Oral Health and Dental Management

Abstract

Alignment of a Vertical Migrated Periodontal Pre-injured Upper Central Incisor

Botzenhart Ute U, Gedrange Tomasz, Gredes Tomasz

Introduction: Labial and vertical migration of maxillary incisors is a common complication of moderate to severe periodontitis and it is often the motivation for patients to seek periodontal and orthodontic treatment. Aims: This case report demonstrates a minimal invasive orthodontic therapy with modified aligners to straighten a periodontal pre-injured upper central incisor with sophisticated bone defect. Methods: A female patient, aged 36 years, presented in our department with the chief complaint of elongation and protrusion of her right upper central incisor, which had strongly changed its position within at least the last year on account of a sophisticated periodontal injury and it had already been incisal grinded by her general dentist up to the exposure of dentin. The clinical evaluation revealed a vertical divergence and protrusion of 2 mm, respectively, frontal dental crowding, and distinctive vertical bone loss with probing depth of at least 8 mm at the most affected side, mild loosening, but no signs of periodontal inflammation. A minimal invasive treatment with a modified aligner appliance, including a total of 3 aligner series and 6 set-ups, was carried out. Intrusion was realized with vertical elastic, little buttons bonded at the aligner and an incisal slot opening. Results: Total treatment time amounted 6 months. The result was stabilized with a bonded retainer. Radiologic control revealed no variation in tooth length and a stable periodontal pocket after active orthodontic treatment. Discussion and conclusion: This case report demonstrates that orthodontic aligner treatment in the aesthetical area is possible and can be safely performed even in case of distinctive bone loss.