Team work is the essence for the success of any venture. A multidisciplinary approach is often necessary to treat and prevent dental problems in a patient. Orthodontics and periodontics are interrelated in a variety of ways. Orthodontic treatment is based on the principle that if prolonged pressure is applied to a tooth, tooth movement will occur as the bone around the tooth remodels. Bone is selectively removed in same areas and added in others. In essence, the tooth moves through the bone carrying its attachment apparatus with it, as the socket of the tooth migrates. Since the bony response is mediated by the periodontal ligament, tooth movement is primarily a periodontal ligament phenomenon.
Orthodontic tooth movement, which is the basis of the orthodontic treatment, is possible because of the inherent nature of the periodontium. Many advances have been made in understanding the mechanisms involved in the process of tooth movement. However, there are many pathologic conditions affecting the periodontium which may affect these mechanisms of tooth movement and alter the end result of the orthodontic treatment. Similarly awareness of the pathologic changes or other undesirable changes which can occur in the periodontium as a result of ideal or less than ideal orthodontic procedures would help in better treatment procedure and management of the patients. Altered tooth position may affect periodontal health. Placement of orthodontic appliances causes microbiological changes as well as changes in the periodontium. With the success, in the recent decades of the fixed multi banded appliance, orthodontic treatment in adults has continuously grown in the United States and Europe. It is in connection with adult orthodontics that periodontal factors are becoming more important to the orthodontist.
Orthodontics in the adult patient, specially the periodontally compromised patient requires adequate periodontal considerations to maintain the periodontium in a healthy condition during and after treatment. Minor periodontal surgery may be required to prevent relapse after orthodontic treatment. In addition, since periodontal diseases can secondarily cause malocclusion, very often orthodontic treatment would be an essential adjunct if the periodontal therapy is to succeed.
Table of Contents
1. INTRODUCTION
2. THE BIOLOGIC BASIS OF ORTHODONTIC THERAPY
2.1 Periodontal and bone response to normal function
2.2 Periodontal ligament and bone response to sustained orthodontic force
2.2.1 Biologic control of tooth movement
2.2.2 Biologic electricity
2.2.3 Pressure tension theory
2.2.4 Effect of force magnitude
2.3 Physiologic response to sustained pressure against a tooth
3. GINGIVAL RESPONSE TO ORTHODONTIC FORCE
3.1 Effect of force
3.1.1 Clinical observations
3.1.2 Histologic findings
3.1.3 Ultrastructural analysis
3.1.4 Molecular analysis
3.1.5 Changes in the phenotype of gingival fibroblast and tooth relapse
3.1.6 Effect on root structure
4. RELATIONSHIP BETWEEN ALTERED TOOTH POISTION AND PERIODONTAL HEALTH AND DISEASE
5. EFFECT OF ORTHODONTIC TREATMENT ON THE HEIGHT OF ALVEOLAR BONE
6. ORTHODONICS AND PERIODONTAL PROPHYLAXIS
7. PERIODONTAL ASPECTS OFADULT ORTHODONTIC TREATMENT
7.1 Minimal periodontal involvement
7.2 Moderate periodontal involvement
7.3 Severe periodontal involvement
7.4 Types of orthodontic appliances
7.5 Tissue response to certain types of tooth movement
8. INTERRELATIONSHIP OF ORTHODONTIC TOOTH MOVEMENT WITH PERIODONTAL HEALTH
8.1 Loss Of Periodontal Attachment And Bone Relative To Orthodontic Therapy
8.2 Gingival recession relative to orthodontic therapy
8.3 Interdental recession
8.4 Gingival hyperplasia relative to orthodontic therapy
8.5 Mucogingival considerations
9. ORTHODONTIC TREATMENT AS A PART OF PERIODONTAL THERAPY
10. PERIODONTAL CONSIDERATIONS IN AN ORTHODONTIC PAIENT
Research Objectives & Key Themes
The primary objective of this work is to explore the complex interrelationships between orthodontic treatment and periodontal health. It examines how orthodontic procedures can influence periodontal structures, the mechanisms of tooth movement, and strategies for managing patients with varying levels of periodontal compromise to achieve optimal therapeutic results.
- Biologic mechanisms of orthodontic tooth movement and bone remodeling.
- Gingival tissue responses to mechanical orthodontic forces.
- Management strategies for periodontal health in adult orthodontic patients.
- Interdisciplinary cooperation between periodontists and orthodontists.
- The impact of orthodontic intervention on alveolar bone height and periodontal defects.
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THE BIOLOGIC BASIS OF ORTHODONTIC THERAPY
Orthodontic treatment is based on the principle that if prolonged pressure is applied to a tooth, tooth movement will occur as the bone around the tooth remodels. Bone is selectively removed in same areas and added in others. In essence, the tooth moves through the bone carrying its attachment apparatus with it, as the socket of the tooth migrates. Since the bony response is mediated by the periodontal ligament, tooth movement is primarily a periodontal ligament phenomenon.
Forces applied to the teeth can also affect the pattern of bone apposition and resorption at sites distant from the teeth, particularly the sutures of the maxilla and bony surfaces on both sides of the temporomandibular joint. Thus, the biologic response to orthodontic therapy includes not only the response of the periodontal ligament but also the response of growing areas distant from the dentition.
