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Senior Lecturer, Department of Oral Growth and Development, Bart's and The London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary's College, London, UK
This article focuses on the latest S3-level clinical practice guidelines, which allow for an evidence-based and patient-centred decision-making process for managing periodontitis patients who require orthodontics as part of their interdisciplinary care. Orthodontic management, including types of appliances, movement, use of adjuncts and timing are discussed. Management of periodontitis relapse, as well as the importance of successful maintenance and retention, are also highlighted.
CPD/Clinical Relevance: Severe periodontitis can result in pathological migration of teeth that may benefit from orthodontic therapy.
Article
Periodontitis is characterized by the progressive destruction of the periodontium and severe periodontitis may lead to disability due to impaired chewing function and aesthetics, significantly impacting quality of life.1
Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc), which require additional interventions following the completion of active periodontal therapy.
The recently published clinical practice guideline for the treatment of stage IV periodontitis provides evidence-based recommendations for the treatment of periodontitis patients,2 defined according to the 2018 classification.3 It provides guidance on the necessary interdisciplinary therapy, including orthodontics, required to rehabilitate the compromised dentition in such patients.
Stage IV periodontitis cases may present with great phenotypic variation based on the individual patterns of their periodontal breakdown, number of missing teeth, inter-maxillary relationships and residual alveolar ridge, which will result in different degrees of functional and aesthetic compromise, as well as different treatment needs. When providing recommendations on orthodontic management, the guidance2 focuses on case type 2, defined by the patient with pathological tooth migration, characterized by tooth elongation, drifting and flaring, which is amenable to orthodontic correction. Table 1 summarizes the four case types that are referred to in the main guidelines.2
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