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Basics in Periodontic-Orthodontic Interrelationships; a Review
Author
Dr. Aous Dannan (D.D.S, M.Sc.)
Department of Periodontology
Faculty of Dental Medicine
Witten/Herdecke University
Witten-Germany
Corresponding author's address
Dr. Aous Dannan
Breite Str. 94
58452 Witten
Deutschland
Tel: +49-(0)2302-1795268
Fax: +49-(0)2302-1795267
Email: aousdannan@yahoo.com
Abstract
It is well established that the patients who undergo orthodontic treatment have a high
susceptibility to present plaque accumulation on their teeth because of the presence of
brackets, wires and/or other orthodontic elements on the teeth surfaces with which the oral
hygiene procedures might be more difficult. The considerable variance of the design and the
material characteristics of orthodontic elements may also play an important role in this field.
The orthodontic treatment is a double-action procedure, regarding the periodontal tissues,
which may be sometimes very meaningful in increasing the periodontal health status, and
may be sometimes a harmful procedure which can be followed by several types of
periodontal complications, namely: gingival recessions, bone dehiscences, gingival
invaginations and/or the formation of gingival pockets.
In this review, some initial concepts and past documented basics concerning the periodontic-
orthodontic interrelationships were demonstrated after categorized as follows:
1- Adverse effects of orthodontic procedures on the periodontal tissues;
2- How could orthodontic procedures afford some degree of protection against periodontal
breakdown?
3- The relationship between orthodontic treatment and oral hygiene.
Key Words: oral hygiene, orthodontic treatment, periodontaltissues.
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1- Adverse effects of orthodontic procedures on the
periodontal tissues
All evidence-based literature concerning the orthodontic - periodontic relationships show that
a good orthodontic treatment of patients, who have excellent oral hygiene and do not suffer
any periodontal breakdown, is a non-harmful treatment for the periodontium, it has been
also demonstrated that a diminished oral hygiene in corporation with periodontal disorder
would make the orthodontic treatment a real high risk for the periodontium (1). Darwish MA
et al. 2007 (2) conducted a clinical study aimed at detecting the reaction of the periodontal
tissues to some orthodontic retraction techniques applied by means of (Ricketts) springs,
(Power Chain) and (Lace Back) in order to find out whether a "specific" orthodontic
technique has "specific" negative effects on the periodontium, and it has been shown that the
periodontal tissues did not demonstrate any inflammatorical reactions which could be
considered specific to every single type of the canine retraction techniques. Otherwise,
familiar different signs of gingival inflammation, bleeding on probing and an increase of the
probing depth could be all remarkable as a consequence to plaque accumulation produced
because of the difficulties in keeping the teeth free of plaque. This plaque accumulation is a
result of the nature of the orthodontic wires and brackets, as well as the failure of the patient
to correctly follow the oral hygiene instructions.
A patient with a past history of previous periodontitis obviously is, always, more susceptible
to develop the disease once again in the future. Therefore, It is not recommended to begin any
orthodontic treatment if active destructive sites are present, and a person who has had
periodontal disease in the past should be monitored more closely to prevent new bursts of
active sites which may in turn result in rapid bone loss during the orthodontic treatment.
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Clinically, there are ranges of force that are biologically acceptable to the periodontium. The
root length and configuration, the quantity of bone support, the point of force application and
the center of rotation come into play to determine stress areas in the periodontal ligament. To
prevent tissue damage, it is important to consider areas of maximal stress that might occur in
the periodontal ligament. The risk of bone loss is always higher when inflamed connective
tissues are located apical to the crestal alveolar bone. Moreover, certain types of orthodontic
force may aggravate the progression of inflammatory periodontal disease (3). Those facts are
documented through many animal studies which have shown that periodontal disease in a
periodontal ligament under stress, where infectious inflammatory infiltration already existed,
spreads from the epithelial aspect into the transseptal ligament. A complete destruction of the
transseptal ligament had been shown within 28 days (4).
