Orthodontic treatment in periodontal patients: The use of periodontal gold standards to overcome the “grey zone”

Predictors of tooth loss during long‐term periodontal maintenance: An updated systematic review

“…3–6 months) should be established according the presentation and aggressiveness of the disease by stage (I, II, III and IV) and grade (A, B and C) and the patient`s systemic condition: Stage I and II periodontitis patients displaying a slow to moderate rate of progression and periodontal destruction (Grades A and B) may follow regular maintenance care appointments at a 6 month interval. However, Stage III and IV periodontitis patients, smoker, diabetic patients and patients with a rapid rate of destruction/progression (Grade C) should follow a shorter maintenance interval (3–4 months) (Pini Prato & Chambrone, 2020). Additionally, it is important to highlight that diabetic patients must be encouraged to maintain controlled glycemic status, as well as, smoking cessation should be encouraged in active smokers.…”

The effect of timing of orthodontic therapy on the outcomes of regenerative periodontal surgery in patients with stage IV periodontitis: A multicenter randomized trial

“…According to a recently published commentary, the lack of an accurate “gold standard”, a research‐based moment for initiating orthodontic tooth movement after periodontal therapy, would demonstrate that a “grey zone” of evidence remains and knowledge on periodontal wound‐healing dynamics may be considered the best “biologic starting point” of orthodontic treatment for treated periodontitis patients (Pini Prato & Chambrone, 2020). The authors proposed a personalized periodontal algorithm and postulated that OT should be initiated 1 year after regenerative treatment.…”

“…In particular, the optimal time interval between periodontal surgery and the initiation of OT is a matter of ongoing debate. It may be safe to wait until the end point of regenerative therapy has been reached (usually between 6 and 12 months) and not to interfere with periodontal wound‐healing (Pini Prato & Chambrone, 2020). Case reports and series with long‐term follow‐ups have reported favourable periodontal outcomes using such a delayed approach (Ghezzi et al, 2008; Jepsen et al, 2015; Roccuzzo et al, 2018; Aimetti et al, 2020).…”

Regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: A retrospective practice‐based cohort study

“…According to a recently published commentary, the lack of an accurate "gold standard," a research-based moment for initiating orthodontic tooth movement after periodontal therapy, demonstrates that a "grey zone" of evidence remains and knowledge on periodontal wound healing dynamics may be considered the best "biologic starting point" of orthodontic treatment for treated periodontitis patients (Pini Prato & Chambrone, 2020). The authors proposed a personalized periodontal algorithm and postulated that orthodontic therapy should be initiated 1 year after regenerative treatment.…”

“…While the value of regenerative procedures in intra-bony defects in stage III periodontitis is well established (Cortellini & Tonetti, 2015;Bröseler et al 2017;Nibali et al 2019;Sanz et al 2020), the literature remains unclear with regard to the best time point to initiate orthodontic therapy after regenerative surgery of migrated teeth with intra-bony defects-as typically present in stage VI periodontitis. It may be safe to wait until an endpoint of regenerative therapy has been reached (usually between 6 and 12 months) and not to interfere with early periodontal wound healing (Pini Prato & Chambrone, 2020). Indeed, several longer-term case series and reports with a follow-up of at least 3 years after regenerative surgery have shown favourable outcomes with such a delayed approach (Ghezzi et al 2008;Jepsen et al 2015;Roccuzzo et al 2018;Aimetti et al 2020).…”