 |
| Title |
Adults with Periodontitis Can Experience Increased Changes to Clinical Attachment Level (CAL) as a Result of Orthodontic Treatment |
| Clinical Question |
In adult patients with malocclusion, what are the effects of orthodontic tooth movement on clinical attachment level changes in periodontitis patients compared to non-periodontitis patients? |
| Clinical Bottom Line |
For adult patients in need of orthodontic treatment, patients with periodontitis are more likely than healthy patients or patients with stable treated periodontitis to experience an increase in clinical attachment levels from orthodontic intervention. This is supported by a systematic review of 26 studies conducted by Martin et al. Confidence in the validity of the review is impacted by heterogeneity in severity of periodontitis, appliances, and clinical protocols among the studies. The two other prospective studies evaluated also indicate that if the periodontium is stabilized, orthodontic treatment does not appear to be detrimental to the periodontium and clinical attachment levels. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 33998045 | Martin/2022 | 669 adult patients in 26 studies with malocclusion treated by orthodontic fixed appliance | Systematic Review with Meta-Analysis | | Key results | The mean effect for change in CAL in periodontitis patients with baseline measurements reported before periodontal therapy was a gain of 3.52 mm (95% CI, 2.35 to 4.69 mm). The 95% Prediction Interval (PI) was -1.10 to 8.15 mm. The prediction interval allows for informative inferences and illustrates which range of true effects can be expected in future settings. The p-value was <0.001. The heterogeneity (I^2) was 99.3%. Meta-analysis showed a statistically significant increase in CAL from orthodontic treatment when a patient has periodontitis compared to a patient without periodontitis. | | #2) 34882193 | Gehlot/2022 | 36 periodontally compromised adult patients (mean age: 29.67 ± 4.8 years) randomly allocated to either test (perio-ortho) or control group (perio) | Randomized Controlled Trial | | Key results | The study evaluated the effect of fixed orthodontic treatment on periodontal parameters in periodontally compromised adult orthodontic patients. In the study, CAL subgroup analysis showed a reduction in 71% of severe and 53% of moderate CAL sites in the test group with an increase of 55% in mild sites in the test group, while the control group showed a reduction in 54% of severe and 51% of moderate sites with an increase of 38% in mild sites. The difference in the reduction of PD and CAL sites was not statistically significant between the groups (P ≥ .05). This study found that orthodontic treatment after periodontal stabilization does not have any detrimental effect on periodontal health in adult periodontally compromised orthodontic patients and may add to the benefits achieved by periodontal treatment alone. | | #3) 29602347 | Carvalho/2018 | 10 subjects (ages 25.0 ± 5.22 years) with AP received periodontal treatment followed by orthodontic treatment. Control: 10 periodontally healthy subjects (ages 22.9 ± 5.23 years) who received orthodontic treatment. | Comparative Study | | Key results | The study aimed to investigate the effect of orthodontic treatment on the clinical parameters of aggressive periodontitis (AP) subjects. The variables were assessed after the periodontal treatment and before the orthodontic treatment (baseline, T0), immediately after the orthodontic treatment (T1), and 4 months after the end of orthodontic treatment (T2). The AP group had a significant 0.29 mm reduction in PPD and a significant 0.38 mm CAL gain between T0 and T2. The control group showed a significant 0.2 mm reduction in PPD and a significant 0.19 mm CAL gain. There were no significant differences in all variables between T1 and T2 for both groups. There were significant differences between the 2 groups throughout the study for PPD and CAL, with the AP subjects exhibiting significantly higher mean values of both variables. This study suggests that AP patients with reduced periodontium can undergo orthodontic movement without additional attachment loss, provided that the patients adhere to rigid biofilm control and regular professional follow-up visits. | |
| Evidence Search |
orthodontic therapy AND periodontitis AND adult AND (clinical attachment level OR CAL) |
Comments on
The Evidence |
Due to the high heterogeneity (99.3%) and limited sample size of patients with periodontitis receiving orthodontic treatment, the evidence is low quality for the study conducted by Martin et al. The results may be statistically significant (p-value<0.001), but it is challenging to have confidence in the evidence due to the variability and bias. Each of the included studies varied in their inclusion/exclusion parameters, such as age. Periodontal inclusion criteria for each of the studies showed a wide variation in their definitions. The studies focused on younger adults with periodontitis making it difficult to generalize the results to the whole population. The ability of subjects to maintain proper oral hygiene is a confounding factor to the CAL results.
In the Carvalho et al. study, the small sample size must be considered when analyzing the quality of the evidence. To achieve stronger evidence, future studies with larger power, greater sample sizes, long-term follow-up, and exploring other aspects involved in routine treatment of adult orthodontic patients, should be performed to verify these results. |
| Applicability |
Based on the results of the study, it is best to wait until the progression of periodontitis is arrested before beginning orthodontic treatment. Patients with severe periodontitis experienced the greatest changes in clinical attachment level from orthodontic intervention, while healthy patients or patients with arrested periodontitis experienced little to no changes to CAL from orthodontic treatment. The results from the Carvalho et al. study can only be applied to aggressive periodontitis cases, so it can’t be generalized to all periodontitis patients. Some factors that may affect the ability to arrest periodontitis before starting treatment include patient compliance or severe crowding, where orthodontic treatment would allow better hygiene. It is important to note that the findings in these studies were with fixed orthodontic treatment, so no conclusions should be made for patients undergoing clear aligner therapy. |
| Specialty/Discipline |
(Orthodontics) (Periodontics) |
| Keywords |
“Orthodontic therapy” “Periodontitis” “Clinical attachment level”
|
| ID# |
3560 |
| Date of submission: |
06/04/2024 |
| E-mail |
Robinsonj1@livemail.uthscsa.edu |
| Author |
Jacob Robinson |
| Co-author(s) |
Alexander Reed |
| Co-author(s) e-mail |
Reeda4@livemail.uthscsa.edu |
| Faculty mentor/Co-author |
Kelly Lemke DDS, MS |
| Faculty mentor/Co-author e-mail |
LemkeK@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
|
|
