Orthodontic-Periodontal and Restorative Interrelationships
Orthodontic-Periodontal and Restorative Interrelationships tests safe tooth movement through the periodontium and sequencing with restorative and implant treatment. It emphasizes biologic width, gingival health, and interdisciplinary planning.
Core rules
- Periodontal health must be established before orthodontic force. Moving teeth into inflamed tissue worsens attachment loss. Check pocket depths, bleeding, plaque control, and radiographic bone levels.
- Biologic width is the soft-tissue attachment above bone, roughly 2 mm including junctional epithelium and connective tissue attachment. Restorations or tooth movement that impinge on it can cause inflammation and recession.
- Forced eruption can move a fractured tooth or its margin coronally, improving the restorative margin and treating biologic width violation. A fiberotomy may reduce rotational relapse by severing supracrestal gingival fibers.
- Orthodontic uprighting and space creation help implant sites, but implants do not move. Plan implant placement after tooth movement and verify root proximity with CBCT when needed.
- Intrusion in a reduced periodontium requires light force and close periodontal monitoring.
Worked example
A maxillary central incisor has a crown-root fracture below the gingival margin and the biologic width is violated. Reasoning: forced eruption moves the fracture margin coronally, creating a ferrule and restoring biologic width. After stabilization, the tooth is restored or crowned. A fiberotomy may be added if rotational relapse is a concern. Orthodontic movement should not begin until periodontal inflammation is controlled.
Traps
- Moving teeth through active periodontal inflammation.
- Ignoring biologic width when planning a restoration.
- Attempting to move an implant.
- Using heavy intrusion forces in a reduced periodontium.