γδT Cells Are Essential for Orthodontic Tooth Movement.

Sustained mechanical forces applied to tissue are known to shape local immunity. In the oral mucosa, mechanical stress, either naturally induced by masticatory forces or externally via mechanical loading during orthodontic tooth movement (OTM), is translated, in part, by T cells to alveolar bone resorption. Nevertheless, despite being considered critical for OTM, depletion of CD4+ and CD8+ T cells is reported to have no impact on tooth movement, thus questioning the function of αßT cells in OTM-associated bone resorption. To further address the role of T cells in OTM, we first characterized the leukocytes residing in the periodontal ligament (PDL), the tissue of interest during OTM, and compared it to the neighboring gingiva. Unlike the gingiva, monocytes and neutrophils represent the major leukocytes of the PDL. These myeloid cells were also the main leukocytes in the PDL of germ-free mice, although at lower levels than SPF mice. T lymphocytes were more enriched in the gingiva than the PDL, yet in both tissues, the relative fraction of the γδT cells was higher than the αß T cells. We thus sought to examine the role of γδT cells in OTM. γδT cells residing in the PDL were mainly Vγ6+ and produced interleukin (IL)-17A but not interferon-γ. Using Tcrd-GDL mice allowing conditional ablation of γδT cells in vivo, we demonstrate that OTM was greatly diminished in the absence of γδT cells. Further analysis revealed that ablation of γδT cells decreased early IL-17A expression, monocyte and neutrophil recruitment, and the expression of the osteoclastogenic molecule receptor activator of nuclear factor-κß ligand. This, eventually, resulted in reduced numbers of osteoclasts in the pressure site during OTM. Collectively, our data suggest that γδT cells are essential in OTM for translating orthodontic mechanical forces to bone resorption, required for relocating the tooth in the alveolar bone.

Skeletal stability in patients with clefts after large maxillary advancements using intraoral distraction.

Maxillary hypoplasia is a common outcome in patients with cleft lip and palate after surgical and orthodontic interventions, and maxillary distraction osteogenesis has become a useful procedure for patients with extensive maxillary deformities. The aim of this study was to evaluate long term (two years) stability after maxillary advancement of more than 10mm by distraction osteogenesis in cleft patients using internal devices. We organised a retrospective study on 42 patients with cleft lip and palate using cephalometric analysis before and after maxillary distraction osteogenesis and evaluated them for 24 months. Postoperative measurements showed a marked advancement with an increase of 13.3mm and 10.8° in the length of the maxilla (Co-A) and SNA, respectively, including a shift from Angle class III to class I in dental relations. Follow-up observations showed preservation of maxillary length with a relapse of only 6.0 % (mean (SD) 0.8 (0.7) mm) and 10% relapse in SNA angle (mean (SD)1.1 (1.4) °) one year postoperatively and a negligible regression at the two years' follow up. This large-scale study shows stable results of skeletal advancement using distraction osteogenesis, indicating safe and reliable outcomes among patients with cleft lip and palate.

Two-stage reconstruction of the severely deficient alveolar ridge: bone graft followed by alveolar distraction osteogenesis.

Distraction osteogenesis for the augmentation of severe alveolar bone deficiency has gained popularity during the past two decades. In cases where the vertical bone height is not sufficient to create a stable transport segment, performing alveolar distraction osteogenesis (ADO) is not possible. In these severe cases, a two-stage treatment protocol is suggested: onlay bone grafting followed by ADO. An iliac crest onlay bone graft followed by ADO was performed in 13 patients: seven in the mandible and six in the maxilla. Following ADO, endosseous implants and prosthetic restorations were placed. In all cases, the onlay bone graft resulted in inadequate height for implant placement, but allowed ADO to be performed. ADO was performed to a mean total vertical augmentation of 13.7mm. Fifty-two endosseous implants were placed. During a mean follow-up of 4.85 years, two implants failed, both during the first 6 months; the survival rate was 96.15%. In severe cases lacking the required bone for ADO, using an onlay bone graft as a first stage treatment increases the bone height thus allowing ADO to be performed. This article describes a safe and stable two-stage treatment modality for severely atrophic cases, resulting in sufficient bone for implant placement and correction of the inter-maxillary vertical relationship.

Oxidative Stress and Nitric Oxide in Sedentary Older Adults with Intellectual and Developmental Disabilities.

