
• A 2-year longitudinal study. J Clin Periodontol. 1993 Mar;20(3):212-8.
• 2. Boyd RL, Leggott PJ, Quinn RS, Eakle WS, Chambers D. Periodontal implications
of
• orthodontic treatment in adults with reduced or normal periodontal tissues
versus
• those of adolescents. Am J Orthod Dentofacial Orthop. 1989 Sep;96(3):191-8.
• 3. Edwards JG. A surgical procedure to eliminate rotational relapse.
• Am J Orthod. 1970 Jan;57(1):35-46.
• 4. Edwards JG. The diastema, the frenum, the frenectomy: a clinical study.
• Am J Orthod. 1977 May;71(5):489-508.
• 5. Lindhe J. 1992, Clinical Periodontology, 2nd Ed, Munksgaard, Copenhagen
• 6. Monefeldt I, Zachrisson B. Adjustment of clinical crown height by gingivectomy
• following orthodontic space closure.
• Angle Orthod. 1977 Oct;47(4):256-64.

Benefits of orthodontics for a
periodontal patient
O.SANDID
SQODF
spécialiste qualifié en orthodontie
2007

A-Benefits of orthodontics for a periodontal patient
1- Healthy periodontium-Facilitates good oral hygiene
2 -Reduced risk of periodontal disease, Reduce Gingival recession
4-Create quality bone for implant placement
5-Treatment of fractured teeth-extrusion
6-Orthodontic Treatment in Periodontally Compromised Patients Intrusion
7-interradicular septum- bone formation
8-Uprighting the Mandibular Second Molar- bone apposition
9-Tooth mobility-Orthodontic retention
10-Orthodontic therapy in treatment of TMJ dysfunction

1-Benefits of orthodontics for a periodontal patient
www.orthofree.com
idh.cdeworld.com
Teeth alignment improve bone loss and loss of gum tissue, Reduced risk of
periodontal disease
Dental Crowding

1- Healthy Periodontium -Facilitates good oral hygiene
www.orthofree.com
http://www.birthtobraces.com
Before After
Orthodontic Treatment

2-Benefits of orthodontics for a periodontal patient
www.orthofree
Máyra Reis Seixas1, Roberto Amarante Costa-Pinto, Telma Martins de Araújo, Dental Press J Orthod. 2012 Sept-Oct;17(5):190-201
Gingival recession and buccal positioning of tooth #32’s root (A, B);
Reduced recession after orthodontically moving root to correct position in alveolar bone (C, D).
www.orthofree.com

2-Crossbite- Gingival recession
www.orthofree.com
Before After
Anterior dental crossbite correction- improving gingival recession

www.orthofree.com
Yvon Roberge, Sylvain Gagnon, Orthod Fr 2008;79:55–57
Implant site preparation : Open Space, root parallelism, Bone quality, height and width bone
implant types…

4-Create quality bone for implant placement
www.orthofree.com
Create quality bone for implant placement, height and width, Forced Eruption
improving the amount of bone available for implant placement.
Dr Jebin

4-implant site preparation
www.orthofree.com
Move the roots from implant site, To create space priorimplant placement, the
roots of the adjacent teeth should be upright and parallel
Dr Jebin

www.orthofree.com
Create bone for implant placement,
Repositioning teeth
Dr Jebin

www.orthofree.com
http://www.orthodontisteenligne.com/wp-content/uploads/2009/05/Redressement-molaires-orthodontie-implants-2-083009-Lemay.jpg
Root parallelism

5-Combined endodontic-orthodontic and prosthodontic
treatment of fractured teeth-extrusion
Treatment of fractured teeth-extrusion

6-Orthodontic Treatment in Periodontally Compromised
Patients-Intrusion
www.orthofree.com
Intrusion: Patient with advanced periodontitis and migration of the maxillary left central incisor,
Clinical view after the end of the orthodontic treatment the teeth are retained by means of a resin-bonded
splints
Biomechanics used to intrude and move the central incisor into the defect
Stefanis Re, Giuseppe Corrente IJP and DR

Patients
www.orthofree.com
Radiographic view of the osseoous defect ,
Radiographic wiew at the end of the treatment with reduction of the defect
interradicular septum- bone formation

Patients
www.orthofree.com
interradicular septum- bone formation

8-Uprighting the Mandibular Second Molar- bone
apposition
www.orthofree.com
Uprighting the Mandibular Second Molar- bone apposition

9-Tooth mobility-Orthodontic retention

10-Orthodontic therapy in treatment of TMJ dysfunction

http://www.wellness.com/blog/13237881/why-we-all-need-arch-integrity/dr-barry-a-kaplan

1g-Loss of the mandibular first molar-46
Occlusal interferences - Overerupted 16- Gum pocket 47- Distalization 45-
Exaggerated curve of Spee

1-Consequences of tooth loss
• Mesial tipping and rotations of distal molars
http://pocketdentistry.com/18-special-considerations-in-treatment-for-adults/
Loss of a lower molar can lead to tipping and drifting of adjacent teeth,
poor interproximal contacts, poor gingival contour, reduced interradicular bone, and
supra-eruption of opposed teeth. Note the loss of alveolar bone in the area where a
mandibular first molar was extracted

1b-Consequences of tooth loss
• Eruption of opposing tooth in edentulous
space
LE MAY J-https://www.orthodontisteenligne.com/en/ortho-101-en/adult-orthodontics-4/
Loss of posterior teeth in an adult. On one side (A), the loss of a lower
molar allowed the other molars to tip forward. On each side (A and B),
the upper molars migrate toward the space below (extrusion).

1l-Intrusion of Overerupted Molars using Miniscrews
http://www.jcdr.net/article_fulltext.asp?id=6165

1m-Intrusion of Overerupted Molars using Miniscrews
http://www.jcdr.net/article_fulltext.asp?id=6165

1n-Implant site preparation
Molar Uprighting, with space creation

2a-Anterior Space Management
https://www.researchgate.net/figure/235394688_fig1_Figure-2-
Occlusal-view-showing-spaces-between-maxillary-central-incisors-and-
between
Occlusal view showing spaces between maxillary central
incisors, and between lateral incisors and canines.

2b-Anterior Space Management
https://www.researchgate.net/figure/235394688_fig1_Figure-2-Occlusal-
view-showing-spaces-between-maxillary-central-incisors-and-between

1h-Tooth loss and Impaction

interdisciplinary treatment in orthodontics dr olivier sandid orthodontist

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