Combined orthodontic-periodontal treatment in periodontal patients with anteriorly displaced incisors

• An adult patient with bone loss was treated with a team approach.
• Orthodontic treatment and guided tissue regeneration improved the periodontal support.
• Changes in bone morphology were obtained with circumferential supracrestal fibrotomy.

IntroductionFlared and elongated incisors are associated with different types of periodontal bone defects, usually horizontal. Combined orthodontic-periodontal treatment is being used in periodontal patients with anterior displacement of the incisors. The purpose of this study was to investigate the changes in periodontal health and the shape of bone defects in the incisors after such combined treatment.MethodsFourteen adults were included in the study. In total, 56 elongated maxillary incisors with horizontal bone defects received orthodontic-periodontal treatment with circumferential supracrestal fibrotomy. To improve bone morphology, periodontal regenerative surgery and guided tissue regeneration were performed on the anterior teeth with angular bone defects after orthodontic treatment. Cone-beam computed tomography scans were taken before treatment (T0), at the end of the orthodontic intrusion (T1), and 6 months after the guided tissue regeneration surgery (T2). Probing pocket depth and clinical attachment loss were examined at T0, T1, and T2. The data were analyzed using paired t tests.ResultsFrom T0 to T1, clinical attachment loss decreased significantly by 0.29 mm (P <0.05). The distance from the cementoenamel junction to the marginal bone crest decreased by 0.66 mm (P <0.05). The labial side of alveolar bone thickness increased by 0.54 mm (P <0.05), and the lingual side of alveolar bone thickness decreased by 0.46 mm (P <0.05). The shape of the bone defect was changed from horizontal to vertical on some teeth. From T1 to T2, both probing pocket depth and clinical attachment loss improved significantly, and the radiographic examinations showed bone redepositions of 2.15 ± 0.68 mm (P <0.05) vertically and 1.44 ± 0.92 mm (P <0.05) horizontally. The distance from the most apical point of the bone defect to the cementoenamel junction after combined treatment decreased by 2.11 ± 1.30 mm (P <0.05).ConclusionsCombined orthodontic-periodontal treatment improved the periodontal conditions of the defective bone sites. Bone morphology, altered by orthodontic intrusion with fibrotomy, can improve the results of subsequent guided tissue regeneration.