Individuals with moderate-to-profound intellectual and developmental disabilities (IDD) are characterized by significant cognitive deficits, abnormal muscle tone, poor posture and balance, and inactive lifestyle. Increased oxidative stress (OS) has been implicated in a variety of chronic diseases, inflammatory conditions, aging, and even following intense physical exercise. Nitric oxide (NO) is a highly reactive mediator that has been shown to play different roles in a variety of different biological process and in aging. The aim of the study was to investigate the serum levels of global OS and NO metabolites (NOx) in sedentary and non-sedentary older adults with IDD. Global OS was measured by CR 3000 instrument, FORM system, and NOx were measured by determination of serum nitrite levels. OS and NOx levels were significantly higher in sedentary IDD comparing non-sedentary controls. The increased of OS and NOx levels suggest their possible involvement in the phenomenon of 'accelerated aging' in IDD. Our findings can provide another aspect indicating both OS and NOx as possible biochemical markers and their potential application in minimizing their negative influence through future therapeutic strategies.

[Distraction osteogenesis of deficient alveolar bone prior to dental rehabilitation].

Implant supported rehabilitation has become very common in treatment plans nowadays, yet many patients lack the vertical and horizontal bone dimensions required for endosseous implant insertion. Distraction osteogenesis is a technique in which bone is generated by progressive elongation of two bone fragments following an osteotomy or corticotomy. Distraction osteogenesis of the alveolar ridge as a treatment modality in implant dentistry is a very useful technique that allows for adequate bone formation suitable for implant insertion. Alveolar distraction can be unidirectional, bidirectional, multidirectional or horizontal. Alveolar distraction osteogenesis can be performed by using intraosseous distraction devices, intraosseous distraction implants or by extraosseous devices which are the most prevalent today. Distraction osteogenesis has many advantages such as gradual lengthening of the bone with no need for an autogenous bone graft and lack of the associated donor site morbidity as well as distraction of the surrounding soft tissue together with the transported bone. One of the major challenges when using alveolar distraction osteogenesis is controlling the vector of distraction, this problem should be further addressed in future researches. We describe different methods for alveolar distraction osteogenesis, including the surgical procedure, latency period, lengthening and consolidation period. We also discuss the advantages, disadvantages and complications of the method. In this manuscript a case of mandibular alveolar deficiency following mandibular fracture and loss of teeth and the alveolar bone is presented. This patient was treated by alveolar distraction osteogenesis with excellent results. This patient was later rehabilitated . using endosseous implants as demonstrated by radiographs. Alveolar distraction osteogenesis provides a method to regain both hard tissue and soft tissue without additional grafting and is an efficient modality in cases of medium to severe bone loss.

Treatment considerations in hutchinson-gilford progeria syndrome: a case report.

Hutchinson-Guilford progeria syndrome is an extremely rare condition classified as one of the premature ageing syndromes. This case presents a 16-year-old Israeli female patient, suffering from a variant of Hutchinson-Guilford progeria with a history of treatment with oral biphosphnates. The patient presented with typical cranial and facial features of the syndrome including delayed teeth eruption and root development probably due to insufficient jaw growth and severs retrognatic position of the maxilla and mandible. Orthodontic treatment considerations are described along with those required in light of the previous treatment by oral biphosphonates.All primary teeth were extracted in three appointments while creating as minimal trauma as possible to the surrounding tissue and alveolar bone. For now, the patient refuses to begin the orthodontic treatment course. There are no limitations to conduct any dental procedures in progeria patients, however, extreme caution must be exercised during oral surgery due to the inelasticity of tissues and dermal atrophy. Orthodontic procedure commencement should be early enough to manage the delayed development and eruption of teeth. Patients taking oral biphosphonates should be advised of this potential complication. If orthodontic treatment is considered appropriate, plans should be assessed and modified to include compromises.

Periodontal cytokines profile under orthodontic force and extracorporeal shock wave stimuli in a rat model.

