Periodontium biotype modification prior to an orthodontic therapy: Case report

IntroductionThin periodontium is frequently characterized by osseous defects and dehiscence; moreover, it exhibits pathological changes like gingival recession when subjected to traumatic surgical insults or orthodontic force more than thick periodontium. Therefore, this case report aimed to validate the need for bio-modification of thin periodontium before an orthodontic treatment.Case descriptionA 30-year old female patient who had started on orthodontic treatment which was not completed because of hypermobility of the anterior teeth. Periodontal diagnosis revealed a localized chronic slight periodontitis and severe crowding in the anterior mandibular arch and ridge defects (Siebert class I) at the sites of missing maxillary lateral incisors. The patient was prepared for periodontal surgery by scaling and root planning. Periodontal surgery included frenectomy and simultaneous bone augmentation using GBR procedure which was done using 0.5 mg of BioOss® and 20 × 30 mm size/GBR membrane (AlloDerm®) then 625 mg Augmentin® TID and 400 Ibuprofen® TID, were prescribed for 7 days.ResultsThe patient responded well to the surgical treatment and neither bleeding pockets nor probing depth exceeding 4 mm was detected at the follow-up examinations. The mobility of Teeth #11 and #21 reduced from grade II to almost normal status. The soft tissues were well adapted and the defects in the sites of the missing maxillary lateral incisors disappeared. One year later the orthodontic therapy was restarted.ConclusionsThe outcomes of this case treatment showed that the thickening of the soft tissues, before an orthodontic treatment has a clinical positive effect. Moreover; transferring the case from thin periodontium to thick periodontium would have reduced the possibility of future breakdown of the periodontium during the orthodontic therapy.