ORTHODONTICS PERIODONTICS RELATIONSHIP.pptx

ORTHO-PERIO
INTERRELATIONSHIP
Dr. BEENA VIJAYAN PARVATHY

CONTENTS
Introduction
Biological basis for orthodontic
therapy
Periodontal tissue response to
orthodontic force
Effects of orthodontic tooth
movement on the periodontium
Orthodontic tooth movement in
adults with periodontal tissue
breakdown
Specific factors associated with
orthodontic tooth movement
Implants and orthodontic therapy
Systematics of combined ortho –
perio treatment
Periodontally Accelerated
Osteogenic Orthodontics (PAOO)
Minor periodontal surgery and
orthodontic treatment
Review of literature
Conclusion
References

INTRODUCTION
BETTER MASTICATION,
SPEECH, FACIAL
ESTHETICS.
GENERAL AND ORAL
HEALTH
ORTHODONTIC
TREATMENT
With appropriate tooth
movements FUNCTIONAL AND
ESTHETIC
OCCLUSION
BENEFITS ADVERSE EFFECTS
 ACCUMULATION OF
PLAQUE AND CALCULUS
 ROOT RESORPTION
 PERIODONTAL
COMPLICATIONS
 PSYCHOLOGICAL
DISTURBANCES
 GI COMPLICATIONS

Clinical conditions which predispose to periodontal
disease are:
 Crowding
 Increased over jet and overbite
 Cross bite
 Open bite
 Inadequate or poor lip seal
 Mouth breathing
 Tooth rotations

 Bollen 2008, conducted two systematic reviews to address the following
questions:
(i) does a malocclusion affect periodontal health ??
(ii) does orthodontic treatment affect periodontal health??
 The first review found a correlation between the presence of a malocclusion and
periodontal disease
 The second review identified an absence of reliable evidence on the effects of
orthodontic treatment on periodontal health.

Periodontal ligament structure and function:-
 Each tooth is attached to and separated from the adjacent alveolar bone by a heavy
collagenous supporting structure, the periodontal ligament (PDL).
 Major component of this PDL is collagen fibers, inserting in to cementum of the
root on one side and into to the bony plate of lamina dura, on the other side.
PERIODONTAL LIGAMENT AND BONE RESPONSE TO
ORTHODONTIC FORCE

 The response to sustained force against the teeth is a function of force magnitude:
 In orthodontic practice, the objective is to produce tooth movement as much as
possible by frontal resorption.
Lighter forces are compatible with
survival of cells within the PDL and a
remodeling of the tooth socket by a
painless “frontal resorption” of the
tooth socket.
Heavy forces lead to rapidly
developing pain, necrosis of cellular
elements within the PDL, and the
phenomenon of “undermining
resorption” of alveolar bone near the
affected tooth.

BIOLOGIC CONTROL OF TOOTHMOVEMENT
 It is necessary to consider the biologic control mechanism that lead from the
stimulus of sustained force application to the response of orthodontic tooth
movement.

BIOELECTRICITY
THEORY/PIEZOELECTRIC THEORY/BONE
BENDING THEORY
Farrar et al, 1876

PRESSURE – TENSION THEORY
(CLASSIC THEORY)
Schwarz et al,1932

TIME EVENT
1 SEC PDL fluid incompressible, alveolar bone bends, piezo electric
signal generated.
1-2 SEC PDL fluid expressed, tooth moves within PDL space.
3-5 SEC Blood vessels within PDL partially compressed on pressure
side, dilated on tension side; PDL fibers and cells mechanically
distorted.
MINUTES Blood flow altered, oxygen tension begins to change;
prostaglandins and cytokines released.
HOURS Metabolic changes occurring: chemical messengers affect
cellular activity, enzyme levels change.
4 HOURS Increased cAMP levels detectable, cellular differentiation
begins with in PDL
2 DAYS Tooth movement beginning as osteoclasts / osteoblasts remodel
bony socket.
LIGHT PRESSURE

