reviewarticle orthodontic management in aggressive...

Review ArticleOrthodontic Management in Aggressive Periodontitis

Rajesh Gyawali1 and Bhagabat Bhattarai2

1Department of Orthodontics College of Dental Surgery BP Koirala Institute of Health Sciences Dharan 56700 Nepal2Department of Periodontics Kathmandu Medical College and Teaching Hospital Kathmandu 44600 Nepal

Correspondence should be addressed to Rajesh Gyawali gyawalirajeshgmailcom

Received 6 September 2016 Revised 18 January 2017 Accepted 26 January 2017 Published 16 February 2017

Academic Editor Hee-Jin Kim

Copyright copy 2017 Rajesh Gyawali and Bhagabat Bhattarai This is an open access article distributed under the Creative CommonsAttribution License which permits unrestricted use distribution and reproduction in any medium provided the original work isproperly cited

Aggressive periodontitis is a type of periodontitis with early onset and rapid progression and mostly affecting young adults whooccupy a large percentage of orthodontic patients The role of the orthodontist is important in screening the disease making aprovisional diagnosis and referring it to a periodontist for immediate treatment The orthodontist should be aware of the diseasenot only before starting the appliance therapy but also during and after the active mechanotherapy The orthodontic treatmentplan biomechanics and appliance system may need to be modified to deal with the teeth having reduced periodontal supportWith proper force application and oral hygiene maintenance orthodontic tooth movement is possible without any deleteriouseffect in the tooth with reduced bone support With proper motivation and interdisciplinary approach orthodontic treatment ispossible in patients with controlled aggressive periodontitis

1 Introduction

Periodontitis is the inflammation of the supporting tissuesof the teeth caused by specific microorganisms which leadsto progressive destruction of the periodontal ligament andalveolar bone with pocket formation recession or bothAggressive periodontitis (juvenile or early onset periodon-titis) is characterized by early onset mostly affecting youngpeople and in the absence of significant plaque and calculusand shows a rapid progression of destruction It has beenfound to show a familial pattern of occurrencewith no knowncontributing medical history [1 2]

Localized aggressive periodontitis is characterized byinvolvement of at least one first molar and one incisor orsecond molar and two or fewer canines or premolars withgreater than 3mm of attachment loss Generalized aggressiveperiodontitis involves four or more teeth with greater than3mm of attachment loss and at least two affected teeth weresecond molars canines or premolars [3]

Aggressive periodontitis affects adolescents and the per-centage of adolescents is highest among orthodontic patients[4] Hence it is of utmost important for an orthodontist tohave knowledge and ability to diagnose and manage the caseof aggressive periodontitis with multidisciplinary approach

2 Etiology and Epidemiology

Aggressive periodontitis shows its onset at puberty [5] maybe because of the elevation of certain hormones in bloodand gingival fluid both of which may act as growth factorsfor the causative bacteria Aggressive periodontitis is morecommon among younger individuals but it does not meanthat all youth are equally susceptible Prevalence of aggressiveperiodontitis varies widely among various races and ethnic-ities from 01 to 15 [2 6] It is more prevalent in AfricanAmericans and Hispanics as compared to Caucasians [7ndash10]Besides genetics age and environmentmay also influence itFemales are found to be more affected than male [11]

The major pathogen found to be involved in aggressiveperiodontitis is Aggregatibacter actinomycetemcomitans (pre-viously known as Actinobacillus actinomycetemcomitans)Besides other bacteria like Porphyromonas gingivalisCampy-lobacter rectus Eikenella corrodens and Capnocytophaga spare also found to be associated with it Even with these patho-gens the susceptibility of the disease differs among individu-als and the reason behind is the immune defects

Neutrophils are the major blood cells of innate defenseactive against bacterial pathogens and are derived from thebone marrow stem cells In periodontium these neutrophils

HindawiInternational Scholarly Research NoticesVolume 2017 Article ID 8098154 8 pageshttpsdoiorg10115520178098154

