This document discusses the adjunctive role of orthodontic therapy for adult periodontal patients. It outlines several benefits such as improving access for cleaning crowded teeth, helping correct osseous defects, and improving esthetics before restorative work. It describes how orthodontics can treat various periodontal problems like hemiseptal defects, advanced bone loss, furcation defects, and gingival discrepancies. Precautions are discussed like controlling periodontal inflammation first and using bone level instead of crown anatomy to guide bracket placement for patients with significant bone loss.

1. ADJUNCTIVE ROLE OF
ORTHODONTIC THERAPY

2. BENEFITS OF ORTHODONTIC THERAPY
TO ADULT PERIODONTAL PATIENTS
• CROWDED OR MALPOSED ANTERIOR TEETH can be aligned so that better access
to cleaning is obtained
• Vertical orthodontic tooth repositioning can improve certain types of osseous
defects in periodontal patients.
• Can improve esthetic relationship of max gingival margin levels before restorative
dentistry.
• In case of fractured max anterior teeth forced eruption permit adequate restoration
of root.
• Open embrasure can be corrected to regain lost papilla
• Orthodontic treatment could improve adjacent tooth position before implant
placement or tooth replacement.

4. PREORTHODONTIC OSSEOUS
SURGERY
• Osseous craters
• 3 wall intrabony defects-bone grafting done ….if result is stable 3-6 months after
periodontal surgery orthodontic treatment can be initiated.

5. ORTHODONTIC TREATMENT OF
OSSEOUS DEFECT

6. HEMISPETAL DEFECT
• Hemiseptal defect-1 or 2 wall osseous defect are found on
• mesially tipped teeth or
• teeth that have supraeerupted……

7. HEMISEPTAL DEFECT CAN BE TREATED
WITH ORTHODONTIC THERAPY BY
• In such case
• Uprighting and eruption of tooth will level the bony defect

8. Supraeruted -can
be intruded

11. • Before orthodontic treatment –PERIODONTAL INFLAMMATION should be
controlled.
• In periodontally healthy patients- orthodontic brackets are positioned on the
posterior teeth relative to the marginal ridges and cusps.
• When marginal ridge discrepancies are encountered, assess these teeth
radiographically to determine the interproximal bone level.

12. ADVANCED HORIZONTAL BONE LOSS
• In a periodontally healthy individual, the position of the brackets is usually determined by the anatomy of
the crowns of the teeth.
• Anterior brackets should be positioned relative to the incisal edges.
•
• Posterior bands or brackets are positioned
• relative to the marginal ridges.
•

13. If the incisal edges and marginal ridges are at the correct
level, the cementoenamel junction (CEJ) will also be at the
same level. This relationship creates a flat, bony contour
between the teeth.
However, if a patient has underlying periodontal problems
and significant alveolar bone loss around certain teeth,
using the anatomy of the crown to determine bracket
placement is not appropriate

14. In a patient with advanced horizontal bone loss, the bone
level may have receded several millimeters from the CEJ. As
this occurs, the crown-to-root ratio becomes less favorable.
By aligning the crowns of the teeth, the clinician may perpetuate tooth
mobility by maintaining an unfavorablecrown-
to-root ratio.
In addition, by aligning the crowns of the teeth and disregarding the bone
level, significant bone discrepancies occur between healthy and
periodontally diseased roots.
This could require periodontal surgery to
ameliorate the discrepancies.

15. Many of these problems can be
corrected by using the bone level
as a guide to position the brackets
on the teeth

17. FURCATION DEFECT…………..

18. These lesions require special attention in the patient undergoing orthodontic treatment.
Often, the molars require bands with tubes and other attachments that impede the patient’s
access to the buccal furcation

21. FRACTURED TEETH AND FORCED
ERUPTIONS

28. ORTHODONTIC TREATMENT OF
GINGIVAL DISCREPANCIES

29. SIGNIFICANT ABRASION AND
OVERERUPTION

30. OPEN GINGIVAL EMBRASURE