PERIODONTIC

ORTHODONTICS
INTERRELATIONSHIPS
ERNIE MADURATNA
SETIAWATI

Prevalence of Periodontal pockets and

inadequate attached gingiva as a
function of age

Proffit, William R.. Contemporary

Orthodontics,4th Edition. Mosby, 122006

Interdisciplinary dentofacial therapy

(IDT): 80% of adult patients require

involvement of more than one dental
specialty provider to accomplish
treatment objectives.

PERIODONTAL TREATMENT

ORTHODONTIC TREATMENT

ADULT PATIENT

Effects of reduced periodontal support

Loss of alveolar bone

Need lighter forces and relatively larger
moments
Periodontal evaluation
Periodontal treatment

SEQUENCE OF PERIODONTAL TREATMENT

PHASES
PHASE 1
REEVALUATION
PHASE IV / MAINTENANCE

PHASE II SURGERY

PHASE 3 RESTORATIVE

PERAWATAN TAHAP 1

SCALING , ROOT PLANING

RESTORATIF/PROSTHODONTIC
CORRECTION
TOPICAL ANTIBIOTICS / SISTEMIC
CARIES TREATMENT
OCCLUSAL ADJUSTMENT
MINOR ORTHODONTIC MOVEMENT
PROVISIONAL SPLINT & PROTHESIS

PERIODONTAL SURGERY

Micro implants for periodontally compromised patients

World J Orthod 2009;10:350360.
Gradual intrusion of the maxillary and mandibular anterior teeth
was achieved with a relatively simple orthodontic force system. A
significant profile improvement was observed during the 18
months of treatment due to the retraction and intrusion of the
incisors in both arches. This intrusion was accomplished without
any sign of apical root resorption. The mandibular incisors were
uprighted 6.5 degrees, and their maxillary counterparts were
uprighted 13.4 degrees. The 2-year follow-up examination
revealed a stable result with an increase in periodontal attachment
as well as esthetics and function. Conclusion: A combined
orthodontic, periodontic, and restorative treatment approach with
adequate patient motivation can lead to improved masticatory
function, esthetics, and periodontal conditions

MAINTENANCE PHASE

STOP RECOLONIZATION
PREVENT RECURRENCE OF THE DISEASE
IN ADEQUATE SPT 50 FOLD INCREASE
RISK OF PROBING ATTACHMENT LOSS
MOTIVATIONAL & REINFORCEMENT
LONG TERM PREVENTION PROGRAM

STRATEGI PERAWATAN PERIODONTITIS

MODIFIKASI FAKTOR RESIKO

MENURUNKAN BAKTERI
BEST
THERAPY

HOST MODULATION
THERAPY

Preorthodontic Gingival Surgery

Gingival
Teeth

grafting

with less than 2 mm of attached gingiva

Gingival

Recession and Root Coverage

Connective

tissue grafts
Placed based on esthetics, tooth sensitivity,
depth of erosion in the root, presence of
composite gingival restoration

Postorthodontic Periodontal
treatment
3

month periodontal maintenance

New set of periapical radiographs and
periodontal re-examination after 6 months
Occlusal

adjustments to fine-tune occlusion

Nightguard (maxillary nightguard may serve as
retainer)
Restorative treatment after periodontal stability
is achieved

Orthodontic elimination of gingival

pockets caused by dental crowding

Orthodontics as an aid in correcting

biologic width violations

Leveling of gingiva by extrusion of

lateral incisors

Orthodontics as an aid in improving

implant sites

External and internal

resorption on the labial
of mandibular left lateral
incisor
Tooth was extruded 7
mm to create adequate
hard and soft tissue for
implant placement

The use of implant supported

anchorage

Patient presented with anterior open

bite and pathological flaring of
maxillary teeth
Endosseous implants in molar
regions were used as anchorage to
retract the maxillary teeth
Anterior distorted alveolar
architecture can be reengineered
with periodontically accelerated
osteogenic orthodontic
augmentation (PAOO) surgery to
produce regional acceleratory
phenomenon (RAP)
Results in a vast increase in
osteoblast and osteoclast activity
and a softening of the healing
alveolus bone

Conclusion

Before any orthodontic treatment an initial

diagnosis and referral for treatment to
control active periodontal disease is to be
considered.

treatment should be completed before the

orthodontic treatment

Clinical effects of periodontal tissue

from orthodontic tooth movement

Gingival inflammation
Gingival recession
Gingival hyperplasia
loss of attachment
( Sanders et al., 1999)

Gingival inflammation

Mechanical irritation caused by band and cement

Patients inability to clean promotes plaque accumulation
Increase in Lactobacillus and P. intermedia
Decrease in facultative anaerobes

GINGIVAL RECESSION

Loss of attachment

Gingival hyperplasia

( Kouraki et al.,2005 )

Conclusions

Interdisciplinary collaboration often offers the

best treatment for patients
Such sophisticated treatment requires
excellent communication and coordination.

Thank you