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Clinical guide to periodontology: part 3. Multidisciplinary integrated treatment
I N B R I E F
Stresses drifted anterior teeth may be a sign of severe periodontitis. Management may include periodontal treatment, splinting and supportive care.
Informs crown lengthening surgery is one of the commonest pre-restorative periodontal procedures.
Highlights replacement of missing teeth using dental implants in periodontitis patients requires appropriate treatment of remaining teeth.
PRACTICE
R. M Palmer,*1 M. Ide2 and P. D. Floyd3
The establishment of periodontal health should be a primary aim in all treatment plans. The methods by which this can be achieved have been dealt with in previous chapters, but there are a number of situations where integration of these treatment methods with other dental disciplines needs to be claried. To simplify matters this chapter will consider periodontal implications in threemain areas: treatment of drifted anterior teeth, pre-restorative procedures and replacement of missing teeth.
DRIFTED ANTERIOR TEETH
Drifting or spacing of the maxillary anterior teeth is a frequent complaint of patients with periodontitis and demands careful diagnostic evaluation before choosing the treatment options. This is because the cause of the problem is usually multifactorial. The evaluation can therefore be conveniently divided into threesections: Periodontal Orthodontic Restorative/occlusal.
EVALUATION OF AETIOLOGY
Periodontal
In situations where occlusal or soft tissue forces are persistent and likely to produce movement of teeth, the required magnitude
of force will be inversely proportional to the amount of periodontal support. Chronic periodontitis is the most common cause of destruction of the periodontal support. Inflammation destroys the integrity of local interdental collagen bundles and consequently alters the equilibrium stabilising the buccopalatal position of the tooth. The pattern of attachment loss on an individual tooth is also pertinent. In many cases the deepest pocketing and the most severe bone loss is on the palatal aspect of a labially migrated incisor. This has led to the (unproven) proposal that the forces generated within the inammatory lesion are responsible for the tooth movement. Recurrent abscesses in this situation may lead to rapid destruction and drifting. The amount of periodontal support will also depend upon factors such as: Root length Root shape (for example, very tapering root forms)
Root resorption (for example, post orthodontic)
Endodontic lesions destroying the apical periodontium.
These factors can...