The gingival inflammation, hyperplasia and the periodontal pathogens:
Besides decalcification, leading to white spots and eventually caries, many past studies
mentioned that several types of gingivitis, periodontitis, gingival recession and the
formation of gingival pockets had been noted during and / or after the orthodontic
treatment (5-8).
On the other hand, during any orthodontic treatment, a slight to moderate degree of gingival
overgrowth might be seen (9-11). This can be explained by the accumulation of plaque on the
teeth surfaces and the increase of periodontal pathogens consequently. Interruption of the
orthodontic treatment is often advised when a hyperplastic/ hypertrophic form of gingivitis is
diagnosed. However, gingival hyperplasia usually resolves itself or responds to plaque
removal, curettage or both. Should the gingival tissue or enlargement interfere with tooth
movement, however, it must be removed surgically. Otherwise, it is preferable to wait until
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the orthodontic appliances are removed to correct surgically abnormal gingival form and to
use the procedure to enhance post-treatment stability.
It has been also shown that different species of bacteria such as Bacterioids intermedius ,
spirochetes , motile roads , B.forsythus , T.dentcola , P.nigrescens , C.rectus and fusiform
Bacteria were considered to increase more frequently in the dental plaque of patientsundergoorthodontic treatment (11).
In a more recent study (12), the influence of the orthodontic bracket design on microbial and
periodontal parameters in vivo had been tested, especially two types of brackets: Speeds® (S)
and GAC® (G), and it has been shown that the shift from aerobic to anaerobic bacterial
species was observed earlier in S-sites than in G-sites, and it was concluded that bracket
design can have a significant impact on the bacterial load and on the periodontal parameters.
Mucogingival considerations:
An adequate amount of attached gingiva is necessary for gingival health and to allow
appliances (functional or orthopedic) to deliver orthodontic treatment without causing bone
loss and gingival recession. Clinical experiments and animal studies have shown that
clinically recognizable inflammation occurs in regions with a lack of attached gingiva than in
areas with a wider zone of attached gingiva. With labial bodily movement, incisors showed
apical displacement of the gingival margin, but no loss of connective tissue attachment was
apparent where there were no signs of inflammation. Where inflammation was present, loss
of connective tissue attachment occurred (13). Therefore if the tooth movement is expected
to result in a reduction of soft tissue thickness and an alveolar bone dehiscence may have
occurred in the presence of inflammation, gingival recession is a risk.
Thin, delicate tissue is far more prone to exhibit recession during orthodontic treatment than
in normal or thick tissue. If a minimal zone of attached gingiva or thin tissue exists, a free
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gingival graft that enhances the type of tissue around the tooth helps control inflammation.
This should be done before any orthodontic movement is begun.
The occurrence of gingival invagination:
Tooth extraction is considered to be a frequently needed procedure when planning most
orthodontic treatments, especially those which aim at correcting the insufficient space
disorders in the upper and the lower jaws and/or some other aesthetic and occlusal problems.
The first premolars - and sometimes the second premolars - in either the upper or the lower
jaw are usually the first choice when extraction becomes a part of the whole orthodontic
treatment plan.
Gingival invaginations are defined as superficial changes in the shape of gingiva which arise
after moving the teeth orthodontically in order to close the spaces resulted from extraction
procedures(14).Gingival invaginations vary from slight fissures located in the keratinized
gingiva to deep gaps crossing the interdental papilla buccally or lingually through the
alveolar bone deeply(15, 16).
The exact reason for gingival invaginations is still unknown. One expected reason could be
the break up of the continuity of the fiber models within the gingiva, and also the movement
of the root(17). However, other studies suggest the gingival peeling as a reason for these
gingival changes(18). Gingival invaginations were noted in 35% of cases after orthodontic
space closure procedures(19).
Histological and histo-chemical specimens taken from sites of gingival invagination showed
hypertrophy in the epithelial and the connective tissues, and sometimes, loss of gingival
collagen (19, 20) .
As the gingival invaginations offer good sites in which the dental plaque can be easily
embedded, the researchers considered these changes in the gingiva as risk factors for the
periodontal tissue disorders (21).
