Periodontal Considerations In Orthodontic Treatment Chun-Hsi Chung. Episode 37. IOC 2020

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Farooq Ahmed


  • Gingival recession is the apical shift of the marginal gingiva to levels apical to the cemento-enamel junction


Gingival biotype

  • Thick Vs Thin = translucency of free gingiva when probing De Rouck 2009


Thin gingiva

  • Thin labial bony plate
  • Narrow karatanised tissue – if less than 2mm can remain persistently inflamed Lang 1974
  • Greater distance from CEJ – alveolar crest Cook 2011
  • Greater likelihood of breakdown compared to thick gingiva Ericsson 1984


Occlusal trauma

  • Increase tooth mobility
  • Angular bone destruction
  • Loss of attachment Lindhe 1974
    • Recession defect improves after occlusal trauma removed


Bone thickness

  • CBCT appropriate tool
  • However can over-estimate defect due to limitations in Voxel size Patcas 2012


Orthodontic treatment with periodontal considerations

  • Thickness of gingiva
  • Direction of tooth movement


Labial movement of different gingival thickness

  • Thin gingiva = reduction in free gingiva, reduction in thickness of connective tissue, reduction in bone height
  • Thick gingiva – reduction in free gingiva and bone, BUT no change in connective tisse thickness
  • Difference to labial movement = thick gingiva maintains connective tissue thickness


Transverse expansion

  • Can cause gingival recession
  • In older adolescence and adults surgically assistd expansion is recommended as resistance to expansion from Nasomaxillary, Zygomaxillary, Pterygomaxillary buttresses prevent bony change – dentition moved outside of the bony envelope
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