Interaction between Periodontics and Orthodontics 2011 10 25

Interaction between Periodontics and Orthodontics 2011. 10. 25 치주과 인턴 황민 KHU PERIO

Introduction 1, 3, 4 1. In many patients with a periodontally involved dentition the migration of teeth leads to spacing and extrusion, resulting in serious functional and esthetic problems 2. Alteration in the mucogingival complex will occur during orthodontic tooth movement 3. Interrelationship between orthodontics and periodontics, each field can contribute to optimize treatment of combined orthodontic–periodontal clinical problems KHU PERIO

Contents 1 Effect of orthodontic tx on periodontal tissue 2 Orthodontics in compromised periodontium 3 Periodontal Tx related to orthodontic Tx 4 Discusion and conclusion KHU PERIO

Effect of orthodontic treatment on periodontal tissue 1. Periodontal tissue response to orthodontic force 2. Influence of orthodontic treatment on periodontal tissue 3. Periodontal tissue remodeling KHU PERIO

1. Periodontal tissue response to orthodontic force 2 Force Tissue response Strong/heavy force (>>capillary blood pressure) PDL crushed on pressure side ->local ischaemia ->degeneration of PDL= Hyalinization =>delayed tooth movement Moderate force(>capillary blood pressure) Strangulation of PDL—>delay in bone resorption Light force(<capillary blood pressure=20 -25 mm. Hg) Ischaemia in PDL, tooth movement continuous with simultaneous bone resorption and formation KHU PERIO

2. Influence of orthodontic treatment on periodontal tissue 7 No plaque – No periodontal tissue destruction Infrabony defect with connective tissue inflammation - Periodontal destruction Orthodontic tooth movement… Supragingival plaque –> subgingiva Tooth with plaque –> Infrabony defect Tooth without plaque –> No infrabony defect KHU PERIO

3. Periodontal tissue remodeling 8 Orthodontic force! PDL & Alveolar bone– resorption & apposition bone Remodeling Gingival tissue NO Remodeling Gingival tissue – compression & retraction KHU PERIO

Contents 1 Effect of orthodontic tx on periodontal tissue 2 Orthodontics in compromised periodontium 3 Periodontal Tx related to orthodontic Tx 4 Discusion and conclusion KHU PERIO

Orthodontics in compromised periodontium 9 Positive ? KHU Negative ? PERIO

Orthodontics in compromised periodontium 9 Intraosseous deformity Underlying bone Osseous topography Successfu l Treatment KHU PERIO

Orthodontics in compromised periodontium 1. Movement of teeth with infrabony defect 2. Orthodontic extrusion 3. Orthodontic intrusion 4. Labial tooth movement /proclination KHU PERIO

1. Movement of teeth with infrabony defect 10, 11 1) Hemiseptal Defects - mesial tilting or overeruption teeth 2) Root proximity & marginal ridge discrepancies - Distance between the roots : >2~3 mm 3)Advanced horizontal bone loss KHU PERIO

2. Extrusion 12 Van Venrooy & Yukna(1985) Beagle –Mn premolar extrusion w/o controled inflamation Pocket depth BOP PDL spacing Cementum width Alveolar bone height KHU PERIO

2. Extrusion 13, 14 Pikdoken L et al(2009) 10 Patient – orthodontic tx, no periodontic tx extrusion of Mn incisors Gingival margin - 80% of total amount of extrusion MGJ – 52. 5% of total amount of extrusion Kajiyama et al(1993) Free gingiva- 90%, Attached gingiva-80% Follows the extrusion teeth KHU PERIO

3. Intrusion 15 Erkan et al(2007) Patient- Intrusion of lower incisors with intact periodontium Gingival margin - 79% of total amount of intrusion MGJ – 62% of total amount of intrusion KHU PERIO

4. Labial tooth movement /proclination 1, 16 Resolve Crowding But Produce Gingival recession? The most important factor… Thickness of the Soft tissue , Bone * predetermined ‘Bone envelop’ of the tooth KHU PERIO

4. Labial tooth movement /proclination 1, 16 Does not cause. . Gingival recession Final incination > amount of proclination KHU PERIO

Contents 1 Effect of orthodontic tx on periodontal tissue 2 Orthodontics in compromised periodontium 3 Periodontal Tx related to orthodontic Tx 2 Discusion and conclusion KHU PERIO

Periodontal Tx related to orthodontic Tx 1 Initial periodontal therapy before orthodontic tx Orthodontic & repeated In spite oftxplaque control… curettage periodontal pocket bone change Periodontal surgery – after orthodontic tx(6~9 mon) for reorganization of periodontal tissue KHU PERIO

Periodontal Tx related to orthodontic Tx 4 Surgical ? KHU Non Surgical ? PERIO

Periodontal Tx related to orthodontic Tx 4 Surgical therapy vs Non surgical therapy Stefania et al(2000) Not statistical significance(m. PPD, Bo. P) KHU PERIO

Periodontal Tx related to orthodontic Tx 4 KHU PERIO

Periodontal Tx related to orthodontic Tx 1, 4, 17 1. 2. 3. 4. Plaque cotrol Preorthodontic osseous surgery Mucogingival Surgery Circumferential Supracrestal Fiberotomy(CSF) KHU PERIO