TIME EVENT
1 SEC PDL fluid incompressible, alveolar bone bends, piezo
electric signal generated.
1-2 SEC PDL fluid expressed, tooth moves within PDL space.
3-5 SECS Blood vessels within PDL occlused on pressure side
MINUTES Blood flow cut off to compressed PDL area.
HOURS Cell death in compressed area
3-5 DAYS Cell differentiation in adjacent marrow spaces,
undermining resorption begins
7-14 DAYS Undermining resorption removes lamina dura adjacent to
compressed PDL, tooth movement occurs.
HEAVY PRESSURE

SEQUENCEOFEVENTSAFTERFORCEAPPLICATION
Movement of PDLfluid
Development of strain in cells and ECM
Direct transduction of mechanical forces to nucleus of cells leading to activation of specific genes
Release of nociceptive and vasoactive neuropeptides
Interaction with endothelial cells
Adhesion of circulating leucocytes to endothelial cells

Plasma extravasation from dilated blood vessels
Diapedesis of leucocytes into extravascular spaces
Synthesis and release of signal molecules(cytokines, GF,CSFs) from leucocytes
Interaction with various paradental cells
Activation of cells to participate in modeling and remodeling of paradental tissues

SIGNALING MOLECULES AND METABOLITES IN
ORTHODONTIC TOOTH MOVEMENT

EFFECT OF ORTHODONTIC FORCES ON PERIODONTIUM
 When a removable appliance is worn less than 4 to 6 hours per day, it will produce no
orthodontic effects, but above this duration threshold, tooth movement does occur.
 Experiments have shown increase levels of PG and IL-1ß in PDL within short time after
pressure application.
 Yamasaki et al (1980) prostaglandins that were produced during orthodontic tooth movement
may increase bone resorption activity.
 PG E was injected in the gingiva of the teeth to be moved. They reported enhanced rate of tooth
movement. Also, evidence shows PG release when cells are mechanically deformed.

• Now increasing evidence proves that although PG E is involved in the transduction of
mechanical stress on the PDL and alveolar bone during orthodontic tooth movement, several
other inflammatory mediators are also active.
• Cytokines and NO and other regulators of cellular activity are also involved
• For tooth movement to occur,
-Osteoclasts must be formed to remove bone from the area adjacent to compressed PDL.
-Osteoblasts are needed for formation of bone on tension side.
• PG E stimulates both osteoclastic and osteoblastic activity.

 In mechanical deformation of PDL  it is up to 48 hrs before osteoclasts appear, they arrive in
2 waves :
• first wave is derived from local cell population,
• while the larger second wave are brought from distant areas via blood flow.
 These cells attack adjacent lamina dura on pressure side, removing bone by frontal resorption
and tooth movement begins soon thereafter.
 At the same, lagging behind osteoblasts appear (locally from progenitor cells in PDL) from bone
on tension side and begin remodeling activity on pressure side.

 In clinical orthodontic it is difficult to avoid pressure that produces at least some avascular area
in the PDL, and it has been suggested that releasing pressure against a tooth at intervals while
maintaining the pressure for enough hours to produce the biologic response, could help in
maintaining tissue vitality.
 Because of its histological appearance as the cells disappear, an avascular area in the periodontal
ligament traditionally has been referred to as hyalinized.

 After a delay of several days, cellular elements begin to invade the necrotic (hyalinized)
area.
 More importantly, osteoclasts appear within the adjacent bone marrow spaces and begin
an attack on the underside periodontal ligament area - "undermining resorption“.
 When hyalinization and undermining resorption occurs, an inevitable delay in tooth
movement occurs.
 This is caused by :
– delay in stimulating differentiation of cells within marrow spaces
– considerable thickness of bone must be removed from the underside before any
tooth movement can take place.

 So, it is apparent that optimum force levels for orthodontic movement should be just high
enough to stimulate cellular activity without completely occluding blood vessels in the
periodontal ligament area.
 Both the amount of force delivered to a tooth and also the area after periodontal ligament over
which that force is distributed are important in determining the biologic effect.
 The periodontal ligament response is determined not by force alone, but by force per unit area,
or pressure.

