BACKGROUND:

No evidence is present on the risk for external apical root resorption (EARR) during orthodontic treatment (OT) of adult patients with periodontal disease.

AIM:

To examine EARR after OT in subjects with periodontal disease and to analyse how intrusion and change in inclination of the most proclined maxillary incisors influence EARR.

METHODS:

The study included 50 patients with periodontal disease. Sub-gingival debridement by ultrasonic instrumentation supplemented with hand instruments was performed by experienced dental hygienist after baseline examination for all patients. For the control group, final periodontal treatment (PT) was performed before orthodontic tooth movement. For the test group patients, final PT was performed after levelling and alignment phases were finished, before the active space closure with elastic chain and/or inter-arch elastic traction for sagittal correction was started. OT was performed with a straight-wire appliance. Micro-implants or implants were used for posterior anchorage. Cone beam computed tomography examinations were performed before and after OT. EARR of all single-rooted teeth were measured. EARR of the most proclined maxillary incisor was related to intrusion and change in inclination angle.

RESULTS:

EARR after OT was observed in median 80.7 per cent (interquartile range 22.02) of single-rooted teeth [mean 1.2 (standard deviation 0.44) mm]. In 82.3 per cent of teeth, EARR was 2 mm or less. Severe EARR was found in 8 per cent of patients and five maxillary incisors (less than 1 per cent of all teeth). The amount of intrusion and change in inclination angle of the most proclined maxillary central incisor influenced the extent of EARR. Mean EARR was significantly higher when OT lasted more than 18 months (P = 0.02).

CONCLUSIONS:

OT in conjunction with PT in periodontal patients resulted in EARR in 81 per cent of all single-rooted teeth. Intrusion and change in inclination angle of the most proclined maxillary central incisor influenced the extent of EARR, as did longer OT. 

AIM:

To examine alveolar bone level (ABL) changes before (T1) and after (T2) orthodontic treatment (OT) in subjects with periodontal disease.

METHODS:

The study included 50 subjects with periodontal disease. All patients received subgingival debridement following baseline examination. Control group patients received final periodontal treatment before the start of OT. For the test group patients final periodontal treatment was performed simultaneous to OT. OT was performed with a straight-wire appliance. Micro-implants or temporary crowns on implants were used for posterior anchorage when needed. ABL measurements of 3821 tooth surfaces were performed on cone beam computed tomography images.

RESULTS:

No difference was observed between mean ABL at T1 and T2. ABL remained unchanged on 69 per cent of surfaces. A mean of 15.6 (SD 7.4) per cent of surfaces experienced ABL gain, and a mean of 15.1 (SD 7.5) per cent was found with ABL loss. Small significant median ABL difference was observed on mesial and distal surfaces (P < 0.001). A significant difference was found between median ABL changes on mesial/distal in comparison to buccal/lingual surfaces (P < 0.01). Significantly more buccal (17.9 %) and lingual (18.5 %) surfaces experienced ABL loss when compared with mesial (11.3 %) and distal (12.0 %) surfaces (P < 0.001). Significant difference was found in the median ABL change of intruded (0.5 (IQR 0.94) mm) and non-intruded (-0.4 (IQR 1.07) mm) maxillary incisors (P = 0.04). Significant median ABL gain was found on the lingual surface of maxillary incisors, which were retroclined more than 8.6 degree and intruded more than 1.6 mm.

CONCLUSIONS:

ABL changes after periodontal-orthodontic treatment in patients with periodontal disease were small. ABL gain was more observed on mesial and distal surfaces and ABL loss on buccal and lingual surfaces. Larger orthodontic movements of maxillary incisors influenced ABL gain. 

Aim: To compare two treatment strategies regarding the effect of orthodontic treatment on periodontal status in patients with plaque-induced periodontitis.

Subjects and Methods: This was a randomized clinical trial. Fifty periodontal patients were randomly assigned to the test or control groups according to periodontal treatment timing. All patients received supra- and subgingival debridement following baseline examination. Control group patients received cause-related periodontal treatment before the start of orthodontic treatment and which was performed simultaneous to orthodontic treatment for the test group patients.

Results: No difference between the test and control groups was found regarding change of clinical attachment level (CAL) after periodontal–orthodontic treatment. Fewer sites with initial pocket depth (PD) of 4–6 mm healed after periodontal–orthodontic treatment in the test group (20.5%, IQR = 11.9%) in comparison with controls (30.4%, IQR = 27.1%) (p =.03). Anterior teeth [OR 2.5] and teeth in male patients [OR 1.6] had a greater chance for PD improvement ≥2 mm. Total periodontal–orthodontic treatment duration was significantly longer for the control group (p <.01).

