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Studies on orthodontic treatment in subjects with periodontal disease
Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Orthodontics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.ORCID iD: 0000-0001-8364-0510
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2018. , p. 124
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 090
Keywords [en]
orthodontic treatment, periodontal disease, periodontal treatment, clinical attachment level, external apical root resorption, alveolar bone level
National Category
Dentistry
Identifiers
URN: urn:nbn:se:hj:diva-39350ISBN: 978-91-85835-89-8 (print)OAI: oai:DiVA.org:hj-39350DiVA, id: diva2:1203651
Public defence
2018-06-01, Forum Humanum, School of Health and Welfare, Jönköping, 09:00 (English)
Opponent
Supervisors
Note

On cover: The Institute for Postgraduate Dental Education, Jönköping, and Lithuanian University of Health Sciences

Available from: 2018-05-04 Created: 2018-05-04 Last updated: 2018-05-04Bibliographically approved
List of papers
1. Orthodontic treatment in periodontitis-susceptible subjects: a systematic literature review
Open this publication in new window or tab >>Orthodontic treatment in periodontitis-susceptible subjects: a systematic literature review
2016 (English)In: Clinical and Experimental Dental Research, ISSN 2057-4347, Vol. 2, no 2, p. 162-173Article, review/survey (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
Alveolar bone loss, chronic periodontitis, humans, orthodontic tooth movement, periodontal pocket depth, periodontal treatment
National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-34805 (URN)10.1002/cre2.28 (DOI)000389218200008 ()
Available from: 2017-01-19 Created: 2017-01-19 Last updated: 2018-05-04Bibliographically approved
2. Orthodontic treatment simultaneous to or after periodontal cause-related treatment in periodontitis susceptible patients. Part I: Clinical outcome. A randomized clinical trial
Open this publication in new window or tab >>Orthodontic treatment simultaneous to or after periodontal cause-related treatment in periodontitis susceptible patients. Part I: Clinical outcome. A randomized clinical trial
Show others...
2018 (English)In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, no 2, p. 213-224Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
clinical attachment level, gingival recession, orthodontic treatment, periodontal treatment, periodontitis, pocket depth
National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-38627 (URN)10.1111/jcpe.12835 (DOI)000419830500007 ()29106749 (PubMedID)2-s2.0-85040336769 (Scopus ID)HHJADULTIS, HHJARNIS, HHJOralIS (Local ID)HHJADULTIS, HHJARNIS, HHJOralIS (Archive number)HHJADULTIS, HHJARNIS, HHJOralIS (OAI)
Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2018-05-04Bibliographically approved
3. Outcome of periodontal-orthodontic treatment in periodontitis susceptible patients. Part II: A CBCT study of external apical root resorption
Open this publication in new window or tab >>Outcome of periodontal-orthodontic treatment in periodontitis susceptible patients. Part II: A CBCT study of external apical root resorption
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-39348 (URN)
Note

Included in thesis in submitted manuscript form.

Available from: 2018-05-04 Created: 2018-05-04 Last updated: 2018-05-04
4. Outcome of periodontal-orthodontic treatment in periodontitis susceptible patients. Part III: A CBCT study of alveolar bone changes
Open this publication in new window or tab >>Outcome of periodontal-orthodontic treatment in periodontitis susceptible patients. Part III: A CBCT study of alveolar bone changes
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-39349 (URN)
Note

Included in thesis in submitted manuscript form.

Available from: 2018-05-04 Created: 2018-05-04 Last updated: 2018-05-04

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