Periodontal considerations during orthodontic intrusion and extrusion in healthy and reduced periodontium.

In patients with advanced periodontal disease, pathological tooth migration may occur, which may require subsequent orthodontic treatment for both aesthetic and functional purposes. When planning orthodontic treatment mechanics, intrusive or extrusive forces are frequently indicated. Understanding tissue reactions during these movements is essential for clinicians when devising a comprehensive orthodontic-periodontal treatment plan. This knowledge enables clinicians to be fully aware of and account for the potential effects on the surrounding tissues. The majority of our understanding regarding the behavior of periodontal tissues in both healthy and compromised periodontal conditions is derived from animal studies. These studies offer the advantage of conducting histological and other assessments that would not be feasible in human research. Human studies are nevertheless invaluable in being able to understand the clinically relevant response elicited by the periodontal tissues following orthodontic tooth movement. Animal and human data show that in dentitions with reduced periodontal support, orthodontic intrusion of the teeth does not induce periodontal damage, provided the periodontal tissues do not have inflammation and plaque control with excellent oral hygiene is maintained. On the contrary, when inflammation is not fully controlled, orthodontic intrusion may accelerate the progression of periodontal destruction, with bacterial plaque remnants being displaced subgingivally, leading to further loss of attachment. Orthodontic extrusion, on the other hand, does not seem to cause further periodontal breakdown in dentitions with reduced periodontal support, even in cases with deficient plaque control. This is attributed to the nature of the tooth movement, which directs any plaque remnants coronally (supragingivally), reducing the risk of adverse effects on the periodontal tissues. This specific type of tooth movement can be leveraged to benefit periodontal conditions by facilitating the regeneration of lost hard and soft periodontal tissues in a coronal direction. As a result, orthodontic extrusion can be employed in implant site development, offering an advantageous alternative to more invasive surgical procedures like bone grafting. Regardless of the tooth movement prescribed, when periodontal involvement is present, it is essential to prioritize periodontal therapy before commencing orthodontic treatment. Adequate plaque control is also imperative for successful outcomes. Additionally, utilizing light orthodontic forces is advisable to achieve efficient tooth movement while minimizing the risk of adverse effects, notably root resorption. By adhering to these principles, a more favorable and effective combined orthodontic-periodontal approach can be ensured. The present article describes indications, mechanisms, side effects, and histological and clinical evidence supporting orthodontic extrusion and intrusion in intact and reduced periodontal conditions.

Comparative evaluation of treatment of angular bone defect related to over-erupted tooth using guided tissue regeneration (GTR) followed by orthodontic intrusion (OI) versus OI followed by GTR: a controlled clinical trial.

BACKGROUND: Prematurity resulted from pathological migration of periodontally involved teeth with the loss of vertical stopping points between teeth, which can lead to teeth over eruption with dimensional changes favoring occlusal discrepancies. Therefore, evaluating and comparing the effect of guided tissue regeneration followed by orthodontic intrusion as opposed to orthodontic intrusion tracked by guided tissue regeneration in the treatment of an over-erupted tooth with angular bone loss. METHODS: Twenty teeth in ten cases were selected with at least two teeth with vertical over-eruption and angular bone loss with the presence of their opposing. In group one, ten teeth over-erupted were treated by guided tissue regeneration followed by orthodontic intrusion, whereas, in group two, ten teeth over-erupted were treated by orthodontic intrusion followed by guided tissue regeneration. They were evaluated clinically for pocket depth, bleeding on probing, and tooth mobility. Radiographical evaluation assessed by cone beam computed tomography. RESULTS: Clinically, there existed a statistically significant difference (P value ≤ 0.05) in favor of group one at six months post and in favor of group two at one year from re-evaluation regarding pocket depth and tooth mobility. Radiographically, in group one, there was a statistically significant improvement (P value ≤ 0.05) at six months post-guided tissue regeneration or orthodontic intrusion regarding defect depth and dimensional changes of the defect area, with a statistically significant difference (P value ≤ 0.05) in favor of group two at one year from re-evaluation phase regarding defect depth and defect area dimensional changes. CONCLUSION: There was a short-term improvement in group one, which deteriorated over a long period compared with group two, so it is preferable to start orthodontic intrusion before guided tissue regeneration.

Treatment of Extrusive Luxation in Permanent Teeth: Literature Review with Systematic Criteria.