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The gingival recession:
The gingival recession has been shown to be a common adverse effect during and/or after the
orthodontic treatment. This effect has been noted more frequently after the application of
buccal ortho-movement(22) . If the orthodontic tooth movement is in a labial direction, this
area may require a soft tissue graft. For best esthetics in the anterior areas, a connective tissue
graft is preferred. If teeth that have thin tissue are going to be moved lingually, there is a
potential for the tissue to move coronally and become thicker(23). If no orthodontic
treatment is planned for children adolescents, areas of thin gingival tissues should be
monitored only periodically as the width of the attached gingiva generally increases with
normal growth from the mixed to the permanent dentition(24).
Most gingival recessions which occur during an orthodontic treatment had been shown to
occur in the regions of the anterior upper and lower teeth (25-28). However, there are few
studies showed no features of gingival recession after an orthodontic treatment. Steiner and
his colleagues (29) mentioned that the gingival recessions noted after an orthodontic
treatment tend to occur in the regions were the keratinized gingiva and the underlying bone
tissues are thin.
An expected relationship could be established between (Tipping) orthodontic movements and
gingival recession. However, this relationship is still- to date- controversial. In a study of
Batenhorst (30), gingival recessions and bone dehiscences after orthodontic tipping of the
lower incisors in monkeys had been recorded. In other studies, no real gingival recessions or
muco-gingival defects had been recorded after orthodontic tipping of the incisors (23, 31-33).
Moreover, no relationship between the degrees of tipping (proclination) and the gingival
recessions had been noted in those studies.
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:Orthodontic Intrusion
The orthodontic tooth intrusion used in some orthodontic treatments is considered to be a
harmful procedure which may negatively affect the periodontal tissues. A non-controlled
intrusive force may be resulted in root resorption, pulp disorders (22), alveolar bone
resorption, a concentrated stress within the apical part of the ligament (34) and/or an increase
in the periodontal bone defects.
The effect of dental intrusion on the periodontium during an orthodontic treatment is still a
controversial issue. Intrusive movements can change the relationship between the cemento-
enamel conjunction and the alveolar crest which may produce an epithelial attachment along
the root. With a poor oral hygiene during an orthodontic treatment, intrusion can initiate
periodontal problems. It has been shown that intrusive forces usually change the position of
dental plaque from supra-gingival sites to sub-gingival sites (35) which may be resulted in the
formation of infra-bony defects and loss of connective tissue attachment. An increase of sub-
gingival pathogens was also noted after teeth intrusion (36).
However, only few studies did not mention the formation of periodontal pockets after tooth
intrusion (37). In another study (38), it has been shown that after the achievement of surgical
periodontal therapy of upper teeth, the intrusive forces did not show any negative effects on
the periodontium, and a reduction of probing depths was clearly noted.
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2- How could orthodontic afford some degree of protection
against periodontal breakdown?
A strong relationship between the abnormal positions of the teeth in the dental arch and the
periodontal disorders had been previously described (39, 40).
Moreover, it had been shown that the number of periodontal pathogens in the anterior sites of
crowded teeth is much greater than that in the sites of aligned teeth (3). The correction of the
crowded teeth can eliminate any harmful occlusal interference which may offer a great
opportunity for the development of a periodontal breakdown (41). Those data definitely
support the concept that orthodontic treatment can positively affect the periodontal health,
prevent the development of periodontal diseases and offer a possible action to enhance the
bone formation within the bony defects (42).
Significant evidence shows that drawing mesially inclined molars upright reduces pocket
depth and improves altered bone morphology (43, 44). When mesially-inclined molars are
uprighted, the connective tissue attachment on the mesial aspect of the molar to the crestal
bone creates tension and allows for remodeling of the bone. Therefore, the bone on the mesial
sides erupts as the molar tips distally.
:uprightingThe orthodontic extrusion, eruption and
Extrusion, or eruption, of a tooth or several teeth, has been reported to reduce infrabony
defects and decrease pocket depth (45, 46). Extrusion of an individual tooth is used
specifically for correction of isolated periodontal osseous lesions. Studies have shown that
eruption in the presence of gingival inflammation reduces bleeding on probing, decreases
pocket depth and even causes the formation of new bone at the alveolar crest as tooth erupt.
