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. 2021 Dec 17;26(6):e21bbo6.
doi: 10.1590/2177-6709.26.6.e21bbo6. eCollection 2021.

Orthodontic treatment in the presence of aggressive periodontitis

Alexandre Trindade Simões da Motta  1   2
Affiliations

Orthodontic treatment in the presence of aggressive periodontitis

Alexandre Trindade Simões da Motta. Dental Press J Orthod. .

Abstract
in English, Portuguese

Introduction: Aggressive periodontitis causes periodontal destruction, with loss of supporting alveolar bone. The common symptom is rapid attachment loss in the first molar and incisor area, in young adults.

Objective: The aim of this study was to discuss the challenges, implications and the impact of orthodontic treatment in patients affected by severe periodontal problems, specifically aggressive periodontitis.

Discussion: In addition to other bacteria, the main pathogen involved in aggressive periodontitis is the Aggregatibacter actinomycetemcomitans. However, the susceptibility to the disease differs among individuals, being immune deficiencies the main reason for this variability. Many orthodontists are not comfortable about performing treatments on individuals with aggressive periodontitis.

Conclusion: Orthodontic treatment is feasible in young patients with severe and localized aggressive periodontitis, as long as the limitations imposed by the disease are respected. An interdisciplinary approach is required, with frequent periodontal follow-up before, during and after orthodontic treatment, allowing the correction of dental positions without aggravating bone loss.

Introdução:: A periodontite agressiva causa destruição periodontal, com perda do osso alveolar de suporte. O sintoma mais comum é a rápida perda de inserção na área de primeiros molares e incisivos, em adultos jovens.

Objetivo:: O objetivo do presente trabalho foi discutir os desafios, as implicações e os impactos do tratamento ortodôntico em pacientes acometidos por problemas periodontais graves, especificamente a periodontite agressiva.

Discussão:: Apesar da presença de outras bactérias, o principal patógeno envolvido na periodontite agressiva é o Aggregatibacter actinomycetemcomitans. Entretanto, a suscetibilidade da doença difere entre os indivíduos, sendo as deficiências imunológicas o principal motivo dessa variabilidade. Muitos ortodontistas não se sentem confortáveis em realizar tratamentos em indivíduos com periodontite agressiva.

Conclusão:: O tratamento ortodôntico é possível em pacientes jovens com periodontite agressiva severa e localizada, desde que se respeite as limitações impostas pela doença. Uma abordagem multidisciplinar é fundamental, com acompanhamento periodontal frequente antes, durante e depois do tratamento ortodôntico, permitindo a correção dos posicionamentos dentários sem agravar a perda óssea.

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Conflict of interest statement

The authors report no commercial, proprietary or financial interest in the products or companies described in this article.

Figures

Figure 1:
Figure 1:. Pretreatment extraoral and intraoral photographs.
Figure 2:
Figure 2:. Pretreatment panoramic radiograph.
Figure 3:
Figure 3:. Pretreatment lateral cephalometric radiograph (A) and cephalometric tracing (B).
Figure 4:
Figure 4:. Maxillary arch occlusal views during maxillary expansion: A) placement of Hyrax expander; B) completion of screw activation.
Figure 5:
Figure 5:. Maxillary right canine crossbite correction: Frontal (A) and right lateral(B) views of canine crossbite at the end of maxillary expansion. C) Frontal open mouth view of intermaxillary elastic in position. Frontal and right lateral views after 1 month (D, E) and 2 months (F, G) of cross elastics mechanics.
Figure 6:
Figure 6:. Alignment and leveling stage, and distalization of maxillary right canine with archwire bypassing maxillary incisors.
Figure 7:
Figure 7:. After bone graft in maxillary right central incisor region. Alignment of rotated maxillary second molars with Twist-flex double-archwire mechanics.
Figure 8:
Figure 8:. After placement of implant and temporary crown on maxillary right central incisor. Double-archwire mechanics aligning maxillary second molars. Auxiliary mechanics with button and chain elastic, to improve position of the maxillary right second molar.
Figure 9:
Figure 9:. Post-treatment extraoral and intraoral photographs.
Figure 10:
Figure 10:. Post-treatment panoramic radiograph.
Figure 11:
Figure 11:. Post-treatment periapical radiographs.
Figure 12:
Figure 12:. Post-treatment lateral cephalometric radiograph (A) and cephalometric tracing (B).
Figure 13:
Figure 13:. Total (A) and partial (B) superimpositions of the initial ( black ) and final ( red ) cephalometric tracings
See this image and copyright information in PMC

References

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