Effects of force distribution and types of tooth movement
Optimum forces for orthodontic tooth movement
Type of movement Force (gm)
Tipping 35 – 60
Bodily movement 70 – 120
Root uprighting 50 – 100
Rotation 35 – 60
Extrusion 35 – 60
Intrusion 10 - 20

Effects of continuous force
Effects of light continuous force:
• Smooth tooth movement will
result from frontal resorption.
Effects of heavy continuous
force:
• Tooth movement will be delayed
until undermining resorption can
remove the bone necessary for
tooth movement. Tooth will
change its position rapidly.
• It is destructive for both the tooth
and PDL.

Effects of interrupted force
Effects of light interrupted
force:
• Tooth will move a small amount
by frontal resorption and then
remain in that position until the
appliance is activated again.
Effects of heavy interrupted
force:
- Heavy forces produce undermining
resorption, tooth will move when
undermining resorption is eliminated.
Since the force has dropped to zero, the
tooth will remain in same position until
next activation.
- Although the original force is heavy,
after the tooth moves there is a period of
regeneration and repair of the PDL
before force is applied again.

GINGIVAL RESPONSE TO ORTHODONTIC FORCE
EFFECT
OF
FORCE
Clinical
findings
Ultrastructural
analysis
Molecular
analysis
Histological
findings

CLINICAL CHANGES
 The teeth that approximated resulted in an accumulation of gingival tissue and enlargement of
the interdental papilla.
 The tissue accumulation is the result of both retraction and compression.
 The gingiva retracts together with the tooth movement, although at a less distance.
 At the mesial surface of orthodontically retracted tooth, a triangular patch of red tissue appears.

During orthodontic treatment:
 The gingiva rotates to the same degree and in the same direction of the tooth.
 Extensive rotational movement causes the rotational gingiva to be compressed in the interdental
area at the direction of rotation
 From a clinical point of view, special attention should be given to the possible consequences of
excessive labial tooth movement, especially that of incisors, which may bring about irreversible
gingival recession.

HISTOLOGIC FINDINGS
 Discontinuation of the transseptal fibers is seen after a tooth has been extracted.
 During healing of the extraction site, newly formed collagen fibers bring about a
reestablishment of continuity of the transseptal fibers, thus creating a fibrous bridge connecting
the seperated teeth.
 The orthodontic approximation is accompanied by papillary hyperplasia.
 The newly formed transseptal fibers are coiled and compressed, and have a ''foot ball' shaped
appearance. (Parker GR et al.,1972)

 According to another study by Edwards JG et al.,1971, the new transseptal fibers have a normal
morphologic appearance after closure of the extraction site.
 In the transeptal region, distant to the alveolar crest, significant increase in oxytalan fibers as
well as increased level of GAG has been described.
 This elevates the elastic proportion of the tissue at the extraction sites.

 In rotational movement, an increase in oxytalan fibers and reorientation ("Stretching") of the
gingival collagen fibers has been reported.
 The clinical instability of the rotated tooth, which almost always relapse has been attributed to
these stretched collagen fibers.
 The stretched fibers that originate from the gingiva and are inserted in to the cementum, pull the
tooth back to the pre-treatment position.
 It has been reported that proline uptake of the newly formed collagen increased significantly in
both the lamina propria and transeptal region thus suggesting that orthodontic force stimulates
collagen production in the gingiva (Boison M et al., 1981)

International Journal of Preventive and
Clinical Dental Research, July-September
2016;3(3):206-212

ULTRA STRUCTURAL ANALYSIS
 The effect of orthodontic tooth movement on both collagen and elastin in the gingiva has been
investigated also by ultra structural analysis.(Franchi M et al., 1989)
 The diameter of collagen fibers is significantly increased in both pressure and tension aspects
when compared to untreated controls.
 In some areas with in the compressed papilla, degraded collagen fibers have been longitudinally
split and without the typical banding pattern.
 On the pressure aspect of the gingiva, a slight increase in the number and size of elastic fibers
has been seen.
 On the tension aspect, however, only few elastic fibers have been observed.

MOLECULAR ANALYSIS
 The effect of mechanical force on gene transcription of collagen type I and tissue collagenase
(MMP I, Matrix metalloproteinase - I) has been studied on gingival fibroblasts in vitro using the
reverse transcriptase polymerase chain reaction. (Reidlich M et al., 1998)
 Under these observations the transcription level of collagen type I has been significantly
increased whereas that of collagenase has been significantly decreased.
 These changes indicate disturbed equilibrium between collagen synthesis and degradation
required to maintain adequate tissue stability at the pre-translational level.

