The adult orthodontic patient over 40 years of age: association between periodontal bone loss, incisor irregularity, and increased orthodontic treatment need

Abstract

Objectives: Adult orthodontic treatment, especially in patients over 40 years, is steadily increasing. One causal factor for the treatment need in this age group is periodontal breakdown. The aim of this study was to detect correlations between periodontal problems and orthodontic parameters in interdisciplinary patients.

Methods: This observational, cross-sectional study included 118 patients over 40 years (51 men/67 women; mean age, 58.03 years) classified into three groups according to periodontal breakdown (group I, controls; group II, moderate periodontitis; group III, severe periodontitis). Clinical periodontal and orthodontic parameters as well as the index of orthodontic treatment need (IOTN) were assessed and compared between the groups.

Results: A gradual deterioration of all periodontal and orthodontic parameters according to periodontal bone loss (lowest values in group I; highest values in group III) was observed. Especially groups I and III differed significantly regarding the overjet (p < 0.001) and the little indices of the maxilla (p < 0.001) and mandible (p < 0.010). The IOTN was highest in group III: 90% of the patients with severe periodontitis were classified to have moderate to very great treatment need.

Conclusions: The higher the degree of periodontal breakdown was, the more severe were overjet, overbite, irregularity of the anterior teeth, and the orthodontic treatment need.

Clinical relevance: Adult patients over 40 years represent a challenge for an orthodontic/periodontal treatment approach with high incidence of pathologic tooth migration, orthodontic treatment need, and periodontal breakdown. Therefore, this special patient collective requires a focus in clinical orthodontics and research.

Keywords: Adult; Bone loss; Orthodontics; Periodontics; Treatment need.

Fig. 1

Three-dimensional digital dental cast of the three analyzed groups classified according to their periodontal bone loss. a Group I: control group—neither moderate nor severe periodontitis. b Group II: moderate periodontitis—≥ 2 interproximal sites with CAL ≥ 4mm or PD ≥ 5mm. c Group III: severe periodontitis—≥ 2 interproximal sites with CAL ≥ 6mm and ≥ 1interproximal site with PD ≥ 5mm. From a to c, the overjet, the severity of malocclusion, incisor irregularity, and orthodontic treatment need increase