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1. Ortho - Perio Relations
Presented by :Dr Sajeya Karimi
Department : Periodontology
Stomatology Teaching Hospital 1402/9/13
In The Name Of Allah

2. Table of content :
Interdisciplinary Orthodontics,
Periodontal and implant therapy
Adjunctive Role of
Orthodontic Therapy
Multidisciplinary treatment of
esthetic problems
Tooth Movement in Periodontally
Compromised Patient

3. 1
Adjunctive role of
orthodontic therapy

4. Benefits of Orthodontic
Therapy :
Aligning crowded anterior teeth
permits adult patients
better access to clean all
surfaces of their teeth
Vertical orthodontic tooth repositioning
improve certain types
of osseous defects in
periodontal patients
tipping of the adjacent dentition
• improve adjacent tooth positioning
before implant placement
• uprighting of tipped molars
Aesthetic relationship
improve the aesthetic
relationship of the
maxillary gingival margins
open gingival embrasures
to be corrected to regain lost
papillae
forced eruption
permit adequate
restoration of the root

5. Orthodontic Treatment of Osseous Defects
Hemi septal Defects
Hemi septal defects are one- or two-wall osseous defects that often are found around mesially tipped
teeth or teeth that have super erupted
Usually, these defects can be eliminated with the appropriate orthodontic treatment

7. Furcation Defects
• Furcation defects can be classified as incipient (class I), moderate (class II), or advanced (class III) These
lesions require special attention in patients undergoing orthodontic treatment.
• If a patient with a class III furcation defect will be undergoing orthodontic treatment, a possible
method for treating the furcation is to eliminate it by hemisecting the crown and root of the tooth.
• If the patient will be undergoing orthodontic treatment, it is advisable to perform the orthodontic
treatment first.

9. Fractured Teeth and Forced Eruption
• If fracture extends beneath the level of the gingival margin and terminates at the level of the alveolar ridge,
Restoration of the fractured crown is impossible because the tooth preparation would extend to the level of
the bone.
• This overextension of the crown margin could result in an invasion of the biologic width of the tooth and
cause persistent inflammation of the marginal gingiva

10. Six criteria which are used to determine whether the tooth should be forcelly
erupted or extracted:
Root length
The root-to-crown ratio
should be about 1:1 , if
the root is fractured to
the bone level and must
be erupted 4 mm .
Level of the fracture
If the entire crown is
fractured 2 to 3 mm
apical to the level of the
alveolar bone, it is
difficult, if not impossible
Aesthetics
If the patient has a high lip
line and displays 2 to 3 mm of
gingiva when smiling, any type
of restoration in this area will
be more obvious
Sample Headline
Root form
The shape of the root should
be broad and nontapering
rather than thin and tapered
and The root canal should not
be more than one-third of the
overall width of the root
importance of the tooth
In younger patient forced
eruption would be more
conservative and
appropriate.
prognosis
Endodontic/periodontal
prognosis. If the tooth has
a significant periodontal
defect, it may not be
possible to retain the root

11. The root may be erupted rapidly or slowly. If the movement is
performed rapidly, the alveolar bone will be left behind
temporarily, and a circumferential fiberotomy may be performed
to prevent bone from following the erupted root. However, if the
root is erupted slowly, the bone follows the tooth. In this situation,
the erupted root requires crown lengthening to expose the correct
amount of tooth to create the proper ferrule, resistance form, and
retention for the final restoration
Keys point about forced eruption technique

12. Hopeless Teeth Maintained for Orthodontic Anchorage :
Patients with advanced periodontal disease may have specific teeth that are diagnosed as hopeless and would be
extracted before orthodontic therapy . However, these teeth may be useful for orthodontic anchorage if the
periodontal inflammation can be controlled.

13. 2
Multidisciplinary treatment
of esthetic problems

14. Orthodontic Treatment of Gingival Discrepancies
The following four factors contribute to ideal gingival form:
1. The gingival margins of the two central incisors should be at the same level.
2. The gingival margins of the central incisors should be positioned more apically than the lateral incisors and at
the same level as the canines.
3. The contour of the labial gingival margins should mimic the CEJs of the teeth.
4. A papilla should exist between each tooth
When gingival margin discrepancies are present, the proper solution for the problem must be determined:
orthodontic movement to reposition the gingival margins or surgical correction of the discrepancies.

