Prospective students who searched for Difference Between Orthodontist & Periodontist found the articles, information, and resources on this page helpful. Orthodontic Treatment As An Adjunct To Periodontal there is no consistent relation between malocclusion and periodontal. The Relationship Between Orthodontics and Periodontics: An Interdisciplinary Approach. Alankar Ashok Shendre, Anurag Ashok Shendre and Johar Rajvindar .
Furcation defects require special attention during orthodontic treatment. They are difficult to maintain and can worsen during orthodontic treatment.
In Class III furcation cases, a possible method for treating the furcation is by hemisecting the crown and root and pushing the roots apart may be advantageous. This could improve adjacent tooth position before placement of implant or tooth replacement. However, it is widely believed that insufficient width of the attached gingiva predisposes the development of recession. To maintain proper gingival health, a 2-mm width of keratinized gingiva is adequate.
To maintain adequate width of the attached gingiva in these conditions, mucogingival surgery may be advised during the course of orthodontic treatment. The abnormal frenum prevents mesial migration of the central incisor and the aberrant fiber increases the relapse tendency after orthodontic space closure. Surgical removal of the frenum is usually advised in these situations and it should be performed after the completion of orthodontic treatment unless the frenum prevents space closure or become painful or traumatized.
Proper exposure of the impacted tooth and preservation of the keratinized tissue are important to avoid loss of attachment after orthodontic treatment. Apically or laterally positioned pedicle graft is usually advised in this situation.
In order to prevent orthodontic relapse and to achieve proper rearrangement of the supporting tissues, the teeth must be retained. However, Sharpey's fibers of the newly formed bundle bone as well as supraalveolar and transseptal fibers undergo rearrangement even after months of retention, especially after the correction of rotation. Hence, the teeth must be retained for at least 12 months to allow time for complete remodeling of these fibers.
Circumferential supracrestal fiberotomy is usually advised to reduce this relapse tendency. Fiberotomy is usually performed toward the end of the active orthodontic therapy, i.
Crown lengthening is usually performed by gingivectomy or an apically repositioned flap in combination with gingivectomy prior to orthodontic bonding procedures. Osseous craters are interproximal, two-wall defects that do not improve with orthodontic therapy alone. Some shallow craters i. Large craters can be eliminated by reshaping the bony defect.
This enhances the patient's ability to maintain these interproximal areas during orthodontic treatment. Bone grafts are usually advised to fill these defects. If the result of periodontal therapy is stable, orthodontic treatment can be initiated months after periodontal surgery. These invaginations act as a site for plaque retention and are considered as one of the risk factors for periodontal disease during orthodontic treatment.
A surgical correction of these invaginations is usually performed to eliminate plaque accumulation. A combined orthodontic-periodontic interdisciplinary approach is usually preferred to correct these abnormalities. Missing interdental papilla are frequently referred to as gingival "black holes" and may be due to a number of factors such as over-divergence of adjacent roots and advanced periodontal disease with loss interdental alveolar crest.
An orthodontic periodontic interdisciplinary approach is usually advised to manage these problems. Vertical maxillary excess also results in a gummy smile. Orthognathic surgery involving a LeForte I osteotomy with maxillary impaction is usually advised in adult patients; however, in growing patients "first bicuspid extractions followed by application of a high pull J-hook headgear to the premaxillary segment" helps to prevent the development of this problem.
Adult orthodontics need special consideration in several aspects such as psychosocial, biological, mechanical, and age-related considerations such as the aging of tissues, lack of growth potential, vulnerability to temporomandibular joint TMJ disorder, and root resorption. Compared to children and teenagers, the tissue response to orthodontic force, especially cell mobilization and conversion of collagen fibers, is much slower in adults. The hyalinized zones are easily formed on the pressure side of orthodontically moved teeth and it temporarily prevents tooth movement in the intended direction.
Once the hyalinized zone is eliminated, tooth movement can occur. Compared to the elderly, there is a greater risk of marginal bone loss and loss of attachment with mild gingival infection. Loss of attachment results in apical shift of the center of resistance, thereby increasing the distance from the point of force application to the center of resistance, which in turn increases the tipping moment produced by the given force than that of the healthy tooth. Hence, the absolute magnitude of force should be reduced.
Later, the force might be increased up to g in bodily movement and g in tipping, corresponding to a distance of movement of 0. The lack of adequate space for implant can be managed by orthodontic movement of the neighboring teeth to an optimal position, which will allow redistribution of the available space in the dental arch and provide space for implant placement.
Both the alveolar bone and periodontal tissues follow the extruded tooth, leading to bone formation in the direction of tooth movement. The reduced buccolingual ridge thickness associated with extraction space shows difficulty in implant placement. It can be managed by orthodontic movement of the adjacent tooth to the edentulous space, which results in bone deposition along the tension side and the implant can be placed at the site of the orthodontically moved tooth.
This is an alternative to surgical horizontal ridge augmentation.
However a study done on humans  failed to prove the same. Steiner  suggested that tension in the marginal tissue created by the orthodontic forces could be an important factor in causing gingival recession. This means, the thickness of the gingival tissue at the pressure side and not its apico-coronal width, is an indicator of possible recession.
