Orthodontical Management of Secondary Dental Migration Associated with a Reduced Periodontium: A Case Report

Abstract

Introduction: Dental migrations following periodontal pathology may lead to significant aesthetic and functional complaints. In this case report, the presence of evident gingival recessions and mandibular crowding pushed us to opt for an ortho-periodontal multidisciplinary treatment plan, using extractions and incisive repositioning. Through this, we ensured tissue gain at the level of the superficial and deep periodontitis, thus avoiding the use of periodontal surgery.Clinical Case: A Moroccan 26-years-old female medical secretary who, being very concerned about her appearance and facial aesthetics, presented with pathological dental migrations following severe periodontitis, an unsatisfactory periodontal status, a clear mandibular crowding of the anterior inter-incisive diastemas, gingival recessions, attachment losses and quite large pocket depths with advanced bone resorptions in different areas. This required a specific multidisciplinary approach aiming at creating a healthy and well-structured periodontal environment through extensive periodontal treatment, combined with regular plaque control, and supplemented by an orthodontic treatment using extractions and incisive repositioning in order to avoid any vestibular movement that may worsen the recessions and will require possible overlapping. After 22 months of combined treatment, a stable occlusion was obtained with class I molar and canine relationship, perfect dental alignment, healthy periodontal architecture and significant attachment gain and bone growth. In addition, the patient’s facial aesthetics and self-confidence have been significantly improved. Conclusion: The orthodontic treatment supplementing the meticulously planned periodontal therapy that was administered for this patient has helped to improve functionality, facial aesthetics as well as psychological self-confidence. However, it must be gradual with application of mild forces and constant control of the periodontal status, for optimal tissue response.

Microbiological and Periodontal Status of Patients Enduring Orthodontic Treatment

“…Plaque management must be stressed as the key to maintaining periodontal health in patients receiving orthodontic treatment. Plaque removal from the tooth and gingival surfaces is made more difficult by orthodontic appliances 23 . Plaque and the patient may coexist in harmony in the oral environment.…”