Periodontal phenotype modification in surgically facilitated orthodontics: A case report.

Abstract

Background: Orthodontic treatment in adults with thin periodontal phenotype presents challenges such as lengthy treatment time and increased risk for gingival recessions. In this case, surgically facilitated orthodontic treatment (SFOT) was proposed to accelerate orthodontic tooth movement while modifying the periodontal phenotype.

Methods: An orthodontic patient was referred for periodontal evaluation of lower anterior teeth, which presented a thin gingival phenotype and bone dehiscence. SFOT was performed on the mandible using particulate allograft combined with platelet rich fibrin (PRF) and collagen membrane to augment soft and hard tissue, thereby preventing future recessions, while accelerating the treatment times.

Results: Six-month and 3-year follow-ups confirmed radiographic bone fill, absence of gingival recession and thick band of keratinized gingiva. SFOT also resulted in a shorter treatment time where desired tooth movements were achieved within 6 months with periodontal stability.

Conclusions: SFOT provided clinical benefits by accelerating orthodontic movement, improving periodontal phenotype, preventing the displacement of teeth beyond the alveolar housing and minimizing the risk for development of dehiscences and gingival recessions.

Key points: Orthodontic movements can create recessions and dehiscence in thin periodontal phenotypes. SFOT can help prevent bone dehiscence and creates a thicker gingival phenotype while accelerating treatment time.

Plain language summary: Adults who face lengthy orthodontic treatments and have thin gums have risks of gum problems. Surgically facilitated orthodontic treatment (SFOT) can help by speeding up tooth movements and improving gum health and thickness. A patient with thin gums and lack of bone in the lower front teeth was evaluated. The SFOT procedure involved using a bone graft, healing factors, and a collagen membrane to strengthen the gums and bones. This approach aimed to prevent future gum problems and speed up orthodontic treatment. Follow-ups at 6 months and 3 years after treatment showed good healing of the gums and bones, with no signs of gum recession and healthier, thicker gums. The desired tooth movements were achieved within 6 months, resulting in a shorter treatment time. The patient's gums remained stable throughout this period. SFOT offered significant clinical benefits, including faster tooth movement and improved gum health. It also helped prevent teeth from moving out of place and minimized the risk of gum recession and bone issues. This approach can be a valuable option for adults with thin gums undergoing orthodontic treatment.