Korean J Orthod.  2022 Nov;52(6):439-450. 10.4041/kjod21.263.

Orthodontic treatment with clear aligners for a patient with chronic periodontitis

• Zhang J
• Li J
• Peng Y

• KMID: 2536337
• DOI: http://doi.org/10.4041/kjod21.263

Abstract

This case report describes the treatment of an adult female patient with a history of periodontal disease, Class I malocclusion with extrusion, dental spaces, and pathologic tooth migration. The patient was treated with clear aligners, which effectively controlled the strength and direction of orthodontic forces after 3 months of systematic periodontal treatment. The Peer Assessment Rating (PAR) index was calculated from study models before and after treatment. The pretreatment PAR score was 24, and the posttreatment PAR score was 4. The PAR score for this patient changed by 83%. Satisfactory appearance and good function were achieved for this patient.

Keyword

Adult treatment; Periodontitis; Aligners; Malocclusion

Figure

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  Figure 1 Pretreatment facial and intraoral photographs of an adult with inactive periodontal disease.

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  Figure 2 Initial cone-beam computed tomography scan showing cephalometric (A) and panoramic radiographs (B) of an adult with inactive periodontal disease.

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  Figure 3 Initial cone-beam computed tomography scan showing dental radiographs of an adult with inactive periodontal disease. The numbers in this figure refer to the FDI notation for permanent teeth.

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  Figure 4 A, Bite ramps on the lingual surface of the maxillary aligners. B, Interproximal reduction chart.

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  Figure 5 Treatment progress: intraoral photographs 14 months after the start of orthodontic treatment (upper) as compared to patient’s planned tooth positions (lower). The deep bite was corrected, and the spaces between teeth were closed.

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  Figure 6 Posttreatment facial and intraoral photographs of an adult with inactive periodontal disease treated with clear aligners. Proper overjet and overbite were achieved, and the lateral profile was maintained.

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  Figure 7 Posttreatment cone-beam computed tomography scan showing cephalometric (A) and panoramic radiographs (B) of an adult with inactive periodontal disease treated with clear aligners.

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  Figure 8 Posttreatment cone- beam computed tomography scan showing dental radiographs of an adult with inactive periodontal disease treated with clear aligners. The numbers in this figure refer to the FDI notation for permanent teeth.

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  Figure 9 Superimposed cephalometric tracings showing the changes from pretreatment (black) to posttreatment (red) in an adult with inactive periodontal disease treated with clear aligners. A, Superimposed on the sella-nasion plane at sella. B, Superimposed on the palatal plane at the anterior nasal spine. C, Superimposed on the mandibular plane at the menton. The intrusion of the incisors was achieved, and the inclination of the anterior teeth was improved.

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  Figure 10 Facial and intraoral photographs at 7 months after treatment. Prosthodontic rehabilitation of the left maxillary canine yielded optimal esthetic results.

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  Figure 11 Blocking out the undercuts and trimming the line of the aligners. These designs applied gentle instantaneous force when inserting and removing the aligners to protect the periodontal tissues. The following gaps are considered to be eliminated in this case: (i) triangle-shaped gaps between teeth; (ii) the gaps between the anterior teeth are greater than 1 mm, and (iii) the gaps between the posterior teeth are greater than 2 mm. Blue means undercut areas between the teeth that need to be eliminated. Orange means undercut areas around the virtual pontic for the right maxillary canine in each aligner need to be blocked out. The dashed line is the boundary of the aligners.

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