An interdisciplinary treatment to manage pathologic tooth migration: A clinical report

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Pathologic tooth migration (PTM) is a common symptom of periodontal disease and a motivation for the patient to seek dental therapy. The primary factors causing PTM are periodontitis and occlusal trauma. Comprehensive treatment for managing a moderate degree of PTM, including periodontal, orthodontic and prosthodontic treatment is described. Increasing the occlusal vertical dimension (OVD) with provisional restorations was attempted to create space for retracting maxillary flared teeth. Retraction and intrusion of maxillary flared incisors were achieved by a sectional orthodontic appliance. Splinted crowns from maxillary right lateral incisor to left lateral incisor were fabricated and connected to posterior prostheses by means of attachments to prevent relapse and to provide long-term stability.

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Clinical Report

A 48-year-old woman presented to the Department of Periodontics, Samsung Medical Center (SMC) Dental Clinic, Seoul, South Korea with spacing between the maxillary central and lateral incisors. The patient also had type 2 diabetes mellitus as a systemic contributory factor.23 Previously, the patient had visited the dental clinic due to severe gingival swelling and bleeding around the maxillary central and lateral incisors while hospitalized with diabetic shock at SMC. The mandibular incisors

Discussion

The use of orthodontic intrusion in periodontally compromised patients remains controversial since there is no histologic evidence in humans that orthodontic intrusion produces new attachment. While extrusion is recommended to improve periodontal conditions,28 it is not the best option as PTM involves the extrusion of teeth which already have long clinical crowns. Therefore, orthodontic retraction and intrusion was planned for this patient. The gingival recession was decreased at the end of

Summary

This clinical procedure with a short-term follow-up demonstrated that orthodontic treatment of periodontally compromised teeth could improve their clinical attachment levels by reducing gingival recession. The etiology causing PTM must be determined before initiating treatment. The appropriate treatment sequence should be used to manage periodontal disease, occlusion, and tooth movement. After completing orthodontic movement, semi-definitive or definitive retention should be considered to

Acknowledgments

The author thanks Dr Kwan-Woo Lee for all his restorative work and Dr Radi M. Masri for his critical reading. The author reports no conflicts of interest related to this case report.

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