041.the role of orthodontics as an adjunct to pd tx

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THE ROLE OF ORTHODONTICS AS AN ADJUNCT TO PERIODONTAL THERAPY


Primary Objective of periodontal therapy is to restore and maintain the health and integrity of the attachment apparatus of teeth loss of teeth or periodontal support can result in pathologic tooth migration involving either a single tooth or a group of teeth. Results in the development of a median diastema or general spacing of the teeth, rotation or tipping of premolars and molars with the collapse of the posterior occlusion and decreasing vertical dimension. Adjunctive orthodontic therapy is necessary to resolve these problems


RATIONALE FOR ORTHODONTIC TREATMENT IN PERIODONTAL THERAPY

REDUCING PLAQUE RETENTION Example: Crowded teeth (arch length deficiency), mesially tipped teeth, usually into an edentulous area creates plaque accumulation sites that are difficult to clean. they open the distal contact creating an area of food impaction. Crowding also creates enlarged contact surfaces and altered embrasure spaces that are displaced apically, thereby becoming less accessible to use floss and other plaque removing devices. In these situations orthodontic treatment can improve the health of the tissues


IMPROVING GINGIVAL AND OSSEOUS FORM There is an interrelation between the position of the tooth, the shape of the gingiva and bone that surrounds it. For example, lower first or second molar tilted into an edentulous mesial space. In these cases there is a narrow space between its crown and the bone that easily becomes inflamed and in which case a pocket may develop. Orthodontic treatment may improve the shape of the periodontium and reduces the indications for bone surgery

FACILITATING PROSTHETIC REPLACEMENTS The uprighting of tilted abutment teeth may be important for a better contoured crown and this will benefit the periodontal condition.


IMPROVING ESTHETICS Correction of pathologic tooth migration and diastema between anterior teeth. Correction of tongue-thrusting and other habits

USE OF ORTHODONTICS AS AN ADJUNCT TO OVERALL TREATMENT 1. Uprighting or repositioning of teeth to improve parallelism of abutment teeth

(e.g. tipped abutment teeth)

2. Improving future pontic spaces (e.g. inadequate spaces)

3. Correcting cross bites

4. Extruding teeth/Intruding teeth

5. Correcting crowding of teeth

6. Achieving adequate embrasure space and proper root positioning

7. Repositioning teeth for implant placement

8. Restoring lost vertical dimension

9. Increasing/decreasing overjet /overbite

10. Closure of diastema.


INDICATIONS

crowded teeth,

closure of anterior diastema,

mesial tilting of molars

open contacts.

CONTRAINDICATIONS

persistence of active disease in spite of phase-I therapy procedures. The superimposition of tooth movement on inflamed gingiva may exacerbate the periodontal problem.

This can occur by shifting the position of plaque subgingivally, increasing the rate of periodontal attachment loss and altering the morphology of the bone.


TIMING OF ORTHODONTIC PROCEDURES IN PERIODONTAL TREATMENT It is generally recommended that orthodontics be preceded by periodontal therapy

IATROGENIC EFFECTS ASSOCIATED WITH ORTHODONTIC TREATMENT Orthodontic treatment may cause injuries to the teeth and periodontium but in most of the cases the changes are reversible and regeneration and repair of the tooth structures and periodontal tissues can occur. Radiography should be performed at regular intervals in order to disclose any iatrogenic effects during the orthodontic treatment.


ROOT RESORPTION

Some amount of root resorption is unavoidable especially if it is seen at the marginal and middle thirds of the root, which can be repaired by apposition of cellular cementum.

EFFECTS OF ORTHODONTIC BANDS ON THE PERIODONTIUM Short-term effects are— Gingivitis and gingival hyperplasia, mostly not associated with loss of attachment. Long-term effects are— Loss of attachment, root resorption or no effects.


MICROBIOLOGY AROUND ORTHODONTIC BANDS

a. Increased Lactobacillus count

b. Increased motile organisms

c. Increased anaerobes like Prevotella intermedia

d. Decreased count of facultative microorganisms/ anaerobes

DENTITION WITH REDUCED HEIGHT OF ATTACHMENT APPARATUS a. In the absence of plaque, orthodontic forces and tooth movements failed to induce gingivitis, whereas in the presence of plaque similar forces cause angular bone defects associated with attachment loss. b. Orthodontic forces if kept within biologic limit failed to cause gingival inflammation even in the regions with reduced periodontal support, but is of the non-inflammatory type.


When bone surrounding the tooth is subjected to a force it responds in the following manner: 1. Resorption occurs where there is pressure and new bone forms where there is tension. 2. When pressure is applied to the tooth, there is a initial period of movement for 6 to 8 days as the periodontal ligament is compressed. Compression of periodontal ligament results in blood supply being cut off to an area of the periodontal ligament and this produces an avascular, cell-free zone by a process termed “hyalinization”. When hyalinization occurs the tooth stops moving (depending on the forces). The hyalinized zone is eliminated by periodontal regeneration that occurs from the reorganization of the area through resorption by the marrow spaces (undermining resorption) and adjacent areas of unaffected periodontal ligament and alveolar bone. Once the hyalinized zone is removed, tooth movement can occur again. Regeneration of periodontal ligament does not occur when inflammation is present in periodontal tissue. Hence, the inflammation needs to be controlled by periodontal treatment.

041.the role of orthodontics as an adjunct to pd tx

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