Expert consensus on orthodontic treatment of patients with periodontal disease

Abstract

Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health, function, and aesthetics, ensuring both patient satisfaction and long-term stability. Managing these patients involving orthodontic tooth movement can be particularly challenging due to compromised periodontal soft and hard tissues, especially in severe cases. Therefore, close collaboration between orthodontists and periodontists for comprehensive diagnosis and sequential treatment, along with diligent patient compliance throughout the entire process, is crucial for achieving favorable treatment outcomes. Moreover, long-term orthodontic retention and periodontal follow-up are essential to sustain treatment success. This expert consensus, informed by the latest clinical research and practical experience, addresses clinical considerations for orthodontic treatment of periodontal patients, delineating indications, objectives, procedures, and principles with the aim of providing clear and practical guidance for clinical practitioners.

Fig. 1

Flowchart illustrating the integration of orthodontic treatment into periodontal management for patients with periodontal disease (modified version; originally sourced from Papageorgiou et al. ). Perio-ortho, Periodontal-orthodontic; BOP, bleeding on probing; PPD, probing pocket depth; CAL, clinical attachment loss; RBL, radiographic bone loss; SPC, supportive periodontal care

Fig. 2

A 27-year-old male patient with traumatic occlusion. a Pathological tooth migration of the anterior maxillary teeth due to the loss of periodontal support is complicated by deepened overjet and overbite, spacing, and extrusion of maxillary incisors. b Radiographic image shows severe generalized horizontal bone loss with infrabony defects and furcation involvements

Fig. 3

Schematic illustration showing the effect of a force when applied to the bracket of a tooth with either an intact or reduced periodontium

Fig. 4

Treatment of a 38-year-old periodontally compromised female using the fixed appliance and TADs. a Pretreatment intraoral and facial view, panoramic radiograph, and lateral cephalogram. b, c After periodontal inflammation control, non-extraction orthodontic treatment with TADs was applied to achieve anterior teeth intrusion and retraction. d Posttreatment intraoral and facial view, panoramic radiograph, and lateral cephalogram. Positive functional and esthetic results were achieved

Fig. 5

Treatment of a 34-year-old periodontally compromised female patient. a Pretreatment intraoral view, facial profile, and panoramic radiograph. The edge-to-edge bite, a full unit Class III molar relationship on the left side, and severe bone loss are evident. b The treatment goal is to eliminate occlusal trauma and improve occlusal contact, without excessively emphasizing on correcting the facial profile or molar relationships. Therefore, tooth 42, with the poorest periodontal condition, was selected for extraction. The first molars were strategically left unbonded to preserve their position and facilitate oral hygiene. c Lingual buttons were bonded on the mandibular first molars to close residual spaces. d Posttreatment intraoral view

Fig. 6

Utility of 3D-printed lingual retainer in an orthodontic patient with controlled periodontitis. a–c Digital design a and photographs of the 3D-printed mandibular lingual retainer with smooth lingual surface b and mesh base for bonding c. d Intraoral view of the retainer bonded to teeth 34–44