The Adjunctive Relationship Between Orthodontics and Periodontics
Understanding the relationship between periodontics and orthodontics is an essential tool for the specialist in modern practice. The use of 3D imaging is important as a diagnostic tool in both entities and is an aid for accuracy in surgical interventions.
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Michael Schmerman and Julio Obando
13.1 Introduction The adjunctive relationship between orthodontics and periodontics is both complex and symbiotic. Both specialties rely on each other’s principals and expertise to accomplish their respective goals. Advances in material science and technical developments have changed the outlook on how we treat patients and what is clinically possible. The interactions of the two have led to a series of proposed goals and guidelines that can be realized [1]. They include: 1 . Improved cleansability by reduction of crowding 2. Vertical positioning changes to reduce osseous resective needs 3. Alignment of maxillary gingival margins to avoid surgery 4. Forced eruption for traumatic fractures 5. Embrasure change to regain papillary form 6. Improved spacing for dental implants
M. Schmerman (*) Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA Department of Dentistry, Advocate Illinois Masonic Medical Center, Chicago, IL, USA e-mail: [email protected] J. Obando Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA © Springer Nature Switzerland AG 2020 S. Nares (ed.), Advances in Periodontal Surgery, https://doi.org/10.1007/978-3-030-12310-9_13
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M. Schmerman and J. Obando
13.2 Patient Evaluation Of paramount importance, prior to performing any procedure, is the formulation of a proper diagnosis. The medical and dental histories must be carefully reviewed for any needed precautions or contraindications that may influence treatment planning. Diagnosis should be based on clinical findings and confirmed radiographically. Marked technological improvements in radiography have had a significant impact on the accuracy of analysis. Most procedures require simple imaging techniques. These include roentgenograms and orthopantomograms. For more complex procedures such as exposure of impacted teeth, the use of cone beam computed tomography (CBCT) is essential [2]. This affords the clinician the ability to accurately determine the position of the impaction in three dimensions. Until the advent of this tool, the guesswork of periapical radiographs using Clark’s rule (tube-shift technique or SLOB rule) was always present [3]. Intraoperatively, procedural progress in many areas may be determined by either periapical or CBCT analysis, depending on the situation.
13.3 Exposures of Impacted Teeth Of historical interest is the evolution of exposures of impacted teeth. Until the development of direct bonding of orthodontic devices, practitioners were limited in their abilities to move impacted teeth. An example of this was the use of wire ligation [4, 5]. The ligature was placed around the cervical neck of the tooth and then attached to the orthodontic appliance. Control of mechanics was haphazard. The use of dental adhesives beginning in the mid-twentieth century changed that dramatically [6]. Multiple generations and advances in etching and adhesive materials have improved our abilities to a
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