Pini Prato GP, Chambrone L. Orthodontic
treatment in periodontal patients: The use of
periodontal gold standards to overcome the “grey
zone”. Journal of Periodontology. 2020
Apr;91(4):437-41

ORTHODONTIC TREATMENT MODALITIES
Method for tooth movement fall into two basic categories
Fixed
appliances Removable
appliances

Three important points used to be addressed when utilizing orthodontic treatment as a part of
periodontal therapy:
Severity of the
periodontal problem
and the possibility
of improving it by
orthodontics.
Level of remaining
bone.
Possibility that the
periodontal problem
may worsen
without orthodontic
correction.

BENEFITS OF ORTHODONTIC TREATMENT
Reducing
plaque
retention
Improving
gingival and
osseous form
Facilitating
prosthetic
replacements
Improving
aesthetics

REDUCING PLAQUE RETENTION
 Crowded teeth are frequently difficult to clean, making the introduction of dental floss and
other cleaning devices practically impossible. This occurs most frequently in lower anterior
areas of the mouth.
 Arch length discrepancies also create abnormal occlusal relationship that may favor trauma
from occlusion.
 Crowding also creates enlarged contact surfaces and altered embrasure spaces that lead to
smaller papillae and a soft tissue facial ridge.

IMPROVING GINGIVAL OSSEOUS
FORM
 There is an inter relationship between the position of the tooth and the shape of the gingiva and
bone that surround it.
 Osseous contouring may correct the bony defect but will also create a tomography inconsistent
with a healthy gingival sulcus.
 Orthodontic therapy may improve the shape of the periodontium and reduce the indication for
bone injury.

FACILITATING PROSTHETIC
REPLACEMENTS
 The up righting of titled abutment teeth may be important in restorative dentistry
 Parallel abutment teeth less frequently require hemisection or removal, are less likely to sustain
pulpal damage are can accommodate better-contoured crowns.

IMPROVING AESTHETICS
 Migration and diastema, one of the frequent features of advanced periodontal disease may be
caused by tongue thrusting or other habits.
 Posterior prematurities are usually associated with periodontal disease.

INDICATIONS
Closure of anterior diastema
Crowded teeth
Mesial tilting of molars
Open contacts.
CONTRA INDICATIONS
Persistence of active disease despite adequate
phase I therapy procedures.
Superimposition of tooth movement on inflamed
gingiva may exacerbate the periodontal problem.
When vertical defects persist, any type of
orthodontic tooth movement may produce
additional loss of connective tissue.

ORTHODONTIC TOOTHMOVEMENT IN ADULTS
WITH PERIODONTAL TISSUE BREAKDOWN
 With properly performed treatment, extensive orthodontic tooth movement can be made in
adults with a reduced but healthy periodontium without further periodontal deterioration.
 Boyd et al. (1989) described 10 adults with generalized periodontitis who received pre-
orthodontic periodontal treatment including surgery, and then regular maintenance at 3-month
intervals during a 2-year orthodontic treatment period.
 They were compared with 10 control adults who had normal periodontal tissues, and 20
adolescent orthodontic patients.

The results demonstrated that:
 Adults were more effective than adolescents in removing plaque, especially late in the
orthodontic treatment period.
 Tooth movement in adults with reduced, but healthy, periodontium did not result in significant
further loss of attachment (none of the adults had additional mean loss of attachment of more
than 0.3 mm)
 Adults with teeth that did not have healthy periodontal tissues may experience further
breakdown and tooth loss due to abscesses during orthodontic treatment.

