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

Abstract

Aim: To compare the outcomes after early (4 weeks post surgery) or late (6 months post surgery) orthodontic therapy (OT) following regenerative surgery of intra-bony defects (IDs). Materials and methods: In a multi-center, parallel-group, randomized clinical trial, 43 patients with stage IV periodontitis were randomized to receive either early (n = 23) or late OT (n = 20) following regenerative surgery of IDs. Primary outcome was change in clinical attachment level (CAL) in one target ID at 12 months after surgery. Secondary outcomes were changes of probing pocket depth (PPD), bleeding on probing (BOP), and frequency of pocket closure.Results: No statistically significant differences between groups could be observed for CAL gain (5.4 mm [±2.1 mm] for early; 4.5 mm [±1.7 mm] for late OT). PPD was reduced by 4.2 mm (±1.9 mm) in the early group and by 3.9 mm (±1.5 mm) in the late group (p > .05). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects in early compared to 85% in late OT. Conclusion:In the inter-disciplinary treatment of periodontitis stage IV, OT can be initiated already 4 weeks after regenerative surgery of IDs with favourable results, thus reducing the overall treatment time.orthodontic tooth movement, pathologic tooth migration, regenerative periodontal therapy, stage IV periodontitis Clinical RelevanceScientific rationale for study: Information on the treatment of patients with stage IV periodontitis with intra-bony defects (IDs) and pathological tooth migration (PTM) in need of orthodontic therapy (OT) is limited. The optimal interval between regenerative periodontal surgery and OT is a matter of ongoing debate.

Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline

“…The results from the RCT comparing OT starting early versus late, after the periodontal regenerative intervention, demonstrated a potential beneficial effect of the early OT, since no statistically significant differences were observed in terms of CAL gain (5.4 mm [SD = 2.1] for early; 4.5 mm [SD = 1.7]) for late OT, or PPD reduction [4.2 mm (SD = 1.9) in the early group versus 3.9 mm (SD = 1.5) in the late group ( p > .05)]. Similarly, pocket closure (PPD ≤ 4 mm) occurred in 91% of the early OT treated teeth versus 85% in late OT (Jepsen et al, 2021).…”

“…Using the Risk of Bias 2.0. tool, two RCTs were rated high risk of bias. The RCT comparing early versus delayed OT (Jepsen et al, 2021) was rated low risk of bias. The remaining 13 studies, using the ROBINS‐I‐tool, were rated as critical risk of bias in eight studies, as serious risk of bias in four, and as fair risk in one study.…”

Complications and treatment errors involving periodontal tissues related to orthodontic therapy

“…As many patients affected by such a condition are interested in seeking orthodontic treatment because of the esthetic and functional changes caused by pathologic tooth migration, 52 this question of early versus late initiation of OT is of high clinical relevance. The results of a recently published multicenter randomized trial could shed new light on this challenging treatment decision 85 . After 12 months, significant periodontal improvements of similar magnitude were accomplished by regenerative treatment of intrabony defects following early (after 4 weeks) and late (after 6 months) initiation of orthodontic tooth movement in patients with a high level of oral hygiene and infection control (Figure 5).…”

Efectos de los tratamientos de ortodoncia en los tejidos periodontales

“…En cuanto al momento ideal para empezar el tratamiento de ortodoncia posterior al tratamiento periodontal existen varios criterios que varía los unos de los otros por ejemplo en el estudio realizado por Aimetti et al 14 el tratamiento de ortodoncia se pospuso por 1 año para evitar la interferencia con la cicatrización de la herida periodontal.…”