An experimental study was done on monkeys to confirm this hypothesis. Periodontal response to different types of orthodontic forces Greenbaum  studied the effects of slow and rapid maxillary expansion on the periodontium.
The Relationship Between Orthodontics and Periodontics: An Interdisciplinary Approach
They concluded that patients subjected to rapid maxillary expansion showed significantly lesser bone relative to the cemento-enamel junction when compared to patients treated with slow expansion and the control group.
However, they did not find any significant difference in probing depth and width of attached gingival between the groups. Siew Han Chay  has shown that gingival margin can be moved incisally by as much as 9 mm using orthodontic extrusion. Extrusion of mandibular incisor produces gingival margin and the mucogingival junction movement in the same direction as the extruded teeth by 80 and Also, no attachment loss was observed. They concluded that if a professional preventive program is pursued throughout the course of orthodontic treatment, loss of attachment can be limited to less than 0.
Repeating the oral hygiene instructions on each visit and rubber cup prophylaxis are effective measures to prevent plaque accumulation and gingival enlargement. They concluded that plaque scores on the buccal surfaces of teeth were lowered in patients using ultrasonic toothbrush.
According to Hannah,  oral hygiene can be improved in orthodontic patients by using a sanguinaria-containing toothpaste along with a sanguinaria-containing oral rinse. Orthodontics as an adjunct to periodontal therapy Orthodontics can serve as an adjunct to periodontal treatment procedures to improve oral health in a number of situations. Pathological tooth migration is one of the few evident signs of periodontitis that affects dentofacial esthetics. This phenomenon is more commonly seen in the anterior dentition due to lack of stable occlusal and sagittal contacts with the opposing teeth.
This can also help control periodontal breakdown and restore good oral function. Fixed appliance allows easy splinting of teeth to achieve stable anchorage. He also highlights the importance of reducing the force magnitude and applying counteracting moments to reduce the stress on periodontal ligament fibres. Lijian  has enlisted the various precautions to be taken when attempting tooth movement in height-reduced periodontium, which includes achieving stable anchorage and long-term periodontal maintenance care.
Deepa  reported the use of orthodontic soft aligners in repositioning a periodontally involved tooth. Light and intermittent forces generated by the soft aligner allow regeneration of tissue during tooth movement. Along with periodontal procedures, orthodontically assisted occlusal improvement may be required in treatment of patients with severely attrited lower anterior teeth.
It is suggested that tooth movement can be undertaken 6 months after completion of active periodontal treatment if there is sufficient evidence of complete resolution of inflammation.
In patients diagnosed with vertical bony defects, adjunctive orthodontic procedures can help improve the condition. Shoichiro  reported improvement in alveolar bone defects, gingival esthetics, and the crown-root ratio in patients with one- or two-wall isolated vertical infrabony defects with a combination of tooth extrusion and periodontal treatment.
Orthodontic intrusion has also been shown to improve periodontal condition.
For instance, a high labial frenum attachment is considered to be a causative factor of midline diastema. Frenectomy is recommended in such cases as the fibres are thought to prevent the mesial migration of the central incisors. However, the timing of periodontal intervention has been a topic of much debate.
According to Vanarsdall,  surgical removal of a maxillary labial frenum should be delayed until after orthodontic treatment unless the tissue prevents space closure or becomes painful and traumatized.
Forced eruption of a labially or palatally impacted tooth is now a common orthodontic treatment procedure. Careful exposure of the impacted tooth while preserving keratinized tissue requires the expertise of a periodontist. Preservation of keratinized tissue is important to prevent loss of attachment. The preferred surgical procedure is primarily an apically or laterally positioned pedicle graft.
Interrelationships between orthodontics and periodontics.
Circumferential supracrestal fiberotomy CSF is a procedure that is frequently used to enhance post-treatment stability. According to him, CSF does not affect the periodontium adversely. Mucogingival surgeries may be needed during the course of orthodontic treatment to maintain sufficient width of attached gingival. This procedure can also be used for smile designing. There is an ever increasing concern for dentofacial esthetics in adult population. The primary motivating factor for seeking orthodontic treatment is dental appearance.
Pathologic migration of anterior teeth is a common cause of esthetic concern among adults. The disruption of equilibrium in tooth position may be caused by several etiologic factors. These include periodontal attachment loss, pressure from inflamed tissues, occlusal factors, oral habits such as tongue thrusting and bruxism, loss of teeth without replacement, gingival enlargement and iatrogenic factors. However, according to the literature, destruction of tooth supporting structures is the most relevant factor.
The periodontal disease and its sequela such as diastema, pathological migration, labial tipping or missing teeth often lead to functional and esthetic problems either alone or with restorative problems. Advanced periodontal disease is characterized by severe attachment loss, reduced alveolar bone support, tooth mobility and gingival recession.
Orthodontic treatment is initiated only after periodontal disease is brought under control. This communication highlights good treatment outcome achieved in a patient with impaired dentofacial aesthetics and advanced periodontal disease.
Comprehensive orthodontics was initiated with pre-adjusted edgewise appliances using very light force, which resulted in optimal biological response. Since there was trauma from lower anterior teeth, anterior bite plane allowed posterior eruption of teeth, which resulted in the opening of the bite. The periodontal health improved the moment trauma was relieved.