Periodontal considerations during orthodontic intrusion and extrusion in healthy and reduced periodontium.

healthy periodontium interdisciplinary treatment orthodontic extrusion orthodontic intrusion orthodontic treatment periodontal disease reduced periodontium

Journal

Periodontology 2000
ISSN: 1600-0757
Titre abrégé: Periodontol 2000
Pays: Denmark
ID NLM: 9313276

Informations de publication

Date de publication:
03 Jun 2024
Historique:
revised: 30 04 2024
received: 17 10 2023
accepted: 13 05 2024
medline: 4 6 2024
pubmed: 4 6 2024
entrez: 4 6 2024
Statut: aheadofprint

Résumé

In patients with advanced periodontal disease, pathological tooth migration may occur, which may require subsequent orthodontic treatment for both aesthetic and functional purposes. When planning orthodontic treatment mechanics, intrusive or extrusive forces are frequently indicated. Understanding tissue reactions during these movements is essential for clinicians when devising a comprehensive orthodontic-periodontal treatment plan. This knowledge enables clinicians to be fully aware of and account for the potential effects on the surrounding tissues. The majority of our understanding regarding the behavior of periodontal tissues in both healthy and compromised periodontal conditions is derived from animal studies. These studies offer the advantage of conducting histological and other assessments that would not be feasible in human research. Human studies are nevertheless invaluable in being able to understand the clinically relevant response elicited by the periodontal tissues following orthodontic tooth movement. Animal and human data show that in dentitions with reduced periodontal support, orthodontic intrusion of the teeth does not induce periodontal damage, provided the periodontal tissues do not have inflammation and plaque control with excellent oral hygiene is maintained. On the contrary, when inflammation is not fully controlled, orthodontic intrusion may accelerate the progression of periodontal destruction, with bacterial plaque remnants being displaced subgingivally, leading to further loss of attachment. Orthodontic extrusion, on the other hand, does not seem to cause further periodontal breakdown in dentitions with reduced periodontal support, even in cases with deficient plaque control. This is attributed to the nature of the tooth movement, which directs any plaque remnants coronally (supragingivally), reducing the risk of adverse effects on the periodontal tissues. This specific type of tooth movement can be leveraged to benefit periodontal conditions by facilitating the regeneration of lost hard and soft periodontal tissues in a coronal direction. As a result, orthodontic extrusion can be employed in implant site development, offering an advantageous alternative to more invasive surgical procedures like bone grafting. Regardless of the tooth movement prescribed, when periodontal involvement is present, it is essential to prioritize periodontal therapy before commencing orthodontic treatment. Adequate plaque control is also imperative for successful outcomes. Additionally, utilizing light orthodontic forces is advisable to achieve efficient tooth movement while minimizing the risk of adverse effects, notably root resorption. By adhering to these principles, a more favorable and effective combined orthodontic-periodontal approach can be ensured. The present article describes indications, mechanisms, side effects, and histological and clinical evidence supporting orthodontic extrusion and intrusion in intact and reduced periodontal conditions.

Identifiants

pubmed: 38831560
doi: 10.1111/prd.12578
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024 The Author(s). Periodontology 2000 published by John Wiley & Sons Ltd.

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Auteurs

Gregory S Antonarakis (GS)

Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Zekeridou Alkisti (Z)

Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Kiliaridis Stavros (K)

Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland.

Giannopoulou Catherine (G)

Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Classifications MeSH