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

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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



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


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



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



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



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