🌟PERIODONTICS-ORTHODONTICS RELATIONSHIP
📌 POINTS TO PONDER
🔹The effects of orthodontic treatment on periodontium are:
– Favors plaque accumulation
– Modifies the gingival ecosystem
– Gingival recession and hyperplasia
– Excessive force causes necrosis of periodontal ligament and alveolar bone.
🔹After 4–6 weeks of regenerative osseous therapy, orthodontic treatment can be initiated.
🔹PAOO is contraindicated in patients with active periodontal disease or gingival recession.
🔹Fiberotomy reduces the occurrence of rotational relapse.
🔹In thin gingival biotype, free gingival grafting is done before the beginning of orthodontic movement.
📣 Systematics Of Combined Treatment
👉 Following is the systematic approach of combined periodontal and orthodontic treatment:
💠 Phase I: Preorthodontic Phase
🔸Reduction of marginal inflammation: Plaque control, scaling and root planing.
🔸Soft-tissue augmentation: Free epithelial graft, connective tissue graft.
🔸Hard-tissue augmentation: Regenerative osseous surgery.
🔸Improvement of oral hygiene status: Caries removal and restorations.
🔸Elimination of functional disorders: Therapeutic position of mandible.
💠 Phase II: Orthodontic Phase
This phase is determined by following two key factors:
🔸Findings-oriented biomechanics: Thorough planning of biomechanics reduces the risk of root resorptions, gingival recession and bone dehiscence.
🔸Continuous monitoring of periodontal health.
💠 Phase III: Post Orthodontic Phase
This phase should last at least 6 months to complete the mineralization of osteoid tissues.
This phase includes the following:
🔸Periodontal reevaluation.
🔸Definitive restorative therapy.
🔸Recall schedule.
📣 Periodontal Response To Various Kinds Of Tooth Movement
🔸Extrusion
🔸Intrusion
🔸Tipping
🔸Bodily movement
📣 The Effects Of Orthodontic Treatment On Periodontium:
🔸Favour plaque accumulation
🔸Modify the gingival ecosystem
🔸Gingival recession and hyperplasia
🔸Excessive force causes necrosis of periodontal ligament and alveolar bone
📌 VIVA VOCE
Q1. What is the association of mouth breathing and orthodontic treatment?
Ans. A significant problem in orthodontic patients is the added periodontal insult of mouth breathing. The drying effect on the exposed tissue in susceptible patients is associated with enlarged, erythematous labial gingiva, particularly in the maxillary and mandibular anterior region. Although the plaque index is not significantly higher in mouth breathers, an increase in the gingival index has been reported. This increased inflammation should be reduced to a minimum before fixed appliances are placed and is usually accomplished by scaling and root planing.
Q2. What are the various periodontal factors which affect orthodontic biomechanics and treatment planning?
Ans. Width and height of alveolar bone, length and shape of the root and width of attached gingiva.
Q3. Which fibres are transected during circumferential supracrestal fiberotomy?
Ans. Supracrestal and transseptal fibres.
Q4. What are the causes of open gingival embrasures?
Ans.
🔸Inadequate papilla height due to alveolar bone loss.
🔸Coronally high interproximal contact due to divergence of root or tapered tooth shape.
Q5. What are the advantages of the PAOO technique?
Ans. Reduction in time for ortho treatment and improvement in post-treatment stability.
Q6. Which brush is generally recommended to patients with orthodontic brackets?
Ans. Soft special bi-level filaments orthodontic brush or powered brush.
Q7. Who introduced periodontally accelerated osteogenic orthodontics (PAOO)?
Ans. Wilcko et al.
Q8. How much root separation is required for adequate bone and embrasure space to achieve periodontal health?
Ans. Approximately 2–3 mm.
Q9. Why are bonds preferred over bands?
Ans. Bonded molars show less plaque accumulation, gingivitis and loss of attachment interproximally.
Q10. Which appliances are used for intra-arch tipping movements for correcting pathologic tooth migration?
Ans.
🔸Hawley appliance
🔸Crozat appliance and
🔸Spring retainer.
📌 MCQs
💡Brush recommended to orthodontic patient:
A. Soft special bi-level brush
B. Novel design brush
C.Small tooth brush
D. Powdered tooth brush
Answer: A
💡Fibers transected in the circumferential supracrestal fiberotomy (CSF) technique are:
A. Transseptal fibers
B. Apical fibers
C. Interradicular fibers
D. None of the above
Answer : A
💡The orthodontic treatment may affect the periodontium by:
A. Favouring plaque accumulation
B. Modifying the gingival ecosystem
C. Gingival recession
D. All of the above
Answer : D
💡Gingival discrepancy in anterior teeth can be corrected by:
A. Gingivectomy
B. Intrusion and incisal restoration /porcelain laminate veneer
C. Extrusion and fiberotomy and porcelain crown
D. Surgical crown lengthening by flap procedure and osteotomy/osteoplasty of bone
E. All of the above
Answer: E