Individualized management of chronic periodontitis in patients with orthodontic abnormalities: a clinical case report

Abstract

Relevance. Chronic periodontitis is a multifactorial disease influenced by a variety of factors. Beyond periodontal pathogens and systemic conditions, important contributing factors include malocclusion, dental misalignment, and tooth loss. These conditions can compromise the tissue blood flow hemodynamics and precipitate occlusal trauma with signs of functional overload. Subsequently, this may intensify the inflammation and degradation of the alveolar bone, often leading to premature tooth loss.Correction of malocclusion is paramount in the effective management of periodontal diseases, requiring orthodontic treatment to resolve malocclusion and mitigate signs of functional overload. This treatment aims to redistribute occlusal forces uniformly, thus creating a conducive environment for successful prosthodontic rehabilitation and promoting optimal personal oral hygiene.Clinical case description. This article outlines a personalized approach to managing periodontal inflammation in individuals with orthodontic anomalies. Patient Z., born in 2002, was diagnosed with moderate severity chronic periodontitis (K05.31), presenting with a Class I molar and canine relationship on both sides, constricted dental arches, individual tooth macrodontia, and retrusion and torsiversion of the incisors. The assessment of the patient's periodontal status and overall health was conducted using standard clinical, radiographic, and laboratory diagnostics, whereas the orthodontic assessment involved anthropometric analysis of dental casts and lateral cephalometric radiographs. The periodontal intervention included foundational non-surgical treatments such as ultrasonic scaling both supra- and subgingivally, biofilm disruption using the Vector Paro system, and specific pharmacotherapy. The orthodontic treatment aimed to widen both dental arches and correct the inclination of the upper and lower incisors, achieving a normal occlusion with fixed orthodontic appliances (Damon Q brackets) in accordance with the treatment plan. The effectiveness of the treatment was measured by examining the improvement in gingival conditions, periodontal parameters, and radiographic evidence before and after the intervention.Conclusion. The research demonstrated that an individualized treatment protocol integrating periodontal and orthodontic care can substantially improve the overall health of the dentofacial complex, masticatory efficiency, and aesthetic aspects.