Korean J Orthod.  2022 Nov;52(6):439-450. 10.4041/kjod21.263.

Orthodontic treatment with clear aligners for a patient with chronic periodontitis

Affiliations
  • 1Department of Stomatology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China

Abstract

This case report describes the treatment of an adult female patient with a history of periodontal disease, Class I malocclusion with extrusion, dental spaces, and pathologic tooth migration. The patient was treated with clear aligners, which effectively controlled the strength and direction of orthodontic forces after 3 months of systematic periodontal treatment. The Peer Assessment Rating (PAR) index was calculated from study models before and after treatment. The pretreatment PAR score was 24, and the posttreatment PAR score was 4. The PAR score for this patient changed by 83%. Satisfactory appearance and good function were achieved for this patient.

Keyword

Adult treatment; Periodontitis; Aligners; Malocclusion

Figure

  • Figure 1 Pretreatment facial and intraoral photographs of an adult with inactive periodontal disease.

  • Figure 2 Initial cone-beam computed tomography scan showing cephalometric (A) and panoramic radiographs (B) of an adult with inactive periodontal disease.

  • Figure 3 Initial cone-beam computed tomography scan showing dental radiographs of an adult with inactive periodontal disease. The numbers in this figure refer to the FDI notation for permanent teeth.

  • Figure 4 A, Bite ramps on the lingual surface of the maxillary aligners. B, Interproximal reduction chart.

  • Figure 5 Treatment progress: intraoral photographs 14 months after the start of orthodontic treatment (upper) as compared to patient’s planned tooth positions (lower). The deep bite was corrected, and the spaces between teeth were closed.

  • Figure 6 Posttreatment facial and intraoral photographs of an adult with inactive periodontal disease treated with clear aligners. Proper overjet and overbite were achieved, and the lateral profile was maintained.

  • Figure 7 Posttreatment cone-beam computed tomography scan showing cephalometric (A) and panoramic radiographs (B) of an adult with inactive periodontal disease treated with clear aligners.

  • Figure 8 Posttreatment cone- beam computed tomography scan showing dental radiographs of an adult with inactive periodontal disease treated with clear aligners. The numbers in this figure refer to the FDI notation for permanent teeth.

  • Figure 9 Superimposed cephalometric tracings showing the changes from pretreatment (black) to posttreatment (red) in an adult with inactive periodontal disease treated with clear aligners. A, Superimposed on the sella-nasion plane at sella. B, Superimposed on the palatal plane at the anterior nasal spine. C, Superimposed on the mandibular plane at the menton. The intrusion of the incisors was achieved, and the inclination of the anterior teeth was improved.

  • Figure 10 Facial and intraoral photographs at 7 months after treatment. Prosthodontic rehabilitation of the left maxillary canine yielded optimal esthetic results.

  • Figure 11 Blocking out the undercuts and trimming the line of the aligners. These designs applied gentle instantaneous force when inserting and removing the aligners to protect the periodontal tissues. The following gaps are considered to be eliminated in this case: (i) triangle-shaped gaps between teeth; (ii) the gaps between the anterior teeth are greater than 1 mm, and (iii) the gaps between the posterior teeth are greater than 2 mm. Blue means undercut areas between the teeth that need to be eliminated. Orange means undercut areas around the virtual pontic for the right maxillary canine in each aligner need to be blocked out. The dashed line is the boundary of the aligners.