Conclusions: Both groups showed a gain of CAL and a reduction in sites with PD ≥ 4 mm. Orthodontic treatment, simultaneously to the periodontal treatment, could be used in the routine treatment of patients with plaque-induced periodontitis.

The thesis focuses on periodontal-orthodontic treatment of adult subjects with periodontal disease.

Aims: The overall aim of this thesis was to explore the effects, risks and benefits of periodontal-orthodontic treatment on periodontal tissues in subjects with periodontal disease.

Methods: The research was conducted through a systematic literature review (Study 1), a randomised controlled trial (Study 2) and cone beam computed tomography examinations (Studies 3 and 4). The clinical part of the thesis was designed as a randomised controlled trial, which aimed to compare two periodontal treatment timing strategies regarding the effect of orthodontic treatment on periodontal status (Study 2). Fifty subjects with periodontal disease were randomly assigned either to the test (periodontal treatment simultaneous with orthodontic treatment) or control group (periodontal treatment before the start of orthodontic treatment). Initial treatment included oral hygiene instruction, supra- and sub-gingival debridement and was performed for all study patients. Nonsurgical and subsequent surgical periodontal treatment was performed at different time points for the test and control groups. Orthodontic treatment was performed with a straight-wire appliance. Clinical attachment level (CAL) change was chosen as a primary outcome variable. All patients were examined by cone beam computed tomography (CBCT) before and after orthodontic treatment to explore the extent of external apical root resorption (EARR) (Study 3) and changes in alveolar bone levels (ABL) (Study 4).

Results: The findings in the systematic literature review yielded absence of randomized controlled trials orcontrolled clinical trials on comprehensive orthodontic treatment in subjects with periodontal disease. No difference in CAL change, EARR and ABL was found whether orthodontic treatment was performed simultaneously with (test group patients) or after (control group patients) periodontal treatment. Results yielded a median CAL change (sites CAL ≥4 mm) of 0.4 mm (Q1, Q3: 0.19, 0.61). Gain in clinical attachment level was observed in 22 (88%) patients in both treatment groups. CAL remained unchanged in an average of 3/4 of the sites; CAL gain was observed in an average of 1/4 of the sites. Root lengths were shortened in a median of 80.7% (Q1, Q3: 68.0, 90.0) of orthodontically moved teeth with a mean EARR of 1.2 mm (SD 0.44). EARR of <2 mm was observed in 82% of teeth. ABL levels remained unchanged on a mean of 69.3% (SD 8.8) of surfaces, ABL improved on a mean of 15.6% (SD 7.4) of surfaces, more on the mesial and distal, and ABL decreased on a mean of 15.1% (SD 7.5) of surfaces, more on the buccal and lingual.

Conclusions: Based on the results of the present research it can be concluded that periodontal-orthodontic treatment under optimal conditions (experienced clinicians and patients with excellent oral hygiene routines overtime), if needed, could be included in the rehabilitation of patients with periodontal disease without deleterious effects. However, there are two important prerequisites: meticulous personal oral hygiene of the patient and optimal sub-gingival control of inflammation before and throughout the combined treatment.

The aim is to evaluate the literature for clinical scientific data on possible effects of orthodontic treatment on periodontal status in periodontitis-susceptible subjects. A systematic literature review was performed on studies in English using PubMed, MEDLINE, and Cochrane Library central databases (1965-2014). By manually searching reference lists of selected studies, we identified additional articles; then we searched these publications: Journal of Periodontology, Periodontology 2000, Journal of Clinical Periodontology, American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, International Journal of Periodontics & Restorative Dentistry, and European Journal of Orthodontics. Search terms included randomized clinical trials, controlled clinical trials, prospective and retrospective clinical studies, case series >5 patients, periodontitis, orthodontics, alveolar bone loss, tooth migration, tooth movement, orthodontic extrusion, and orthodontic intrusion. Only studies on orthodontic treatment in periodontally compromised dentitions were included. One randomized controlled clinical trial, one controlled clinical trial, and 12 clinical studies were included. No evidence currently exists from controlled studies and randomized controlled clinical trials, which shows that orthodontic treatment improves or aggravates the status of periodontally compromised dentitions.