Pathologic migration--spontaneous correction following periodontal therapy: a case report.

Periodontal disease is often associated with pathologic migration, which becomes an esthetic concern. A 17-year-old girl developed increasing gaps among her maxillary incisors. She had gingival enlargement in the palatal maxillary anterior region. The central incisors had pathologically migrated, resulting in a 2-mm diastema. Periodontal treatment was planned and completed. Following periodontal treatment, there was "spontaneous" repositioning of the central incisors. The 6-month follow-up revealed no change or deterioration of the periodontal condition. The patient was referred for orthodontic closure of the remaining diastema between the central and lateral incisors.     

A multidisciplinary approach for the management of pathologic tooth migration in a patient with moderately advanced periodontal disease

The physiologic tooth position is determined by interactions between the periodontal tissue and occlusal, tongue, and lip forces. Bone destruction resulting from chronic periodontal disease disturbs the equilibrium of these interactive balances, leading to pathologic tooth migration, often requiring multidisciplinary treatment approaches. The present case demonstrates a systematic periodontal-orthodontic-prosthetic treatment for achieving the optimal structural, functional, and esthetic outcomes.     

Interdisciplinary treatment of a patient with severe pathologic tooth migration caused by localized aggressive periodontitis.

An interdisciplinary approach was used to treat a patient with pathologic migration of teeth, with severe anterior proclination and molar mesial inclination due to localized aggressive periodontitis. The combination of regenerative periodontal therapy, prosthodontic rehabilitation, and orthodontic treatment greatly improved function and esthetics.     

Periodontal conditions of teeth presenting pathologic migration

The aim of the present study was to evaluate the periodontal conditions of anterior teeth that presented pathologic migration in patients with chronic periodontitis and to compare periodontal destruction in migrated versus non-migrated teeth. The sample included 32 patients of both sexes (mean age: 46.0 +/- 11.6 years) diagnosed with generalized chronic periodontitis and selected on the basis of the presence of pathologic migration in one or more anterior teeth. This migration was classified according to the following categories: facial flaring, diastema, proximal tilting, rotation or extrusion. The periodontal parameters recorded were clinical attachment loss (CAL) and percentage of radiographic bone loss (BL). Mean CAL of 5.50 +/- 2.20 mm and mean BL of 41.90 +/- 15.40% were found in 115 teeth assessed. The most frequent type of migration was facial flaring (34.80%), followed by diastema (27.00%). Extrusion was hardly observed in the sample (4.30%). However, greater severity of BL and CAL were observed in teeth with this type of migration (59.44% and 8.42 mm, respectively), and in teeth with facial flaring (45.17% of BL and 6.07 mm of CAL). Kruskal-Wallis test indicated that BL presented by teeth with extrusion or facial flaring was greater than that observed in rotated or tilted teeth (p < 0.05), while there was no difference between groups regarding CAL (p = 0.11). It was observed that anterior teeth with pathologic migration presented greater CAL and BL (5.1 mm and 40%) than non-migrated teeth (4.1 and 31%). The study indicated that the most prevalent kind of pathologic migration is facial flaring, which was associated to higher level of bone loss.     

Spontaneous repositioning of pathologically migrated teeth.

BACKGROUND: There is limited clinical evidence that pathologically migrated teeth may reposition themselves after conventional periodontal treatment. The current research was carried out to determine the frequency of spontaneous repositioning of pathologically migrated teeth after routine periodontal therapy, and to study the relation between the severity of migration and the degree of repositioning following treatment. METHODS: Sixteen patients with moderate to severe periodontal disease and presenting 33 diastema sites secondary to pathologic migration participated in this study. After conventional periodontal treatment had been performed, reactive repositioning was assessed by measuring the space between pathologically migrated teeth and adjacent teeth on study models obtained at baseline, re-evaluation at 6 weeks after scaling and root planing, and 4 months after surgery. RESULTS: After scaling and root planing only, 48.5% of all sites exhibited some degree of repositioning with 36.4% of all sites closing completely. After surgery (6 months after baseline observations), 69.7% of all sites exhibited some degree of repositioning with 51.5% of all sites closing completely. When only small to moderate diastemata were considered (<1 mm), 77.8% of sites closed completely. CONCLUSIONS: The findings of this study support the hypothesis that spontaneous repositioning after conventional periodontal treatment is likely, particularly when only light to moderate degrees of pathologic migration are considered. We hypothesize that this spontaneous movement is due to wound contraction during healing.     