ORTHODONTIC TREATMENT OF OSSEOUS DEFECTS
PRE-ORTHODONTIC OSSEOUS SURGERY
A)Osseous Craters: interproximal, two-wall defect that does not improve with orthodontic
treatment.
Shallow defect: nonsurgically. Based on patient response.
B) Three-Wall Intrabony Defects: pocket reduction with regenerative periodontal therapy. 3-6
months  ORTHODONTIC TREATMENT

Hemispetal defects :
 Commonly located around mesially tipped teeth or those
which are supra-erupted
 Tipped teeth  uprghting and eruption of the tooth levels
the bone defect
 Supraerupted teeth  intrusion and leveling of the
adjacent CEJs useful for leveling the osseous defect

Furcation Defects :
- Hemisected roots when seperated orthodontically , permits favourable restoration and splinting.
(Grant et al 1988)
- Endodontic therapy and periodontal surgery precede the orthodontic treatment.
- Bands or brackets and coil springs are placed on the root fragments to be seperated
- Space created between the roots help better maintenance of the area.

Root proximity :
 Orthodontic treatment helps maintain or improve space between approximating roots of
posterior teeth
 2-3mm of root seperation leads to adequate bone and embrassure space to achieve optimal
periodontal health
Fractured teeth- Forced eruption :
 In cases of crown fractures, extending till the level of alveolar bone , the tooth can be extruded
and then restored .
 Elastic traction or orthodontic banding and bracketing can be performed.

Hopeless tooth maintenance :
 Can prove useful for orthodontic anchorage as well as space maintenance , when periodontal
inflammation is controlled.
 Flap surgery can be performed for the debridement of roots to control inflammation during the
treatment.

ORTHODONTIC TREATMENT OF GINGIVAL
DISCREPANCIES
 Uneven gingival margins
The relationship of the gingival margin of the 6 maxillary anterior teeth is crucial in
maintaining the esthetic appearance of the crowns.
Significant attrition and over-eruption
Intrusion movement is applied on 4 incisor which level the gingival margin apically. Then
the incisal edges are restored and final crowns are placed.
Open gingival embrasures
During the tooth movement orthodontically , the gingival tissue present in between –
squeezes into the shape of an interdental papilla.

CORRECTIONOF PATHOLOGICAL MIGRATION
Basic appliances used for intra-arch tipping movements:
Hawley’s appliance
Crozat appliance
Spring retainer

IMPLANT PLACEMENT
 Orthodontic extrusion of a single tooth that needs to be extracted is considered as an ideal
method for improving marginal bone levels before single implant placement.
 During orthodontic extrusion, both the bone and its supporting soft tissues will move vertically
with the teeth.
 Useful for esthetic improvement of marginal gingival levels associated with the implant
placement.

PERIODONTAL APPLICATIONS IN ORTHODONTICS
 On many occasions, a stable and esthetically acceptable outcome cannot be achieved with
orthodontics without adjunctive periodontal procedures. For instance, a high labial frenum
attachment is considered to be a causative factor of midline diastema.
 Frenectomy is recommended in such cases as the fibres are thought to prevent the mesial
migration of the central incisors.
 According to Vanarsdall, surgical removal of a maxillary labial frenum should be delayed until
after orthodontic treatment unless the tissue prevents space closure or becomes painful and
traumatized.

 Retention of orthodontically achieved tooth rotation is a problem that has always plagued the
orthodontist. Circumferential supracrestal fiberotomy (CSF) is a procedure that is frequently
used to enhance post-treatment stability.
 Edwards concluded from his long-term prospective study that CSF is more successful in
preventing relapse in the maxillary arch. According to him, CSF does not affect the
periodontium adversely.
 Mucogingival surgeries may be needed during the course of orthodontic treatment to maintain
sufficient width of attached gingiva.

FRENOTOMY / FRENECTOMY
 Abnormal frenum attachment:
results when a v-shaped bony cleft is formed between the two central incisors and a thick
frenum resists orthodontic forces and is responsible for the relapse of space closure.
 Frenectomy is more commonly performed procedure; however the undesirable loss of
interdental papilla is a common complication encountered with this procedure.
 Hence, the frenotomy despite being a superficial procedure, is esthetically preferable.
Angle concluded that the presence of an abnormal frenum is a
cause for midline diastema.

 Also, crown lengthening procedures can facilitate easy placement of orthodontic attachments
on teeth with short clinical crowns. This procedure can also be used for smile designing.
 Alveolar ridge augmentation and placements of dental implants are the other adjunctive
periodontal treatment procedures undertaken to facilitate achievement of orthodontic treatment
goals.

