Abstract
Today many adult patients with periodontal disease demonstrate positioning of teeth that comprise their ability for proper mechanical tooth cleaning of approximal tooth surfaces. With adequate combined periodontal-orthodontic treatment it is possible to re-establish a healthy and well-functioning dentition. However, while orthodontic treatment can realign periodontally affected teeth, esthetic appearance may be compromised by gingival recession due to alveolar bone dehiscences or fenestrations in combination with a thin gingival biotype. This article reports an interdisciplinary (periodontic, orthodontic, restorative) approach for the treatment of a periodontally compromised patient with anterior dental malalignment. Periodontal therapy, including periodontal plastic surgery to obtain root coverage as well as orthodontic treatment by means of a miniscrew implant anchorage were used to achieve stable periodontal conditions and successful esthetic and functional final results.
Highlights
Orthodontic tooth movement may provide a substantial benefit to periodontal therapy
Today many adult patients with periodontal disease demonstrate positioning of teeth that comprise their ability for proper mechanical tooth cleaning of approximal tooth surfaces
Today many adult patients with periodontal disease exhibit problems with tooth malpositioning that comprise their ability for proper mechanical tooth cleaning of approximal tooth surfaces
Summary
Orthodontic tooth movement may provide a substantial benefit to periodontal therapy. Today many adult patients with periodontal disease exhibit problems with tooth malpositioning (e.g. frontal crowding) that comprise their ability for proper mechanical tooth cleaning of approximal tooth surfaces. A different orthodontic treatment approach is required in periodontally compromised patients in terms of stabilizing anchorage system, force system, retention, as well as plaque control during treatment. The TADs can provide a fixed anchorage for various tooth movements, are placed and removed, reduce overall treatment time requiring minimal patient compliance. This clinical report describes an interdisciplinary (periodontic, orthodontic, restorative) approach for the treatment of a periodontally compromised patient with anterior dental crowding. After 6 months of retention, a correction of recession of the gingival margin in the esthetic area 41 (Miller Class III) was performed with the placement of a connective tissue graft employing the “envelope” technique [3] (Figures 5-8). The final restorative treatment included a new fixed metal ceramic bridge replacing the maxillary left second premolar, insertion of a gold inlay on the maxillary right first premolar and a new full coverage gold crown on tooth 47 (Figure 9)
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