Interrelationships orthodontics periodontics
Orthodontics is a therapy whose scope of action is none other than the periodontium of the dental organ as well as the other elements of the masticatory system. As a result, a close relationship is automatically established between periodontics and orthodontics; a relationship during which the two therapies will work for a single objective which is oral health.
II- Reminders:
a- Dento-facial physiological balance:
The dental arch is maintained between the lingual pressure which tends to vestibulate it and the pressure of the buccinator and orbicularis oris muscles which tend to lingualize it. Thus, there is a balance zone called the “castle corridor or dental corridor”.
b- Dental forces and movements:
1- The strengths:
Force is defined as the action of one body on another body. Depending on the rate of application, there are three types of forces:
- Continue
- Discontinuous
- Intermittent
2- Origin of forces:
- Functional
- Forces of orthodontic origin: generated by orthodontic appliances, they are studied and well oriented respecting periodontal health.
3- Types of orthodontic forces:
- Intermittent forces: the daily alternation of work periods and rest periods.
- Discontinuous forces: the alternation of periods of activity and periods of rest extends over a time interval long enough to allow tissue reorganization.
- Continuous forces: distributed by fixed devices and long-acting springs.
4- Types of orthodontic movements:
- Version
- Ingression and egression
- Torque
- Rotation
III- Reactions of periodontal tissues to orthodontic treatment:
1- At the gum level:
The various devices used for dental movement promote plaque retention and therefore the development of inflammation. Hygiene measures must be reinforced. In unfavorable anatomical conditions, the appearance of recessions is observed.
2- At the level of the epithelial attachment:
The insertion of orthodontic braces into the gingival sulcus not only causes profound alterations in the epithelial attachment but also inflammation which could be responsible for the apical migration of the epithelial attachment.
3- At the level of the periodontal ligament:
- Hydraulic system reaction: collapse of the vessels with expulsion of blood into the surrounding tissues. As the blood escapes, the thickness of the periodontium decreases and the tooth moves slightly.
- Reaction of the desmodontal fibers: It is schematically translated by a stretching on the tension side and a compression on the pressure side.
4- Reaction at the level of the alveolar bone:
- Direct resorption: If the force is light or constant at the pressure zone, resorption will occur directly at the lamina dura and will continue regularly as long as this force is maintained.
- Indirect resorption: If the force is relatively high, a hyalinization zone occurs, in front of which no resorption occurs. However, resorption occurs within the cancellous bone, so the entire bone wall is thin and the tooth moves in the direction of the cancellous tissue.
- Bone apposition: Under the effect of traction, new bone is deposited on the internal surface of the alveolus along the stretched fibers.
5- At the level of cementum and radical dentin:
- Large and long-lasting forces cause cementum and dentin resorption.
- The most serious lesions can reach the apical 1/3 (hypercementosis and radical curvature).
IV- Clinical examination:
The treatment plan can only be established after a careful clinical examination:
1- From a periodontal point of view: it is necessary to evaluate
- Oral hygiene and the patient’s level of motivation.
- Gingival condition: inflammation, hypertrophy, recession, HGA.
- Depth of pockets.
- Dental condition: migration, version, mobility.
- Study of static and dynamic occlusion.
- Bone assessment.
- Additional examinations.
2- From an orthodontic point of view:
- Clinical examination from the front and from the side.
- Endoral examination: teeth, jaws.
- Examination of soft tissues: gum, vestibule.
- Static and dynamic occlusion.
- Functional examination to detect behavioral abnormalities by examining facial expressions and the activity of propulsive muscles.
- Detect parafunctions and tics.
- Additional examinations: TLR profile and casts.
Orthodontic treatment should never be undertaken on a diseased periodontium, as this could cause further inflammation and loss of attachment, hence the need to wait until the periodontium has completely healed. A reduced but healed periodontium is suitable for receiving orthodontic forces adapted and adjusted according to the quantity and quality of the residual bone.
V- Contribution of periodontics to orthodontics:
1- Patient with healthy periodontium:
a- Before ODF treatment:
- Hygiene motivation and teaching of brushing methods.
- Examination of the teeth and their periodontium which informs us about the possible risks of the treatment envisaged.
b- During ODF treatment:
- Regular monitoring of the periodontal condition by regular probing of the SGD and taking X-rays to detect any loss of attachment before it reaches alarming proportions.