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Eruption or uprighting of molars without scaling and root planning in human patients has
been shown to reduce the number of pathogenic bacteria.
In a double-blind molar uprighting study bacterial samples were taken from the mesial
pockets of molars to be uprighted (experimental tooth) and from the contralateral mesially
inclined molar that served as the control in each subject. During the study no scaling, root
planning or subgingival inflammatory control was used. This study revealed that in all
experimental sites that showed these microorganisms at the time of bonding, the number had
diminished significantly by the end of treatment (47).
: defect bony into as movement orthodonticBodily
It has been suggested that orthodontic tooth movement into infrabony defects can result in
healing and regeneration of the tooth attachment apparatus. In addition, periodontists have
believed that if a wide osseous defect is adjacent to a tooth and the tooth were moved to
narrow the defect, better healing potential may be possible. On the other side, few studies had
shown that bodily tooth movement may increase the rate of destruction of the connective
tissue attachment of teeth with inflamed infrabony defects (48). In a histological study
concerning the same concept, it had been shown that moving the tooth into infrabony defect
was resulted in a long epithelial attachment on the roots, with no creation of a new
attachment apparatus (49).
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3- The orthodontic treatment and oral hygiene
A high standard of oral hygiene is essential for patients undergoing orthodontic treatment.
Without good oral hygiene, plaque accumulates around the orthodontic appliance, causing
gingivitis and, in some cases, periodontal breakdown. To avoid such problems, the
orthodontist has a double obligation: to advise the patient about methods of plaque control
and, at routine visits, to monitor the effectiveness of the oral-hygiene regime. However,
despite receiving appropriate advice, many patients undergoing orthodontic treatment fail to
maintain an adequate standard of plaque control. It is important that the orthodontist is able to
communicate the importance of oral hygiene to motivate patients to maintain a satisfactory
standard of oral hygiene during orthodontic treatment.
Before any orthodontic treatment an initial diagnosis and referral for treatment to control
active periodontal disease is to be considered. Moreover, all general, dental and periodontal
treatment should be completed before the orthodontic treatment.
Once the orthodontic appliances are placed, the patients need to be instructed in how to
manage the new oral environment and how to maintain the health of the dental and
periodontal structures. The orthodontist has to provide the patient with initial brushing
instructions with either a conventional toothbrush or a powered one when the appliances are
first placed. However, if the orthodontists correctly advice their patients to follow proper oral
hygiene instructions during the orthodontic treatment is still an opened question. In a limited
questionnaire among Syrian orthodontists, Dannan (50) has shown that the concept of
establishing high level of oral hygiene in patients during orthodontic treatment was still not
really understood and that further education for orthodontists in this field is still needed.
Manual tooth brushing, one of the oldest methods of plaque removal, remains the basis of
oral hygiene and plaque control. It is often used as the standard or control against which other
methods of plaque removal are assessed (51, 52). Instruction should emphasize the need to
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use sufficient pressure to remove plaque; a pressure sensitive toothbrush would be a valuable
aid to patients undergoing orthodontic treatment.
Chlorhexidine mouthwashes, as an adjunct to tooth brushing, have been found effective in the
control of gingival inflammation (53), although prolonged use may cause problems with
staining as Chlorhexidine rinses can potentially stain the margins of composite restorations
that cannot be easily removed. More recently, pre-brushing rinses have been introduced,
though these show no differences in effect on plaque accumulation or gingival health (54).
Chlorhexidine is also useful for patients after orthognathic surgery, especially when
intermaxillary fixation is to be used.
On the other hand, Fluoride mouth rinses significantly reduce the extent of enamel
decalcification and gingival inflammation during orthodontic treatment (54-57).
A number of studies evaluated the effect of mechanical aids, as compared with manual tooth
brushing, on oral hygiene in orthodontic patients (52, 53) and it has been shown that the use
of electric toothbrushes brought a significant improvement in oral hygiene.
