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Orthodontic treatment simultaneous to or after periodontal cause-related treatment in periodontitis susceptible patients. Part I: Clinical outcome. A randomized clinical trial
Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Orthodontics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.ORCID iD: 0000-0001-8364-0510
Department of Dental and Oral Pathology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.ORCID iD: 0000-0002-3223-0068
Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
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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. Vol. 45, no 2, p. 213-224
Keywords [en]
clinical attachment level, gingival recession, orthodontic treatment, periodontal treatment, periodontitis, pocket depth
National Category
Dentistry
Identifiers
URN: urn:nbn:se:hj:diva-38627DOI: 10.1111/jcpe.12835ISI: 000419830500007PubMedID: 29106749Scopus ID: 2-s2.0-85040336769Local ID: HHJADULTIS, HHJARNIS, HHJOralISOAI: oai:DiVA.org:hj-38627DiVA, id: diva2:1176536
Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2018-05-04Bibliographically approved
In thesis
1. Studies on orthodontic treatment in subjects with periodontal disease
Open this publication in new window or tab >>Studies on orthodontic treatment in subjects with periodontal disease
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
orthodontic treatment, periodontal disease, periodontal treatment, clinical attachment level, external apical root resorption, alveolar bone level
National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-39350 (URN)978-91-85835-89-8 (ISBN)
Public defence
2018-06-01, Forum Humanum, School of Health and Welfare, Jönköping, 09:00 (English)
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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

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Zasčiurinskienė, EglėLindsten, RuneJansson, Henrik

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