Periodontal-Orthodontic Treatment For Generalized Stage III Grade C Periodontitis

The treatment goal of periodontitis is to generate a health periodontal condition that can retain many teeth as long as possible. Orthodontic treatment is essential for patients with periodontitis to inhibit progression of periodontitis, because generalized periodontitis causes some pathologic tooth migration. A 30-year-old male patient was referred for periodontal evaluation prior to orthodontic treatment. Clinical examination revealed fair oral hygiene (calculus index 2), with probing depths ranging from 7 to 12 mm. Cone-beam CT scans showed horizontal alveolar bone resorption to the middle 1/2 to apical 1/3 of tooth roots, vertical resorption in teeth 37, 47, 11, 23, 26. After 6 months of non-surgical periodontal therapy, bone grafting and guided tissue regeneration were performed for teeth 37, 47, 11, 23, 26. After 2 years of orthodontic treatment, tooth 47 developed mesial root resorption to the apex, periapical radiolucency, suspected cementum tear, and pulp necrosis. Tooth 47 was extracted with alveolar ridge preservation for future implant restoration. In this case, timely diagnosis and comprehensive periodontal therapy stabilized the periodontium, allowing safe orthodontic tooth movement. Root resorption of tooth 47 likely resulted from its history of severe periodontitis, altered occlusal forces following extraction of tooth 48, and orthodontic stress during treatment. Integrated periodontal-orthodontic management provides a biological foundation for orthodontic treatment and improves esthetics and long-term periodontal maintenance. Regular follow-ups and maintenance therapy are essential for early detection and intervention to prevent complications.