Gingivectomy/gingivoplasty
 One of the most common soft tissue problems associated with fixed orthodontic appliances is
gingival enlargement or hyperplasia.
 The prevalance rate of 10% is reported. Sinclair PM 1987
 Nonsurgical periodontal treatment is the conventional management approach for GE but is not
always effective when it is extensive and self care is compromised .

Corticotomy assisted Orthodontics
 Corticotomy-assisted orthodontics has been employed in various forms to accelerate
orthodontic treatment.
 Rapid tooth movement associated with corticotomy was first introduced by Henry Kole. (RAP-
Regional accelerated phenomenon)
 The cortical plates of the bone are believed to be the main resistance to orthodontic tooth
movement.
 In corticotomy-assisted orthodontics, rapid tooth movement is achieved by disrupting the
continuity of the cortical bone by a selective cut and preserving the vitality of the teeth and
marginal periodontium.

 The biology behind corticotomy-assisted orthodontics is the regional acceleratory phenomenon
(RAP).
 It is a local response of the tissue to noxious stimuli, through which the tissue regenerates at a
faster rate than normal (without corticotomy).
 The areas around the cuts are associated with intensified bone response, i.e., increased
osteoblastic-osteoclastic activity and increased level of inflammatory mediators, which
accelerate the bone turnover and facilitate rapid orthodontic tooth movement.

Periodontally Accelerated Osteogenic Orthodontics (PAOO)
 Periodontally accelerated osteogenic orthodontics (PAOO), also termed Wilckodontics, was
introduced by Wilcko et al. in 2001.
 Clinical procedure that combines selective particulate bone grafting, alveolar corticotomy and
the application of orthodontic forces.
 It is a revised corticotomy-associated technique, which involves a full-thickness labial and
lingual flap elevation accompanied by selective surgical scarring of the labial and lingual
cortical bones (corticotomy) followed by placement of the graft material, surgical closure, and
orthodontic force application.

Advantages:
 Reduces the treatment time
 Facilitates expansion of the dental arch
 Root resorption is less compared to normal tooth movement due to reduced resistance from
cortical bone.
 Provides improved prosthodontic stability and reduces relapse tendencies.
Amit G et al;2012

Piezocision-Assisted Orthodontics
 New minimally invasive surgical procedure introduced by Dibart et al. in 2009.
 In this technique microincision is performed on the buccal gingiva that allows the piezoelectric
knife to give osseous cuts to the buccal cortical plates and initiate RAP.
 This procedure provides rapid tooth movement without an extensive traumatic surgical
approach.
 Maintains the clinical benefit of the bone or soft tissue grafting, along with tunnel approach.

 Piezosurgery works only on mineralized tissues, sparing soft tissues and producing micrometric
and selective osteotomy cuts without any osteonecrosis.
 Compared to the classic decortication procedure, piezosurgery has added advantages such as
being minimally invasive, safe, and less traumatic to the patients.
 Piezocision can also be combined with Invisalign in selected cases to produce outcomes that are
less time-consuming as well as satisfy the patient's desire of aesthetic appliance.

Gingival Recession and Root Coverage
in Orthodontic patients
• If the area has recession and inadequate gingiva, then the procedure may be done before or
during orthodontic treatment.
(David P. Mathews and Vincent G. Kokich,1997)

• Labial tooth movement or tooth proclination does not cause gingival recession, but in specific
cases can result in thin soft tissues or bone dehiscences that comprise low-resistance regions to
inflammation or trauma . Based on similar observations, several authors suggest that the
thickness of periodontal tissues should be surgically increased before orthodontic tooth
movement when it is estimated that it will cause bone dehiscence.
(Wennstro¨m 1996, Holmes 2005, Melsen B 2009)

• On the other hand, animal studies have shown that no such precaution is necessary for lingual
movement of labially displaced teeth with dehiscences, as it leads to new bone formation and
soft tissue thickness augmentation.
(Karring T 1982, Wennstrom 1987)

 Orthodontic treatment should not be started until the inflammation of the gingiva has been
reduced to a minimum through adequate scaling, root planning & correcting other irritational
factors.
 Periodically during the orthodontic therapy, the periodontist should check the condition of the
tissues, remove all irritants and reinforce the patient’s oral hygiene as needed. The frequency of
these examinations is usually every 8-12 weeks.
Maintaining a good oral hygiene is a challenge to everyone. But particularly for orthodontic
patients whose appliances make them more susceptible to gingivitis, hyperplastic tissues,
decalcification and dental caries.
ORAL HYGIENE FOR ORTHODONTIC PATIENT

Use of bi-bevel bristles
Use of powered tooth brush
Fixed appliances make plaque removal more difficult because of the increase in
surfaces & the inaccessibility in some areas .

