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Perio ortho
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PERIODONTIC – ORTHODONTICS
INTERRELATIONSHIPS
ERNIE MADURATNA SETIAWATI
Prevalence of Periodontal pockets and inadequate attached gingiva as a function of age
Proffit, William R.. Contemporary Orthodontics, 4th Edition. Mosby, 122006
Interdisciplinary dentofacial therapy
(IDT): 80% of adult patients require involvement of more than one dental specialty provider to accomplish treatment objectives.
PERIODONTAL TREATMENT
ORTHODONTIC TREATMENT
ADULT PATIENT
Effects of reduced periodontal support Loss of alveolar bone Need lighter forces and relatively larger
moments Periodontal evaluation Periodontal treatment
SEQUENCE OF PERIODONTAL TREATMENT PHASES
PHASE 1PHASE 1
REEVALUATIONREEVALUATION
PHASE IV / MAINTENANCEPHASE IV / MAINTENANCE
PHASE 3 RESTORATIVEPHASE 3 RESTORATIVEPHASE II SURGERYPHASE II SURGERY
PERAWATAN TAHAP 1
SCALING , ROOT PLANING RESTORATIF/PROSTHODONTIC
CORRECTION TOPICAL ANTIBIOTICS / SISTEMIC CARIES TREATMENT OCCLUSAL ADJUSTMENT MINOR ORTHODONTIC MOVEMENT PROVISIONAL SPLINT & PROTHESIS
PERIODONTAL SURGERY
Micro implants for periodontally compromised patientsWorld J Orthod 2009;10:350–360.
Gradual intrusion of the maxillary and mandibular anterior teeth was achieved with a relatively simple orthodontic force system. A significant profile improvement was observed during the 18 months of treatment due to the retraction and intrusion of the incisors in both arches. This intrusion was accomplished without any sign of apical root resorption. The mandibular incisors were uprighted 6.5 degrees, and their maxillary counterparts were uprighted 13.4 degrees. The 2-year follow-up examination revealed a stable result with an increase in periodontal attachment as well as esthetics and function. Conclusion: A combined orthodontic, periodontic, and restorative treatment approach with adequate patient motivation can lead to improved masticatory function, esthetics, and periodontal conditions
MAINTENANCE PHASE
STOP RECOLONIZATION PREVENT RECURRENCE OF THE DISEASE IN ADEQUATE SPT – 50 FOLD INCREASE
RISK OF PROBING ATTACHMENT LOSS MOTIVATIONAL & REINFORCEMENT LONG TERM PREVENTION PROGRAM
STRATEGI PERAWATAN PERIODONTITIS
MENURUNKAN BAKTERI MODIFIKASI FAKTOR RESIKOMODIFIKASI FAKTOR RESIKO
HOST MODULATIONHOST MODULATION THERAPYTHERAPY
BEST THERAPY
Preorthodontic Gingival SurgeryGingival grafting
Teeth with less than 2 mm of attached gingiva
Gingival Recession and Root CoverageConnective tissue graftsPlaced based on esthetics, tooth sensitivity,
depth of erosion in the root, presence of composite gingival restoration
Postorthodontic Periodontal treatment
3 month periodontal maintenance New set of periapical radiographs and
periodontal re-examination after 6 months
Occlusal adjustments to fine-tune occlusionNightguard (maxillary nightguard may serve as
retainer)Restorative treatment after periodontal stability
is achieved
Orthodontic elimination of gingival pockets caused by dental crowding
Orthodontics as an aid in correcting biologic width violations
Leveling of gingiva by extrusion of lateral incisors
Orthodontics as an aid in improving implant sites
External and internal resorption on the labial of mandibular left lateral incisor
Tooth was extruded 7 mm to create adequate hard and soft tissue for implant placement
The use of implant supported anchorage
Patient presented with anterior open bite and pathological flaring of maxillary teeth
Endosseous implants in molar regions were used as anchorage to retract the maxillary teeth
Anterior distorted alveolar architecture can be reengineered with periodontically accelerated osteogenic orthodontic augmentation (PAOO) surgery to produce regional acceleratory phenomenon (RAP)
Results in a vast increase in osteoblast and osteoclast activity and a “softening” of the healing alveolus bone
Conclusion
Before any orthodontic treatment an initial diagnosis and referral for treatment to control active periodontal disease is to be considered.
treatment should be completed before the orthodontic treatment
Clinical effects of periodontal tissue from orthodontic tooth movement
Gingival inflammation Gingival recession Gingival hyperplasia loss of attachment
( Sanders et al., 1999)
Gingival inflammation
Mechanical irritation caused by band and cement Patient’s inability to clean promotes plaque accumulation Increase in Lactobacillus and P. intermedia Decrease in facultative anaerobes
GINGIVAL RECESSION
Loss of attachment
Gingival hyperplasia
( Kouraki et al.,2005 )
Conclusions Interdisciplinary collaboration often offers the
best treatment for patients Such sophisticated treatment requires
excellent communication and coordination.
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