2 International Scholarly Research Notices

are the protective cells and any defects associated with themlead to increased susceptibility to periodontitis Neutrophildefects like abnormalities in adherence chemotaxis superox-ide generation phagocytosis and bactericidal activities havealso been found to be accountable for the susceptibility toaggressive periodontitis [2] It is multifactorial in origin andis a genetically complex disease It is found to be inherited byan autosomal dominant [12] autosomal recessive [13ndash15] andX-linked dominant mode [5 16 17]

3 Diagnosis of Aggressive Periodontitis

Diagnosis is based on history clinical examination andradiographs Besides immunological tests microbiologicaltests are also performed More often its diagnosis is madein the age which is the same age as that when orthodontictreatment is generally started [18] The first molar whichis usually involved in aggressive periodontitis is the toothimportant for orthodontist because it is frequently used foranchorage in various removable or fixed appliance Also con-tact of bands used in first molars with the gingival tissue mayirritate it aggravating the condition [19] Hence it is essentialthat orthodontist screens each case for aggressive periodon-titis and is able to make an honest diagnosis and coordinatewith the periodontist for proper care

For the diagnosis of localized aggressive periodontitisthere should be attachment loss of at least 4mm on atleast one permanent first molar and one incisor [20] Hereare some features which help in the diagnosis of aggressiveperiodontitis

31 Clinical [21]

(i) Generally affecting the young adults(ii) Rapid loss of attachment and alveolar bone height(iii) Familial aggregation(iv) Absence of significant medical history(v) Severe periodontal destruction which is inconsistent

with the amount of deposits(vi) Lack of clinical signs of inflammation in spite of the

presence of deep pockets and bone loss

32 Radiographic [3]

(i) Vertical loss of alveolar bone height aroundfirstmolarand incisors

(ii) Arc shaped bone loss seen extending from the distalsurface of the second premolar to the mesial surfaceof the second molar

33 Microbiologic [22] Although a large number of patho-gens are associated with periodontitis many studies haveshown few specific strains related to aggressive periodon-titis A actinomycetemcomitans is found in high frequencyin microbial deposits on the teeth affected with localizedaggressive periodontitis Similarly patients with generalized

aggressive periodontitis show high subgingival levels ofSelenomonas sp and T lecithinolyticum

34 Host Susceptibility [2] Some people are more susceptibleto aggressive periodontitis indicating a significant role of hostsusceptibility behind the disease In addition local and gen-eral environmental factors also play significant roles Herpesvirus may increase the host susceptibility and aggravate theseverity of aggressive periodontitis

4 Orthodontic Problems Associated withthe Aggressive Periodontitis

The loss of interproximal attachment is the main factorleading to pathologic toothmigration [23] and clinically seenas extrusion proclination rotation diastema or drifting intoedentulous space [24] Altered level of the incisal edge andspace between anterior teeth leads to unaesthetic appearanceand is the prime reason for seeking orthodontic treatment

5 Role of Orthodontist in the Management ofAggressive Periodontitis

Aggressive periodontitis may develop before during or evenafter the completion of orthodontic treatment So periodontalscreening should be done in all patients regardless of theinitiation of orthodontic treatment [25] Khocht et al foundthat periodontal screening and recording (PSR) is an effectivetool to scrutinize periodontal diseases [26]

51 Before Starting Orthodontic Treatment For any patientattending the orthodontic clinic the orthodontists shouldensure that their oral hygiene is good In patients with poororal hygiene oral prophylaxis is recommended and theirability to maintain the hygiene is evaluated If the compliancetowards the oral hygiene is poor orthodontic therapy ispostponed till the achievement of proper plaque control

Mathews and Kokich recommended that during clinicalexamination at least five minutes of periodontal examina-tion including probing of key indicator teeth is manda-tory before making orthodontic diagnosis and treatmentplanning [27] Gingival inflammation swelling recessiontooth mobility and pathological pockets should be assessedBesides the patient should be asked for the recent change inthe position or drifting of teeth Radiographic assessment ofbone loss is made from the bite wing radiograph of the firstmolar and intraoral periapical radiograph of incisors [19]Newer imaging methods like CBCT give more insight intothe bony defects which facilitates better treatment planning[28] Further serum IgG titer test against each pathogenicbacterium can be done with ELISA as the serum levelof IgG directly correlates with the number of pathogenicbacteria in the periodontium [29] Elimination of bacteriafrom the periodontal pockets can be assessed with this testwhich is useful for determining the optimal timing to startorthodontic treatment [30] Any clinical signs of aggressiveperiodontal disease like attachment loss pockets and bone