Use of stimudent to remove
plaque
Use of floss threader

Use of interproximal brush to clean
around the brackets
Rubber stimulator to disrupt
plaque and massage the papilla

Conclusion: In the inter-disciplinary treatment of periodontitis
stage IV, OT can be initiated already 4 weeks after regenerative
surgery of IDs with favourable results, thus reducing the overall
treatment time
Int J Periodontics Restorative Dent 2018;38:801–809. doi: 10.11607/prd.3756
Conclusions:If periodontal infection is under control, the orthodontic
treatment does not reduce the longterm benefits of periodontal regeneration,
even where the disease has caused massive tissue destruction.

CONCLUSION
Every dental treatment requires good periodontal health especially orthodontic treatment.
The orthodontic procedure is the double-action procedure regarding the periodontal tissue, it
provides healthy state of the periodontal ligament, but on the other hand, it produces negative
effects on periodontium including the gingival recession, gingivitis and bone defects.
In the recent years, because of the increased number of adults seeking orthodontic treatment,
orthodontists frequently face patients with periodontal disease. Adult patients must undergo
regular oral hygiene performance and periodontal maintenance in order to maintain healthy
gingival tissue during active orthodontic therapy.
The development of new methods to accelerate tooth movement via periodontal procedures has
shortened the treatment time, therefore, increased patient compliance.
Thus the harmonious correlation among the two specialties provides the best treatment for
combined orthodontic-periodontal problems.

REFERENCES
1)Newman MG, Takei HH, Klokkevold PR, Caranza FA. Caranza’s clinical periodontology- 10th
edition
2)Lang NP, Lindhe J. Clinical Periodontology and Implant Dentistry- 6th edition
3)William R. Profitt. Contemporary Orthodontics ; 3rd edition.Pg.298-301
4)Pini Prato GP, Chambrone L. Orthodontic treatment in periodontal patients: The use of
periodontal gold standards to overcome the “grey zone”. Journal of Periodontology. 2020
Apr;91(4):437-41.
5)Vanarsdall RL. Orthodontics and periodontal therapy. Periodontology 2000. 1995 Oct;9(1):132-
49.
6)Antoun JS, Mei L, Gibbs K, Farella M. Effect of orthodontic treatment on the periodontal
tissues. Periodontology 2000. 2017 Jun;74(1):140-57.

7) Patil AK, Shetty AS, Setty S, Thakur S. Understanding the advances in biology of orthodontic
tooth movement for improved ortho-perio interdisciplinary approach. J Indian Soc
Periodontol 2013;17:309-318.
8) An update on Periodontic-orthodontic interrelationships, Aous Dannan , J Indian Soc
Periodontol. 2010; 14(1): 66–71
9) Vanarsdall RL. Orthodontics and periodontal therapy. Periodontology 2000. 1995;9(1):132-
149.
10) Agarwal L, Tandon R, Srivastava S, Gupta A. Ortho-perio integration: An orthodontic review.
Indian Journal of Multidisciplinary Dentistry. 2016;6(2):99-103.

ORTHODONTICS PERIODONTICS RELATIONSHIP.pptx

ORTHODONTICS PERIODONTICS RELATIONSHIP.pptx

Recommended

Recommended

More Related Content

Similar to ORTHODONTICS PERIODONTICS RELATIONSHIP.pptx

Similar to ORTHODONTICS PERIODONTICS RELATIONSHIP.pptx (20)

More from Dr. B.V.Parvathy

More from Dr. B.V.Parvathy (20)

Recently uploaded

Recently uploaded (20)

ORTHODONTICS PERIODONTICS RELATIONSHIP.pptx