Management Of A Complex Osseous Defect During Orthodontic Treatment.

This report covers a case of periodontitis with a complex bone defect in the maxillary left central incisor (21) during orthodontics. Successful outcomes and tissue regeneration were achieved by combining corticotomy, guided tissue regeneration(GTR)and bone grafting, with early postoperative orthodontic treatment. Medical history: A 30-year-old man with severe periodontitis started orthodontic treatment post-initial periodontal treatment. After two years of orthodontics, a deep pocket was discovered in 21 tooth. Physical examination: The probing depths (PD) of 21 were measured as follows: 7 mm in the mesial buccal, 8 mm in the mesial palatal, and 9 mm in the central labial areas. Cone-beam computed tomography (CBCT) revealed 21 bone defects in the mesial, labial, and palatal regions. The interdental space between 11,21 measured 4 mm. Diagnosis: Periodontitis (stage III, grade C), Malocclusion Treatment progress: Corticotomy, bone grafting and GTR were performed in 21 cases. Orthodontic treatment recommenced one month post-surgery. Patients were monitored at three-month intervals and received periodontal maintenance care. Outcome: The orthodontic treatment was completed after one year, the PD at site 21 was less than 3 mm, and CBCT revealed mesial, labial and palatal alveolar bone regeneration at the same site. EFP guidelines suggest that intraosseous defects impact orthodontic treatment outcomes. Delaying orthodontics after regeneration isn't necessary, as both short (1 month) and long (6 months) intervals yield similar results. Corticotomy, bone grafting, and GTR effectively treat complex bone defects, while early orthodontic treatment post-surgery enhances periodontal regeneration.