improving gum tissue health through orthodontics

Improving Periodontal Health

ThroughOrthodontics

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Tipped molar creates plaque trap at mesial surface, however bone is still at CEJ.

10 years later the bone is deteriorating at the mesial surface creating a periodontal pocket.

By uprighting the molar and erupting the mesial surface the periodontal pocket is leveled and future hygiene and axial loading is improved.

Improving Periodontal Health Through Orthodontics


Tipped posterior tooth, with poor axial loading from occlusal forces and inadequate space for tooth replacement.

Uprighted posterior tooth. Note all new bone formation at mesial surface of uprighted posterior tooth.

Implant replacement of missing tooth.



Although both molar teeth are periodontally involved, the purpose of movements is to aid in creating more level bone especially distal to the bicuspid.

Improved bone architecture as the first molar is uprighted.



Intrusion of over-erupted posterior teeth to achieve level occlusal plane and level gum tissue line.


Before

After


Intrusion of over-erupted posterior tooth to achieve level occlusal plane and level gum tissue line.



To restore upper anteriors with crowns to normal length will require gum tissue and bone removal on either the over-erupted lower anteriors (if the reverse smile line is to be treated) or on the shorter maxillary anteriors for adequate crown length after preparation.

By intruding the lower anteriors adequate interocclusal space is created to restore maxillary anterior length without removing any gum tissue or bone.

Restored smile and function and leveling of gum and bone tissue with no surgery.



To restore the smile and create and even gum line with adequate interocclusal tooth height would require gum and bone tissue removal in both arches.

By intruding over-erupted teeth , the bone and gum tissue return to normal positions, and the teeth can be restored without excessive reduction in gum tissue, bone or teeth.

Restored smile and function and leveling of gum and bone tissue with no surgery.



In order to expose the mesial restorative margin on the lower first molar for a crown, the tooth was extruded in such a way so that the bone level remains the same and the tooth margin is exposed. This avoids the need to remove gum and bone tissue coverage which would: 1) expose adjacent teeth as well; 2) create a taller crown, and less favourable crown to root ratio.



Fractured tooth has little sound tooth exposed outside the alveolar bone.

Extruded tooth can be restored without encroaching on biological width limitations.



Left central incisor requires new crown and with present bone defect the final gingival margin will be too high.

The tooth and bone have been erupted to now allow periodontal therapy, then followed by a restorative crown with the prognosis for an even height tooth much improved.



Prognosis of upper right central incisor is poor, however orthodontic eruption of this tooth serves to grow alveolar bone downward, so that future restorations of this area will be more favourable in size.



Upper right central incisor has recession and bone loss and is going to be replaced with implant. The concern is that final tissue height will be too high compared to adjacent central incisor.

Using esthetic orthodontic techniques patient is able to grow bone and gum tissue into area for future implant.

Start EruptingTooth moves down into appliance space

Case continued on next slide


Patient now has extra tissue in area for more predictable implant success.At present there is a bonded lingual retainer as bone and gum tissue mature for implant.

Before AfterDuring


Case continued from previous slideImproving Periodontal Health Through Orthodontics


Before

Before

Before

After

After

Tissue already receded.

Early treatment of severe crowding with excellent gum and bony tissue response.

Later treatment of severe crowding: an excellent tissue response with minor recession on labial of lower right cuspid.

Severe recession and tissue loss on labial of lower right cuspid due to displacement of tooth labially without treatment.



Alignment correction improves gingival architecture and ability to maintain hygiene.

Crossbite correction eliminates traumatic occlusal forces to the tooth, gum and bone tissue.



Case 2Minor palatal recession related to trauma due to deep bite.

Case 2Improved tissue anatomy with correction of deep bite, and no other gum tissue treatment.

Case 1Severe palatal recession related to trauma due to deep bite.

AfterAfter

Before Before


Ideal alignment of teeth allows adequate space for bone and gum tissue growth between the teeth, as well as access for healthy brushing and flossing.


Crowded and overlapped teeth leave inadequate room between teeth for healthy bone and gum tissue growth. Brushing and flossing are more difficult and less effective.


AfterAfter

Before Before


Following alignment there is improved access for brushing and flossing. Notice that there is now room for bone and gum tissue to grow between the teeth, although in adults rejuvenation of this tissue is limited and some dark spaces between teeth are visible.



Eliminating the Dark Triangular Spaces

Due to previous crowded and overlapped teeth, as teeth align dark spaces of previous tissue loss are evident.

Specialized orthodontic techniques empoyed to eliminate dark triangular spaces.

Final result with no dark spaces between teeth, and teeth well aligned for future health, esthetics and function.



Previous recession and bone loss has created flat gingival architecture with large embrasure spaces and large areas for food impaction.

Posterior interproximal reduction is used to gain space for crowding relief and to improve gingival architecture and re-establish proper function (to avoid food impaction) and esthetics.

Case continued on next slide



Early in Treatment FinalLater in Treatment

Early in Treatment FinalLater in Treatment

Case continued from previous slide

Improved gingival architecture through interproximal reduction and space closure.



Thank You

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