The increasing demand for complex rehabilitative dental treatments in the adult patient and in developmental age raises the need for multidisciplinary therapies. The book is intended to trace the orthodontic-periodontal relationships, analyzing how orthodontic procedures can enhance the periodontal treatment plan, increasing its predictability, integrating it, interacting in the surgical approach and, at the same time, how Periodontology increases the potential and predictability of orthodontic treatments, synergically completing them. 

Authos:

ROBERTO KAITSAS

Roberto Kaitsas Postgraduated in Oral Surgery University of Rome "La Sapienza ", Private Practice in Rome.

MARIA GIACINTA PAOLONE 

Postgraduated in Orthodontics Catholic University of the Sacred Heart of Rome, Private Practice in Rome.

Key Features:

➜Step by step procedures

➜Clinical cases in both vestibular and lingual orthodontic techniques

Table of contents:

 

Chapter 1

“Perio-Guided” orthodontic treatment plan ............................................................................1

Introduction ...............................................................................................1

Orthodontic diagnosis integrated by periodontal data ............2

References .................................................................................. 5

 

Chapter 2

“Ortho-Guided” periodontal treatment plan. Ortho-Perio Risk Assessment (OPRA)........................ 7

Introduction .............................................................................................. 7

Microbiology and orthodontics .........................................................9

   Orthodontic appliances .......................................................................9

   Bands .................................................................................................... 10

   Aligners ................................................................................................ 10

   Lingual appliances ............................................................................... 11

   Conclusions .......................................................................................... 11

Clinical effects of orthodontics on tissues .................................... 11

Long-term ortho-perio treatment ..................................................12

Risk assessment of the ortho-perio patient .................................12

Ortho-Perio Risk Assessment (OPRA) ...........................................14

   Pre-existing factors ............................................................................14

   Orthodontic considerations ..............................................................15

References ................................................................................. 17

 

Chapter 3

The role of orthodontics in the periodontal treatment plan ...................21

Introduction .............................................................................................21

“Patient” level .........................................................................................21

   Alignment and better access to oral hygiene .................................21

   Correction of the levels of the gingival margins ...........................23

   Optimization of the adjacent teeth position before implant placement........................................23

Optimization of the position of dental abutments and parallelism before prosthetic rehabilitation............24

“Tooth” level ...........................................................................................24

   Correction of Pathologic Tooth Migration (PTM) .........................24

Closure of the diastema and better adaptation of the soft tissues to the gingival margins and in the          embrasures .............................24

   Dental extrusion and intrusion ........................................................24

   Alignment of the interdental bone level ........................................24

“Site” level ...............................................................................................26

   Improvement of crestal, interdental and interradicular bone structures .............................................26

   Elimination of furcation defects by moving the separated roots........................................................... 27

   Implant site development and pre-restorative dental structure recovery.............................................28

References ................................................................................ 28

 

Chapter 4

Ortho-periodontal diagnostics ...........................29

Introduction ............................................................................................29

Notes on the new classification ........................................................29

Periodontal diagnostics ........................................................................31

   General history ....................................................................................31

   Radiographic exam ............................................................................32

   Periodontal probing ...........................................................................32

   Bone defects anatomy ........................................................................34

Orthodontic signs in the periodontal patient ........................... 37

   Considerations on Pathologic Tooth Migration ............................ 37

Clinical case 1 .....................................................................................39

References ................................................................................ 45

 

Chapter 5

Dental movement in the periodontal patient. Concepts of biomechanics ......................................... 47

Introduction ............................................................................................ 47

Movements in the periodontal patient .........................................48

   Movements towards the bone defect ..............................................48

   Movements away from the bone defect ........................................52

Biomechanics in the periodontal patient ..................................... 57

   Orthodontic biomechanics considerations ................................... 57

   Center of resistance and periodontal bone loss ............................59

   Considerations on lingual mechanics ............................................ 60

References .................................................................................61

 

Chapter 6

Orthodontics as a periodontal treatment ........................................................................................65

Introduction ............................................................................................65

Change in bone levels ..........................................................................65

Clinical case 1 .....................................................................................66

Orthodontics and space redistribution ........................................ 73

    Prosthetic spaces redistribution ...................................................... 73

Clinical case 2 .................................................................................... 75

   Movement in edentulous areas ........................................................ 81

Clinical case 3 ....................................................................................83

Crowding .................................................................................................85

Clinical case 4 ....................................................................................85

References .................................................................................91

 

Chapter 7

Phenotypes and orthodontics ...............................93

Notes on the new classification .......................................................93

   Mucogingival conditions ...................................................................93

   Biotype and phenotype .....................................................................93

Substrate and irritative stimuli ........................................................95

Anatomical considerations and recessions .................................95

   Incisors inclination ............................................................................95

   Shape of the symphysis .....................................................................96

   Soft tissue thickness and keratinized tissue ..................................97

Clinical behavior ....................................................................................99

   Orthodontic approach .......................................................................99

Clinical case 1 ................................................................................... 100

   Surgical approach .............................................................................106

   Interceptive combined approach ..................................................106

Clinical case 2 ....................................................................................111

References ................................................................................116

 

Chapter 8

GOR (Guided Orthodontic Regeneration): orthodontics as a regenerative means .......119

Extrusion as regeneration .................................................................119

Clinical application .............................................................................. 121

   Tissue modelling ............................................................................... 121

   Tissue regeneration .......................................................................... 130

Clinical case 1 (dental extrusion - anterior sector) ................144

Clinical case 2 (dental extrusion - posterior sector) .............150

Clinical case 3 (orthodontic extraction) ...................................153

Clinical case 4 (GOBR - Guided Orthodontic “Bone” Regeneration)....................................................158

Clinical case 5 (GOTR - Guided Orthodontic “Tissue” Regeneration) ...................................170

Clinical case 6 (GOR with immediate loading) ...................... 189

References ............................................................................... 193

 

Chapter 9

Ortho-perio timing ..........................................................197

Introduction ...........................................................................................197

Surgical timing ..................................................................................... 198

   Conservative surgery and bone surgery ....................................... 198

   Regenerative surgery ....................................................................... 198

   Mucogingival surgery ...................................................................... 201

Phases of treatment ............................................................................ 201

Operative timing ..................................................................................202

   First Perio – Then Ortho ..................................................................203

   First Ortho – Then Perio ..................................................................203

References ...............................................................................207

 

Chapter 10

Orthodontics and restorative dentistry. Considerations in the periodontal patient .................... 211

Clinical case 1 ....................................................................................212

References ............................................................................... 219

 

Chapter 11

Orthodontics in interdisciplinary treatment ...................................221

Clinical case 1 ................................................................................... 223

Clinical case 2 ..................................................................................230

References .................................................247