A MAGNIFICENT ORTHODONTIC TREATMENT CAN BE DESTROYED BY POOR PERIODONTAL SUPPORT. EVALUATION AND MAINTENANCE OF PERIODONTAL HEALTH BEFORE, DURING AND AFTER TREATMENT IS VERY IMPORTANT.

1. ORTHO-PERIO
RELATIONSHIP
DR. ABHISHEK GAUR
BDS, MDS
DEPARTMENT OF PERIODONTICS
R. R. DENTAL COLLEGE & HOSPITAL

3. INTRODUCTION
A MAGNIFICENT ORTHODONTIC
TREATMENT CAN BE DESTROYED BY
POOR PERIODONTAL SUPPORT.
EVALUATION AND MAINTENANCE OF
PERIODONTAL HEALTH BEFORE , DURING
AND AFTER TREATMENT IS VERY
IMPORTANT.
ORTHO-PERIO RELATIONSHIP

4. HISTORY
Edward H. Angle (1899)
advocated the correlation
between Orthodontics and
Periodontics.
ORTHO-PERIO RELATIONSHIP

5. ORTHO-PERIO RELATIONSHIP
OBJECTIVE
To restore and maintain
the health and integrity
of the attachment
apparatus of teeth.

6. ORTHO-PERIO RELATIONSHIP
RISK ASSESSMENT BEFORE
ORTHODONTIC TREATMENT
1.Bleeding on probing
2.Tooth mobility
3.Thin fragile gingiva
4.Pockets

7. PERIODONTAL PROBLEMS DURING
ORTHODONTIC TREATMENT
Gingival hyperplasia developed after
1-2 months of orthodontic appliance
being placed.
It may also interfere with completion
of orthodontic treatment
ORTHO-PERIO RELATIONSHIP

9. SCALING
Professional scaling indicated
during active intrusion of elongated
maxillary incisors because
orthodontic intrusion may shift
supragingival plaque to a sub-
gingival location.
(Ericsson, 1977&1978; Melsen 1988&1992)
ORTHO-PERIO RELATIONSHIP

10. PROBLEMS AFTER
ORTHODONTIC
TREATMENT
ORTHO-PERIO RELATIONSHIP

11. Black triangleOpen gingival embrasures “black triangles” are defined as the
embrasures cervical to the inter-proximal contact that is not filled
by gingival tissues.

12. RELAPSE
PERMANENT RETENTION - BONDED RETAINERS
REMOVABLE PLATES OR SPRING RETAINERS
TRANS-SEPTAL FIBRES STRETCHES ELASTICALLY : PULLS THE TOOTH BACK TO
IT’S ORIGINAL POSITION
RELAPSE

13. TOOTH MOBILITY

14. EFFECTS OF ORTHODONTICS TREATMENTS ON THE PERIODONTIUM
Short Term :
1. Gingivitis
2. Gingival Enlargement
3. No Attachment Loss
Effects : Reversible
Long Term :
1. Root Resorption
2. Attachment Loss
Effects : Irreversible
ORTHO-PERIO RELATIONSHIP

15. RESPONSE OF THE ‘PDL’ TO
ORTHODONTIC FORCES
▸ “PDL” is compressed.
▸ Hylanization occurs, the tooth stops moving.
▸ Hyalinized zone : Eliminated by PDL Regeneration.
▸ Once the hylanized zone is removed, tooth movement can
occur again.
ORTHO-PERIO RELATIONSHIP

16. RESPONSE OF BONE TO ORTHODONTIC FORCES
▸ Bone Surrounding a tooth subjected to a force.
▸ Resorption occurs where there is pressure.
▸ New Bone deposition where there is tension.
ORTHO-PERIO RELATIONSHIP

17. COMPLICATIONS AFTER ORTHODONTIC
TREATMENTS
▸ Mouth Breathing
▸ Tongue Thrusting
▸ Gingival Hyperplasia
▸ Un-erupted teeth ankylosis
▸ Gingival Recession
▸ Tooth mobility
ORTHO-PERIO RELATIONSHIP

18. TREATMENT
RX

19. CIRCUMFERENTIAL
SUPRACRESTAL
FIBEROTOMY
CIRCUMFERENTIAL
SUPRACRESTAL
FIBEROTOMY

20. CIRCUMFERENTIAL SUPRACRESTAL
FIBEROTOMY
The term “circumferential supracrestal fiberotomy”
was first introduced not only transect free gingival
fibers but also trans-septal ones.
(Campbell etal 1975)
Supra-alveolar fibers do not adapt to new tooth
positions and are in part responsible for relapse.
(Thompson etal)
ORTHO-PERIO RELATIONSHIP

21. INDICATIONS
•Rotated teeth
•Crowded mandibular teeth.
•Median diastemas
•Poor oral hygiene, gingivitis or periodontal
pocketing.
•Gingival recession or lack of attached gingiva
CONTRA-INDICATIONS
ORTHO-PERIO RELATIONSHIP

26. PERIODONTAL
ACCELERATED
OSTEOGENIC
ORTHODONTICS
PERIODONTAL
ACCELERATED
OSTEOGENIC
ORTHODONTICS

27. ‘PAOO’ - TECHNIQUE
Periodontal accelerated osteogenic
orthodontics (PAOO) is a clinical procedure
that combines :
• Selective alveolar corticotomy,
• Particulate bone grafting,
• Application of orthodontic forces.
ORTHO-PERIO RELATIONSHIP

28. RESULTS OF “PAOO”
An increase in alveolar bone width
Shorter treatment time
Increased post- treatment stability
Decreased amount of apical root resorption
ORTHO-PERIO RELATIONSHIP

33. DISADVANTAGES
OF
“PAOO”

34. DISADVANTAGES
OF
“PAOO”
1. Additional cost.
2. Morbidity associated with surgery.
3. Post-operative pain.
4. More discomfort with arch wire activation.
5. Highly Skilled Periodontist.
ORTHO-PERIO RELATIONSHIP