Specialist in Orthodontics, Aarhus University Diplomate Italian Board and European Board of Orthodontics President Elected SIDO 2026
Biomechanics in patients with periodontal problems
Patients with stage 4 periodontitis are characterized by severely reduced periodontal support, tooth loss and pathologic tooth migration, causing poor occlusal stability, inadequate masticatory function, difficulties in finalizing the prosthetic restauration and aesthetic impairment. Orthodontic treatment is often necessary to align prosthetic abutment, create ideal space for implant restorations, reduce overbite and overjet, improve aesthetic and occlusion, while trying to maintain the natural dentition of the patient after periodontal therapy. Patients with severely reduced periodontium undergoing orthodontic treatment need clear definitions of treatment goals and timing of the different therapeutic steps, as well as careful planning of biomechanics, appliance design and retention phase. A severely reduced periodontium is not a contraindication for orthodontic treatment, but it is very important to adapt the biomechanics to the new anatomic conditions and select the appliance accordingly. A thorough interdisciplinary treatment plan should be performed with definition of all the aspects of treatment, including precise steps and timing of the different interventions performed by the practitioners involved.
Furthermore, orthodontics should be performed in a healthy periodontium following step 1-2-3 of periodontal treatment, combined with close maintenance and monitoring of periodontal health throughout the treatment. According to scientific evidence and 20 years of clinical experience we will analyze indications, goals and limitations to allow a safe and successful orthodontic treatment of periodontal patients.