Orthodontic treatment of periodontitis patients – is such a thing possible ...?

21.12.2021

PD Dr. Kristina Bertl, PhD MSc MBA

Patients with periodontitis often suffer from the problem that loss of attachment has caused the position of their teeth to change – i.e. they have drifted, rotated and/or elongated. Flared anterior teeth with a gap between the central incisors is a very common finding among periodontitis patients. As a result, these patients very often ask about the possibility of getting the (usually unaesthetic) position of their teeth straightened – either before they undergo periodontal treatment, or at the latest after.

Orthodontic treatment of periodontitis patients – is such a thing possible...?

But is it even possible to orthodontically treat periodontitis patients? This topic was investigated in 2017 in a review (Bertl et al.), and the most important conclusions for the dental practice are as follows:

Tooth movements in an inflamed, untreated periodontium lead to further loss of attachment and should not be attempted under any circumstances.
The patient’s periodontitis must therefore always be treated as the first therapeutic step, and orthodontic treatment must only be started after an inflammation-free condition and optimum home oral hygiene have been established.
This is because tooth movements in an inflammation-free environment do not cause further loss of attachment.
Close follow-ups should take place during orthodontic treatment. ‘Close’ means approximately every 2 to 3 months, whereby the interval can of course be shorter or longer depending on the severity of the patient’s periodontal disease and their compliance.
The patient’s home oral hygiene should be monitored at every follow-up, and the aids they use for oral care should be adjusted if necessary.
Should the patient experience a relapse during orthodontic treatment and again exhibit increased pocket probing depths and signs of inflammation, periodontal treatment must be restarted immediately. It may also be necessary to pause orthodontic treatment.
Even among periodontitis patients with loss of attachment, the outcome of orthodontic treatment can be maintained in the long term.

Thus, the question posed above of ‘is it even possible to orthodontically treat periodontitis patients?’ can be answered as follows: yes, periodontitis patients can be orthodontically treated, but only after periodontal treatment has been completed successfully and the periodontium is free from inflammation.

Reference

Kristina Bertl, Birte Melsen, Andreas Stavropoulos. Kieferorthopädie bei Parodontitispatienten – Worauf sollte man Acht geben? Inf Orthod Kieferorthop 2017; 49: 11–17 http://dx.doi.org/10.1055/s-0043-101389