How do orthodontics interface with periodontics?

This summary is based on the article published by the Journal of Orofacial Orthopedics: Interfaces between orthodontic and periodontal treatment. Their current status (July 2011)

Christoph Reichert, Martin Hagner, Søren Jepsen, Andreas Jäger

 Context 

The contextual relationships between orthodontics and periodontology are diverse and complex. While the consequences of orthodontic tooth movements are discussed in terms of possible damage and improvements in the long-term health of periodontal tissues, orthodontic treatment of adults is a routine clinical procedure nowadays, even in patients presenting already-damaged periodontal tissues. As developments in both fields have been so rapid, there is a constant need for evidence-based concepts in this interdisciplinary field.

Purpose of the Review

The goal of this review was to discuss the latest aspects of interdisciplinary treatment and to reflect on the latest developments in research. A treatment scheme is also presented which aims to facilitate coordination of the orthodontic treatment of patients with periodontal diseases.

Key Messages

1. Tooth movements in patients suffering from reduced but healthy periodontium occur under the same biological conditions as in patients with intact periodontium. (1) 
2. Before orthodontic treatment, adults patients should have a periodontal screening. (2) Best precaution advises continuous periodontal screening (e.g. periodontal screening index (PSI) [3]) of all patients to be determined prior to and during treatment so that no acute findings are overlooked. This type of screening should continue during the orthodontic treatment also, especially in patients with preexisting damage.
3. Pathological tooth migration is often associated with advanced periodontal disease and is possibly caused by a disruption in the balance between attachment and functional soft tissue, inflammatory pressure in intraosseous defects, tension phenomena from periodontal fibers and occlusal influences (4).
4. There is still so little interdisciplinary orthodontic-treatment evidence for patients susceptible to periodontitis, so the need remains for many
5. well-designed clinical studies (5) [29] to further treatment safety and establish better standards for planning, treatment and retention.
6. This is particularly important considering the current demographic trend, whereby the treatment of adult patients with periodontal disease will present an increasingly frequent challenge for orthodontists in the future.

References

1. Boyd RL, Leggott PJ, Quinn RS et al (1989) Periodontal implications of orthodontic treatment in adults with reduced or normal periodontal tissues versus those of adolescents. Am J Orthod Dentofacial Orthop 96:191–198.
2. Mathews DP, Kokich VG (1997) Managing treatment for the orthodontic patient with periodontal problems. Semin Orthod 3:21–38.
3. Meyle J, Jepsen S (2000) Der parodontale Screening-Index (PSI). Parodontologie 11:17–21.
4. Brunsvold MA (2005) Pathologic tooth migration. J Periodontol 76:859–866.
5. Glenny AM, Harrison JE (2003) How to interpret the orthodontic literature. J Orthod 30:159–164.

Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

You are invited to comment on this post and provide further insights by posting in the comment box which you will find by clicking on “Post a reply” below. You are welcome to remain anonymous and your email address will not be posted.