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Think pink – orthodontics a problem or solution to gingival recession. 6 MINUTE SUMMARY
Join me for a summary looking at gingival recession in orthodontics, and whether it is detrimental or beneficial. This lecture was given by James Andrews, he explored the effect of orthodontics on the periodontium, an area under increasing interest within aesthetics to achieve the ideal ‘pink aesthetics’ with the increasing adult population receiving orthodontic treatment. His lecture was based on, is orthodontics good or bad for the gingiva?
What is the starting point ?
Increase in adult orthodontics from 1970 by 800%
50% of adults have some element of periodontal disease
Untreated adult population 51% dehiscence 37% areas of fenestration Evangelista 2010
Facial type and bone morphology Tunis 2021
Dolichocephalic = narrow alveolus and elongated to compensate for vertical growth
Brachycephalic = larger alveolus
Dolichocephalic - Red flag patients
Tooth movement:
What happens when teeth move buccally?
facial tooth movement Wennström 1996
Reduced bucco lingual width
Therefore, reduced free gingiva
Increased risk only if tooth is moved out of the alveolar housing
What type of movement
Tipping (uncontrolled) increase likelihood of recession Condo 2017
Proclination causes recession, but inconclusive
Thickness more relevant than final inclination Yared 2006
How to decide what to do?
WALA line – Will Andrews Larry Andrews ridge Andrews 2000
Limit of labial bone – shape is coincident with the mucogingival junction, coincident with centre of resistance
Upper incisors – located anterior 1/3 of alveolus
Mandibular incisors – cantered within the alveolus
Gingival recession did not increase in treatment orthodontic population with segmental mechanics Melsen 2005
Aligners any different?
Association between non-extraction clear aligner therapy and alveolar bone deficiency and fenestration
Presence of both fenestration and dehiscence
What do we do to correct extra-alveolar teeth?
If teeth pushed outside of cortical plate then retracted, what happens
Monkey – moved teeth outside of bone for 8 months, then reposition within bone with appliances = repair bony dehiscence and fenestration
Morten Laursen and Melsen 12 consecutive patients 2020
Teeth moved towards the centre of the cortical plate = improvement in gingival height of depth decrease of 23%, the width with 38%
Intrusion
Use of intrusion arch increases the thickness of the periodontal fibres 0.7 to 2.3 mm Melsen 1988
Gingival graft when to move teeth
Free gingival graft – 6 weeks
Connective tissue graft – 12 weeks
“Diagnose and treat each tooth no miracles shortcuts for good orthodontics” Peck 2017
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By Farooq Ahmed
5
77 ratings
Join me for a summary looking at gingival recession in orthodontics, and whether it is detrimental or beneficial. This lecture was given by James Andrews, he explored the effect of orthodontics on the periodontium, an area under increasing interest within aesthetics to achieve the ideal ‘pink aesthetics’ with the increasing adult population receiving orthodontic treatment. His lecture was based on, is orthodontics good or bad for the gingiva?
What is the starting point ?
Increase in adult orthodontics from 1970 by 800%
50% of adults have some element of periodontal disease
Untreated adult population 51% dehiscence 37% areas of fenestration Evangelista 2010
Facial type and bone morphology Tunis 2021
Dolichocephalic = narrow alveolus and elongated to compensate for vertical growth
Brachycephalic = larger alveolus
Dolichocephalic - Red flag patients
Tooth movement:
What happens when teeth move buccally?
facial tooth movement Wennström 1996
Reduced bucco lingual width
Therefore, reduced free gingiva
Increased risk only if tooth is moved out of the alveolar housing
What type of movement
Tipping (uncontrolled) increase likelihood of recession Condo 2017
Proclination causes recession, but inconclusive
Thickness more relevant than final inclination Yared 2006
How to decide what to do?
WALA line – Will Andrews Larry Andrews ridge Andrews 2000
Limit of labial bone – shape is coincident with the mucogingival junction, coincident with centre of resistance
Upper incisors – located anterior 1/3 of alveolus
Mandibular incisors – cantered within the alveolus
Gingival recession did not increase in treatment orthodontic population with segmental mechanics Melsen 2005
Aligners any different?
Association between non-extraction clear aligner therapy and alveolar bone deficiency and fenestration
Presence of both fenestration and dehiscence
What do we do to correct extra-alveolar teeth?
If teeth pushed outside of cortical plate then retracted, what happens
Monkey – moved teeth outside of bone for 8 months, then reposition within bone with appliances = repair bony dehiscence and fenestration
Morten Laursen and Melsen 12 consecutive patients 2020
Teeth moved towards the centre of the cortical plate = improvement in gingival height of depth decrease of 23%, the width with 38%
Intrusion
Use of intrusion arch increases the thickness of the periodontal fibres 0.7 to 2.3 mm Melsen 1988
Gingival graft when to move teeth
Free gingival graft – 6 weeks
Connective tissue graft – 12 weeks
“Diagnose and treat each tooth no miracles shortcuts for good orthodontics” Peck 2017
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