INTRODUCTION: Extrusive luxation is a traumatic dental injury caused by the action of oblique forces, characterized by partial displacement of the tooth out of its socket. The ideal treatment for this type of trauma involves repositioning the tooth in its socket. However, in cases where the tooth cannot be repositioned, different options may be considered, such as intentional reattachment and orthodontic intrusion. The aim is to review the literature on the extrusive luxation of permanent teeth while assessing the risks of complications for two methods of delayed treatment for extrusive luxation. MATERIALS AND METHODS: An electronic search from August 2005 to August 2014 was performed by two reviewers independently, and conflicts were resolved by a third reviewer. The databases used were PubMed and Scopus; the reviewers performed a manual search of the following journals: Dental Traumatology, American Journal of Orthodontics, and Clinical Oral Investigation. RESULTS: After removing the duplicate studies, 328 articles were found. Out of these, 321 were rejected as not addressing the proposed research topic. In addition, five articles were excluded because apical repositioning was used for treatment. Therefore, four articles formed the basis of the study. CONCLUSION: Factors, such as root formation, the degree of tooth mobility, and the presence of tooth vitality were decisive for the choice of treatment. However, both treatments were effective and showed favorable results, i.e., without periodontal and root damage. CLINICAL SIGNIFICANCE: Knowledge of the risks of complications among two methods of delayed treatment for extrusive luxation, as well as other important factors to take into consideration when choosing a treatment assists dentists in improving the prognostic.

To intrude or not to intrude? A systematic review of the controversy surrounding orthodontic intrusion on reduced periodontium.

OBJECTIVE: The main objective of this review was to evaluate the effects of orthodontic intrusion on patients with reduced periodontium. Additionally, this review aims to explore the potential for attachment gain and tissue regeneration in these patients and identify optimal therapeutic conditions to mitigate any negative effects of intrusion. METHODS: A systematic review was conducted according to the PRISMA 2020 statement. Duplicate electronic searches of the PubMed, Cochrane, EMC Premium, and Science Direct databases were performed by two independent reviewers. Data extraction and quality assessments, including risk of bias evaluation using the Cochrane and ROBINS-I tools were conducted. RESULTS: From an initial pool of 418 articles, 29 were selected after title and abstract screening for full-text review. Following thorough full-text reading, 15 studies were ultimately included in the analysis. The total number of patients included in the studies is 528, who underwent orthodontic intrusion on reduced periodontium. Studies indicated a decrease in periodontal pocket depth and an increase in clinical attachment with ortho-periodontal treatment. Alveolar bone level outcomes varied, showing both increases and losses. Authors generally observed improved papillary regeneration and reduced gingival recessions. CONCLUSION: Clinical studies involving combined ortho-periodontal treatment showed that orthodontic intrusion on a reduced but healthy periodontium can be considered a beneficial treatment for the periodontium, provided that potential adverse effects are carefully monitored.

Orthodontic Intrusion Using Temporary Anchorage Devices Compared to Other Orthodontic Intrusion Methods: A Systematic Review.

OBJECTIVE: To systemically review all clinical trials that evaluate the effectiveness of orthodontic intrusion using bone anchorage devices versus using other orthodontic techniques in adult patients. MATERIAL AND METHODS: All randomized, controlled clinical trials and prospective studies that compare the use of TADs in intrusion versus alternative devices from the year 2000 to 2019 were searched using various electronic databases. Databases used include Pubmed, Cochrane, Scopus, Lilacs, and ScienceDirect. Selection was initially made by reading the titles and abstracts of potential suitable studies. The final selection was made after reading the full retrieved articles. A methodological score developed by Lagravère was used to assess the quality of evidence. The selection process was illustrated using a PRISMA flow chart. RESULTS: A total of 3942 articles were retrieved, from which only two randomized clinical trials met the inclusion criteria. This presented a low to medium level of evidence to support the hypothesis that TADs are more effective than other orthodontic intrusion techniques for intruding upper incisors and improving upper incisor to lip relation while eliminating the adverse effect of compromising vertical posterior anchorage. Shorter treatment times and less root resorption were found in the TAD group. CONCLUSION: There is insufficient evidence to state that TADs can be used as orthodontic anchorage to effectively intrude the incisors without the need for patient cooperation. Future high quality prospective randomized clinical trials are required.

Direct usage of miniscrew anchorage to intrude overerupted maxillary posterior teeth before prosthodontic preparation: a case report.

Overeruption of maxillary molars due loss of opposing teeth creates occlusal and functional interferences. Before reconstruction can be initiated, intrusion of overerupted molars becomes essential. This report illustrates treatment of overerupted maxillary premolar and molar via direct use of miniscrew anchorage. A 24-year old female had lost first and second left mandibular molars due to pulpal necrotizing agents, resulting with a large alveolar bone defect and overerupted maxillary premolar and molar. She had a history of unsuccessful alveolar distraction of mandibular left premolars to increase the alveolar bone height prior to implant placement. Patient was satisfied with her smile and refused comprehensive orthodontic treatment. Maxillary premolar and molar were intruded segmentally for 4mm in 8 months, using a combination of a mini-implant and partialfixed edgewise appliances. Biological responses of teeth and surrounding bony structures to intrusion appeared normal and acceptable in radiographic and clinical examination.

