PERIODONTIC – ORTHODONTICS

INTERRELATIONSHIPS

ERNIE MADURATNA SETIAWATI

Prevalence of Periodontal pockets and inadequate attached gingiva as a function of age

Proffit, William R.. Contemporary Orthodontics,  4th Edition. Mosby, 122006

Interdisciplinary dentofacial therapy

(IDT): 80% of adult patients require involvement of more than one dental specialty provider to accomplish treatment objectives.

PERIODONTAL TREATMENT

ORTHODONTIC TREATMENT

ADULT PATIENT

Effects of reduced periodontal support Loss of alveolar bone Need lighter forces and relatively larger

moments Periodontal evaluation Periodontal treatment

SEQUENCE OF PERIODONTAL TREATMENT PHASES

PHASE 1PHASE 1

REEVALUATIONREEVALUATION

PHASE IV / MAINTENANCEPHASE IV / MAINTENANCE

PHASE 3 RESTORATIVEPHASE 3 RESTORATIVEPHASE II SURGERYPHASE II SURGERY

PERAWATAN TAHAP 1

SCALING , ROOT PLANING RESTORATIF/PROSTHODONTIC

CORRECTION TOPICAL ANTIBIOTICS / SISTEMIC CARIES TREATMENT OCCLUSAL ADJUSTMENT MINOR ORTHODONTIC MOVEMENT PROVISIONAL SPLINT & PROTHESIS

PERIODONTAL SURGERY

Micro implants for periodontally compromised patientsWorld J Orthod 2009;10:350–360. 

Gradual intrusion of the maxillary and mandibular anterior teeth was achieved with a relatively simple orthodontic force system. A significant profile improvement was observed during the 18 months of treatment due to the retraction and intrusion of the incisors in both arches. This intrusion was accomplished without any sign of apical root resorption. The mandibular incisors were uprighted 6.5 degrees, and their maxillary counterparts were uprighted 13.4 degrees. The 2-year follow-up examination revealed a stable result with an increase in periodontal attachment as well as esthetics and function. Conclusion: A combined orthodontic, periodontic, and restorative treatment approach with adequate patient motivation can lead to improved masticatory function, esthetics, and periodontal conditions

MAINTENANCE PHASE

STOP RECOLONIZATION PREVENT RECURRENCE OF THE DISEASE IN ADEQUATE SPT – 50 FOLD INCREASE

RISK OF PROBING ATTACHMENT LOSS MOTIVATIONAL & REINFORCEMENT LONG TERM PREVENTION PROGRAM

STRATEGI PERAWATAN PERIODONTITIS

MENURUNKAN BAKTERI MODIFIKASI FAKTOR RESIKOMODIFIKASI FAKTOR RESIKO

HOST MODULATIONHOST MODULATION THERAPYTHERAPY

BEST THERAPY

Preorthodontic Gingival SurgeryGingival grafting

Teeth with less than 2 mm of attached gingiva

Gingival Recession and Root CoverageConnective tissue graftsPlaced based on esthetics, tooth sensitivity,

depth of erosion in the root, presence of composite gingival restoration

Postorthodontic Periodontal treatment

3 month periodontal maintenance New set of periapical radiographs and

periodontal re-examination after 6 months

Occlusal adjustments to fine-tune occlusionNightguard (maxillary nightguard may serve as

retainer)Restorative treatment after periodontal stability

is achieved

Orthodontic elimination of gingival pockets caused by dental crowding

Orthodontics as an aid in correcting biologic width violations

Leveling of gingiva by extrusion of lateral incisors

Orthodontics as an aid in improving implant sites

External and internal resorption on the labial of mandibular left lateral incisor

Tooth was extruded 7 mm to create adequate hard and soft tissue for implant placement

The use of implant supported anchorage

Patient presented with anterior open bite and pathological flaring of maxillary teeth

Endosseous implants in molar regions were used as anchorage to retract the maxillary teeth

Anterior distorted alveolar architecture can be reengineered with periodontically accelerated osteogenic orthodontic augmentation (PAOO) surgery to produce regional acceleratory phenomenon (RAP)

Results in a vast increase in osteoblast and osteoclast activity and a “softening” of the healing alveolus bone

Conclusion

Before any orthodontic treatment an initial diagnosis and referral for treatment to control active periodontal disease is to be considered.

treatment should be completed before the orthodontic treatment

Clinical effects of periodontal tissue from orthodontic tooth movement

Gingival inflammation Gingival recession Gingival hyperplasia loss of attachment

( Sanders et al., 1999)

Gingival inflammation

Mechanical irritation caused by band and cement Patient’s inability to clean promotes plaque accumulation Increase in Lactobacillus and P. intermedia Decrease in facultative anaerobes

GINGIVAL RECESSION

Loss of attachment

Gingival hyperplasia

( Kouraki et al.,2005 )

Conclusions Interdisciplinary collaboration often offers the

best treatment for patients Such sophisticated treatment requires

excellent communication and coordination.

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