Decision making in the treatment of patients with malocclusion and chronic periodontitis: Scientific evidence and clinical experience

With a marked increase in the number of adult patients seeking corrective orthodontic care and the high prevalence of destructive periodontal diseases in the adult population in the United States, the importance of addressing inflammatory periodontal diseases in patients receiving treatment for malocclusion is critical and timely. Control of initiating etiologic factors should be a preface to corrective orthodontic treatment of patients with inflammatory periodontal disease. Once these factors have been controlled, the progression of treatment should be based upon the stability of the periodontal attachment apparatus, the severity and bony morphology associated with destructive periodontal disease, and the nature of the orthodontic tooth movement inform the treatment sequence for patients with malocclusion and concomitant periodontal disease. In the presence of horizontal bone loss, elimination of periodontal pockets and other clinical signs of inflammation would allow for immediate progression to corrective orthodontic therapy. Reevaluation of periodontal conditions after orthodontic tooth movement may then be followed by definitive periodontal care based upon clinical findings. Pre-orthodontic surgical periodontal therapy is appropriate to control periodontal inflammation and/or address deep periodontal defects that may compromise periodontal stability during orthodontic intervention. Periodontal maintenance therapy during active orthodontic treatment and post-treatment is critical to long-term maintenance of orthodontic results and periodontal health. A staged, interdisciplinary approach can most adequately treat patients to achieve optimal esthetics, function, and oral health.