Combined periodontal and orthodontic treatment of pathologic migration of anterior teeth

Abstract

There is an ever increasing concern for dentofacial esthetics in adult population. The primary motivating factor for seeking orthodontic treatment is dental appearance [1]. Pathologic migration of anterior teeth is a common cause of esthetic concern among adults. Pathologic migration is defined as change in tooth position resulting from disruption of the forces that maintain teeth in normal position in relation to their arch. The disruption of equilibrium in tooth position may be caused by several etiologic factors. These include periodontal attachment loss, pressure from inflamed tissues, occlusal factors, oral habits such as tongue thrusting and bruxism, loss of teeth without replacement, gingival enlargement and iatrogenic factors. However, according to the literature, destruction of tooth supporting structures is the most relevant factor associated with pathologic migration. Periodontal disease in the upper anterior region can be in isolation or may affect more teeth. The periodontal disease and its sequale such as diastema, pathological migration, labial tipping or missing teeth often lead to functional and esthetic problems either alone or with restorative problems [2]. Advanced periodontal disease is characterized by severe attachment loss, reduced alveolar bone support, tooth mobility and gingival recession. Orthodontic treatment is initiated only after periodontal disease is brought under control [3]. This communication highlights good treatment outcome achieved in a patient with impaired dentofacial aesthetics and advanced periodontal disease.