Periodontal Disease & Malocclusion

Perio - Cases
2017-03-01

A 20 years old female presented with mobile teeth, signs of inflammation and evident malocclusion.

Fig. 1

Img. 1

Fig. 2

Img. 2 – Radiographic status and clinical analysis of a case of malocclusion at first visit and after 30 years. The initial radiographs were taken during the first visit, before the non-surgical therapy. The only antierior contacts happen between teeth 11 and 41 and 21 and 32. No signs of traumatic lesions may be seen on the radiograph, while gingivitis and gingival recession are clinically present on teeth #31 and #41. An extracoronal splint and a free gingival graft have been performed on the mandibular central incisors to improve the periodontal situation. An epithelial connective tissue graft of 1.5 mm thikness has been taken from the palatal premolar/molar area with a Bard-Parker no. 15 blade and then sutured in place with a suspended 4-0 silk suture. The wound has been protected with a Coe-Pak periodontal dressing which was removed 10 days later.

Fig. 3

Img. 3 – Right quadrants

Fig. 4

Img. 4 – Radiographic and clinical analysis of a case of malocclusion at first visit and after 30 years. Contacts only exist between teeth #16 and #47. No signs of traumatic lesions may be seen on the radiographs.

Fig. 5

Img. 5 – Left quadrants

Fig. 6

Img. 6 – Radiographic and clinical analysis of a case of malocclusion at first visit and after 30 years. Contact only occurs between teeth #27 and #37. No traumatic lesions may be seen on the radiographs.

Fig. 7

Img. 7 – These illustrations show the surgical procedure that was chosen for the treatment of this case. A free gingival graft was executed: first step was probing beyond the mucogingival junction in the area of the mandibular incisors followed by an intra-sulcular incision.

Fig. 8

Img. 8 – Two external bevel incisions were angled at 45 degrees. The vertical incisions were then connected by another incision at the base of the fornix, perpendicular to the bone surface.

Fig. 9

Img. 9 – We then proceeded to the removal of the tissue to be eliminated and gingivoplasty of the interproximal area.

Fig. 10

Img. 10 – Fenestration of the periosteum with the blade perpendicular to the periosteum and sling suture anchored to the periosteum.

Fig. 11

Img. 11 – An X-shaped suture makes the graft intimately adhere to the underlying surface; this allows, in the end, a healing with leveled gingival margins and an adequate width of attached gingiva.

 

Through the control of the inflammatory lesions with periodic recalls and minor surgical treatment in the lower incisors area it has been possible to maintain the natural dentition for many years.
In this particular case trauma for occlusion didn’t play any role in teeth mobility.