2. Preorthodontic osseous surgery 11 Neccesity - inflammation & infrabony defect loss of attachment Osseous crater(two-wall defect) - alveolar bone surgery pocket depth Three-wall defect - regenerative bone surgery pocket depth orthodontic tx is possible after 3 -6 mon KHU PERIO

3. Mucogingival surgery 4, 17 Labial tooth movement Thin attached gingiva recession Double pedicle flap Gingival graft Apically positioned flap FGG KHU PERIO

4. Circumferential Supracrestal Fiberotomy(CSF)1, 2, 5, 6 Neccessity: Prevention of relapse Timing: At the final stage of orthodontic tx Contraindication 1) thin of gingival biotype 2) active movement 3) gingival inflammation 4) thin of cortical bone plate KHU PERIO

4. Circumferential Supracrestal Fiberotomy(CSF)1, 2, 5, 6 Procedure 1) Bisection of the interdental papilla by two vertical incisions(labially & lingually) 2) Extending from below the tip of the papilla to 1~2 mm below the level of the alveolar crest Effect 1)Less invasion & safer 2)Best choice for the anterior aesthetic zone KHU PERIO

4. Circumferential Supracrestal Fiberotomy(CSF)1, 2, 5, 6 Frenectomy A B C Circumferential Supracrestal Fiberotomy A B KHU C PERIO

Contents 1 Effect of orthodontic tx on periodontal tissue 2 Orthodontics in compromised periodontium 3 Periodontal Tx related to orthodontic Tx 4 KHU Discusion and conclusion PERIO

Discussion and Conclusion 1, 18 Orthodontic treatment and Absence of periodontal inflammation can provide satisfactory results without causing irreversible damage to periodontal tissues. Orthodontic treatment can expand the possibilities of periodontal therapy in certain patients, contributing to better control of microbiota, reducing the hazardous forces applied to teeth KHU PERIO

Discussion and Conclusion 1, 18 Comprehensive knowledge of the fields of periodontology and orthodontics leads to an optimal qualitative , functional and aesthetic management, providing the best treatment plan in complex situation There is considerable lack of sound scientific evidence so, a strong need for further research in certain directions through well-designed studies to provide patients with evidence-based treatment. KHU PERIO

REFERENCES 1. Gkan. Itdis N, et al. The orthodontic–periodontic interrelationship in integrated treatment challenges. Journal of Oral Rehabilitation 2010; 37: 377390 2. Marianne M. A. et al. Periodontic and orthodontic treatment in adults. Am J Orthod Dentofacial Orthop 2002; 122; 420 -8 3. Wennsrtom Jan L. Mocogingival Considerations in Orthodontic Treatment. Seminars in Orthodontics 1996; 2: 46 -54. Stefania Re, et al. Orthodontic treatment in periodontally compromised patients: 12 -year report. Int J Periodontics Restorative Dent. 2000 Feb; 20(1): 31 -39 5. Edwards JG. A Surgical procedure to eliminate rotational relapse. . Am J Orthod. 1970; 57; 35 -46 6. Edwards JG. Soft-tissue surgery to alleviate orthodontic relapse. Dent Clin North Am. 1993; 37: 205– 225. KHU PERIO

REFERENCES 7. Ericsson et al. The effect of Orthodontic Tilting Movements on the Periodontal tissues of Infected and Non-infected dentitions in dogs. I. J Clin Periodontol ; 1977; 4; 278 -293. 8. Reitan K Tissue rearrangement during retention of orthodonticcally rotated teeth. Angle Orthod. 1959; 29; 105 -13 9. Boyd RL, et al. Periodontal implications of orthodontic treatment in adults with reduced or normal periodontal tissues versus those of adolescents. Am J Orthod Dentofacial Orthop. 1989 Sep; 96(3): 191 -198. 10. Corrente G, et al. Orthodontic movement into infrabony defects in patients with advanced periodontal disease: a clinical and radiological study. J Periodontol. 2003; 74: 1104– 1109. 11. Newman , et al. Carranza’s Clinical Periodontology. Ninth edition. Ch. 53. (Editor: Vincent G. Kokich)704 -718 12. van Venrooy JR & Yukna RA. Orthodontic extrusion of single-rooted teeth affected with advanced periodontal disease. Am J Orthod. 1985 Jan; 87: 67 -74. KHU PERIO

REFERENCES 13. Pikdoken L, et al. Gingival response to mandibular incisor extrusion. Am J Orthod Dentofacial Orthop. 2009; 135: 432. 14. Kajiyama K, et al. Gingival reactions after experimentally induced extrusion of the upper incisors in monkeys. Am J Orthod Dentofacial Orthop. 1993 Jul; 104(1): 36 -47 15. Erkan M, et al. Gingival response to mandibular incisor intrusion. Am J Orthod Dentofacial Orthop. 2007; 132: 143. e 9– 13. 16. Yared KF, et al. Periodontal status of mandibular central incisors after orthodontic proclination in adults. Am J Orthod Dentofacial Orthop. 2006; 130: 6. e 1– 8. 17. Pini Prato G. et al. Mucogingival interceptive surgery of buccally erupted premolars in patients scheduled for orthodontic treatment. J. Periodontol. 2000; 71; 172 -81 18. Ong MA, et al. Interrelationship between periodontics and adult orthodontics. J din Periodontol 1998; 25: 271 -277. KHU PERIO

Thank you for Attention. KHU PERIO