BACKGROUND AND OBJECTIVE: Extracorporeal shock wave therapy has been used in various clinical conditions as a result of its ability to stimulate healing processes in acute and chronic inflammatory states. Orthodontic force application triggers an inflammatory reaction in the periodontal tissue surrounding the involved teeth, resulting in tooth movement. Preliminary work revealed that extracorporeal shock wave therapy increased the expression of the inflammatory cytokines involved. Our aim was to investigate the expression of inflammatory cytokines in the periodontal tissues following orthodontic force induction, with and without shock wave therapy, in experimental rats. MATERIAL AND METHODS: An orthodontic appliance was fabricated and applied between the molars and the incisors of adult Wistar rats. In conjunction with orthodontic force commencement, the rats were treated with a single episode of 1000 shock waves. Every day, during the 3 d of the study, rats were killed and the immunolocalization of RANKL, interleukin (IL)-1ß, IL-6 and tumor necrosis factor-alpha was evaluated. RESULTS: The percentage of the area staining positively for all inflammatory cytokines during the first 2 d decreased statistically significantly more in the shock wave-treated group compared with the nontreated control group. On the first day, the percentage of the area staining positively for IL-1ß and RANKL on the compression side peaked in both groups, with a sequential rise in the number of TRAP-positive cells. CONCLUSION: The induction of shock wave therapy during orthodontic tooth movement influences the expression of different inflammatory cytokines in the tissue and might alter the expected periodontal remodeling rate.

Relationship between history of smoking, metabolic and inflammatory markers, parameters of body composition and muscle strength.

The objective of this study was to investigate the relationship between smoking history expressed by pack-years, metabolic and inflammatory markers, parameters of body composition (BC) and muscle strength among heavy smokers. A detailed smoking history was obtained from 49 heavy smokers (age = 44 ± 12, pack-years = 31 ± 23). Blood samples were analyzed for levels of glucose, lipids, liver enzymes and C-reactive protein (CRP). Anthropometric measurements included waist circumference and assessment of BC by dual energy X-ray absorptiometry (DEXA) and bioelectrical impedance analysis (BIA). Muscle strength was assessed by handgrip dynamometry and predicted one-repetition maximum (p1RM) tests. Positive correlations were found between pack-years of smoking, fasting glucose, alkaline phosphatase and CRP levels. Pack-years were also positively correlated with waist circumference, body mass index (BMI), whole-body and trunk fat mass measured by both DEXA and BIA. A negative correlation was found between pack-years of smoking and muscle strength measured by p1RM for the leg press exercise. After adjustment for age, sex and BMI, a positive correlation remained between pack-years of smoking and CRP levels. In conclusion, after controlling for possible confounders, smoking history was found to be positively associated with CRP levels among heavy smokers.

Time and dose effects of cigarette smoke and acrolein on protein carbonyl formation in HaCaT keratinocytes.

Cigarette smoke (CS) is an important environmental source of human exposure to a highly toxic and chemically active α,ß-unsaturated aldehyde: acrolein. It is capable of causing protein carbonylation and dysfunction, especially in oral tissues of smokers, constantly exposed to CS toxic constituents. The foremost damage is considered to be cumulative, but even a short exposure can be potentially harmful. The objectives of the current study were to examine the short time and dose effects of direct CS and acrolein exposure on intracellular protein carbonylation in epithelial cells. HaCaT-keratinocytes were exposed to different doses of acrolein and whole phase CS using a unique smoking simulator apparatus that mimics the exposure in smokers. The rate of intracellular protein carbonyl modification was examined 10-60 min after the exposure by Western blot. In addition, the effect of pre-incubation with a thiol scavenger N-acetylcysteine (NAC) was also assessed. We found that intracellular protein carbonyls increased as fast as 10 min after CS exposure and their concentration doubled after 20 min, with a slight elevation afterwards. Also, carbonyl levels increased gradually as CS and acrolein doses were elevated. Addition of 1 mM NAC neutralized part of the damage. We conclude that CS and acrolein intracellular protein carbonylation is dose- and time- dependent. Even a short time exposure to CS and its aldehydic constituents can be potentially harmful.

Green tea drinking improves erythrocytes and saliva oxidative status in the elderly.

We have previously shown that green tea (GT) drinking combined with vitamin E supplementation reduced plasma protein carbonyls and increased erythrocytes catalase activity in exercising healthy elderly. In the present study we set out to investigate the antioxidative effects of GT drinking in an aging population. We performed an interventional, crossover, controlled prospective trial with 35 healthy elderly subjects (mean age 67.3±4.8 years), supplemented with four daily placebo maltodextrin "tea-bags" for 12 weeks, followed by four 1.5 g daily GT bags for another 12 weeks. Data were obtained at baseline, at the end of the placebo period, and at the end of the GT intervention period. We found that GT did not alter erythrocyte catalase activity. However, it provided protection against 2,2'-azobis (2-amidinopropane) dihydrochloride (AAPH)-induced oxidative hemolysis which declined by 10.2% (p<0.001). No changes were observed in saliva oral peroxidase enzymes. Nonetheless, saliva total antioxidant capacity increased by 42.0% (p<0.01). Plasma oxidative products, such as protein carbonyls, lipid peroxides and thiobarbituric acid reactive substances (TBARS) were stable throughout the intervention period. We conclude that four daily cups of GT are well tolerated in elderly free living subjects. Our results demonstrate that both erythrocyte resistances to oxidation and saliva antioxidant capacity are improved by GT drinking. The clinical implications of these oxidation modifications require further research.

