Long-term Interdisciplinary Management of Severe Vertical Bony Defects Using Periodontal Accelerated Osteogenic Orthodontics (PAOO)

Background: Management of severe malocclusion in patients with chronic periodontitis poses significant challenges due to compromised periodontal support and alveolar bone loss. Periodontally accelerated osteogenic orthodontics (PAOO) may facilitate tooth movement while promoting bone regeneration in such cases. Case presentation: A 33-year-old male with chronic periodontitis and severe malocclusion presented for orthodontic correction. Initial treatment included comprehensive periodontal therapy—oral hygiene control, open-flap debridement, and bone grafting—prior to orthodontic intervention. Congenital absence of tooth 12 resulted in mesial drift, and teeth 17, 24, and 27 were extracted due to poor prognosis. Despite initial periodontal improvement, inflammation and labial plate collapse at the extraction site of tooth 24 hindered space closure. Localized PAOO with regenerative materials restored bone integrity, allowing efficient orthodontic tooth movement and achieving stable occlusion. Outcome and follow-up: Periodontal health and occlusion remained stable over a 13-year follow-up period. Conclusion: In patients with chronic periodontitis and severe malocclusion, localized PAOO combined with regenerative therapy can effectively address alveolar defects, enabling safe and stable orthodontic treatment. Long-term interdisciplinary management is critical to maintaining both periodontal and occlusal stability.