An increasing number of adult patients seen in the orthodontic offices are presenting with an ongoing degeneration caused either by loss of one or more teeth and/or progressing periodontal disease. The treatment of these patients can rarely stand alone and both diagnosis and treatment planning should be a production of a close interaction between orthodontists, periodontists and prosthodontists eventually assisted by gnathologists, implantologists and oral surgeons. The close interaction with the periodontist before and during the treatment cannot be stressed enough. In spite of the conservative approach practiced in many places within periodontology, it should be appreciated that any orthodontic tooth movement involving intrusive components should not be performed in the presence of pathological pockets. New regenerative periodontal treatment procedures have improved the prognosis for treatment of tooth movement even of teeth with vertical defects. The appliances should be selected taking the periodontal status and the eventual metabolic factors into consideration. The importance of the correct biomechanical system has a crucial influence on long-term prognosis for the dentition. Animal experiments carried out on monkeys and dogs have repeatedly demonstrated that it is possible to regain lost attachment even in the case of horizontal bone loss through a carefully conducted combined periodontal- and orthodontic treatment and long-term follow-up have confirmed that the results can be maintained over decennia. Improved understanding of the tissue reaction generated during tooth movement have opened new aspects of tooth movement ‘with bone' and the regeneration of atrophic alveolar processes through tooth movements have created a new basis for major reconstructions. The spectrum of orthodontics has been widened further through the introduction of the skeletal anchorage systems. A result characterized by an ideal occlusion may not be obtainable but the possible treatment goal should be defined and agreed upon between involved colleagues and between the therapeutic team and the patient before initiating the treatment. Cost benefit both in term of time and money required in relation to different alternatives should be discussed.
8th Congress of the Czech Orthodontic Society: Abstract Book, 2007
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8th Congress of the Czech Orthodontic Society, 2007