Interdisciplinary approach for patients with stage-IV periodontitis
“ Orthodontic treatment can start shortly after regenerative surgery .”
Christina Tietmann | Germany Periodontist , Private Practice for Periodontology Aachen
Karin Jepsen | Germany Priv . Doz ., Center for Dental and Oral Medicine University of Bonn
Interview conducted by Verena Vermeulen
We discussed two publications documenting treatment of stage IV periodontitis . Both studies were about the combination of regenerative periodontal surgery and orthodontic tooth movement . Is this a valuable combination ? Whom does it help ?
Dr . Tietmann , we are talking about patients with stage IV periodontitis . What characterizes them ?
Dr . Tietmann : These patients show severe attachment loss and vertical bone loss . The most visible sign of stage IV periodontitis is pathological tooth migration , the typical drifting and flaring of the anterior teeth . You can usually see these patients hiding their smile because they are unhappy about the compromised esthetics . Furthermore , they suffer from functional problems due to the loss of teeth in the posterior region and tooth mobility .
When they come to your office , what is their expectation ?
Major concern is to keep their own dentition . Due to the esthetic and functional changes they want to get the migrated teeth realigned and regain esthetics and masticatory function . Very often , pathologic tooth migration of an anterior tooth is the first sign for the patients which makes them seeking – periodontal – treatment . A lot of the patients already had many dental visits and were told their teeth would have to be extracted and would need either implants or removable prostheses .
Implant placement in a patient with a history of severe periodontitis is also not very predictable …
That ’ s true . Periodontal problems must be solved first , before implants can be placed , and still there is a threat of peri-implantitis , because a history of periodontitis is a risk factor for implants . Within the days of periimplantitis it is the major goal to keep the natural dentition as long as possible .
How do you usually treat such patients ?
It ’ s a three-step approach . The first step is always to control the infection – antiinfective treatment must be finished before moving on . Second step is periodontal regenerative surgery . This means that I open a flap with minimally invasive surgical techniques to clean the defect and the root and use biomaterials to regenerate the vertical bony defect . It is crucial to stabilize the blood clot during the healing period of regenerative therapy for successful results in mobile teeth . This can be done either by retainers or by implementing the orthodontic appliance before periodontal regenerative surgery starts . And then , the final step is orthodontic treatment . In our retrospective study we started orthodontic tooth movements 3 months postoperatively .
Orthodontic counselling has to take place early in the treatment – during anti-infective therapy and before moving on to regenerative therapy . You need to develop a joint vision about the interdisciplinary treatment plan - communication between periodontist und orthodontist is very important in these complex cases .
You published a retrospective study including 48-patients who received periodontal regenerative surgery plus orthodontic treatment , and you had followups up to 4-years .¹ What did you learn ?
At 1-year we found a mean radiographical bone gain of 4.67 mm ( see infographic ). Also , the pocket reduction was impressive with 87 % pocket closure . These findings remained stable or even improved
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