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