Reference

1. Nazir MA. 2017; Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim). 11:72–80. PMID: 28539867. PMCID: PMC5426403.
2. Hirschfeld J, Reichardt E, Sharma P, Hilber A, Meyer-Marcotty P, Stellzig-Eisenhauer A, et al. 2019; Interest in orthodontic tooth alignment in adult patients affected by periodontitis: a questionnaire-based cross-sectional pilot study. J Periodontol. 90:957–65. DOI: 10.1002/JPER.18-0578. PMID: 30950037. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85072057575&origin=inward.
3. Bollen AM, Cunha-Cruz J, Bakko DW, Huang GJ, Hujoel PP. 2008; The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence. J Am Dent Assoc. 139:413–22. DOI: 10.14219/jada.archive.2008.0184. PMID: 18385025. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=42349091008&origin=inward.
4. Roccuzzo M, Marchese S, Dalmasso P, Roccuzzo A. 2018; Periodontal regeneration and orthodontic treatment of severely periodontally compromised teeth: 10-year results of a prospective study. Int J Periodontics Restorative Dent. 38:801–9. DOI: 10.11607/prd.3756. PMID: 30304070. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85055100844&origin=inward.
5. Zhang J, Zhang AM, Zhang ZM, Jia JL, Sui XX, Yu LR, et al. 2017; Efficacy of combined orthodontic-periodontic treatment for patients with periodontitis and its effect on inflammatory cytokines: a comparative study. Am J Orthod Dentofacial Orthop. 152:494–500. DOI: 10.1016/j.ajodo.2017.01.028. PMID: 28962734. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85031719520&origin=inward.
6. Khorsand A, Paknejad M, Yaghobee S, Ghahroudi AA, Bashizadefakhar H, Khatami M, et al. 2013; Periodontal parameters following orthodontic treatment in patients with aggressive periodontitis: a before-after clinical study. Dent Res J (Isfahan). 10:744–51. PMID: 24379862. PMCID: PMC3872625.
7. Maeda S, Maeda Y, Ono Y, Nakamura K, Matsui T. 2007; Interdisciplinary approach and orthodontic options for treatment of advanced periodontal disease and malocclusion: a case report. Quintessence Int. 38:653–62. PMID: 17823683. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=34547801380&origin=inward.
8. Cao T, Xu L, Shi J, Zhou Y. 2015; Combined orthodontic-periodontal treatment in periodontal patients with anteriorly displaced incisors. Am J Orthod Dentofacial Orthop. 148:805–13. DOI: 10.1016/j.ajodo.2015.05.026. PMID: 26522041. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84946034843&origin=inward.
9. Paolone MG, Kaitsas R. 2018; Orthodontic-periodontal interactions: orthodontic extrusion in interdisciplinary regenerative treatments. Int Orthod. 16:217–45. DOI: 10.1016/j.ortho.2018.03.019. PMID: 29661677. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85045564003&origin=inward.
10. Feng YM, Fang B, Xia Yh, Shu R, Hans MG. 2009; Mia-assisted orthodontic treatment for dental malocclusion secondary to periodontal disease. World J Orthod. 10:49–56. PMID: 19388433. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=68049100226&origin=inward.
11. Geron S. 2004; Managing the orthodontic treatment of patients with advanced periodontal disease: the lingual appliance. World J Orthod. 5:324–31. PMID: 15633379. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=14944372114&origin=inward.
12. Aldeeri A, Alhammad L, Alduham A, Ghassan W, Shafshak S, Fatani E. 2018; Association of orthodontic clear aligners with root resorption using three-dimension measurements: a systematic review. J Contemp Dent Pract. 19:1558–64. DOI: 10.5005/jp-journals-10024-2465. PMID: 30713189. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85059915268&origin=inward.
13. Aman C, Azevedo B, Bednar E, Chandiramami S, German D, Nicholson E, et al. 2018; Apical root resorption during orthodontic treatment with clear aligners: a retrospective study using cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 153:842–51. DOI: 10.1016/j.ajodo.2017.10.026. PMID: 29853242. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85047523249&origin=inward.
14. Jiang Q, Li J, Mei L, Du J, Levrini L, Abbate GM, et al. 2018; Periodontal health during orthodontic treatment with clear aligners and fixed appliances: a meta-analysis. J Am Dent Assoc. 149:712–20.e12. DOI: 10.1016/j.adaj.2018.04.010. PMID: 29921415. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85048510284&origin=inward.
15. Xie Y, Zhao Q, Tan Z, Yang S. 2014; Orthodontic treatment in a periodontal patient with pathologic migration of anterior teeth. Am J Orthod Dentofacial Orthop. 145:685–93. DOI: 10.1016/j.ajodo.2013.08.018. PMID: 24785933. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84899761599&origin=inward.
16. Wheeler TT. 2017; Orthodontic clear aligner treatment. Semin Orthod. 23:83–9. DOI: 10.1053/j.sodo.2016.10.009. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85014105169&origin=inward.
17. Han JY. 2015; A comparative study of combined periodontal and orthodontic treatment with fixed appliances and clear aligners in patients with periodontitis. J Periodontal Implant Sci. 45:193–204. DOI: 10.5051/jpis.2015.45.6.193. PMID: 26734489. PMCID: PMC4698945. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84953853261&origin=inward.
18. Ishihara Y, Tomikawa K, Deguchi T, Honjo T, Suzuki K, Kono T, et al. 2015; Interdisciplinary orthodontic treatment for a patient with generalized aggressive periodontitis: assessment of IgG antibodies to identify type of periodontitis and correct timing of treatment. Am J Orthod Dentofacial Orthop. 147:766–80. DOI: 10.1016/j.ajodo.2014.09.022. PMID: 26038081. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84930427726&origin=inward.
19. Tavares CA, Allgayer S, Calvete Eda S, Polido WD. 2013; Orthodontic treatment for a patient with advanced periodontal disease: 11-year follow-up. Am J Orthod Dentofacial Orthop. 144:455–65. DOI: 10.1016/j.ajodo.2012.09.025. PMID: 23992818. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84886399235&origin=inward.
20. Türkkahraman H, Sayin MO, Bozkurt FY, Yetkin Z, Kaya S, Onal S. 2005; Archwire ligation techniques, microbial colonization, and periodontal status in orthodontically treated patients. Angle Orthod. 75:231–6. DOI: 10.1016/s0084-3717(08)70201-0. PMID: 15825788.
21. Boyd RL. 2007; Complex orthodontic treatment using a new protocol for the Invisalign appliance. J Clin Orthod. 41:525–47. quiz 523PMID: 29130926. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85068449926&origin=inward.
22. Eissa O, Carlyle T, El-Bialy T. 2018; Evaluation of root length following treatment with clear aligners and two different fixed orthodontic appliances. A pilot study. J Orthod Sci. 7:11. DOI: 10.4103/jos.JOS_120_17. PMID: 29963506. PMCID: PMC6004740. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85053304462&origin=inward.
23. Lee JW, Lee SJ, Lee CK, Kim BO. 2011; Orthodontic treatment for maxillary anterior pathologic tooth migration by periodontitis using clear aligner. J Periodontal Implant Sci. 41:44–50. DOI: 10.5051/jpis.2011.41.1.44. PMID: 21394296. PMCID: PMC3051056. PMID: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84859148012&origin=inward.
Full Text Links
  • KJOD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr