The Ortho-Perio Interface? 12 MINUTE SUMMARY

Join me for look at the orthodontic -periodontal interface, the latest evidence looking at the effects of orthodontic tooth movement as well what periodontal surgery can offer in recession management. This podcast is a summary of Christos Kassaro and Anton Spurrier’s excellent lecture, as part of the AngleNet Webinar Series. Timestamp 0:44 – At 1-year recession risks of orthodontics 2:30 – At 15-year recession risks of orthodontics 4:37 – Retainer relapse: "X" & "Twist" effects 5:13 – Biomechanics: Using mixed bracket slots for torque 6:17 – Perio surgery principles & donor sites 7:54 – Flap designs: Full vs. split-thickness 8:14 – Surgical techniques: MCAT vs. LCT 9:27 – Timing: Surgery before vs. after ortho? 10:33 – Surgical adjuncts: Hyaluronic acid Orthodonticaetiology at 2 time points: 1. During active orthodonticmovement 2. During retention phase Kloukos2025 1year follow up study of adult orthodontic patients Vs control · 1 year post debond of non-extractiontreatment at 67% greater incidence of recession within the orthodontic group (IRR = 1.67,95% CI: 1.05, 2.67, P = 0.03). Five main findings: 1. Recessionlocation: canines and first premolars, 2. Proclination:incisor proclination of 6.35o with no recession 3. Recessionin control group: increased but less than orthodonticgroup 4. Recessionquantity: Generally small at 1 mm 5. Reductionin recession for some: Both groups showedsome patients had a reversal of their recession Long term though what do we see? · Gebistorf 2018 Swiss group · At 15 years 77% of orthodonticpatients had 1-14 areas of recession, · Control group who had 62%. · Greater recession on lingual aspectthan labial · 2.73 x more recession with crossbitescorrected (95% CI, 0.28-5.17; P = 0.029) · Crowding in controls: 3 mm = 3.29 x more recessions (95% CI, 0.73-5.68; P =0.012) Orthodontics onaverage does not compromise long term health or function, but may compromise aesthetics Fixed Braided Retainers ‘X’effect (torque) or twist effect (proclination) unwanted movement from wire activation · Not relapsed as new movement · Occurrence: 2.7% (n=221 patients) –Renkema 2011 Treatment‘X’ effect 1- Differentialslot side i. Affectedtooth - .18 slot with -17 degrees of torque ii. Remainingteeth.22 slot with 0 torque iii. Sideeffect of intrusion of incisor, due to slot differences Periodontal Surgery concepts: Indication: inadequate gingiva = <2 mm Zhong 2025 · Wound healing o Flapdesign to enhance wound stability – avoid vertical releasing incisions · Connective tissue graft, harvest itfrom the palate. o Keratinizedtissue and quantity o Mostavailable, quick healing Karring 1975 o fibroblastfrom the palate biological potential to inducekeratinization. Surgicaltechniques: 1- Fullthickness: mucosa, connective tissue and includes periosteal layer 2- Splitthickness: mucosa and connective tissue · Timingof surgery Surgeryafter orthodontics · Only when the teeth are in the correctposition · Favorable environment for the woundhealing. · Usual timing of surgery Surgerybefore orthodontics · Require more tissue for the orthodonticmovement: Adjuststo surgery 1- Amelogenins attach proteins to the rootsurface. 2- Hyaluronicacid promotehealing through attracting proteins. Expert consensus on orthodontic treatment of patients with periodontal disease. Zhong2025 https://pmc.ncbi.nlm.nih.gov/articles/PMC11965299/ Contributions Contents:Shanya Kapoor Editedand produced: Farooq Ahmed