05 September 2022

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Effect of orthodontic treatment on periodontal health of periodontally compromised patients

Davide Elsido

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An increasing number of adult patients are now seeking orthodontic treatment due to an increased focus of society on esthetics and health consciousness. With the incidence of periodontal problems shown to increase with age, ortho-perio interactions play an important role in management of these patients.

Orthodontic problems in the majority of these adult patients are a consequence of their underlying periodontal issues leading to reduced periodontal support and resulting in pathological migration, proclination of maxillary anterior teeth, interdental spacing, rotation and overeruption, resulting in compromised function and esthetics. 

As orthodontic tooth movement is basically a bone remodeling phenomenon, the effect of orthodontic treatment on osseous topography in patients whose bone levels are already compromised is crucial.

Therefore, in this study published in the November issue of The Angle Orthodontist, cone beam computed tomography (CBCT) was used to assess bony changes.

Thirty-six periodontally compromised adult patients (mean age: 29.67 +- 4.8 years) were randomly allocated to either test (perio-ortho) or control group (perio). After periodontal stabilization in both groups, orthodontic treatment was started in the test group, whereas the control group remained on periodontal maintenance only. Evaluation and comparison of clinical parameters (plaque index [PI]; gingival index [GI]; bleeding on probing [BOP]; probing depth [PD]; clinical attachment level [CAL]) of both groups was assessed.

The results of the study showed favorable results of a combined periodontic-orthodontic treatment in periodontally compromised patients. There was a statistically significant improvement in all the periodontal parameters in the control and test groups with a highly significant CAL gain.

The present trial provided an evidence-based conclusive answer that orthodontic treatment had no detrimental effect on the periodontal health in periodontally compromised patients if proper periodontal health was maintained throughout orthodontic treatment.

Further studies with larger power, greater sample sizes, long-term follow-up, and exploring other aspects involved in routine treatment of adult orthodontic patients, are recommended to verify these results.