Periodontal conditions in Hesse, Federal Republic of Germany, measured by CPITN

The periodontal status and the need for treatment were investigated among 3140 inhabitants of the Federal German state of Hesse, using the CPITN index. The male and female subjects forming the case material were divided into 6 age categories (I up to 19 yr, II 20-24 yr, III 25-29 yr, IV 30-34 yr, V 35-44 yr, VI 45 yr or more). The dentitions of 1.3% of those examined were healthy from the periodontal aspects (CPITN 0). 3.3% of examined persons displayed an increased tendency towards bleeding on probing as the sole pathologic manifestation (CPITN 1); calculus and bleeding on probing (CPITN 2) were recorded in 35.5% of patients. Shallow pocketing (CPITN 3) was observed in 49.3, and deep pocketing (CPITN 4) in 10.6% of the examined subjects. There was a marked increase in scores 3 and 4 among patients from age group V. In addition, the posterior teeth were more susceptible to disease than those in the anterior segments, with slightly higher figures being recorded among female than among male individuals. 98.7% of the patients were in need of periodontal treatment. Application of the PTNS index yielded a treatment requirement of 6841.0 hours for the examined population. 2323 hours of this time were allocated to oral hygiene instruction, 4148 hours to scaling and 370 hours to surgical intervention.     

Multidisciplinary management including endodontics,periodontics, orthodontics,anterior maxillary osteotomy and prosthetics in an adult case with a severe openbite

Adult patients frequently have periodontal problems, resulting in a loss of alveolar bone, the migration and tipping of teeth, and interdental spaces. This case report describes the orthognathic treatment of a 33-year-old adult female with a severe openbite. Her labial-tipped maxillary central incisors were affected by severe periodontitis and treated by guided tissue regeneration (GTR). After the presurgical orthodontics, an anterior maxillary osteotomy was performed and the anterior segment was moved distal and downward direction. The patient achieved a stable and satisfactory occlusion after the prosthetic treatment. This report describes multidisciplinary dental management including endodontics, periodontics, orthodontics, oral surgery and prosthetics in an adult case with a severe openbite and periodontitis, and highlights the importance of co-operation of interdisciplinary fields.     

The use of a resin-bonded fixed splint in periodontally compromised mandibular anterior teeth: a case report

In the treatment of patients with severe periodontal disease, it is becoming possible to re-establish a healthy and well-functioning dentition through interdisciplinary dental teamwork. This article presents a case using a resin-bonded splint for stabilizing periodontally compromised mandibular anterior teeth after orthodontic treatment. A 30-year-old woman came to the authors with severe periodontitis, which had resulted in spacing of the anterior teeth and tipping of the posterior teeth. Periodontal-orthodontic treatment was combined with prosthodontic reconstruction, and a resin-bonded splint extending from canine to canine was placed for postorthodontic stabilization of the periodontally compromised teeth. No debonding of the splint occurred, and no further periodontal invasion was found in this case after 4 years of follow-up.     

正畸结合牙龈环切术治疗牙周炎致前牙病理性移位的初步研究

目的　通过正畸和牙周基础、牙龈环切术联合治疗因牙周炎导致前牙病理性移位的患者 ,观察治疗后牙周组织的改变。方法　牙周炎导致前牙病理性唇向散开移位患者经牙周基础治疗后 ,对需压入的前牙进行牙龈环切术 ,再开始正畸加力。使用牙周临床检查、常规根尖片、前牙区CT来观察比较正畸治疗前后患牙的牙龈出血、探诊深度、牙槽骨高度和附着水平的变化。结果　结合牙龈环切的正畸治疗后患牙牙槽嵴顶高度增加 ,产生新附着。结论　正畸结合牙周系统治疗和牙龈环切术矫治牙周炎所致前牙唇向散开移位患者 ,可以排齐牙列、关闭散开的间隙 ,并促使牙周改善 ,形成新附着     

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目的观察姑息正畸治疗对重度牙周病前牙错位的疗效。方法选择2006年1月至2010年12月在首都医科大学口腔医学院正畸科和牙周科接诊的重度慢性牙周病导致的前牙伸长、唇向倾斜、牙间隙增宽等移位的患者20例为研究对象,采用牙周基础治疗联合正畸治疗,总结分析其治疗效果。结果治疗后患者的移位牙齿复位良好,排列整齐,间隙关闭,覆[牙合]手舍覆盖正常;患牙松动度明显减小,牙周探诊深度、出血指数虽无明显改善,亦未加重。结论对于重度牙周病患牙在患者拒绝拔除时可试行姑息正畸治疗,可在一定时期内改善咬合功能及容貌美观．延缓牙齿脱落。     

多学科联合治疗重度牙周炎合并上前牙错牙合畸形复杂病例的临床观察（附1例6年随访报告）

重度牙周炎患者伴有上前牙扇形移位是临床治疗中常见的难题。临床中，医生需运用多学科的知识综合考虑如何恢复健康、重建功能及改善美观，并结合实际情况和患者需求制定个性化的治疗方案，在治疗过程中针对新出现的问题及时做出调整。文章通过1例应用多学科手段治疗的重度牙周炎合并上前牙前突复杂病例，讨论美学区牙齿拔与留、缺失牙修复、龈乳头重建等临床问题，期望为前牙美学区域的多学科治疗提供经验。     

Advanced periodontal disease and development of anterior open bite. A case report.

