AACD Website Blog Clinical Insights Sequencing of Per...

Sequencing of Periodontal Procedures and Orthodontic Treatment

September 15, 2015 by AACD Executive Office

Sequencing of Periodontal Procedures and Orthodontic Treatment For Long-Term Esthetic Outcome: A 5-Year Case Report

by Cobi J. Landsberg, DMD and Ofer Sarne, DMD

Advanced periodontal disease is primarily characterized by severe attachment loss and reduction of alveolar bony support. The condition usually presents as tooth mobility, migration, spacing, and marginal gingival recession. In the maxillary anterior region, the functional damage is usually accompanied by compromised esthetics. Patients with advanced periodontal disease often require periodontal surgery that frequently results in additional gingival recession and esthetic deterioration. Since the 1960s, several surgical techniques have been developed to minimize postsurgical gingival recession and preserve the interdental papillae.1-7 These techniques are specified by the effort to prevent unnecessary excision of healthy gingival tissue, prevent reduction of bony tissue, and locate the flaps as far coronally as possible by advanced flap procedures and suturing techniques.   x-ray, teeth
Orthodontic realignment of migrated, severely periodontally involved teeth is usually initiated after surgical control of inflammation.8 The timing of this treatment after periodontal surgery is still controversial. A long healing period and radiographic evidence of bone apposition before initiating orthodontic tooth movement has been advocated.9 Others claim that better results are achieved when orthodontic movement starts shortly after completion of periodontal regenerative therapy.   teeth, braces
This article describes a case that utilized the “regeneration-then-earlyorthodontics” approach, which was applied to restore function and esthetics in a maxillary anterior dentition severely compromised by periodontal disease. The fulfillment of esthetic requirements by periodontal plastic surgery, carried out only after realignment of the anterior dentition, is also demonstrated.
Read more.
teeth, gums, braces, sutures


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