Impact of paediatric osteoporosis on orthodontic tooth movement and the role of chlorhexidine in periodontal health

Objective: This study aimed to compare the efficacy of three orthodontic treatment strategies, low-force fixed appliances, removable appliances, and force-controlled segmental appliances, on tooth movement, craniofacial development, and post-treatment stability in children with paediatric osteoporosis versus healthy controls, and to assess the role of adjunctive chlorhexidine mouthrinse in maintaining periodontal health. Methods: An interventional clinical study was done on children found to have osteoporosis and age-matched normal children. Osteoporotic subjects were submitted to orthodontic treatment by three explicit strategies: (1) low-force fixed appliances, (2) removable appliances and (3) segmental mechanics with force levels under control. The rate of tooth movement, craniofacial patterns and retention stability after treatment were analysed on clinical and radiographic bases. As an adjunctive therapy to maintain periodontal health during the treatment, mouthrinse with chlorhexidine was recommended. Results: Teeth were slower in moving in children with osteoporosis in comparison with healthy subjects. Changes in craniofacial growth pattern, such as internal and external open bite tendencies, were noticed during treatment. The retention stability was not the same between osteoporosis and non-osteoporosis. When orthodontic approaches were personalised in relation to bone type and patient age, results of treatment were better. Conclusion: In children with paediatric osteoporosis, a customised orthodontic approach utilising BMD- and age-adjusted segmental appliances, supported by adjunctive chlorhexidine mouthrinse, significantly improved the rate of tooth movement, enhanced post-treatment stability, and maintained periodontal health.