Abstract
The basic approach to periodontitis is to eliminate causative agents by means of scaling and root planing. In advanced periodontitis, however, the treatment goal should be set to establish a long-lasting, functional, easy-care dentition free of occlusal trauma. Opportunities to restore severely deteriorated dentition have dramatically increased, and multidisciplinary work is a must. This is a case report of a skeletal class II patient with advanced periodontitis. Because of the retruded small mandible and proclination of upper incisors, the 40-year-old woman had a bird-face profile with a deep bite and a huge overjet. Lip seal had been lost and her temporo-mandibular joints clicked audibly. The radiographs showed considerable alveolar bone loss despite ralatively shallow periodontal pockets —5mm at the deepest. Since her malocclusion had to be solved by surgical orthodontics, we set up a team to provide interdisciplinary therapy. During the first 8 months, periodontal therapy —oral hygiene instruction followed by meticulous root planing— was carried out together with endodontic treatment and temporary restoration. The patient was highly motivated and the tissue responded satisfactorily. The next 2 years were spent in orthodontic treatment. With the help of multi-bracketed appliances, the cant of occlusal plane was corrected by Le Fort I osteotomy and the mandibular deficiency was improved by distraction osteogenesis (DOG). During the active movement phase, the teeth became loose and slight gingivitis developed. Once retention started, the patient was retrained in oral hygiene and the teeth were again thoroughly planed. Provisional restorations were also installed in this corrective phase. After the periodontal tissue recovered from damage and the new occlusal position functioned well, carefully designed permanent restorations were brought in. The outcome was successful esthetically as well as in function. As most of the abutment teeth are poorly supported with alveolar bone, it is essential to keep check-ups to maintain good plaque control and avoid occlusal trauma.
