Assessing the state of the alveolar morphotype when planning and carrying out orthodontic treatment for patients with inflammatory periodontal disease

BACKGRAUND: Negative functional and anatomical disorders of the periodontal complex tissues occur in 30–55% of cases against a background of orthodontic tooth movement. New diagnostic capabilities are needed to monitor the state of periodontal tissues during orthodontic tooth movement when using removable and non-removable types of orthodontic equipment to prevent the pathology of the supporting apparatus of the tooth.

AIM: To assess the state of periodontal tissues when planning and performing controlled orthodontic movement of crowns and roots of teeth using 3D computed tomography overlay in patients with inflammatory periodontal disease.

METHODS: The study included 80 patients aged 25–35 years, who were divided into a control group (with clinically healthy periodontium) and the main (with chronic generalized periodontitis) group for orthodontic treatment of dentoalveolar anomalies. The orthodontic equipment for the groups was identical (aligners, vestibular, and lingual braces with passive self-ligation). Before starting the orthodontic program, the alveolar morphotype was determined by a patient CT superimposed on a digital modeling program of the future result; the optical density of the alveolar bone was estimated in Hounsfield units. Clinical indicators to assess the condition of the periodontal tissues and the level of tissue recession were determined before treatment, after active periodontal treatment, including resection surgery, and after completion of the orthodontic program.

RESULTS: After the completion of orthodontic treatment, patients in group 1 had fewer periodontal complications (42% in group 1 vs. 54% in group 2), with an initially normal periodontium and a thin alveolar morphotype; 18% and 23%, with a thick alveolar morphotype. The best results were noted in the aligner subgroup (group 1, 16% vs. group 2; the worst were observed in the subgroup with lingually fixed braces at 50% and 55%, respectively). The most common periodontal complication was tissue recession. A positive orthodontic result was obtained after assessing the patient's computed tomography scans superimposed on the digital modeling program of the final result after the teeth were displaced.

CONCLUSIONS: The ability to control the state of the alveolar ridge bone using 3D visualization of tooth movement with a CT overlay increased the efficiency of orthodontic treatment planning by 40%, ensuring minimal side effects and complications.