Long-term evaluation of an adult with a skeletal Class II with severe crowding and periodontitis treated with an interdisciplinary approach with lingual brackets and miniscrews

Orthodontic treatment for adults with severe periodontal disease requires an interdisciplinary approach. An adequate periodontal diagnosis and extensive initial treatment are important for successful orthodontic treatment. The combination of lingual brackets with miniscrews as the anchorage is an ideal tooth movement in adult patients who have esthetic concerns with buccal brackets. A 45-year-old man with a skeletal Class II, high-angle malocclusion with crowding and severe periodontitis was successfully treated with a periodontal and orthodontic multidisciplinary approach to achieve long-term stability. Extensive periodontal treatment was performed for approximately 6 months before the orthodontic treatment. Lingual brackets were used because the patient was concerned about esthetics, and miniscrews were used to reinforce the anchorage (anteroposterior) and control the vertical dimension (high angle) and anterior torque. Adequate incisor torque control was achieved by ribbon-wise lingual brackets and with the use of midpalatal miniscrews. The incisor retraction direction was close to the center of resistance, which resulted in the bodily movement of maxillary incisors with intrusion. There was no substantial change in the pocket depth, and the periodontal status was maintained throughout the entire orthodontic treatment. Therefore, we believe that ideal occlusion can be achieved in cases of a severe periodontal compromised status in adults using ribbon-wise lingual brackets and midpalatal miniscrews, which result in long-term stability.