ortho-perio Flashcards
(35 cards)
what time period is preventative ortho?
primary - early mixed
what time period is interceptive ortho?
mixed
what time period is corrective ortho?
permanent dentition
adult and geriatric ortho is considered
limited treatment
need healthy perio and no bisphosponates
adult patient characteristics
no growth
aging of maxillofacial structures
bone biology
dental status
chief complaint
aging of adult geriatric maxillofacial structures
small skeletal modifications
nose tip, chin and ears keep growing
resorption at basal bone (holding teeth), anterior areas
point A and B move somewhat back
geriatric patient dental consequence
reduced inter-canine distance (why we dont try to do this in general)
increased crowding (lower more likely)
increased Overbite
class II and III tend to worsen with time
soft tissue changes in adult / geratirc patient
nose and chin increase
retrusion of lips - flatten profile
loss of muclscle tone
less U incisor - more lower incical display
bone biology in this patient population
no growth
less growth factors
periodontal disease
diminished attachment apparatus
flaring of teeth
*always a continue of bone remodeling though
detnal status of older
dentiiton alterations
- wear sgns and irreeuluar pattern
loss of some VDO
tx goals in adult patients
prepate mouth for complex restorative treatment
minimum tx duration
improve periodontal prognosis
ortho - perio diagnosis
perio diagnosis
orrtho diagnosis
perio basic therapy – need to be addressed before ortho
perio surgery could be before during or after
- NEED TO BE ON 3 MONTH RECALL
ORTHO BEFORE PERIO?
no — paper did say ortho tx can only be truly considered to improve perio health in those relatively rare cases where treatment corrects an occlusal relationship causing traumatic injury to the periodonta tissue
improving oral hygeine
something we can do as ortho for our perio patients
- crowding and tipping make it more difficult to maintain periodontal health
- resolve crowding
- proper alignment
- stabilization of teeth with mobility with fixed lingual retainer, maintenance of results long term
plan of action with perio ortho patients
consults (perio, resto, ortho)
basic perio therapy and restorative therapy and surgical SRP if needed
extractions if needed
ortho intervention
gingivoplasty - grafts if needed
maintenance (perio and ortho)
breakdown of improve smile esthetics
- gummy smile
- gingival architecture
- black triangles
- recession
causes of gummy smile
skeletal
- vertical maxillary excess
perio
- altered passive eruption
skeletal cause of gummy smile
tx?
teeth normally shaped, with an increased lower anterior facial height with vertical maxillary excess, all maxillary teeth seem over erupted
tx
- combo ortho and orthgnathi surgery
or plastic surgery
NEW tx: botox upper lip
perio cause of gummy smile
altered passive eruption
- NONE OR REDUCED gingival margin after active eruption phase – late adolescence
so thick fibrotic tisssue migrates slower
teeth seem square and short, margin > 1 mm from CEJ
thick fibrotic gingiva
APICAL migration did not occur normally
tx
- perio surgery to normalize contours
perio surgery timing with gummy smile
if incisal edges are intact, surgery can be delayed until after orthodontic tx is complete and teeth are aligned
in some areas might be necessary to position brackets properly
teeth look short and square
altered passive eruption
perio due to gummy smile
when to do perio surgery DURING ortho?
if incisal edges are abraded – CEJ might not be leveled within the teeth
surgery during
- to allow corrections of discrepencies with intrusion - extrusion or restoration
gingival margin on centrals and cuspids position
1 mm apical than on the lateral incisor
altered architecture causes
altered passive eruption - localized
supra or infraeruption of teeth - loo incisal edges / wear pattern
recession
