Think pink – orthodontics a problem or solution to gingival recession. 6 MINUTE SUMMARY orthodontics In 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