The Explorer Winter 2018 Spring Final | Page 6

ADULT PATIENTS WITH
PERIO PROBLEMS AND
ORTHODONTIC SUCCESS
JADA Specialty Scan – Orthodontics. Posted online July 31, 2014 at
http://www.ada.org/epubs/highroad/jadaOrthodontics/082614.html#three Copyright © 2014 American Dental Association.
All rights reserved. Reprinted with permission.
Orthopedics explains how researchers
implemented a multidisciplinary
approach to prevent worsening
periodontitis and occlusal trauma, while
improving esthetics.
A 22-year-old male patient of the
orthodontic clinic at the West China
Hospital of Stomatology, in Chendu,
complained of displaced upper and
lower front teeth and large gaps
between incisors. Self-conscious about
his appearance, he sought corrective
treatment.
For orthodontists, more adult patients
also means more patients with
periodontal problems (see editor’s note).
Orthodontic treatment of teeth that
have been partially loosened or moved
because of periodontal disease remains
controversial, but recent studies suggest
that light forces can be used for
correction. Still, complicating factors
remain a concern. Periodic periodontal
maintenance, strength and direction of
orthodontic force and surveillance of
periodontal status are integral to
treatment success and can be
challenging for clinicians.
A case report published in the May 2014
issue of the American Journal of
Orthodontics and Dentofacial
Diagnosed with a skeletal Class 1
malocclusion with severe periodontitis
and pathologic tooth movement, the
treating clinicians aimed for stable
occlusion; esthetics, function,
periodontal health in the anterior, and
maintenance of the existing occlusion in
the posterior. They developed a
treatment plan and divided it into four
stages—systemic, hygienic, corrective
and maintenance—with the stipulation
that before the corrective phase could
ensue, the patient’s periodontal
condition would have to meet minimally
their criteria established for this patient
with advanced disease:
• proper infection control;
After consulting with physicians to rule
out the possibility of systemic diseases,
the researchers required the patient to
attend periodic periodontist
appointments. Three months after
scaling and root planing, the team of
orthodontists and periodontists held a
consultation and confirmed that all of the
criteria for periodontal status were met.
In the report, authors described the
monitoring protocol of the patient’s
periodontal status throughout the
treatment process and observations
made at various steps.
“The post-treatment panoramic
radiograph showed acceptable root
parallelism and no marked root
resorption; most importantly, the level
of alveolar bone had been maintained,”
authors explained. “Newly formed
trabecular bone could even be seen in
some regions where resorption had
been severe.”
They were excited by this result, which
suggested to them that the treatment
had prevented further resorption of
alveolar bone and enhanced the
potential for long-term dental health.
http://www.sciencedirect.com/science/a
rticle/pii/S0889540613009050 䡲
• full-mouth plaque index within
acceptable limits;
• reduction of positive bleeding on
probing sites;
• no residual pockets deeper than 5
millimeters.
Los Angeles Dental Society Explorer