Periodontal diagnosis and ODF:
Before starting orthodontic treatment, the patient’s periodontal condition must be taken into consideration.
We can have:
- Diagnosis of an infected periodontium:
In full inflammation, it is a periodontium with subgingival reservoirs of biofilm, so we will have to answer this question: does this periodontium have infectious reservoirs compromising the stability of the bone?
How will we diagnose this infectious periodontitis?
- Screening survey: carried out at the first consultation (measure the depth of the gingivo-dental sulcus), there must not be a pocket greater than 3mm, if it exists, there is a pathological bacterial proliferation requiring periodontal treatment. The orthodontist will have to wait 1 month for the elimination of the infection and 2 months for healing.
- Signs of inflammation:
– Inspection: these are valuable clues but they are inconsistent because their absence does not in any way indicate a healthy periodontium; this inspection can lead to errors.
-Palpation: reveals suppuration, so it is a diagnosis of active periodontitis.
- Radiological signs: objectifying the level of the alveolar bone, radiological bone lysis without periodontal pockets establishes the diagnosis of stabilized periodontitis and does not contraindicate orthodontic activation.
- Orthodontic gingivitis: it is an inflammatory reaction triggered by the presence of orthodontic hardware or material and aggravated by the biofilm, characterized by gingival hyperplasia without migration of the gingival attachment, it does not contraindicate the continuation of the treatment. It requires rigorous hygiene and periodontal maintenance sessions.
- Bacterial tests: their use in screening does not provide any determining elements compared to the survey:
-No pockets larger than 3mm, no bleeding = orthodontic activation is possible
-No pockets larger than 4mm, presence of bleeding = motivation to control the biofilm, scaling, after which orthodontic activation will be possible
-A pocket larger than 4mm with or without bleeding = refer the patient to a specialist consultation or treatment by a periodontology specialist.
Note to beneficiary:
- The absence of signs of inflammation does not indicate a healthy periodontium.
- The presence of signs of inflammation is a valuable warning sign.
- The X-ray image allows the loss of attachment to be assessed but not the presence or absence of infection.
- Diagnosis of a weakened periodontium:
This is a healthy periodontium with bone loss linked to a history of infection, so we will need to answer this question: is this periodontium resistant to the planned dental movement?
- Attached gingiva present but too thin: the mucogingival line is more than 4 mm from the gingival margin (the attached gingiva is 2 mm high), the metallic color of the periodontal probe is visible by transparency. If we plan to move the tooth vestibularly, we must strengthen the gingiva in order to prevent recession and therefore thicken the attached gingiva by buried connective tissue flap.
- Absence of attached gingiva: the height of the mucogingival line is 3mm, it is necessary to increase the height of the attached gingiva before starting orthodontic treatment (by buried connective graft).
- Bone level below the coronal half:
– Attached gingiva present, grade 2 mobility = orthodontic treatment is not contraindicated
-Absent attached gum, grade 2 mobility = perform a graft then orthodontic treatment
-Absent attached gingiva, mobility of degree 3 or 4 = orthodontic treatment contraindicated
- Yag laser in periodontology and its implication in orthodontic treatment:
The interest of the laser:
- Simplified surgery of the superficial periodontium (freinectomy).
- Improved healing and postoperative pain .
- Invisible healing of aesthetic sectors.
- Access to difficult areas (especially for periodontal maintenance with attachments in the mouth).
- Antibacterial action: especially for ortho-periodontal care.
- Possible regeneration and repair phenomena.
- Frequent mechanisms of osteogenesis by neighboring osteoblasts.
Dental crowns are used to restore the shape and function of a damaged tooth.
Bruxism, or teeth grinding, can cause premature wear and often requires wearing a retainer at night.
Dental abscesses are painful infections that require prompt treatment to avoid complications. Gum grafting is a surgical procedure that can treat gum recession. Dentists use composite materials for fillings because they match the natural color of the teeth.
A diet high in sugar increases the risk of developing tooth decay.
Pediatric dental care is essential to establish good hygiene habits from an early age.