Orthodontic movement and periodontal bone defects: Rationale, timing, and clinical implications

Advanced periodontitis may be characterized by the formation of infrabony pockets, infrabony defects, and possible pathologic tooth migration. An interdisciplinary approach is often required in planning the treatment of advanced periodontitis. Periodontal nonsurgical and surgical therapies control the microbial infection whereas orthodontic therapy realigns the migrated teeth. To avoid further periodontal breakdown, active orthodontic movement must always follow proper periodontal therapy. Consequently, orthodontic treatment is no longer a contraindication in patients with controlled periodontal disease. Teeth can be moved into infrabony defects, leading to defect closure, bone fill, and possibly new attachment formation. Orthodontic stimulation at the periodontal ligament level has positive effects on the quality of periodontal wound healing, especially when orthodontic movement starts shortly after surgical periodontal treatment. When the infrabony defects are subject to augmentation procedures, the graft material does not impede orthodontic tooth movement that seems to enhance defect healing. The present article describes the effects of orthodontic movement into infrabony defects adjacent to pathologically migrated teeth.