PERIODONTAL AND BONE RESPONSE TO NORMAL FUNCTION
Each tooth is attached to and separated from the adjacent alveolar bone by a heavy collagenous supporting structure, the periodontal ligament (PDL). Under normal circumstances, the PDL occupies a space approximately 0.5 mm in width around all parts of the root. Major component of this PDL is collagen fibers, inserting in to cementum of the root on one side and the in to the bony plate of lamina dura, on the other side. These fibers run at an angle, attaching further apically on the tooth than on the adjacent alveolar bone. This arrangement resists the displacement of the tooth expected during normal function.
There are two major components of PDL other than collagen fibers which must be considered. These are:- 1) The cellular elements, including mesenchymal cells of various types along with vascular and neural elements; and 2) The tissue fluids. Both play an important role in normal function and in making orthodontic movement possible.
Summary of Chapters
1. INTRODUCTION: An overview of the multidisciplinary nature of dental care, highlighting the fundamental reliance of orthodontic tooth movement on the health and biology of the periodontium.
2. THE BIOLOGIC BASIS OF ORTHODONTIC THERAPY: This chapter details the physiologic and mechanical responses of the periodontal ligament and bone to sustained forces, explaining control mechanisms like the pressure-tension theory.
3. GINGIVAL RESPONSE TO ORTHODONTIC FORCE: Examines clinical, histologic, and molecular changes in gingival tissues due to orthodontic forces, including implications for tooth relapse and root structure.
4. RELATIONSHIP BETWEEN ALTERED TOOTH POISTION AND PERIODONTAL HEALTH AND DISEASE: Discusses the association between occlusal form, malocclusion, and periodontal status, noting that evidence for a direct causal link is often contradictory.
5. EFFECT OF ORTHODONTIC TREATMENT ON THE HEIGHT OF ALVEOLAR BONE: Explores how specific orthodontic movements, such as extrusion or intrusion, can be used to modify bony topography and address periodontal defects.
6. ORTHODONICS AND PERIODONTAL PROPHYLAXIS: Emphasizes the necessity of achieving optimal periodontal health through inflammation reduction and plaque control prior to initiating orthodontic therapy.
7. PERIODONTAL ASPECTS OFADULT ORTHODONTIC TREATMENT: Focuses on the management of adult patients, addressing the specific challenges posed by pre-existing periodontal conditions and the importance of tailored appliance design.
8. INTERRELATIONSHIP OF ORTHODONTIC TOOTH MOVEMENT WITH PERIODONTAL HEALTH: Analyzes the clinical effects of orthodontic therapy on attachment levels, gingival recession, and interdental aesthetics.
9. ORTHODONTIC TREATMENT AS A PART OF PERIODONTAL THERAPY: Outlines the rationale and indications for utilizing orthodontic techniques to facilitate improved periodontal outcomes, such as better crown-to-root ratios and plaque control.
10. PERIODONTAL CONSIDERATIONS IN AN ORTHODONTIC PAIENT: Synthesizes the clinical considerations for maintaining periodontal health throughout orthodontic treatment, stressing the role of long-term retention and hygiene.
Keywords
Orthodontics, Periodontics, Periodontal Ligament, Alveolar Bone, Tooth Movement, Gingival Recession, Periodontal Disease, Occlusion, Malocclusion, Periodontal Therapy, Plaque Control, Gingival Hyperplasia, Bone Remodeling, Fiberotomy, Adult Orthodontics.
Frequently Asked Questions
What is the core focus of this publication?
This work provides an in-depth exploration of the interdisciplinary relationship between orthodontics and periodontics, specifically focusing on how orthodontic treatment affects periodontal tissues and how these can be managed for health.
What are the primary thematic areas covered?
The text covers the biology of tooth movement, gingival responses to force, the management of adult patients with periodontal compromise, and the use of orthodontic mechanics to improve periodontal health and bone levels.
What is the primary goal of the study?
The goal is to analyze the orthodontic-periodontal interrelationship to help clinicians achieve optimal, stable results for patients, particularly those with pre-existing periodontal destruction.
Which scientific methods are analyzed?
The work reviews clinical observations, longitudinal studies, histologic analysis, ultrastructural research, and molecular studies regarding collagen synthesis and gene transcription in response to orthodontic forces.
What is covered in the main body of the text?
The main body systematically examines the biologic mechanisms of tooth movement, gingival and bone responses, the management of mucogingival issues, and the use of specialized techniques like extrusion and intrusion.
Which keywords characterize this work?
Key terms include orthodontics, periodontics, periodontal ligament, alveolar bone, tooth movement, gingival recession, periodontal disease, and periodontal therapy.
How does orthodontic force affect alveolar bone height?
Orthodontic forces can modify bone height; extrusive movement can bring alveolar bone with the tooth, while intrusion may result in loss of crestal bone height depending on the clinical scenario.
What is the role of fiberotomy in orthodontic treatment?
Fiberotomy is a surgical procedure used to sever supracrestal fibers to prevent or alleviate rotational relapse of teeth after orthodontic correction.
Why is interdisciplinary cooperation important in adult orthodontics?
It is essential because adult patients often present with complex periodontal conditions where orthodontic treatment must be carefully planned to prevent further destruction and to enhance the long-term prognosis of the dentition.
- Citation du texte
- vinita boloor (Auteur), 2004, Orthodontic-periodontic Interrelationship, Munich, GRIN Verlag, https://www.grin.com/document/215839
