A Case Of Multidisciplinary Management In Secondary Orthodontic Treatment

A 21-year-old female with severe periodontitis and temporomandibular joint (TMJ) disorders, previously treated with extraction-based orthodontics, sought secondary correction for anterior spacing. Following multidisciplinary periodontal and TMJ therapy, clear aligners were used for remote treatment, achieving stable outcomes without disease progression. Clinical diagnosis included Angle Class II malocclusion, skeletal Class II, severe deep overbite (II°), excessive overjet (II°),normodivergent growth pattern, missing four premolars, spaced dentition, advanced periodontitis, root resorption of anterior teeth, bilateral condylar resorption, mandibular midline deviation, convex facial profile, and facial asymmetry. After multidisciplinary periodontal and TMJ management, the patient completed 17 months of remote aligner therapy without in-person visits. Post-treatment results showed improved molar relationships, reduced overjet and overbite, closed interdental spaces, straightened facial profile, and partial facial symmetry, and overlapping images demonstrated effective intrusion and retraction of anterior teeth with no further root resorption. One-year follow-up confirmed stable occlusion, periodontal health, and TMJ function. Clear aligners exhibit limitations in deep overbite correction due to suboptimal force expression and challenges in torque control during anterior retraction. Precise staging and aligner design are critical for achieving intrusion and torque accuracy. Patient compliance and thorough risk communication enhanced treatment efficacy and satisfaction in this high-risk periodontal-TMJ case. Multidisciplinary collaboration, combined with clear aligner technology and patient adherence, achieves successful secondary orthodontic outcomes in complex cases with severe periodontitis and TMJ disorders, demonstrating long-term stability.