International Scholarly Research Notices 3

loss when found should be consulted with a periodontist forappropriate care

After the patient is diagnosed with aggressive periodon-titis heshe should be referred to a periodontist Along withthe local mechanical debridement adjunctive antibiotics area valuable tool in the management however the literatureis not very clear regarding optimum dosages duration andtiming [31] An adjunctive course of seven days of amoxicillin(500mg) and metronidazole (500mg) three times a daycan significantly improve clinical outcome of aggressiveperiodontitis treated nonsurgically [32] Flap surgeries fordebridement either with resective or regenerative procedurescan be performed to get assess for instrumentation [33]

A follow-up period of 6 months is needed after activeperiodontal therapy so as to observe the resolution of activeinflammation and restoration of the periodontal health [3435] As there is no deleterious effect of orthodontic toothmovement on healthy periodontium orthodontic treatmentcan be started once the health of periodontium is achievedback [36] Now it is the duty of the orthodontist to motivatethe patient to maintain good oral hygiene during the courseof orthodontic treatment [37] and warn the patient regardingthe consequences of poor oral health

The decrease in the height of the alveolar bone aroundthe affected teeth demands change in orthodontic treatmentplan and biomechanics As the bone surrounding the rootsurface is decreased the periodontal ligament area also getsdecreasedHence even less force appliedmayproduce greaterpressure in the periodontal ligament and thus increases theextrusive component of the applied force Hence light forceshould be used tomove the tooth with reduced bone supportAs the centre of resistance is shifted apically moment of theapplied force increases and thus large moments are needed tocontrol the root movement [38]

Fixed orthodontic appliance is preferred over removablebecause fixed appliance acts as splinting helps in stabilizinganchorage and provides light continuous force which is notpossible with removable appliances Also applying momentsto control root movements is easier with fixed appliance

Most of the removable and fixed orthodontic appliancesuse first molar as an anchorage unit Reduced bone supportof the first permanent molar in aggressive periodontitisdecreases its anchorage quality leading to undesirable sideeffects If anchorage is critical temporary anchorage devices(TAD) can be used in such cases Also direct applicationof force from TAD avoids bondingbanding of anchoragesegments reducing plaque retentive areas [39] However it isvery important to motivate patient to maintain proper oralhygiene as oral inflammation leads to failure of temporaryanchorage devices [40 41]

52 During Active Orthodontic Treatment Orthodontictreatment should be started only after the clinician is con-vinced that the patient is well motivated and can follow theoral hygiene instructions well Orthodontic therapy includeswires brackets bands or other several components whichfurther lodge plaque and make oral hygiene more challeng-ingHence the importance of rigorous oral hygiene should bereinforced in each visit of the patient Orthodontic patients

with aggressive periodontitis require a separate periodontalappointment with a periodontist once every 3 months [19]

However clinical periodontal examination should bedone in every appointment patient comes for orthodonticfollow-upAny detrimental effects in a patient are noted and iffound severe the patient is referred to a periodontist immedi-ately For any patient who cannot maintain proper oral hygi-ene active orthodontic force should be stopped and removalof the whole appliance may be considered till the desiredimprovement and motivation are achieved The orthodontictreatment may be continued once the condition is improvedRadiographic examination including bitewing for themolarsand the intraoral periapical radiograph for the incisorsshould be taken once a year during the course of orthodontictreatment [19]

Sometimes aggressive periodontitis can be diagnosedduring the course of orthodontic treatment In such con-dition the active orthodontic force should be discontinuedimmediately and the patient should be referred to a peri-odontist for proper therapy [42] To facilitate the properperiodontal therapy removal of the orthodontic applianceshould be considered if necessary [36]