Body composition in heavy smokers: comparison of segmental bioelectrical impedance analysis and dual-energy X-ray absorptiometry.

Smokers tend to have lower body mass index, on one hand, and increased abdominal obesity, on the other hand. Also, low levels of lean mass (LM) and bone mineral content (BMC) were found among older smokers compared with non-smokers. This altered body composition and its consequences raise the need for simple and reliable methods for assessment of body composition in smokers. This study aimed to compare body composition assessment by segmental bioelectrical impedance analysis (sBIA) with the reference method, dual energy X-ray absorptiometry (DEXA). Body composition was measured by sBIA (Tanita BC-545) and DEXA (Hologic) in 49 heavy smokers (>15 cigarettes/day, mean age 43.8±12.0). The comparison included correlations and differences between measurements obtained using the two methods as well as the Blande-Altman analysis. Whole-body fat mass (FM) and LM measured by the two methods were found to be highly correlated (r>0.9, p<0.001). Compared with DEXA, sBIA significantly overestimated whole-body LM and BMC (1,126 g and 382 g, respectively, p<0.01). The Bland-Altman analysis revealed a good agreement for whole-body FM and LM, but a poor agreement for BMC. The segmental FM percentage and LM were also highly correlated (r>0.9, p<0.001). However, sBIA significantly overestimated LM of the trunk and legs and underestimated the appendicular FM percentage. Verified by DEXA, sBIA provides reliable measures of whole-body LM, FM, and trunk FM in heavy smokers. A lesser degree of agreement was found for BMC, appendicular LM, and FM.

Peroxynitrite induces degradation of myosin heavy chain via p38 MAPK and muscle-specific E3 ubiquitin ligases in C2 skeletal myotubes.

Oxidative stress and inflammation play an important role in the catabolism of skeletal muscles. Recently, cigarette smoke (CS) was shown to stimulate muscle catabolism by activation of p38 MAPK and up-regulation of the muscle-specific E3 ubiquitin ligases (E3s) atrogin-1 and MuRF1 which are over-expressed during muscle atrophy. Peroxynitrite (ONOO-), an oxidative ingredient of CS, also produced during oxidative stress and inflammation, was previously shown to induce ubiquitination and degradation of muscle proteins. To investigate the involvement of p38 MAPK and the muscle-specific E3s in ONOO--induced muscle catabolism, C2 myotubes, differentiated from a myoblast cell line, were exposed to ONOO- (25 µM) in a time-dependent manner. Following exposure, degradation of myosin heavy chain (MyHC) and actin, activation of p38 MAPK, and levels of atrogin-1 and MuRF1 were studied by Western blotting. Peak phosphorylation of p38 MAPK was observed at 1 h of ONOO- exposure. ONOO- caused a significant increase in the levels of atrogin-1 and MuRF1. In accordance, a significant decrease in MyHC levels was observed in a time-dependent manner. These findings support previous studies in which the catabolic effects of ONOO- were shown. In addition, ONOO- was demonstrated to induce degradation of muscle proteins by activation of p38 MAPK and up-regulation of the muscle-specific E3s atrogin-1 and MuRF1.

Internal mandibular distraction to relieve airway obstruction in children with severe micrognathia.

Congenital craniofacial malformations such as Pierre Robin sequence or Treacher Collins syndrome are associated with mandibular micrognathia, resulting in obstructive sleep apnea (OSA) due to a decreased pharyngeal airway; in severe cases this leads to tracheostomy dependence. We present a series of 18 patients in whom we performed mandibular lengthening using internal distraction devices to relieve airway obstruction. Seven were tracheostomy-dependent and 11 were respiratory distressed without tracheostomy. The mandible was distracted at a rate of 1mm per day. Following 3 months of consolidation for bony maturation, the distraction devices were removed. Results demonstrated forward mandibular elongation of a mean 22mm (range 20-25mm) and an increase in SNB angle and in pharyngeal airway. All patients with tracheostomies were decannulated, and there was an improved airway with resolution of signs and symptoms of OSA and elimination of oxygen requirement in all patients. We conclude that mandibular distraction using internal devices is a useful and comfortable method for younger children to expand the mandible forward and increase the pharyngeal airway.