- If gingival hypertrophy appears, strengthen plaque accumulation control and perform a gingivectomy.
- If a recession problem appears during ODF treatment: stop the movements, graft and wait for healing then resume treatment.
- It is also advisable to detect any root prominence on palpation of the vestibule, a sign of fenestration or bone dehiscence (correct the root-vestibular torque).
c- After ODF treatments:
- Fibrotomy: correction of rotations is difficult, often recurrent, which requires fairly long retention.
- Papillomaectomy: Orthodontic treatments involving space closure often cause compression of the papillary gingival tissues incompatible with dental hygiene, hence a papillectomy is performed to eliminate the wedge effect.
2- Patient with reduced periodontium:
a- Case of gingivitis: treatment of gingivitis.
b- Cases of periodontitis:
- A correct periodontal diagnosis.
- An etiological periodontal treatment aimed at controlling inflammation as well as controlling PB.
VI- Place of orthodontics in the periodontal treatment plan:
1- Indication of ODF treatment during periodontal therapy:
- Pathological migration of one or more teeth.
- Appearance of a diastema.
2- Goals of ODF treatment during periodontal therapy:
- Find a correct dental axis.
- Restore aesthetics.
- Prevention of bacterial plaque buildup.
3- Moment of orthodontics in periodontal therapy:
- In the case of gingivitis after initial therapy.
- In the case of periodontitis after initial therapy.
- At the same time as surgical therapy to take advantage of bone healing.
- In the case of severe crowding, ODF treatment will precede periodontal therapy.
4- Particularities of orthodontics on a reduced periodontium:
Lighter and more constant forces should be used to achieve the desired therapeutic effect without inducing iatrogenic action. The use of certain orthodontic therapies can preserve or maintain a reduced periodontium, or even promote bone regeneration.
5- Contribution of orthodontics to periodontology:
- Easier plaque control by correcting dental malpositions and restoring physiological bone and gingival morphology.
- Rehabilitation of aesthetics and facilitate the easy application of a retainer.
- Restoration of a stable occlusal pattern by eliminating harmful forces that may induce occlusal trauma or aggravate pre-existing inflammation.
- When the periodontium is reduced, improve the crown/root ratio, even decrease the depth of the pockets, increase the height of the attached gingiva and improve recessions.
- Repositioning of the tooth in its socket surrounded by sufficient bone.
- Repositioning of the alveolar-dental complex in the arch (the tooth and its alveolus are located in the balance zone to avoid excessive muscular pressure).
- Restoration of balanced neuromuscular function: elimination of tics and bad habits, eliminates microtraumas.
6- Iatrogenic effect of orthodontic treatment:
- Coronary lesions: Poorly fitted braces promote food infiltration, plaque formation, cavities and decalcification.
- Gingival lesions: hyperplasia, decapitation of papillae, ulcerations and sulcus injury.
- Pulp lesions: necrosis, significant force can cause stasis of the blood vessels which can lead to apical reactions, pulp mortifications.
- Root resorption.
- Root curvatures.
- Hypercementosis.
- Alveolar bone necrosis and periodontal degeneration.
7- ODF contention:
At the end of active orthodontic treatment, a retainer is necessary to prevent relapses, which originate from the long period of reorganization of the periodontal tissues and their stabilization in the new dental position achieved by this treatment. The orthodontic retainer can be fixed or removable and will be removed at the end of the period of definitive reorganization of the periodontal tissues. In the case of reduced periodontium, it is necessary to switch after the end of orthodontic treatment to a retainer, often fixed by means of a bonded splint or coated wire.
8- Occlusal adjustment and orthodontics:
The forces generated by orthodontic appliances can act as traumatic forces; for this reason, their harmful effect should be reduced by controlling the occlusion through selective grinding during orthodontic treatment and even after.
VII- Maintenance:
After the end of treatment, the patient undergoes maintenance sessions in order to identify and prevent any recurrence of malposition or periodontal disease.
Conclusion :
Neglecting or underestimating the influence of orthodontic therapy on the periodontium and vice versa can lead to devastating consequences for the dental organ in particular and even for the health of the masticatory system in general.
Interrelationships orthodontics periodontics
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