Australasian Dentist Magazine Sept-Oct 2021

Category Australasian Dentist 57 treatment. With labial movement, incisors showed apical displacement of the gingival margin and loss of connective tissue occurred in regions of inflammation. High frenal attachment: One of the causes for midline diastema. The abnormal frenum prevents mesial migration of the central incisor and the aberrant fibrous tissue increases the relapse tendency after orthodontic space closure. Surgical removal of the frenum is advised and it should be performed close to the completion of orthodontic treatment unless the frenum prevents space closure or becomes painful or traumatized. Forced eruption of an impacted tooth: Proper exposure of the labially or palatally impacted tooth and preservation of the keratinized tissue are important to avoid loss of attachment after orthodontic treatment. Apically or laterally positioned pedicle graft is usually advised in this situation. plaque-infected teeth may lead to apical displacement of supragingival plaque, which results in periodontal destruction. Professional supragingival and subgingival scalings are important during the active phase of intrusion. Hemiseptal Defects: These are one or two-wall osseous defects often found around mesially tipped teeth or teeth that have supererupted. Can be eliminated by uprighting, extrusion and leveling of the bone defect in case of tipped teeth. In case of supraerupted teeth with osseous defect, intrusion and leveling of the bone defect eliminate these problems. Bodily movement of the tooth into an intrabony defect has been believed to “carry the bone,” along with the tooth resulting in improvement of the defect. Also to improve adjacent tooth position before placement of implant or tooth replacement. Initially, the hemiseptal defect has a greater sulcular depth and is more difficult for the patient to clean. As the defect is improved, the patient should be recalled every 2 to 3 months during the levelling process to control inflammation in the interproximal region. topography of the interproximal alveolar crest level and enhance the position of the interdental papilla. Orthodontic treatment is justified as a part of periodontal therapy if used to reduce plaque accumulation, correct abnormal gingival and osseous forms, improve aesthetics, and facilitate prosthetic replacement. Vertical repositioning of teeth by an orthodontic therapy can improvise certain osseous defects in periodontal patient and also to correct uneven gingival marginal discrepancies, and significant abrasion or overerupted tooth. 3. Periodontal treatment as an adjunct to orthodontic therapy It is an initial phase of periodontal therapy where periodontal infection is controlled by oral hygiene instruction, professional plaque control and root planing. Initial periodontal debridement is done by non- surgical, subgingival root instrumentation to minimize the inflammation and to repair the tissue which is aimed for gingival health improvement. This stage of periodontal treatment is usually of about 3-month duration. Width of the attached gingiva: Insufficient width predisposes the development of recession. To maintain proper gingival health, a 2-mm width of keratinized gingiva is adequate to allow appliances to deliver orthodontic treatment without causing periodontal complications. Tension on the gingival margin during orthodontic force application also results in gingival recession. Thickness of cortical plate and type of load distribution affect gingival recession. Thin tissue and thin cortical plate are more prone to gingival recession compared to normal or thick tissue. More commonly in lower anteriors. Tipping movement is one of the types of force causing gingival recession. Free gingival graft can be planned in thin areas as a preventive measure. clinical Inadequate attached gingiva Soft tissue graft placed before orthodontic treatment Apically positioned partial-thickness pedicle graft was placed on the cervical area of the anatomic crown Figure 2 Orthodontic improvement of a Hemiseptal Osseous defect Advanced Horizontal Bone Loss: The bone level which has receded several millimetres from the CEJ, leads to less favourable crown-to-root ratio thereby creating discrepancies in the periodontium. Aligning the crowns of the teeth using the bone level as a guide to position the brackets on the teeth instead of marginal ridges/incisal ridges creates a more favourable crown-root ratio, minimizing the bone loss. Disregarding the bone levels leads to less equilibration of crown to root ratio, worsening the bone loss causing tooth mobility. This stage may require periodontal surgery to ameliorate the discrepancies. Black triangles: Missing interdental papilla are referred to as gingival “black holes” and may be due to over-divergence of adjacent roots and advanced periodontal disease with loss interdental alveolar crest and other factors. Orthodontic teeth approximation might change the Figure 3 Improvement in gingivae with soft tissue graft Proclination of the incisors: Have a greater risk of recession and loss of attachment, especially in areas with minimal gingiva and bone support. To maintain adequate width of the attached gingiva, mucogingival surgery may be advised during the course of orthodontic Figure 4 apically repositioned flap a. Pre-Orthodontic osseous surgery Flared incisors, crowded teeth andmesially inclined molars creates isolated infrabony areas that serve as sites for formation of periodontal pockets and infrabony defects. Osseous craters: It is an interproximal, two-wall defect composed of the facial and lingual cortical plate. Large craters require resective osseous surgery, which involves reshaping of the defect and reducing the pocket depth that enhances the ability to maintain these areas during orthodontic treatment. Shallow craters (4 to 5 mm pocket) may be maintained non-surgically during orthodontic treatment.