[Early orthodontic treatment for growth modification by functional appliances--pros and cons].

The optimal timing for commencement of orthodontic treatment has been controversial. Initial early orthodontic treatment usually begins at the deciduous dentition or early mixed dentition stage and continues for 12-18 months. In most cases, a second treatment phase will be required in the permanent dentition stage to achieve the treatment goals and a stable occlusion. One of the main purposes of the early treatment phase is to affect the growth pattern of the jaw and consequently correct skeletal imbalance and prevent future severe malocclusion by means of growth modification. Some clinicians strongly believe that early intervention with functional appliances improves facial harmony and simplifies as well as shortens the second orthodontic treatment phase. In contrast others advocate that it is unnecessary as the early treatment results will be eliminated by future growth and a recurrent treatment phase is essential in the permanent dentition stage in any case. Thus it is merely a waste of time and resources, and all treatment goals could be reached by a comprehensive single continued treatment phase in the late mixed dentition stage. This article summarizes the scientific literature on the different concepts of early functional orthodontic treatment of Skeletal Class II malocclusion correction vs. a single comprehensive orthodontic treatment process in the late mixed dentition stage. The indications and benefits of each of the approaches are discussed in detail. In conclusion, most of the researchers recommend early orthodontic intervention in children suffering psychological and social problems associated with their malocclusion. Prevention of traumatic injury in cases of maxillary incisor protrusive inclination is also considered an indication for early orthodontic treatment.

[Orthodontic silicone positioner for the treatment of oral symptoms in Amyotrophic Lateral Sclerosis (ALS) patients].

ALS is considered a neurodegenerative disorder caused by progressive death of specific neuronal populations within the gray matter of the central nervous system. The cause of cell death is unknown and patients with ALS will live 3 to 5 years from disease onset. A common cause of death is neuromuscular respiratory failure or cardiac arrhythmias due to insufficient oxygen. The patients develop multiple symptoms and the focus of management is to maintain their quality of life. Orofacial manifestations in ALS are secondary to motor deficits, resulting in dysphagia, muscle spasticity, rigidity and tremor of the orofacial musculature, which can induce soft tissue trauma and sialorrhea. In this report the management of ALS oral symptoms, by means of an elastic silicone full coverage occlusal splint, often used as an orthodontic positioner, is discussed, as well as its advantages and alternatives. The positioner was easily tolerated by the patients who reported improvement in soft tissue trauma lesions due to accidental self biting, and improved control of the drooling due to excessive saliva and difficulty in swallowing.

3D vector control during alveolar ridge augmentation using distraction osteogenesis and temporary anchorage devices: a new technique.

This report describes a combined orthodontic surgical technique involving vertical alveolar distraction using temporary anchorage devices (TADs) in cases of massive alveolar ridge bone and teeth loss. A combined surgical orthodontic protocol included presurgical orthodontic preparation and a preimplantation surgical augmentation stage for insertion of a vertical distractor. During the active vertical alveolar distraction process TADs were inserted. Intraoral orthodontic elastics were attached to the main orthodontic archwire exerting multidirectional forces to control the vertical distraction vector. After 3 months of vector controlling and active bone moulding, the TADs were removed. Anterior alveolar ridge augmentation using distraction osteogenesis was achieved. The application of TADs for better anterior segment curvature enabled dental implant insertion, better positioning and restoration. A combined surgical orthodontic management protocol involving vertical alveolar distraction osteogenesis for augmentation purposes is an efficient treatment method to improve alveolar ridge volume for the preimplantation stage.

Relationship between inferior alveolar nerve imaging and neurosensory impairment following bilateral sagittal split osteotomy in skeletal Class III cases with mandibular prognathism.

