Possibilities of periodontal condition control during orthodontic planning and movement of teeth

Relevance. Modern literature reports various side effects and functional and anatomical disorders in periodontal tissues, up to pathologic tooth migration in 32-50% of cases associated with orthodontic tooth movement. The development of new diagnosis capabilities for periodontal tissue condition monitoring and types of orthodontic appliances in the appearance and progression of the pathology of tooth-supporting apparatus is currently relevant.

Purpose. To increase the objectivity and periodontium condition control degree during the planning and orthodontic tooth movement.

Material and methods. A prospective randomized controlled clinical trial was conducted, which, based on inclusion and non-inclusion criteria, included 60 patients aged 25-35 years and allocated them to groups with healthy (2) and damaged (1) periodontium for orthodontic treatment of malocclusion. Orthodontic appliances for the comparison groups were identical (aligners, buccal and lingual passive self-ligating brackets). Prior to the orthodontic treatment, we determined the alveolar bone thickness by the patients’ CTs superimposed on the program for digital modelling of the result; and estimated the optical bone density in Hounsfield units (HU). Clinical parameters for periodontium condition assessment – the simplified oral hygiene index (OHI-S), the Russel and CPITN periodontal indices, and gingival recession level – were determined before the treatment, after the active periodontal treatment, including resection surgery (in group 1), and after the orthodontic treatment in the c omparison groups.

Results. After the orthodontic treatment, group 1 patients experienced fewer periodontal complications – 42%, versus 54% in group 2, with initially healthy periodontium with a thin alveolar bone; 18% and 23% - with a thick alveolar bone. The aligner subgroup demonstrated the best results – 16% and 18% for groups 1 and 2, respectively; the worst result was in the lingual brackets subgroup – 50% and 55%, respectively. Gingival recession was the most common periodontal complication. The method of patient CT scan evaluation by superimposition on the digital modelling of the final result allo wed the achievement of orthodontic treatment success.

Conclusion. The increase in the objectivity of examination and orthodontic treatment planning, and the ability to control the alveolar bone condition, allows moving the teeth to the desired position with a minimum of side effects and complications.

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