The orthodontic treatment should be performed withgreat care in patients with aggressive periodontitis Ortho-dontic bands predispose to gingivitis gingival enlargementincreased pocket depth and even attachment loss due tomechanical irritation or poor oral hygiene [43 44] ldquoSpecialperiodontally friendly bandsrdquo are being designed which ismore hygienic than the conventional bands [45] BondableBuccal tubes are preferred over bands because they haveminimal negative effects on the periodontium as they are at agreater distance from the gingival margins [46 47] When-ever possible steel ligature wire should be used instead ofelastomeric modules to ligate the archwire to the bracketsbecause the former is less plaque retentive and easier to clean[48ndash50] Special consideration should be given to removeexcess composite around the brackets especially at the gin-gival margin

Placing brackets in an ideal position in all teeth may notbe necessary particularly in the anchorage segment involvingteeth with bone loss Brackets are bonded in such a way thatthe slots are aligned and wire can be engaged passively soas to minimally disturb the anchor teeth in physiologicallysatisfactory position [35] Treatment should be done withthe use of simplest system avoiding multiple wires loopsand multiple attachments to allow better oral hygiene [51]During the stage of levelling and alignment light wires like001210158401015840 or 001410158401015840 Nickel titanium are recommended [18]Activation of orthodontic appliance in patientwith aggressiveperiodontitis should be done at longer interval as the peri-odontal remodeling takes more time when compared tonormal individual

If orthodontic plan includes extraction then the teethwith hopeless prognosis are extracted for which change in theoriginal mechanotherapy may be needed After extraction ofteeth involved in aggressive periodontitis it is better to wait atleast 3 months to move a sound tooth in the extraction spaceto prevent reinvolvement of newly positioned tooth [52]


Table1Summaryof

thec

aser

eportsin

theo

rtho

donticmanagem

ento

faggressivep

eriodo

ntitis

Author

(year)

Patie

ntAggressive

perio

dontitis

Type

ofperio

dontal

procedures

done

Durationof

activ

eorthod

ontic

treatment

Ortho

donticconsiderations

durin

gtre

atment

SexAge

Ishihara

etal[30]

(2015)

F21

Generalized

Surgicalandno

nsurgical

28mon

ths

(i)Closem

onito

ringof

serum

IgGagainstA

actinom

ycetem

comita

nsand

Prevotellainterm

edia

(ii)P

readjuste

dedgewise

appliancew

ithself-ligatingbrackets

(iii)Initiallevelling

with

0012nickeltitanium

wire

(iv)L

ingu

albo

nded

retainer

aswellasw

raparou

ndretainer

after

activ

etherapy

Closse

tal[65]

(2010)

F22

Localized

Surgicalandno

nsurgical

32mon

ths

(i)Ex

tractio

nof

maxillarydecidu

oussecon

dmolarsfollowed

bymesial

movem

ento

fmaxillarymolars(missingmaxillarysecond

prem

olars)

(ii)S

egmentedmechanics

andlight

force

(iii)Re

movableretainer

inmaxillarywhilefixed

lingualretainer

inmandibu

lara

rch

Miyam

otoetal[66]

(2008)

F24

Localized

Non

surgical

40mon

ths

(i)Ex

tractio

nof

maxillaryfirstprem

olarsa

ndsubapicaloste

otom

yto

repo

sitionitback

(ii)E

xtractionof

mandibu

larc

entralincisora

ndproxim

alstrip

ping

ofother

incisorsto

minim

izetoo

thmovem

entinlower

arch

(iii)Flexiblespira

lwire

andremovablecircum

ferentialretainer

Passanezietal[67]

(2007)

F17

Localized

Surgicalandno

nsurgical

26mon

ths

(i)Initiallevelling

with

light

force(0012NITI)

(ii)Intrusio

nof

flaredandextrud

edmaxillaryincisorswith

reversec

urve

wire

(iii)ClassIIelasticsfor

overjetcon

trol

(iv)P

ermanentfi

xedretentionin

both

arches

with

removableretainer

inmaxillaryarch

Craddo

cketal[68]

(2007)

F27

Generalized

mdash7mon

ths

(i)Alignm

entand

levelling

ofthed

rifted

upperinciso

rswith

fixed

appliance

(ii)p

ermanentb

ondedretainer

Ogino

etal[69]

