Orthodontic treatment of periodontal patients: challenges and solutions, from planning to retention

ABSTRACT Introduction: There is an increasing number of adult patients with sequelae of periodontal diseases seeking orthodontic treatment to improve their occlusion and quality of life. However, it is important to highlight that the patient who has vertical bone loss has unique needs, arising from the frequent related pathological migrations. Therefore, it requires an individualized orthodontic treatment in terms of anchorage, biomechanics, and multidisciplinary planning, which raises doubts in the hierarchy of priorities and organization of the treatment plan. Objectives: It was proposed a stratified hierarchy of the needs of orthodontic-periodontal treatment in six levels, which were illustrated with examples of clinical cases in which biomechanical planning and a multidisciplinary approach made it possible to obtain a balanced occlusion, aesthetic improvement and stabilization of the results. Conclusion: Orthodontic treatment of periodontal patients with a multidisciplinary approach is increasingly frequent and should be planned individually, considering bone losses suffered by each patient. Respecting some limitations, it is possible to improve the level of bone insertion, smile aesthetics and masticatory function, to facilitate oral hygiene through the orthodontic treatment of adult patients with little bone support. It is also important to highlight that there are unique aspects in the orthodontic retention in these cases.

RESUMO Introdução: É crescente o número de pacientes adultos portadores de sequelas de doenças periodontais que buscam tratamento ortodôntico para melhorar sua oclusão e qualidade de vida. Contudo, é importante destacar que o paciente que apresenta perda óssea vertical possui necessidades únicas, advindas das frequentes migrações patológicas relacionadas. Logo, requer um tratamento ortodôntico individualizado quanto a quesitos de ancoragem, biomecânica e planejamento multidisciplinar, o que gera dúvidas na hierarquização de prioridades e organização do plano de tratamento. Objetivos: Foi proposta uma hierarquização estratificada das necessidades do tratamento ortodôntico-periodontal em seis níveis, os quais foram ilustrados com exemplos de casos clínicos nos quais o planejamento biomecânico e a abordagem multidisciplinar possibilitaram a obtenção de uma oclusão equilibrada, melhora estética e estabilização dos resultados obtidos. Conclusão: O tratamento ortodôntico de pacientes periodontais com abordagem multidisciplinar é cada vez mais frequente e deve ser planejado de forma individualizada, considerando as perdas de inserção sofridas por cada paciente. Respeitando-se algumas limitações, é possível melhorar o nível de inserção óssea, a estética do sorriso e a função mastigatória, além de facilitar a higiene bucal, por meio do tratamento ortodôntico de pacientes adultos com pouco suporte ósseo. Também é importante destacar que há aspectos únicos na contenção ortodôntica desses casos.

Evolución de la periodontitis del adulto tratada con Apafill-G® / Clinical course of the adult's periodontitis treated with Apafill-G®

Se realizó un estudio descriptivo y longitudinal de 33 pacientes (de 30 a 59 años de edad), atendidos en el Departamento de Periodoncia de la Clínica Estomatológica Provincial Docente "Mártires del Moncada" de Santiago de Cuba, desde enero del 2009 hasta mayo del 2011, y seleccionados durante el procedimiento quirúrgico por presentar los criterios necesarios para el relleno con biomaterial: presencia de defectos óseos con 2 o 3 paredes en los tercios medio y apical, y movilidad dentaria de grados I al III, a fin de evaluar la evolución de la periodontitis del adulto, luego de aplicar el tratamiento con relleno de Apafill-G®; así, las unidades de análisis quedaron conformadas por los dientes y sitios afectados. Posterior al implante se comprobó radiográficamente el relleno del defecto alveolar, con el cual se logró limitar de forma positiva la enfermedad, al incrementar el nivel de inserción mediante la ganancia ósea, y disminuir la profundidad de las bolsas, con la consecuente estabilidad dental.

