OVERVIEW
Dr . Jepsen et al . Dr . Tietmann et al .
Type of study No . of patients
Question
Primary endpoint Follow-up
Multi-center RCT 43 patients
Start orthodontic treatment already 4 weeks or 6 months after regenerative periodontal surgery ?
CAL change 12 months
Retrospective cohort study 48 patients ( 526 defects )
Does the combination of periodontal regenerative surgery and orthodontic treatment provide favourable results ?
Radiographic bone level up to 4 years
RESULTS
Illustration : Quiant very important to visit regularly with the patient depending on their needs in supportive therapy but at least every 3-months .
On the one hand orthodontic treatment improves the results of periodontal treatment . On the other hand , many case reports show periodontal problems resulting from orthodontic treatment . Do you also experience such cases in your daily practice ?
Dr . Jepsen : Oh sure , we are facing very challenging problems . Over-expansion , especially in the lower anterior region , in combination with a thin periodontal phenotype can result in advanced gingival recession . In specific cases retainers in combination with malfunction may lead to very severe recessions on one or two teeth , this is called “ wire syndrome .” ⁴ Here we may find incisors with secondary malposition and roots completely outside the bony basis .
Dr . Tietmann : We see this in our dental office as well . And it is not only an esthetic problem . I have had cases with endodontic infections where the apex was nearly exposed .
Dr . Jepsen : So true , and it is very difficult to treat such patients because extraction or placing implants are not an option .
Dr . Jepsen , what are the keys to treating such cases ?
Dr . Jepsen : We need to cooperate with orthodontists before recession coverage .
CONCLUSION
Twisted retainers have to be removed , the affected tooth or teeth have to be moved back into their bony housing . Then , after completion of the ortho-treatment these gingival defects can be covered without any complications .
References
Mean PPD Reduction
– 4.2 mm for early OT
– 3.9 mm for late OT
Pocket closure ( PPD ≤ 4 mm )
91 % of defects in early OT
85 % in late OT
Mean CAL gain
5.4 mm for early OT
4.5 mm for late OT
It is safe to start orthodontic treatment already 4 weeks after periodontal regenerative surgery .
87 % of all defects
The findings of the two recent publications summarized .
1 Tietmann C , et al .: J Clin Periodontol 2021 ; 48:668-678 . ( clinical study ) 2 Jepsen K et al .: J Clin Periodontol 2021 ; 48:1282-92 ( clinical study ) 3 Bröseler F , et al .: J Clin Periodontol 2017 ; 44:520-9 . ( clinical study )
– 2.55 mm after 1 year – 2.88 mm after 2 – 4 years
Mean BL gain
4.67 mm after 1 year
4.85 mm after up to 4 years
Tooth loss
0.57 %
The combination of periodontal surgery and consecutive orthodontic treatment works well in a real-life setting .
Do orthodontists know about iatrogenic problems after orthodontic treatment ?
Dr . Jepsen : More and more orthodontists are aware of this problem . Today we receive many patients referred from orthodontists to evaluate whether their gingiva needs to be augmented before the orthodontic treatment starts . This can be done with grafts and also with soft tissue substitutes . Also , we hope that new EFP-guideline will further improve the close cooperation and communication between orthodontists and periodontists in the future .
4 Renkema AM , et al .: Am J Orthod Dentofacial Orthop . 2013 ; 143 ( 2 ): 206-12 . ( clinical study )
OUTSIDE THE BOX 27