J Periodontal Implant Sci.  2015 Dec;45(6):193-204. 10.5051/jpis.2015.45.6.193.

A comparative study of combined periodontal and orthodontic treatment with fixed appliances and clear aligners in patients with periodontitis

• Han JY

• KMID: 2354936
• DOI: http://doi.org/10.5051/jpis.2015.45.6.193

Abstract

PURPOSE
With the increasing prevalence of orthodontic treatment in adults, clear aligner treatments are becoming more popular. The aim of this study was to evaluate the effect of orthodontic treatment on periodontal tissue and to compare orthodontic treatment with fixed appliances (FA) to clear aligner treatment (CAT) in periodontitis patients.
METHODS
A total of 35 patients who underwent orthodontic treatment in the Department of Periodontology were included in this study. After periodontal treatment with meticulous oral hygiene education, patients underwent treatment with FA or CAT, and this study analyzed patient outcomes depending on the treatment strategy. Clinical parameters were assessed at baseline and after orthodontic treatment, and the duration of treatment was compared between these two groups.
RESULTS
The overall plaque index, the gingival index, and probing depth improved after orthodontic treatment (P<0.01). The overall bone level also improved (P=0.045). However, the bone level changes in the FA and CAT groups were not significantly different. Significant differences were found between the FA and CAT groups in probing depth, change in probing depth, and duration of treatment (P<0.05). However, no significant differences were found between the FA and CAT groups regarding the plaque index, changes in the plaque index, the gingival index, changes in the gingival index, or changes in the alveolar bone level. The percentage of females in the CAT group (88%) was significantly greater than in the FA group (37%) (P<0.01).
CONCLUSIONS
After orthodontic treatment, clinical parameters were improved in the FA and CAT groups with meticulous oral hygiene education and plaque control. Regarding plaque index and gingival index, no significant differences were found between these two groups. We suggest that combined periodontal and orthodontic treatment can improve patients' periodontal health irrespective of orthodontic techniques.

Keyword

Bone regeneration; Malocclusion; Orthodontics; Periodontitis

MeSH Terms

Adult
Animals
Bone Regeneration
Cats
Education
Female
Humans
Malocclusion
Oral Hygiene
Orthodontics
Periodontal Index
Periodontitis*
Prevalence

Figure

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  Figure 1 Diagram showing the flow of patients for screening.

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  Figure 2 Orthodontic treatment with fixed appliances. (A) Intraoral photograph before orthodontic treatment. (B) Intraoral photograph after orthodontic treatment. (C) Periapical radiograph before orthodontic treatment. (D) Periapical radiograph after orthodontic treatment.

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  Figure 3 Clear aligner treatment. (A) Frontal and (B) occlusal intraoral photograph before clear aligner treatment. (C) Panoramic radiograph before orthodontic treatment. (D) The clear plastic splints that cover all of the teeth and the marginal aspects of the gingiva and gradually move the teeth into an ideal position.

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  Figure 4 Clear aligner treatment. (A) Frontal and (B) occlusal intraoral photograph after clear aligner treatment. (C) Panoramic radiograph after orthodontic treatment.

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  Figure 5 (A) Preoperative and postoperative panoramic radiographs were used to evaluate the exact bone level, which was reconfirmed with (B-D) additional periapical radiographs.

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  Figure 6 Changes in clinical parameters. The plaque index and gingival index scores were improved after orthodontic treatment (a) P<0.01). The probing depth decreased after orthodontic treatment (a) P<0.01). The overall bone level changes showed significant differences between baseline and after orthodontic treatment (b)P=0.045). However, the bone level changes in the FA and CAT groups did not show any significant differences after orthodontic treatment (c)P>0.05). FA: fixed appliance, CAT: clear aligner treatment.

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  Figure 7 Combined periodontal and orthodontic treatment. (A) A periapical radiograph showing an apical radiolucent lesion. (B) After endodontic treatment, regenerative periodontal surgery was performed using demineralized bovine bone mineral. (C) As part of successful regenerative surgery, the resin-wire splint was bonded to the neighboring teeth for more than six months. (D-F) Three years after the regenerative surgery, orthodontic treatment with a fixed appliance was initiated. (G-I) Periapical radiographs four years after orthodontic treatment with a fixed appliance.

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  Figure 8 Combined periodontal and orthodontic treatment. (A) Before orthodontic treatment, periodontal probing showed approximately 7 mm of attachment loss at the mesiobuccal point of right anterior incisor. (B) Periapical radiograph before orthodontic treatment. (C, D) After orthodontic treatment, a flap operation as part of regenerative surgery showed radiographic bone filling with the effect of a supracrestal fibrotomy for preventing relapse.

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  Figure 9 The decision-making process regarding orthodontic treatment in patients with periodontitis.

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