Postoperative inferior alveolar nerve (IAN) neurosensory impairment was prospectively evaluated in 20 consecutive patients with mandibular prognathism who underwent bilateral sagittal split osteotomy. Routine presurgical imaging was obtained for all patients in study and control groups (10 patients each). Cone beam CT of the mandibular ramus and body was performed in 10 randomly selected patients (study group) and the precise location of the IAN was determined preoperatively and intraoperatively. Nerve sensation was evaluated by subjectively monitoring the physical feeling of the lower lip and the chin skin preoperatively and at different times postoperatively. Exact nerve location was successfully determined in all 10 cases in the study group. There were almost no significant differences between patients' sensation scores at the chin skin and lip sites. No significant differences were found between the two sides of the 20 patients. A significant increase in the score trend along the timeframes, in both groups, could be clearly seen together with a statistically significant difference (P≤0.004) between the study and the control groups. In conclusion, precisely locating the IAN using CT is a significant means for efficiently minimizing nerve damage during sagittal split osteotomy.

[Reconstruction of the alveolar ridge by osteodistraction for implant placement].

Alveolar Distraction is a method for reconstructing a deficient or atrophic alveolar bone. Alveolar ridge reconstruction may be indicated for the atrophic alveolar process resulting from maxillofacial trauma, periodontal disease, or post aggressive large cyst or tumor resection. The aim of this paper is to demonstrate the method of reconstruction of the alveolar ridge by Distraction Osteogenesis. A total of 32 patients were treated. An alveolar segmental osteotomy was carried out and the distraction device was mounted. In patients with an extensive alveolar defect two distraction devices were placed in order to better control the vector of elongation in both bone edges. The distraction was started on the fourth post-operative day at a rate of 0.5 mm/day as necessary and according to the length of the distraction device, followed by a consolidation period of 90 days. Subsequently, the devices were removed, and dental implants were placed for osteointegration. The amount of elevation was 8-15mm. All the patients had panoramic x ray before the distraction, during the lengthening, at the end of distraction and after removal of the device. Early mineralization in the distracted area was seen radiographically during the consolidation period that increased after device removal. As a result of alveolar distraction, a segment of mature bone was transported vertically in order to lengthen the crest for better implant anchorage, either for esthetic purposes or for functional prosthetic requirements. A total of 68 implants were introduced. In follow-up at 24 months, failure of only one implant was noted, due to inadequate transported bone stability. In conclusion, distraction osteogenesis is an alternative treatment in moderate to severe alveolar deficiencies for an ideal three-dimensional reconstruction with no need for bone harvesting. This method offers the possibility to place dental implants in a correct position to obtain proper prosthetic results.

[Orthodontic tooth movement under extracorporeal shock wave therapy: the characteristics of the inflammatory reaction--a preliminary study].

Extracorporeal generated shock waves were introduced in medical therapy approximately 20 years ago in order to disintegrate kidney stones. Over the last 10 years, extracorporeal generated shock waves have been used to stimulate healing processes. No report to date has examined its influence on different inflammation mediators and growth factors in the periodontium. Orthodontic tooth movement is a model including the induction of an aseptic inflammation and its resolution. We conducted a preliminary study to investigate the periodontium cytokine concentration fluctuations after induction of orthodontic force with and without extracorporeal shock wave therapy (ESWT) in a rat model. An orthodontic appliance was fabricated and applied between the molars and the incisors of rats. The rats were treated by a single episode of 1000 shock waves and gingival crevicular fluid was collected for 3 days. The concentration of typical acute phase cytokines was evaluated by ELISA assay. Of the three tested cytokines, IL-1beta was the only detected cytokine along the study timeframe. IL-1beta concentration rose in both the treated and non treated shockwave groups on the first day, however it was statistically significantly higher in the treated group on day 2. On day 3, IL-1beta concentrations in both groups decreased and reached a lower level in the treated group, revealing a statistically significant difference than its level on the previous day. The application of ESWT during orthodontic force induction enhances IL-1beta production as part of mechanical forces transduction triggering a biologic response, which may contribute to accelerated periodontal remodeling and therefore foreshortening the orthodontic tooth movement period.

[Orthodontic treatment in periodontal patients].

Orthodontic treatment poses a significant challenge in patients suffering from periodontal disease. Providing orthodontic treatment to periodontal patients should be carefully planned and performed in a tight collaboration between the orthodontist and periodontist. Resolution and stabilization of the periodontal condition is a pre-requisite for orthodontic treatment initiation. Careful oral hygiene performance and highly frequent recall periodontal visits are also crucial. Pre- or post- orthodontic periodontal surgery might help providing better treatment outcomes.