“ For patients with stage-IV periodontitis , this combined approach is less costly in the long run and more predictable than implant therapy .”
Dr . Tietmann
over time . We only lost 3 out of 526 teeth , not for periodontal but for endodontic reasons . It is important to mention that a majority of these teeth was considered to be “ hopeless ” at the beginning of the treatment .
What feedback did you get from patients ?
Most striking for them was that they could keep their teeth and could smile again . But also regaining function and being able to chew again was very important .
Were they also happy with the cost-benefit ratio of the treatment ?
Yes , even if this treatment is expensive I always put the costs into perspective by comparing them with the costs of an implant solution . For such patients , this combined approach is less costly in the long run and more predictable than implant therapy .
Dr . Jepsen , you also investigated this combined approach in a multi-center RCT of 43-patients .² You focused on the best time point to start the orthodontic treatment . What options are there , and what did you learn ?
Dr . Jepsen : We investigated how timing of orthodontic therapy affects outcomes of regenerative periodontal surgery . So far there had not been any prospective randomized controlled clinical trials on this topic . The aim of our study – that was supported by an advanced researcher grant from the Osteology Foundation – was to compare the early initiation of orthodontic therapy – four weeks – and late orthodontic therapy – six months – following regenerative surgery to treat intrabony defects in patients with stage IV periodontitis and pathologic tooth migration and to establish the clinical superiority of one treatment protocol . It was a joint effort of teams from Germany , Italy and Spain .
Did you get a clear result ?
Dr . Jepsen : Yes . Clinical attachment gain at 12 months , our primary endpoint , improved in a similar way in both groups . No statistically significant differences between groups could be observed for CAL gain ( see infographic ).
Results with early orthodontic therapy were at least as good as the results achieved after late orthodontic treatment . The outcomes suggest that initiation of orthodontic therapy is possible as early as four weeks after regenerative treatment of intrabony defects , and that significant clinical improvements can be achieved .
Did the result surprise you ?
Dr . Jepsen : It was what I had anticipated after having seen the results of previous case series . But guessing is not knowing . Now we know that starting orthodontic treatment early does not impair the healing of the periodontium , provided that they perform good oral hygiene and are compliant with supportive care . This will save our patients a lot of treatment time . Recently , I was invited as an expert to participate in the S3-Level Clinical Practice Guideline Workshop of the European Federation of Periodontology on the treatment of stage IV periodontitis and I was delighted that our findings were well accepted and are now the basis for one of the recommendations .
Could early orthodontic tooth movement even stimulate periodontal wound healing ?
Dr . Jepsen : This is possible and it is what we and others assume , but such a conclusion cannot be drawn from a clinical study .
Dr . Tietmann , is this treatment combination of regenerative periodontal surgery and orthodontics recommendable in more cases ?
Dr . Tietmann : I think so . We compared the outcome of this combined approach with results from a previous study performed in our private practice when only regenerative periodontal surgery but no orthodontic tooth movement was done .³ Treatment including orthodontic tooth movement delivered around 0.7 – 0.8 mm more radiographic bone gain . The probing pocket depth was reduced even more with the combined therapy . These findings seem to indicate a possible “ stimulating ” effect of orthodontic tooth movement in the early healing phase on the regenerative outcomes .
You investigated the results over 4-years . What is key for a good , long-term result in such cases ?
Dr . Tietmann : Most important is the patients ’ adherence . It ’ s a long therapy – will the patient comply the entire time ? During treatment and afterwards , it is
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