Orthodontic treatment in stage IV periodontitis patients. Spyridon Papageorgiou. EFP Euro series


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Orthodontic treatment in stage IV periodontitis patients. Spyridon Papageorgiou. EFP Euro series

Join me for a summary of the EFP’s lectures on periodontitis and orthodontic treatment. The orthodontic lecture was by Spyridon Papageorgiou and two lectures from periodontists, The topic explored related to stage IV periodontitis and orthodontics

Stage IV – new classification from world workshop Papapanou 2017

· Clinical attachment loss 5mm+

· Bone loss extend to mid third of root

· Malocclusion / masticatory dysfunction

o Bite collapse: Loss of posterior support resulting in tooth movement in the direction of force – (complex), over-eruption and incorrect relationship with antagonistic teeth

o Drifting Due to mastication forces

o hypermobility due to secondary occlusal trauma

o Even if periodontally stable Further tooth movement 33% at 2 years Zhang 2017.

§ Orthodontic pathological tooth movement: Loss of space in the arch, mesial migration, crowding, crossbites

Periodontal Treatment for stage IV Sanz 2020 Kloukos 2021

1. Stage 1 : Supragingival debridement, oral hygiene, professional plaque removal, risk factors

2. Stage 2 – Supra and subgingival debridement – change the subgingival biofilm Interventions: Repeat subgingival therapy, surgical: flap, reactive, regenerative (Barrier membrane, Enamel matrix derivative)

3. Supportive periodontal care

Effects of appliances on the periodontium R/V Papageorgiou 2018 / 2021

· Transient change in microbiology from orthodontic appliances

· Bone loss marginal 0.5mm

· Clinical attachment loss 0.11mm

· Recession

o Greater recession 1.9mm

o Gingival recession and loss of attachments Salti 2017

· Greater if hyperdivergent

· GTR no consistent clinical benefit

· Fixed better than aligners PPD 1.6mm – small study

· No difference in ligation, conventional self ligating

· 1-3 months periodontal intervals in orthodontic treatment better outcomes than 6 monthly Jiang 2021


Adapting orthodontic treatment

· Centre of rotation moves apically

o Same force = larger moment

o Greater extrusion forces

· Simulate intrusion in normal periodontal support vs reduced Kettenbeil 2013 Bagdadi 2019

o Centre of resistance moves apically 2-3mm

o Increased tooth movement 1.6-2.5, increase strain in PDL 1.4-2 possible harm to periodontium


· Generally different fixed retainers compatible with periodontal health and not detrimental Arn 2020

· Metal bonded retainers still allow physiological movement

· Effect of mobility – UNKNOWN

· Greater failure of bonded retainers in more severe periodontal cases (up to stage 3) Han 2021

· 10 year follow up of ortho and perio = no significant recession or tooth loss BUT increase in root fracture – possibly due to increased forces?


· Orthodontics does not negatively impact periodontal condition

· Initial anti-infective periodontal treatment

o Unsure type of periodontal treatment, GTR unclear, unsure what time to start after perio

· Appliances

o Fixed maybe better

o Segmental better than continuous archwire

o Adapt biomechanics due to attachment loss

· In orthodontic treatment – patients attend periodontics at 1-3 months

· Retention after orthodontic treatment – greater failure rates

· Possible increase in root fractures

· Limited evidence

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