Wire Syndrome: Periodontal Complications and Management

Lingual wire retention is an internationally used modality for long term orthodontic retention. Although generally safe, some wires become activated, leading to severe and sometimes irreversible periodontal complications. These complications are not widely known in the dental profession and have been generally described from an orthodontic perspective. The constellation of issues with activated wires has been referred to as 'Wire Syndrome'. Although some patients are diagnosed within the first five years of completion of orthodontic therapy, there is a subset of patients that is not diagnosed until much later than has been reported in the orthodontic literature. These are frequently referred to periodontists with a diagnosis of 'gingival recession'. By the time the problem is identified, a significant amount of attachment loss has already occurred. The individual patients' periodontal phenotype is a key determinant to the severity of attachment loss. Cases identified in periodontal practice over the course of ten years are hereby presented along with clinical observations and recommendations.