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33Dental Tribune Middle East & Africa Edition | May - June 2014 education tribune Dr. Athanasios E. Athanasiou is Professor and Program Director of Orthodontics, Dubai School of Dental Medicine, United Arab Emirates and Professor of Or- thodontics Aristotle University of Thessaloniki, Greece. He is former President of the World Federation of Orthodon- tists and the European Federa- tion of Orthodontics. About the Author < Page 27 “Failure to provide appropriate treatment of occlusal trauma in patients with chronic periodontitis may result in progressive bone loss” www.dsdm.ac.ae are Dubai Dental Clinic provides comprehensive treatment in all specialized dental needs including: Orthodontics | PeriodontalTreatment | Esthetic Dentistry Dental Implants | Crowns | Pediatric Dentistry | Root Canals Oral Surgery | TeethWhitening : | | | | | | 04-4248777 800-DENTAL (800-336825) For more information or to make an appointment call us on 800-DENTAL (800-336825) or 04-4248777Figure 5. Adult patient with signifi- cant loss of posterior occlusal sup- port,extremeanterioroverbite,and direct trauma to the gingiva from the incisal edges of the mandibular incisors (A). Following orthodon- tic treatment and comprehensive restorative therapy patient’s occlu- sion and health have been signifi- cantly improved (B). Figure 4. Maxillary incisor with negative prognosis due to signifi- cant bone loss (A). Following orth- odontic forced eruption of the tooth, which is planned to be extracted, improved the quality of the avail- able bone (B). (Papadopoulou, 2013) Figure 3. Young adult with lower second premolars congenitally missing (A). Following extraction of lower second deciduous molars orthodontic treatment resulted to the closure of the space (B) and (C). Figure 2. Subgingival horizon- tal fracture of the upper left cen- tral incisor (A) was managed by orthodontic forced eruption, which resulted to the exposure of tooth structure (B), thus allowing the prosthetic management (C), (Melsen, 1982). ward the midline, while at the same time their cusp tip are esthetically reshaped in order to make them resemble to the laterals, which they replace (7). Furthermore, periodon- tal health is greatly improved as compared to that of cases, which have been rehabilitated by means of prosthodontics (8). The orthodontic closure of the space might be indicated when a premolar or even a molar are missing as long as certain in- dications exist concerning the whole occlusion or malocclu- sion (9) (Figure 3). Orthodontics, restorative den- tistry and oral health When teeth have been lost early, those remaining distal to the edentulous space, usually present with a mesial tipping, displacement and rotation. In- dividuals with an abnormal mesio-distal inclination or displacement of the posterior teeth were found to have a posi- tive association between me- sial inclination and periodontal destruction. Once periodontal health is established, occlusal therapy can be used to reduce mobility, to regain bone lost owing to traumatic occlusal forces, and to treat a variety of clinical problems related to occlusal instability and re- storative needs (7). Failure to provide appropriate treatment of occlusal trauma in patients with chronic periodontitis may result in progressive bone loss, adverse change in prog- nosis thus resulting in tooth loss. Uprighting these teeth by orthodontic means before the conventional restoration of the edentulous areas may cor- roborate to their periodontal treatment and maintenance in the dental arch. When premo- lars will be replaced adequate space is necessary not only at the mesio-distal but also at the bucco-lingual direction. Teeth with a negative prognosis can be used to maintain or improve the volume and structure of the alveolar bone at the site where they are located. The forced eruption of a tooth, which is planned to be extracted, alters the architecture of the soft peri- odontal tissues and improves the quality of the available bone (Figure 4). Therefore, the final prosthetic work is associated with a better overall result due to the increase in the gingival height produced by this method (8). Subsequent absence from the dental arch of impacted perma- nent teeth is not an indication for their prosthetic replace- ment but rather a sign for the start of their orthodontic trac- tion, placement and alignment into their natural position in the dentition (9). In cases of extreme anterior overbite, direct trauma to the gingiva from the incisal edges of the mandibular incisors may result in palatal recession of the maxillary incisors (Figure 5). Similarly, in severe Class II, division 2 malocclusions with linguoversion of the maxillary incisors, functional trauma can cause marginal recession of the labial gingiva of the mandibu- lar incisors. This recession, although not the result of peri- odontitis, can result to a signifi- cant loss of attachment. Clinical observation suggests that when crowding causes overlapping of adjacent teeth, the interproximal space may be minimal, root proximity may occur, and the quality and amount of bony support maybe compromised (Diedrich, 2000). This is a poor environment for tissue health. The removal of plaque and subgingival calcu- lus in the inaccessible proximal space may fail despite careful application of prophylaxis pro- cedures. Orthodontic interven- tion can improve the anatomic and functional environment and may limit the recession. Conclusions Provision of adjunctive orth- odontic treatment should be characterized by the following preconditions: (a) Knowledge of the clinical boundaries of gen- eral dentistry and of any other dental specialty involved in maintaining natural dentition under biologically, function- ally, and esthetically optimal conditions; (b) establishment of two-way, structured, and continuous communication between general dentists and orthodontists concerning the contribution of specialised care to the oral rehabilitation; (c) assessment of the cost-benefit relationship concerning treat- ment fees and duration, coop- eration, inconvenience, dis- comfort, pain and difficulty; and (d) diagnosis and treat- ment planning relying on strict evidence-based criteria. (A) (B) (C) (A) (B) (C) (A) (A) (B) (B) References 1. Proffit WR. Special consider- ations in comprehensive treat- ment for adults. In: Proffit WR, Fields HW, eds. Contemporary Orthodontics. St. Louis: Mosby, 2000:644-73. 2. Mavreas D, Athanasiou AE. Orthodontics and its interac- tions with other dental disci- plines. Prog Orthod 2009;10:72- 81. 3. Re S, Corrente G, Abundo R, Cardaropoli D. Orthodon- tic treatment in periodontally compromised patients: 12-year report. Int J Periodontics Re- storative Dent 2000;20:31-9. Editorial note: Full list of references is avail- able from the author.