Therapeutic effect of orthodontic intrusion combined with periodontal regenerative surgery in the treatment of pathologic migration of upper incisors / 上海交通大学学报（医学版）

Objective: To evaluate the effectiveness of orthodontic intrusion combined with periodontal regenerative surgery in the treatment of pathologic migration of upper incisors. Methods: Nine patients with chronic periodontitis who had pathologic migration of upper incisors were selected. After periodontal initial therapy, periodontal regenerative surgery was performed on the vertical defect around 11 displaced teeth, and then orthodontic intrusion was performed 3 months after the surgery. The differences between baseline (T0) and end of orthodontic treatment (T1) of the periodontal clinical parameters and bone defects were analyzed. Results: For all patients, the periodontal clinical parameters and bone defects were significantly improved. The average pocket probing depth reduction was 2.81 mm, the average attachment gain was 3.38 mm, the average gingival recession was reduced by 0.56 mm, and the width of keratinized gingival tissue was not decreased. As measured on the X-ray, the depth and width of the vertical bone defect were reduced by an average of 2.20 mm and 0.55 mm, respectively. Conclusion: Orthodontic intrusion combined with periodontal regenerative surgery can effectively treat pathologic migration of the upper incisors with vertical bone defects, and obtain good periodontal soft and hard tissue regeneration.

Therapeutic effect of orthodontic intrusion combined with periodontal regenerative surgery in the treatment of pathologic migration of upper incisors / 上海交通大学学报（医学版）

Objective · To evaluate the effectiveness of orthodontic intrusion combined with periodontal regenerative surgery in the treatment of pathologic migration of upper incisors.Methods· Nine patients with chronic periodontitis who had pathologic migration of upper incisors were selected.After periodontal initial therapy,periodontal regenerative surgery was performed on the vertical defect around 11 displaced teeth,and then orthodontic intrusion was performed 3 months after the surgery.The differences between baseline (T0) and end of orthodontic treatment (T1) of the periodontal clinical parameters and bone defects were analyzed.Results · For all patients,the periodontal clinical parameters and bone defects were significantly improved.The average pocket probing depth reduction was 2.81 mm,the average attachment gain was 3.38 mm,the average gingival recession was reduced by 0.56 mm,and the width of keratinized gingival tissue was not decreased.As measured on the X-ray,the depth and width of the vertical bone defect were reduced by an average of 2.20 mm and 0.55 mm,respectively.Conclusion · Orthodontic intrusion combined with periodontal regenerative surgery can effectively treat pathologic migration of the upper incisors with vertical bone defects,and obtain good periodontal soft and hard tissue regeneration.

Treatment of periodontal disease by double circumferential fibrotomy combined with orthodontic method / 实用口腔医学杂志

Objective:To explore the effects of double circumferential fibrotomy(CF)in the improvement of periodontal attachment of the teeth with periodontal disease.Methods:22 migrated incisors of 4 adults were randomly assigned to one-time CF group (T1 )and double CF group(T2)by center line.Periapical intraoral radiographic examination was performed using paralleling technique at pre-and post-leveling-alignment stage of the teeth.Root length,crown-root ratio and the distance of CEJ-AC were measured.The periodontal in-dicators were also recorded during the orthodontic treatment.Data were statistically analysed by comparative t-test.Results:CEJ-AC and crown root ratio reduction was greater in T2 group than those in T1 group(P 0.05).Conclusion:Double circumferential fibrotomy can improve periodontal attachment, reasonable orthodontic force does not lead to remarkable root resorption of the periodontitis inflicted teeth.

Combined periodontic-orthodonticendodontic interdisciplinary approach in the treatment of periodontally compromised tooth.

Orthodontic treatment in adult patients is one of the most frequently encountered components involving multidisciplinary approaches. In the present report, a 28-year-old male patient was treated for localized chronic periodontitis with pocket formation, mobility, pathologic migration and malalignment of maxillary left lateral incisor tooth #22. The periodontal therapy included motivation, education and oral-hygiene instructions (O.H.I.), scaling and root planing and periodontal flap surgery. Subsequently on resolution of periodontal inflammation, orthodontic therapy was carried out using the orthodontic aligner for a period of 6 months. Post-treatment (3 years) results showed complete resolution of infrabony pocket with significant bone fill, reduced tooth mobility and complete alignment of the affected maxillary left lateral incisor, thus restoring the esthetics and function.

Orthodontic management of pathological migration of central incisor in a patient with moderate to severe periodontal disease.

Proclination and extrusion of upper central incisors are considered as the main manifestations of pathological migration. They are the most common chief complaint of adult patients nowadays. With adequate orthodontic-periodontal teamwork it is possible to reestablish a healthy and well-functioning dentition with good occlusion, sufficient masticatory function, and satisfactory esthetics that will improve the psychological status of the patient after correcting the elongation and the migration of the anterior teeth. This report present a case with pathological migration of upper right central incisor treated orthodontically with a combination of intrusion, extrusion and retraction movement. This mechanics improve the bone topography, improve esthetics and also helps the patient to achieve good home oral hygiene care.