Periodontal treatment, a key of successful orthodontic treatment

Abstract

Orthodontic treatment on untreated diseased periodontium causes significant destruction of the supporting tissues, and can lead to tooth loss. The present case report shows the side effect of orthodontics on untreated periodontitis and highlights the importance of periodontal screening before undergoing an orthodontic treatment. A 26-year-old female patient in a good general health consulted for spontaneous gingival bleeding and aesthetic damage due to the appearance of generalized recessions and black holes. The medical history revealed that the patient had been wearing a fixed orthodontic appliance for 3 years. Periodontal examination showed severe generalized attachment loss and furcation involvement, and radiographs showed a generalized horizontal bone loss. Based on these findings, this patient was diagnosed with generalized stage IV grade C periodontitis. Intervention: orthodontic treatment was systematically interrupted and periodontal treatment was initiated. After three months, the non-surgical periodontal treatment was reassessed, the periodontitis was stabilized. In this young patient, periodontal treatment was initiated to prevent progression of attachment loss and bone loss, and stabilize the grade C periodontitis. This highlights the importance of screening for periodontitis before orthodontic treatment mainly especially in susceptible patients. Indeed, orthodontic treatment can only be undertaken in a patient with periodontal disease after pre-orthodontic periodontal treatment, and a per-orthodontic maintenance should be set up, in order to prevent any periodontal disease recurrence. In the management of patients with periodontal disease, periodontal and orthodontic collaboration is essential to restore functional and aesthetic changes and to prevent a progressive destruction of periodontal supporting tissues.