Patients with periodontal disease often require periodontal-orthodontic combined intervention to restore periodontal health, function and aesthetics, thereby ensuring patient satisfaction and long-term stability. Management of orthodontic tooth movement is particularly challenging due to damage to periodontal soft and hard tissues, especially in severe cases.
Therefore, close collaboration between orthodontists and periodontists, comprehensive diagnosis and sequential treatment, and ensuring patient compliance throughout the process are essential for achieving good treatment outcomes. In addition, long-term orthodontic retention and periodontal follow-up are essential for maintaining treatment success.
Based on the latest clinical research and practical experience, this expert consensus explores the clinical considerations for orthodontic treatment of periodontal patients, and explains the indications, goals, procedures and principles, aiming to provide clinicians with clear and practical guidance.
Periodontal disease is a common chronic inflammatory disease that affects tooth-supporting tissues (gingiva, alveolar bone and periodontal ligament), mainly manifested as gingivitis and periodontitis. Gingivitis is characterized by reversible inflammation of the gingiva, which can occur at any age, resulting in gingival swelling and bleeding on probing (BOP). Periodontitis involves progressive destruction of periodontal tissues and affects more than half of all adults.
The main symptoms of periodontitis include gingival bleeding and inflammation, periodontal pocket formation, alveolar bone resorption, and loose and displaced teeth. Progressive destruction of periodontal tissues can lead to tooth displacement and eversion, secondary occlusal trauma, occlusal collapse, and ultimately tooth loss, impairing masticatory function, aesthetics, and quality of life.
The population seeking orthodontic treatment is mainly children and adolescents. In recent years, the growing interest in dental aesthetics, coupled with the increasing prevalence of periodontitis and its associated secondary malocclusions, has led to a growing demand for orthodontic intervention in adults.
As a result, orthodontists now encounter more complex cases of adult periodontitis. This shift not only highlights the importance of periodontal therapy for periodontal health in orthodontic treatment, but also emphasizes the integration of orthodontic tooth movement into periodontal treatment to achieve a stable occlusion, especially in cases involving secondary malocclusions. This trend has promoted the development of a comprehensive periodontal-orthodontic treatment approach.
Periodontal-orthodontic combined treatment is to provide comprehensive orthodontic treatment for periodontal patients on the basis of effective periodontal treatment. Its core is to optimize tooth arrangement and adjust occlusal relationship by moving teeth, which is conducive to maintaining oral hygiene, improving occlusal function and enhancing aesthetics.
Recent systematic reviews have shown that the clinical efficacy of periodontitis patients receiving this comprehensive treatment has improved. In addition, long-term follow-up studies up to 10 years have also demonstrated the durability and stability of the treatment effect. Therefore, understanding the integration principles of orthodontics and periodontal management is crucial for clinicians to better serve these patients.
This expert consensus focuses on the clinical considerations of orthodontic treatment for patients with periodontal disease, and clarifies the indications, goals, steps and principles of treatment. This consensus integrates the latest clinical research and practical experience to provide comprehensive guidance for periodontal orthodontic treatment, aiming to optimize treatment effects and ensure the safety and effectiveness of treatment. We hope that this consensus can provide clinicians with a clear and practical reference framework to promote the standardization and consistency of orthodontic treatment for patients with periodontal disease.
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