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
Orthodonticaetiology at 2 time points:
1. During active orthodonticmovement
2. During retention phase
Kloukos2025
1year follow up study of adult orthodontic patients Vs control
· 1 year post debond of non-extractiontreatment 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:
1. Recessionlocation: canines and first premolars,
2. Proclination:incisor proclination of 6.35o with no recession
3. Recessionin control group: increased but less than orthodonticgroup
4. Recessionquantity: Generally small at 1 mm
5. Reductionin recession for some: Both groups showedsome patients had a reversal of their recession
Long term though what do we see?
· Gebistorf 2018 Swiss group
· At 15 years 77% of orthodonticpatients had 1-14 areas of recession,
· Control group who had 62%.
· Greater recession on lingual aspectthan labial
· 2.73 x more recession with crossbitescorrected (95% CI, 0.28-5.17; P = 0.029)
· Crowding in controls: 3 mm = 3.29 x more recessions (95% CI, 0.73-5.68; P =0.012)
Orthodontics onaverage 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
1- Differentialslot side
i. Affectedtooth - .18 slot with -17 degrees of torque
ii. Remainingteeth.22 slot with 0 torque
iii. Sideeffect of intrusion of incisor, due to slot differences
Periodontal Surgery concepts:
Indication: inadequate gingiva = <2 mm Zhong 2025
· Wound healing
o Flapdesign to enhance wound stability – avoid vertical releasing incisions
· Connective tissue graft, harvest itfrom the palate.
o Keratinizedtissue and quantity
o Mostavailable, quick healing Karring 1975
o fibroblastfrom the palate biological potential to inducekeratinization.
Surgicaltechniques:
1- Fullthickness: mucosa, connective tissue and includes periosteal layer
2- Splitthickness: mucosa and connective tissue
·
Timingof surgery
Surgeryafter orthodontics
· Only when the teeth are in the correctposition
· Favorable environment for the woundhealing.
· Usual timing of surgery
Surgerybefore orthodontics
· Require more tissue for the orthodonticmovement:
Adjuststo surgery
1- Amelogenins attach proteins to the rootsurface.
2- Hyaluronicacid promotehealing through attracting proteins.
Expert consensus on orthodontic treatment of patients with periodontal disease. Zhong2025
https://pmc.ncbi.nlm.nih.gov/articles/PMC11965299/
Contributions
Contents:Shanya Kapoor
Editedand produced: Farooq Ahmed