Severe anterior open bite in adults is often both functionally and esthetically unacceptable. The treatment usually consists of a combined orthodontic and surgical correction. The stability of open bite treatment results is often poor. The case presented is of marked anterior open bite in a previously normal bite patient with advanced periodontal disease. An etiology for the development of this condition is suggested and a successful treatment described.     

Spontaneous correction of pathologic tooth migration and reduced infrabony pockets following nonsurgical periodontal therapy: a case report

This case report describes the spontaneous correction of pathologic tooth migration and reduced infrabony pockets after nonsurgical periodontal therapy. A 3-mm diastema between the maxillary incisors was closed completely, and the mandibular teeth, which had migrated pathologically, returned to the optimal position. Clinical evaluation showed a significant reduction in probing depth, with increased clinical attachment and bone deposition demonstrated radiologically.     

慢性牙周炎伴前牙病理性移位的多学科联合治疗1例

目的 本文通过报道Ⅲ期B级牙周炎伴前牙病理性移位（pathological tooth migration, PTM）的治疗过程1例,希望为PTM的临床诊治提供一定参考。诊治经过：患者女性,28岁,哺乳期;因孕期牙缝逐渐变大影响美观,分娩后就诊。对本病例采用牙周序列治疗+多学科联合治疗。结果 牙周序列治疗后,牙周恢复健康稳定,修复治疗后患者对美观和功能较为满意,且修复体设计利于牙周长期稳定。结论 PTM患牙应综合多因素进行病因分析,根据不同的病因制定诊疗方案。     

Spacing correction in adult patients]

Spacing due to periodontal disease with migration of adjacent teeth to extraction space is a common problem in adult patients. Appropriate orthodontic treatment is one of the measures to prevent aggravation of periodontal structure. The objective of the article was to present basic principles of adult orthodontics comprising: establishment of mandibular position, control of tooth movement in three dimensions of space, anchorage preparation, prevention of iatrogenic effects and prevention of relapse along with 2 case reports.     

Pathologic tooth migration

Pathologic tooth migration (PTM) is a common complication of moderate to severe periodontitis and is often the motivation for patients to seek periodontal therapy. In this review of the literature, available information concerning prevalence, etiology, treatment, and prevention of pathologic tooth migration is summarized. Prevalence of PTM among periodontal patients has been reported to range from 30.03% to 55.8%. A survey of the literature regarding chief complaints of periodontal patients support these high prevalence findings. The etiology of PTM appears to be multifactorial. Periodontal bone loss appears to be a major factor in the etiology of PTM. Many aspects of occlusion can contribute to abnormal migration of teeth, and more than one of those factors may be present in an individual patient. Soft tissue forces of the tongue, cheeks, and lips are known to cause tooth movement and in some situations can cause PTM. Also considered important in the etiology of PTM is pressure produced from inflammatory tissues within periodontal pockets. Because extrusion is a common form of PTM, clinical observations support the theory that eruption forces sometimes play a role in the etiology of PTM. Many oral habits have been associated with PTM which are often difficult for the therapist to detect. Most cases of severe PTM require a team approach to achieve success. Periodontal, orthodontic, and prosthodontic treatment are often required. Many patient variables enter into the selection of treatment for PTM. In early stages of PTM, spontaneous correction of migrated teeth sometimes occurs after periodontal therapy. Light intrusive forces are used successfully to treat extrusion and flaring forms of PTM. Based on the literature reviewed, it appears that many cases of PTM could be prevented through the early diagnosis and treatment of periodontal disease, occlusal contributing factors, gingival enlargement, and oral habits.     

Surgical reconstruction of the interdental papilla

The traditional goal of disease elimination in the anterior region opens the interproximal spaces, causing flattening or cratering of the interdental papilla. Today's patients increasingly demand esthetic results in addition to periodontal treatment, and recent advances in periodontal plastic surgery have enhanced the periodontist's ability to address these concerns. Three case reports demonstrate a proposed surgical technique for the reconstruction of collapsed interdental papillae using a connective tissue graft under the buccal and palatal flaps.     

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??Aggressive periodontitis??AgP??is a type of periodontitis with early onset and rapid progression??which mostly affects young adults. The most common problems found in AgP patients include severe periodontal destruction and pathologic tooth migration??PTM????which impair function and aesthetics of the stomatognathic system. Effective orthodontic treatment not only provides an acceptable functional and aesthetic occlusion??and corrects traumatic occlusion??but also stimulates rebuilding of the original periodontal architecture and achieves long-term stability. Hence??it is of utmost importance for an orthodontist to have knowledge and ability to manage the case of aggressive periodontitis with multidisciplinary approach??create harmonious cooperation with the periodontist??initiate the orthodontic treatment after the achievement of proper plaque control??and stick to the strategy of proper design of active treatment??placement with light force??strict control of oral hygiene??regular periodontal maintenance and careful monitoring of the whole course.