The orthodontist can follow some suggestions in order to improve plaque removal by the
patient. Bonding of molars results in better periodontal health than banding. Whenever
possible the use of single arch wires is recommended. The removal of excess composite
around brackets, especially at the gingival margin, and avoiding the use of lingual appliances
whenever possible are also important ideas in order to keep healthy periodontal tissue during
any orthodontic treatment.
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Conclusion
The orthodontic treatment is a procedure which has two ways of action on the periodontal
tissues; it could afford some degree of protection of the periodontium and keep the gingiva,
the bone and the periodontal ligament in a healthy status, but on the other hand, it could have
negative effects on the periodontium such as gingivitis, gingival recessions and bone
dehiscences.
However, a high level of oral hygiene should be achieved before, during and after any
orthodontic treatment in order to prevent any side effects on the periodontal tissues.
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References
1. Sanders NL. Evidence-based care in orthodontics and periodontics: a review of theliterature. J Am Dent Assoc. 1999 Apr;130(4):521-7.2. Darwish MA, Sawan MN, Dannan A, Nasab H. [Periodontal Tissues' Reactions tosome orthodontic Retraction Techniques]. DENTAL MEDIUM. 2007;15(3):4.3. Lindhe J, Svanberg G. Influence of trauma from occlusion on progression ofexperimental periodontitis in the beagle dog. J Clin Periodontol. 1974;1(1):3-14.4. Waerhaug J. The infrabony pocket and its relationship to trauma from occlusion andsubgingival plaque. J Periodontol. 1979 Jul;50(7):355-65.5. Diedrich P. Correlations of orthodontics and periodontics. Fortschritte derKieferorthopadie. 1989;50:347-64.6. Ellis PE, Benson PE. Potential hazards of orthodontic treatment - what your patientshould know. Dental Update 2002;29:492-6.7. Wehrbein H, Diedrich, P. The periodontal changes following orthodontic toothmovement - a retrospective histological study in humans. 1. Fortschritte derKieferorthopadie. 1992a;53:167 -78.8. Wehrbein H, Diedrich, P. The periodontal changes following orthodontic toothmovement - a retrospective histological study in man. 2. Fortschritte der Kieferorthopadie.1992b;53:203-10.9. Trossello VK, Gianelly AA. Orthodontic treatment and periodontal status. JPeriodontol. 1979 Dec;50(12):665-71.10. Zachrisson BU, Alnaes L. Periodontal condition in orthodontically treated anduntreated individuals. II. Alveolar bone loss: radiographic findings. Angle Orthod. 1974Jan;44(1):48-55.11. Zhao H, Xie Y, Meng H. [Effect of fixed appliance on periodontal status of patientswith malocclusion]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2000 Jul;35(4):286-8.12. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracketdesign on microbial and periodontal parameters in vivo. Journal of Clinical Periodontology.2007;34(5):423-31.13. Wennstrom J, Lindhe J, Nyman S. Role of keratinized gingiva for gingival health.Clinical and histologic study of normal and regenerated gingival tissue in dogs .J ClinPeriodontol. 1981 Aug;8(4):311-28.14. Edwards JG. The prevention of relapse in extraction cases. Am J Orthod. 1971Aug;60(2):128-44.15. Rivera Circuns AL, Tulloch JF. Gingival invagination in extraction sites oforthodontic patients: their incidence, effects on periodontal health, and orthodontic treatment.Am J Orthod. 1983 Jun;83(6):469-76.16. Wehrbein H, Bauer W, Diedrich PR. Gingival invagination area after space closure: ahistologic study. Am J Orthod Dentofacial Orthop. 1995 Dec;108(6):59 3-8.17. Atherton JD. The gingival response to orthodontic tooth movement. Am J Orthod.
1970 Aug;58(2):179-86.18. Robertson PB, Schultz LD, Levy BM. Occurrence and distribution of interdentalgingival clefts following orthodontic movement into bicuspid extraction sites. J Periodontol.1977 Apr;48(4):232-5.19. Kurol J, Ronnerman A, Heyden G. Long-term gingival conditions after orthodonticclosure of extraction sites. Histological and histochemical studies. Eur J Orthod. 1982May;4(2):87-92.
