Consideration for Orthodontic Treatment of Patients with Severe Periodontitis

Severe periodontitis (Stage IV) frequently results with the following:

• Pathologic teeth migration, drifting, and flaring
• Posterior bite collapse
• Extrusion of anterior teeth
• Secondary trauma from occlusion
• Changes in masticatory function

The resulting secondary malocclusion requires interdisciplinary treatment with orthodontics. The treatment and management of such cases requires coordination between the periodontal and orthodontic disciplines. The patient needs to be periodontally stable, and the ensuing orthodontic treatment needs to be appropriately modified to the specific patient’s stable but reduced and compromised periodontium. The following guidelines have been established for orthodontic treatment of such patients:

• Confirmed biofilm control, stable periodontal condition, and full-mouth radiographs (with periapicals) before orthodontic treatment starts.
• Constant biofilm control and periodontal probing (minimum of 3 months interval) during orthodontic treatment
• Annual radiographic examinations during orthodontic treatment
• Determining if more periodontal evaluations are needed during orthodontic treatment
• Continue with frequent biofilm control and periodontal probing, along with annual radiographs following the completion of orthodontic treatment
• Using orthodontic appliances that are as hygienic as possible, and not interfere with adequate plaque control.
• Keeping orthodontic treatment as short as possible to minimize recurrent periodontal disease, root resorption, and teeth demineralization
• Controlling orthodontic forces for periodontally compromised teeth
• Be familiar with medications taken by patients which may affect tooth movement dynamics.

These Stage IV periodontal patients undergoing orthodontic treatment have many complex factors that require the orthodontist and periodontist to closely coordinate the treatment from the start to ensure success and stability of the treatment results, as well as long-term patient satisfaction.