Tonetti MS, Jepsen S, Jin L, Otomo-Corgel J Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: a call for global action. J Clin Periodontol. 2017; 44:456-462
Herrera D, Sanz M, Kebschull M Treatment of stage IV periodontitis: the EFP S3 level clinical practice guideline. J Clin Periodontol. 2022; 49:4-71
Chapple ILC, Mealey BL, Van Dyke TE Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018; 45:S68-S77
West N, Chapple I, Claydon N BSP implementation of European S3-level evidence-based treatment guidelines for stage I–III periodontitis in UK clinical practice. J Dent. 2021; 106
Sanz M, Herrera D, Kebschull M Treatment of stage I–III periodontitis–the EFP S3 level clinical practice guideline. J Clin Periodontol. 2020; 47:4-60
Martin C, Celis B, Ambrosio N Effect of orthodontic therapy in periodontitis and non-periodontitis patients: a systematic review with meta-analysis. J Clin Periodontol. 2022; 49:72-101
Papageorgiou SN, Antonoglou GN, Michelogiannakis D Effect of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis: a systematic review with meta-analysis. J Clin Periodontol. 2022; 49:102-120
Kloukos D, Roccuzzo A, Stähli A Effect of combined periodontal and orthodontic treatment of tilted molars and of teeth with intra-bony and furcation defects in stage-IV periodontitis patients: a systematic review. J Clin Periodontol. 2022; 49:121-148
Eliades T, Katsaros C: Quintessence; 2019
Cattaneo PM, Dalstra M, Melsen B Moment-to-force ratio, center of rotation, and force level: a finite element study predicting their interdependency for simulated orthodontic loading regimens. Am J Orthod Dentofacial Orthop. 2008; 133:681-689
Nikolai RJPhiladelphia: Lea & Febiger; 1985
Verna C Biology of tooth movement. Biomechanics in Orthodontics.
Reitan K Evaluation of orthodontic forces as related to histologic and mechanical factors. SSO Schweiz Monatsschr Zahnheilkd. 1970; 80:579-596
Brudvik P, Rygh P Root resorption beneath the main hyalinized zone. Eur J Orthod. 1994; 16:249-263
Roscoe MG, Meira JB, Cattaneo PM Association of orthodontic force system and root resorption: a systematic review. Am J Orthod Dentofacial Orthop. 2015; 147:610-626
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Jiang C, Fan C, Yu X Comparison of the efficacy of different periodic periodontal scaling protocols for oral hygiene in adolescents with fixed orthodontic appliances: a prospective cohort study. Am J Orthod Dentofacial Orthop. 2021; 159:435-442
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The perio–ortho interface: latest guidelines

From Volume 51, Issue 5, May 2024 | Pages 353-359


Reena Wadia

BDS Hons (Lond) MJDF RCS (Eng) MClinDent (Perio) MPerio RCS (Edin) FHEA, BDS Hons, MJDF RCS (Eng), MClinDent (Perio), MPerioRCS (Edin), FHEA

StR in Periodontology at Guy's Hospital, Associate Dentist at Harley Street Dental Group and Woodford Dental Care

Articles by Reena Wadia

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Aliya Hasan


BDS, MJDF RCS(Eng), FHEA, Speciality Dentist in Oral Surgery, Birmingham Dental Hospital UK.

Articles by Aliya Hasan

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Philip M Preshaw

BDS, FDS RCS(Ed), FDS(RestDent) RCS(Ed), PhD, BDS, FDS RCS(Edin), Professor, FDS RCSEd, FDS (Rest Dent), RCSEd, FHEA

Professor of Periodontology, School of Dental Sciences and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK

Articles by Philip M Preshaw

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Ama Johal

BDS, PhD, FDS(Orth) RCS, BDS (Hons), MSc, PhD, FDS, MOrth RCS, DMS, FDS (Orth) RCS, FHEA

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

Articles by Ama Johal


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.


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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