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20. Ronnerman A, Thilander B, Heyden G. Gingival tissue reactions to orthodonticclosure of extraction sites. Histologic and histochemical studies. Am J Orthod. 1980Jun;77(6):620-5.21. Helm S, Petersen PE. Causal relation between malocclusion and periodontal health .
Acta Odontol Scand. 1989 Aug;47(4):223-8.22. Wennstrom JL, Lindhe J, Sinclair F, Thilander B. Some periodontal tissue reactions to
orthodontic tooth movement in monkeys. J Clin Periodontol. 1987 Mar;14(3):121-9.23. Boyd RL. Mucogingival considerations and their relationship to orthodontics. J
Periodontol. 1978 Feb;49(2):67-76.24. Sperry TP, Speidel TM, Isaacson RJ, Worms FW. The role of dental compensations
in the orthodontic treatment of mandibular prognathism. Angle Orthod. 1977 Oct;47(4):293-9.25. Hall WB. The current status of mucogingival problems and their therapy. J
Periodontol. 1981 Sep;52(9):569-75.26. Pearson LE. Gingival height of lower central incisors, orthodontically treated and
untreated. Angle Orthod. 1968 Oct;38(4):337-9.27. Polson AM, Reed BE. Long-term effect of orthodontic treatment on crestal alveolar
bone levels. J Periodontol. 1984 Jan;55(1):28-34.28. Sadowsky C, BeGole EA. Long-term effects of orthodontic treatment on periodontal
health. Am J Orthod. 1981 Aug;80(2):156-72.29. Steiner GG, Pearson JK, Ainamo J. Changes of the marginal periodontium as a result
of labial tooth movement in monkeys. J Periodontol. 1981 Jun;52(6):314-20.30. Batenhorst KF, Bowers GM, Williams JE, Jr. Tissue changes resulting from facial
tipping and extrusion of incisors in monkeys. J Periodontol. 1974 Sep;45(9):660-8.31. Allais D, Melsen B. Does labial movement of lower incisors influence the level of the
gingival margin? A case-control study of adult orthodontic patients. Eur J Orthod. 2003Aug ;
25)4:(
343-52.32. Djeu G, Hayes C, Zawaideh S. Correlation between mandibular central incisor
proclination and gingival recession during fixed appliance therapy. Angle Orthod. 2002Jun;72(3):238-45.33. Wingard CE, Bowers GM. The effects of facial bone from facial tipping of incisors in
monkeys. J Periodontol. 1976 Aug;47(8):450-4.34. Stenvik A, Mjor IA. Pulp and dentine reactions to experimental tooth intrusion. A
histologic study of the initial changes. Am J Orthod. 1970 Apr;57(4):370-85.35. Ericsson I, Thilander B, Lindhe J, Okamoto H. The effect of orthodontic tilting
movements on the periodontal tissues of infected and non-infected dentitions in dogs. J ClinPeriodontol. 1977 Nov;4(4):278-93.36. Folio J, Rams TE, Keyes PH. Orthodontic therapy in patients with juvenileperiodontitis: clinical and microbiologic effects. Am J Orthod. 1985 May;87(5):421-31.37. Melsen B, Agerbaek N, Markenstam G. Intrusion of incisors in adult patients withmarginal bone loss. Am J Orthod Dentofacial Orthop. 1989 Sep ;
96)3:(
232-41.38. Corrente G, Abundo R, Re S, Cardaropoli D, Cardaropoli G. Orthodontic movementinto infrabony defects in patients with advanced periodontal disease: a clinical andradiological study. J Periodontol. 2003 Aug;74(8):1104-9.39. Ashley FP ,Usiskin LA, Wilson RF, Wagaiyu E. The relationship between irregularityof the incisor teeth, plaque, and gingivitis: a study in a group of schoolchildren aged 11-14years. Eur J Orthod. 1998 Feb;20(1):65-72.40. Bjornaas T, Rygh P, Boe OE. Severe overjet and overbite reduced alveolar boneheight in 19-year-old men. Am J Orthod Dentofacial Orthop. 1994 Aug;106(2):139-45.
