Cedro M, Moles DR, Hodges S. Adult orthodontics in the absence of orthognathic treatment: a hospital perspective. J Orthod. 2012; 39:292-302
Claman L, Alfaro MA, Mercado AM. An interdisciplinary approach for improved esthetic results in the anterior maxilla. J Prosthet Dent. 2003; 89:1-5
Ong MM, Wang HL. Periodontic and orthodontic treatment in adults. Am J Orthod Dentofacial Orthop. 2002; 122:420-428
Kalia S, Melsen B. Interdisciplinary approaches to adult orthodontic care. J Orthod. 2001; 28:191-196
Melsen B, Agerbaek N, Markenstam G. Intrusion of incisors in adult patients with marginal bone loss. Am J Orthod Dentofacial Orthop. 1989; 96:232-241
Chasens A. Periodontal disease, pathologic tooth migration and adult orthodontics. N Y J Dent. 1979; 49:40-43
Johal A, Ide M. Orthodontics in the adult patient, with special reference to the periodontally compromised patient. Dent Update. 1999; 26:101-108
Dersot JM. Gingival recession and adult orthodontics: a clinical evidence-based treatment proposal. Int Orthod. 2012; 10:29-42
Sanders NL. Evidence-based care in orthodontics and periodontics: a review of the literature. J Am Dent Assoc. 1999; 130:521-527
Vardimon AD, Nemcovsky CE, Dre E. Orthodontic tooth enhances bone healing of surgical bony defects in rats. J Periodontol. 2001; 72:858-864
Zimmer B, Seifi-Shirvandeh N. Changes in gingival related to orthodontic treatment of traumatic deep bites in adults. J Orofac Orthop. 2007; 68:232-244
Re S, Cardaropoli D, Abundo R, Corrente G. Reduction of recession following orthodontic intrusion in periodontally promised patients. Orthod Craniofac Res. 2004; 7:35-39
Upadhyay M, Nagaraj K, Yadav S, Saxena R. Mini-implants for en masse intrusion of maxillary anterior teeth in a severe Class II division 2 malocclusion. J Orthod. 2008; 35:79-89
Carano A, Stefano V, Leone P, Siciliani G. Clinical application of the miniscrew anchorage system. J Clin Orthod. 2005; 1:1-8
Pinho T, Neves M, Alves C. Multidisciplinary management including periodontics, orthodontics, implants, and prosthetics for an adult. Am J Orthod Dentofacial Orthop. 2012; 142:235-245
Ericsson I, Thilander B. Orthodontic relapse in dentitions with reduced periodontal support: an experimental study in dogs. Eur J Orthod. 1980; 2:51-57
Zachrisson BU. The bonded lingual retainer and multiple spacing of anterior teeth. Swed Dent J. 1982; 15:(Suppl)247-255
Loss of periodontal attachment in adults usually manifests as pathological migration, traumatic deep bite and irregular dental spacing, which lead to compromised aesthetics and function.
This article describes the interdisciplinary management of an adult patient presenting with severe periodontitis accompanied by marginal bone loss and pathological migration of the upper right anterior teeth. The combination of a modified intrusion procedure of the upper anterior teeth and periodontal therapy led to significant improvement in function and aesthetics.
CPD/Clinical Relevance: The modified intrusion technique described in the present case can be a useful alternative to improve the periodontal condition as well as the aesthetics in periodontally compromised adult patients.
Article
The number of adult patients seeking orthodontic treatment has increased significantly during recent years, which may be attributed to improved dental services and greater dental awareness among adult patients.1 The main motivating factors in adults seeking orthodontic treatment are a desire to improve their dento-facial aesthetics and function.2
The fact that the incidence of periodontal disease increases with age means that dental practitioners are more likely to see adult patients with periodontal problems. Periodontal disease usually manifests as tooth mobility, pathological migration, irregular dental spacing, and marginal gingival recession. Other features include drifting of teeth, missing teeth, proclination of the upper labial segment, rotations and over-eruption, which lead to functional and aesthetic problems. Where these features affect the maxillary anterior region, this will particularly result in compromised aesthetics.3
Orthodontic tooth movement in periodontally compromised patients differs considerably from that found in routine orthodontics. Loss of alveolar bone height leads to apical relocation of the centre of resistance. If the centre of resistance moves apically, the tipping moment produced by the force increases, therefore light force and relatively larger countervailing moment produced by a couple applied to the tooth would be necessary to effect bodily movement. A periodontally compromised dentition may also provide inadequate anchorage, provoking further bone loss. Micro-implants may be used as a useful source of anchorage in such cases. Judicious interdisciplinary treatment planning, regular periodontal care during active orthodontic tooth movement and establishing appropriate retention after orthodontic treatment are crucial for successful treatment outcome.4
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