(200

6)F

30Lo

calized

Surgicalandno

nsurgical

19mon

ths

(i)Intrusionof

maxillaryandmandibu

larinciso

rsto

redu

ceoverbite

(ii)R

etractionof

maxillaryincisorsto

redu

ceoverjet

(iii)Be

ggretainer

inmaxillaryarch

andfixed

retainer

inmandibu

lara

rch

Maeda

etal[70]

(2005)

F27

Localized

Surgicalandno

nsurgical

21mon

ths

(i)Ex

tractio

nof

11and31

(ii)L

evellingandalignm

entstarted

with

0012Nickeltitanium

archwire

(iii)Cervicalpullh

eadgear

(iv)M

ultiloo

pedgewise

archwire

(v)M

axillarycircum

ferentialrem

ovableretainer

andmandibu

larb

onded

canine

tocanine

retainer

Okada

etal[71]

(200

0)M

17Lo

calized

Non

surgical

36mon

ths

(i)Patie

ntpresentedwith

Pierre

robins

sequ

ence

(ii)E

xtractionof

maxillaryfirstprem

olarsa

ndretractio

nandalignm

ento

fup

pera

nteriors

(iii)Duringlevelling

maxillaryleftcentralinciso

rsho

wed

markedmob

ility

andthus

isextracted(la

terreplacedwith

fixed

bridge)

(iv)A

ctiveo

rtho

dontictherapywas

haltedforh

alfa

year

(v)S

imultaneou

suse

ofqu

adhelix

form

axillaryarch

expansion

(vi)Wraparou

ndretainer


Table1Con

tinued

Author

(year)

Patie

ntAggressive

perio

dontitis

Type

ofperio

dontal

procedures

done

Durationof

activ

eorthod

ontic

treatment

Ortho


durin

gtre

atment

SexAge

HarpenauandBo

yd[64]

(200

0)F

16Lo

calized

Non

surgical

mdash(i)

Extractio

nof

allfi

rstm

olarsa

ndsubsequent

spacec

losure

with

retractio

nandwellasp

rotractio

n

Folio

etal[72]

(1985)

M32

Localized

mdash4mon

ths

(i)Supra-erup

tedmaxillaryleftlateralincisor

(ii)0

019

by0022inch

passivea

rchwire

with

0018inch

roun

dwire

ldquokickerrdquo

forintrusiv

eforce

(iii)Mild

root

resorptio

nof

theintrudedtoothmaintaining

thev

itality

(iv)U

pper

Haw

leyrsquos

appliancefor

retention

Folio

etal[72]

(1985)

M21

Localized

mdash4mon

ths

(i)Maxillaryleftlateralincisorw

asin

crossbite

which

was

correctedwith

001610158401015840Nickeltitanium

wire

(ii)M

odified

Haw

leyrsquos

retainer

after

alignm

ent

Folio

etal[72]

(1985)

F28

Localized

mdash11mon

ths

(i)Ex

tensively

drifted

maxillaryincisorswerea

lignedandspacec

losure

by0018by

0022inch

wire

with

closin

gloop

s

Folio

etal[72]

(1985)

F16

Localized

mdash19

mon

ths

(i)Intrusionof

mandibu

larinciso

rsandalignm

ento

fmaxillaryanterio

rs(w

hich

was

pathologicallymigrated)

(ii)R

emovableHaw

leyrsquos

retainer

McLainetal[73]

(1983)

F12

Localized

Non

surgical

36mon

ths

(i)Ex

tractio

nof

severelyaffectedteeth(allfirstmolarsa

ndfour

lower

incisors

andleftmaxillarycentralinciso

r)(ii)M

esializationof

second

andthird

molars3

yrsa

fterthe

extractio

n(iii)Upp

er17times22

andlower

17times25

wire

with

loop

swereu

sedto

close

the

space


Teeth bonded with self-ligating brackets had fewer bac-teria in plaque as compared with elastomeric rings [53 54]However brackets ligated with ligature wire harbor still lessbacteria than the self-ligating brackets which may be becauseof the clips and retentive areas in self-ligating brackets [54]Hence metallic ligature wire seems to be appropriate in casesof patients with aggressive periodontitis