15. To make the correct decision, it is necessary to evaluate four criteria.
1
2
3
4
The fourth step is to determine
whether the incisal edges have
been abraded
third step is to evaluate the
relationship between the shortest
central incisor and the adjacent
lateral incisors
First, the relationship between the
gingival margin of the maxillary
central incisors and the lip line
second step is to evaluate the
labial sulcular depth over the
two central incisors

16. Significant Abrasion and Overeruption
Two options are available.
One option is extensive crown lengthening
Other option is to intrude the teeth orthodontically and move the gingival margins apically

17. Open Gingival Embrasures:
The interproximal contact between the maxillary central incisors consists of two parts: the tooth contact and the
papilla. The papilla/contact ratio is 1:1
If the patient has an open embrasure, the first factor that must be evaluated is whether the problem is caused by
the papilla or the tooth contact

18. Open gingival embrasures (Loss of interdental papilla):
the cause is usually a lack of bone support for the papilla due to an underlying periodontal problem
Tarnow et al (1992) correlated the distance from the contact point to the crest of bone with the presence or
absence of the interproximal dental papilla
Considerations : In some situations, a deficient papilla can be improved with orthodontic treatment. By closing
open contacts, the interproximal gingiva can be squeezed and moved incisally

19. Open gingival Embrasure (Tooth contact problems) :
The first step in the diagnosis of this problem is to evaluate a periapical radiograph of the central incisors.
• If the root angulation is divergent, the brackets should be repositioned

20. Open gingival embrasures (Tooth shape problem):
If the periapical radiograph shows that the roots are in their correct relationship, the open gingival embrasure is
caused by a triangular tooth shape
Consideration :
If the shape of the tooth is the problem,
two solutions are possible:
(1) restore the open gingival embrasure
(2) reshape the tooth by flattening
the incisal contact and closing the space
conclusion:
This open space is usually caused by
(1) tooth shape
(2) root angulation
(3) periodontal bone loss

21. 3
Tooth Movement in
Periodontally Compromised
Patient

22. Treatment planning for patient with periodontics , orthodontics problem
Periodontal considerations:
• Effects of orthodontic forces on healthy periodontium
facilitate plaque accumulation and hinder a patient’s oral hygiene practices
changes in the subgingival microbiota
• Orthodontic treatment in patients with a reduced but healthy periodontium
• Orthodontics appliance in patient with poor oral Hygiene
promote gingival enlargement
• Timing of initiating orthodontic treatment after periodontal therapy
After basic periodontal therapy
After periodontal surgery
During orthodontic therapy, the periodontal condition and oral hygiene compliance of
patients should be closely monitored

23. Treatment planning for patient with periodontics , orthodontics problem
Orthodontic considerations
Orthodontic tooth movements do not cause periodontal attachment loss and/or gingival
recession but presense of some predisposing factor may be contribute to gingival recessions
• thin buccal cortical bone
• labial or proinclination orthodontic tooth movements
• Which when accompanied with thin gingival phenotype in conjunction with presence of
plaque derived gingival inflammation and/or toothbrush trauma
• If labially positioned tooth is orthodontically moved lingually the bone dehiscence may
disappear and the gingival thickness increase
In these risk situations, the orthodontist should consult with the periodontist

24. Orthodontic tooth movements through cortical bone
• Alveolar ridge contraction is the physiologic consequence of tooth extraction
• When the alveolar bone housing is thin and there is minimum trabecular bone between the buccal and lingual
cortical plates, the orthodontic tooth movement may be slowed or result in bone dehiscence defects in these
areas
• To avoid these unwanted consequences, surgical interventions aimed at bone augmentation width have been
suggested before the orthodontic movement
• when bodily movements are carried out through cortical bone in a labial direction there is no bone formation
in the buccal aspect of the tooth and a dehiscence defect occurs
• pure lingual root movements through cortical bone are difficult and in most cases crown tipping or rotation
components will occur,

25. 4
Orthodontics, Implants, and
Periodontal Interactions

26. Implant Interactions in Orthodontics
Planning Phase
Implants can be used to facilitate orthodontic mechanotherapy by providing anchorage, and
orthodontic treatment can facilitate implant therapy by providing site development
• Implants in orthodontic therapy can have two fundamentally different goals
First, implants are used for anchorage purposes (TAD)
Second, implants are used for the replacement of missing or lost teeth

27. Preimplant Orthodontics site preparations
There are differences in regard to root angulation and parallelism between congenitally missing teeth and
missing teeth that existed at one time and were subsequently lost.
• congenitally missing tooth

28. Space management in a case of tooth relocation or drifting after earlier tooth loss

30. • orthodontists and their suppliers have sought to improve appliance efficiency and hence treatment time by:
low-friction wires
exotic alloys
temperature-sensitive archwires
self-ligating brackets
• Consequently, procedures and even devices aimed at the biologic responses to tooth movement have
evolved ( stimulation of the body’s remodeling)
 surgical intervention
 Decortications
 PAOO periodontally accelerated osteogenic orthodontics
 Micrperforations
 Piezocision
 vibratory stimulation(Stimulatory Device)
 AcceleDent (20min/24hr)
 VPro5 (5min/24hr)
Orthodontic Acceleration

31. References:
Newman and Carranza's Clinical Periodontology 2019
Lindhe’s Clinical Periodontology and Implant Dentistry 2022
Papageorgiou et al. 2018a
Taiwanese Journal of Orthodontics. 32 79-84, 2020