Search

Are we heading into a recession – periodontal considerations in orthodontic management Ian Dunn. BOS 2021. Episode 133. September 29th 2021

Play episode
Hosted by
Farooq Ahmed

Join me for Ian’s lecture looking at periodontics and orthodontics from the perspective of the periodontist

 

o   Litigation

o   Periodontium is no 1 reason for litigation in dentistry

o   Up to 200k payouts

 

Cases

o   Aggressive periodontitis more common in Chinese population

o   Adults – majority have some periodontal disease

o   BPE easiest method to assess disease – pocket depth and bleeding

 

 

Defining stability

Site level

o   Closed pocket

o   4mm or less

o   No bleeding on probing – bleeding 30% go on to worsen, not completely accurate

Patient level

o   Stable

o   BOP 10% less

o   PPD 4mm less

o   No BOP at 4mm sites

Unstable

o   PPD 5mm+ or PPD 4mm + BOP

 

General rule

o   Perio stability prior to orthodontic treatment

o   Stability sustained 3-6 months – patient able to maintain during orthodontics

o   Supportive care – 6-8 week with hygienist when in orthodontic treatment

o   Without orthodontic treatment every 3 months, most effective dental intervention

 

Gingival recession

o   Aetilogy

o   Toothbrush

o   Smoking

o   Trauma

o   Inflammation

o   Frenal pull- very unlikey not active surface

o   Anatomical bony dehiscence’s – naturally occuring

§  Common

·      Around upper canines

·      Crowded cases with anterior teeth – without orthodontics

·      Expansion cases – Ian’s experiences

 

o   Phenotype gingiva

o   Thin – high scalloped, thin interdental papilla, narrow zone keratinised tissue

o   Thick – low scallop, thick interdental papuilla, thick band of keratinised tissue

o   Indication for intervention

o   Aesthetics – usually self limiting, aesthetics drive intervention

o   Worsening of recession

o   Persistent inflammation

o   Unable to clean due to access

o   NOT treatment for sensitivity

 

Intervention

Free gingival graft

o   Most stable surgery

Miller 1 and 2

o   Predictable recession correction

Miller 3 and 4

o   Unpredictable

Gingival recession

o   Orthodontics first, graft later

 

Retention

o   Retainers don’t effect oral hygiene (bonded retainer)

o   However adverse tooth movement with torquing in retention

o   Consider removal and replacement if movement observed

 

Join the discussion

More from this show