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41. Gazit E, Lieberman M. The role of orthodontics as an adjunct to periodontal therapy.Refuat Hapeh Vehashinayim. 1978 Jan;27(1):5-12 ,5-1.42. Brown IS. The effect of orthodontic therapy on certain types of periodontal defects. I.
Clinical findings. J Periodontol. 1973 Dec;44(12):742-56.43. Ingber JS. Forced eruption. I. A method of treating isolated one and two wall
infrabony osseous defects-rationale and case report. J Periodontol. 1974 Apr;45(4):199-206.44. Wise RJ, Kramer GM. Predetermination of osseous changes associated with
uprighting tipped molars by probing. Int J Periodontics Restorative Dent. 1983;3(1):68-81.45. Van Venrooy JR, Vanarsdall RL. Tooth eruption: correlation of histologic and
radiographic findings in the animal model with clinical and radiographic findings in humans.Int J Adult Orthodon Orthognath Surg. 1987;2(4):235-47.46. van Venrooy JR, Yukna RA. Orthodontic extrusion of single-rooted teeth affected
with advanced periodontal disease. Am J Orthod. 1985 Jan;87(1):67-74.47. Vanarsdall RL. [Reaction of the periodontal tissues to orthodontic movement]. Orthod
Fr. 1986;57 Pt 2:421-33.48. Wennstrom JL, Stokland BL, Nyman S, Thilander B. Periodontal tissue response to
orthodontic movement of teeth with infrabony pockets. Am J Orthod Dentofacial Orthop.1993 Apr;103(4):313-9.49. Polson A, Caton J, Polson AP, Nyman S, Novak J, Reed B. Periodontal response after
tooth movement into intrabony defects. J Periodontol. 1984 Apr;55(4):197-202.50. Dannan A. The Oral Hygiene Instructions from the Orthodontist's Point of View: a
Questionnaire among Syrian Orthodontists. The Orthodontic CYBER journal [serial on theInternet]. 2007 Date: Available from: http://www.oc-j.com/may07/OHInstructions.htm.51. Jackson CL. Comparison between electric toothbrushing and manual toothbrushing,with and without oral irrigation, for oral hygiene of orthodontic patients. Am J OrthodDentofacial Orthop. 1991 Jan;99(1):15-20.52. Wilcoxon DB, Ackerman RJ, Jr., Killoy WJ, Love JW, Sakumura JS, Tira DE. Theeffectiveness of a counterrotational-action power toothbrush on plaque control in orthodonticpatients. Am J Orthod Dentofacial Orthop. 1991 Jan;99(1):7-14.53. Brightman LJ, Terezhalmy GT, Greenwell H, Jacobs M, Enlow DH. The effects of a0.12% chlorhexidine gluconate mouthrinse on orthodontic patients aged 11 through 17 withestablished gingivitis. Am J Orthod Dentofacial Orthop. 1991 Oct;100(4):324-9.54. Pontier JP, Pine C, Jackson DL, DiDonato AK, Close J, Moore PA. Efficacy of aprebrushing rinse for orthodontic patients. Clin Prev Dent. 1990 Aug-Sep;12(3):12-7.55. Boyd RL. Two-year longitudinal study of a peroxide-fluoride rinse on decalcificationin adolescent orthodontic patients. J Clin Dent. 1992;3(3):83-7.56. Boyd RL, Chun YS. Eighteen-month evaluation of the effects of a 0.4% stannousfluoride gel on gingivitis in orthodontic patients. Am J Orthod Dentofacial Orthop. 1994Jan;105(1):35-41.57. Denes J, Gabris K. Results of a 3-year oral hygiene programme, including aminefluoride products, in patients treated with fixed orthodontic appliances. Eur J Orthod. 1991Apr;13(2):129-33.
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