A descriptive and longitudinal study of 33 patients (from 30 to 59 years old), assisted in the Periodoncia Department of "Mártires del Moncada" Teaching Provincial Stomatological Clinic in Santiago de Cuba was carried out from January, 2009 to May, 2011, and selected during the surgical procedure for presenting the necessary criteria for the filling with biomaterial: presence of bony defects with 2 or 3 walls in the middle and apical thirds, and teeth mobility from I to III degrees, in order to evaluate the clinical course of adult's periodontitis, after applying the treatment with filling of Apafill-G®; thus, the analysis units were formed by the teeth and places affected. After the implant the filling of the alveolar defect was radiographically proven, with which it was possible to limit the disease positively, with the increase of the insertion level through the bony gain, and the decrease in the pockets depth, with the consequent dental stability.

Severe bimaxillary protrusion with adult periodontitis treated by corticotomy and compression osteogenesis / 대한치과교정학회지

This paper describes the case of a 50-year-old female with a Class II malocclusion who presented with severe bimaxillary protrusion and generalized alveolar bone loss due to adult periodontitis. The treatment plan consisted of extracting both upper and lower first premolars and periodontal treatment. Anterior segmental osteotomy (ASO) of the mandible and upper anterior segment retraction using compression osteogenesis after peri-segmental corticotomy (Speedy orthodontics) was performed. Correct overbite and overjet, facial balance, and improvement of lip protrusion were obtained. However, a slight root resorption tendency was observed on the lower anterior dentition. The active treatment period was 9 months and the results were stable for 27 months after debonding. This new type of treatment mechanics can be an effective alternative to orthognathic surgery.

The Mode of Detection of Helicobacter pylori in Saliva and Subgingival Plaques of Adult Periodontitis Patients / 대한치주과학회지

Helicobacter pylori(H. pylori) has been associated with the cause of chronic gastritis, peptic ulcers and gastric cancer. Although it may be transmitted through the oral cavity, it is unknown whether the oral cavity acts as a reservoir of H. pylori. The purpose of this study was to investigate the mode of detection of H. pylori in oral cavity of adult periodontitis patients with plaque and periodontal pocket which atmosphere is grown well H. pylori. We analysed detection rate of H. pylori in saliva and subgingival plaques of 17 adult periodontitis patients without symptoms of gastroduodenal disease by nested PCR. Samples tested comprised saliva and subgingival plaques from central incisor, 1st premolar and 1st molar. H. pylori DNA was not identified in saliva from all patients. The detection rate in subgingival plaque from incisors, premolars and molars was 5.9%, 5.9% and 17.7%, respectively. In conclusion, the dental plaque and periodontal pocket (especially, of molars) in adult periodontitis can be favorable reservoir of H. pylori and may be the source of infection and transmission of H. pylori.

The influence of Advanced Adult Periodontitis on the pulp / 대한치주과학회지

The purpose of this study was to observe histopathologically the influence of advanced periodontitis on pulp tissue, and to conclude the correlation between the results with clinical madifestations. The samples were teeth with over 7mm pocket depth and over 50% radiographic bone loss. These were diagnosed to have very poor prognosis and thus planned to be extracted. Those with any of following conditions were excluded from the samples, loss of vitality, periapical pathology, restoration or prosthesis, dental caries, and attrition or abrasion. It was because these conditions could affect pulp without any correlation with periodontal disease. For the experiment, 17 teeth from 11 patients were selected. Average age of patient was 47. Each tooth was examined for following categoris; pocket depth, gingival recession, electric pulp test, mobility, percussion test, sensitivity test. The extracted teeth were fixed buffered neutral formalin solution. It was decalcified using 4% nitric acid. Sliced histological samples observed using light microscope, for pulp status, and severeity of inflammation. 4 samples were excluded due to histologic sample discrepency. Thus 13 samples were subject to observation. 4 showed normal conditions. Focal reversable pulpitis was shown in 5 samples. Chronic pulpitis was observed 1 samples. Pulpal abscess observed in 3 samples.