Orthodontic and periodontal treatment in generalized stage IV periodontitis: A case report.
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Background: Periodontitis is an inflammatory disease of bacterial origin and complex etiology that triggers a destructive immune-inflammatory response on the dental support structures. Among its most relevant clinical consequences, particularly when associated with posterior tooth loss, are occlusal collapse, decreased vertical dimension, proclination, diastemas, and extrusion, situations that often require orthodontic intervention to restore the functional stability of the masticatory system.
Case description: This clinical case presents the diagnosis and orthoperiodontal treatment of a systemically healthy patient with stage IV periodontitis, generalized grade C, skeletal class I, maxillary and mandibular prognathism, hypodivergent pattern, microgenia, dental protrusion and proinclination, and bimaxillary anterior lingual thrust.
Clinical findings: The therapeutic approach was aimed at improving gingival health, facial aesthetics, and occlusal function by correcting tooth position, closing spaces, improving arch form, and muscle re-education to correct dysfunctional tongue patterns in order to maintain a stable and functional bite and long-term stability, combining biological, functional, and aesthetic principles in a personalized treatment plan.
Treatment: The treatment was carried out in three phases. First, periodontal therapy included risk factor control, oral hygiene education, scaling and root planing, gingivectomy, and speech therapy to control tongue thrusting, achieving periodontal improvement. Then, in the orthodontic phase, the MBT technique was applied with 0.022" slot brackets, using light and continuous forces together with sliding mechanics, complemented by periodontal maintenance at each check-up.
Result/Outcome: Facial profile improvement, stable occlusion through correction of anterior crossbite, normalization of tooth inclinations, elimination of occlusal trauma and closure of interdental spaces, anterior guidance, stable posterior occlusion, and adequate force distribution were achieved, significantly improving both masticatory function and facial aesthetics, which had a positive impact on the patient's self-esteem. The ortho-periodontal approach with gentle forces is key to preserving bone support, highlighting the importance of biofilm control, oral hygiene, and tongue re-education for stability and relapse prevention.
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