Periodontal Problems

With advanced periodontal disease, teeth are prone to drift producing an unsightly appearance. The teeth can be realigned orthodontically, but prior to this it is essential that all pre-existing periodontal disease is eliminated and the patient can maintain a meticulous standard of oral hygiene. If treatment is undertaken in the

Fig. 4a The presence of a supernumerary tooth prevented the eruption of the upper central incisors

Fig. 4b The supernumerary was surgically removed and brackets bonded to the upper incisors. A modified trans-palatal bar with wire ligatures was used to extrude the teeth

Fig. 4c Once the teeth were successfully extruded the dentition was allowed to develop prior to comprehensive treatment in the permanent dentition

Fig. 4b The supernumerary was surgically removed and brackets bonded to the upper incisors. A modified trans-palatal bar with wire ligatures was used to extrude the teeth

presence of active disease, very rapid bone loss can result.

Figure 6 shows a patient who had substantial vertical and horizontal bone loss, and as a consequence, drifting of the upper teeth had occurred, in particular the upper lateral incisor. Alignment of the teeth was achieved using fixed appliances. Near the completion of treatment a residual black triangle was left between the upper incisors. This is quite a common problem in adults and is caused by the inability of the gingival tissue to regenerate and re-form an inter-dental papilla. In order to reduce the size of the black triangle, some inter-proximal reduction was undertaken to reshape the mesial contact points of the incisors allowing the teeth to be brought more closely together. Permanent retention is needed in situations like this because the tooth will drift as soon as the appliances are removed.

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