The Ortho-Perio Interface

6 months ago

Hosted by

Farooq Ahmed

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The Ortho-Perio Interface

Join me for look at the orthodontic – periodontal interface, the latest evidence looking at the effects of orthodontic tooth movement as well what periodontal surgery can offer in recession management. This podcast is a summary of Christos Kassaro and Anton Spurrier’s excellent lecture, as part of the AngleNet Webinar Series.

Timestamp

0:44 – At 1-year recession risks of orthodontics
2:30 – At 15-year recession risks of orthodontics
4:37 – Retainer relapse: “X” & “Twist” effects
5:13 – Biomechanics: Using mixed bracket slots for torque
6:17 – Perio surgery principles & donor sites
7:54 – Flap designs: Full vs. split-thickness
8:14 – Surgical techniques: MCAT vs. LCT
9:27 – Timing: Surgery before vs. after ortho?
10:33 – Surgical adjuncts: Hyaluronic acid

Orthodontic aetiology at 2 time points:

During active orthodontic movement
During retention phase

Kloukos 2025

1 year follow up study of adult orthodontic patients Vs control

1 year post debond of non-extraction treatment at 67% greater incidence of recession within the orthodontic group (IRR = 1.67, 95% CI: 1.05, 2.67, P = 0.03). Five main findings:

Recession location: canines and first premolars,
Proclination: incisor proclination of 35^owith no recession
Recession in control group: increased but less than orthodontic group
Recession quantity: Generally small at 1 mm
Reduction in recession for some: Both groups showed some patients had a reversal of their recession

Long term though what do we see?

Gebistorf 2018 Swiss group
At 15 years 77% of orthodontic patients had 1-14 areas of recession,
Control group who had 62%.
Greater recession on lingual aspect than labial
73 x more recession with crossbites corrected (95% CI, 0.28-5.17; P = 0.029)
Crowding in controls: 3 mm = 29 x more recessions (95% CI, 0.73-5.68; P = 0.012)

Orthodontics on average does not compromise long term health or function, but may compromise aesthetics

Fixed Braided Retainers

‘X’ effect (torque) or twist effect (proclination) unwanted movement from wire activation

Not relapsed as new movement
Occurrence: 2.7% (n=221 patients) – Renkema 2011

Treatment ‘X’ effect

Differential slot side
1. Affected tooth – .18 slot with -17 degrees of torque
2. Remaining teeth.22 slot with 0 torque

Side effect of intrusion of incisor, due to slot differences

Periodontal Surgery concepts:

Indication: inadequate gingiva = < 2 mm Zhong 2025

Wound healing
- Flap design to enhance wound stability – avoid vertical releasing incisions
Connective tissue graft, harvest it from the palate.
- Keratinized tissue and quantity
- Most available, quick healing Karring 1975
- fibroblast from the palate biological potential to induce keratinization.

Surgical techniques:

Full thickness: mucosa, connective tissue and includes periosteal layer
Split thickness: mucosa and connective tissue

Modified coronally advanced tunnel (MCAT) Allen 1994
- Multiple teeth
- Combination full thickness papilla and split thickness apical region.
- No vertical releasing incisions (tension)
- Minimal scar tissue formation
- good vascularization,
- Tissue blending

Laterally closed tunnel (LCT)
- Single deep vertical recession defect
- if the tooth is not perfectly in the middle of the bone, orthodontist first
- full thickness tunnel. = lift the entire tissue.
- Release the fibers internally, advantage of the elasticity of the frenulum in order to move the frenulum laterally and then

Timing of surgery

Surgery after orthodontics