There is difficulty inmaintaining oral hygienewith lingualappliance as compared to labial [55ndash57] A actinomycetem-comitans is associated with aggressive periodontitis whichis found in very high frequency among orthodontic patients[58 59] As oral hygiene is critical during management ofpatients with aggressive periodontitis labial appliance canbe preferred However increased prevalence of A actino-mycetemcomitans and P gingivalis has not been observed inpatients with lingual appliance [60]

The orthodontist may need to intrude the extrudedincisor with vertical bone loss involved in the aggressive dis-ease Improvement in alveolar bone defects probing depthgingival esthetics and clinical attachment gain can be seenwith proper application of orthodontic force [36 61] Toprevent the apical displacement of plaque therapy aimed toreduce pocket depth should be done earlier [62]

53 During Retention and Long Term Follow-Up Removableretainers are best if periodontal health is considered but poorcompliance may result in relapse Also clear vacuum formedretainer which has minimal gingival contact would be betterthan the acrylic removable retainer with retentive claspsin close proximity with the gingiva Fixed retainers placedafter active orthodontic treatment may contribute to plaqueretention [63] So periodontal examination should be done asa part of follow-up Those patients who have not developedaggressive periodontitis till the end of active orthodontictherapy may develop during the retention phase so similarprecautions should be taken in all the patients Regularperiodontal follow-up alongwith strict oral hygienemeasurescontribute to long term maintenance of the achieved result[64 65] Successful orthodontic therapy can be done despitethe compromised periodontium with aggressive periodonti-tis (Table 1)

6 Conclusion

Aggressive periodontitis mostly affects young adults causingrapid periodontal destructionwith loss of supporting alveolarbone For the movement of teeth healthy periodontium isrequired Hence in patients with aggressive periodontitisorthodontic treatment is possible only when the disease isbrought under control via careful monitoring before duringand after the active therapy

Competing Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

References

[1] G C Armitage ldquoDevelopment of a classification system for per-iodontal diseases and conditionsrdquoAnnals of Periodontology vol4 no 1 pp 1ndash6 1999

[2] H Meng L Xu Q Li J Han and Y Zhao ldquoDeterminants ofhost susceptibility in aggressive periodontitisrdquo Periodontology2000 vol 43 no 1 pp 133ndash159 2007

[3] M G Newman H Takei P R Klokkevold and F A CarranzaCarranzarsquos Clinical Periodontology Elsevier Health SciencesAmsterdam Netherlands 10th edition 2011

[4] D K Bagga ldquoAdult orthodontics versus adolescent orthodon-tics an overviewrdquo Journal of Oral Health amp Community Den-tistry vol 4 no 2 pp 42ndash47 2010

[5] R C Page G E Vandesteen J L Ebersole B L Williams I LDixon and L C Altman ldquoClinical and laboratory studies of afamily with a high prevalence of juvenile periodontitisrdquo Journalof Periodontology vol 56 no 10 pp 602ndash610 1985

[6] J M Albandar L J Brown and H Loe ldquoClinical features ofearly-onset periodontitisrdquo Journal of the American Dental Asso-ciation vol 128 no 10 pp 1393ndash1399 1997

[7] A L Neely ldquoPrevalence of juvenile periodontitis in a circum-pubertal populationrdquo Journal of Clinical Periodontology vol 19no 6 pp 367ndash372 1992

[8] L Saxen ldquoPrevalence of juvenile periodontitis in FinlandrdquoJournal of Clinical Periodontology vol 7 no 3 pp 177ndash186 1980

[9] W L Melvin J B Sandifer and J L Gray ldquoThe prevalenceand sex ratio of juvenile periodontitis in a young racially mixedpopulationrdquo Journal of Periodontology vol 62 no 5 pp 330ndash334 1991

[10] H Loe and L J Brown ldquoEarly onset periodontitis in the UnitedStates of Americardquo Journal of Periodontology vol 62 no 10 pp608ndash616 1991

[11] J Hoslashsrmand and A Frandsen ldquoJuvenile periodontitis localiza-tion of bone loss in relation to age sex and teethrdquo Journal ofClinical Periodontology vol 6 no 6 pp 407ndash416 1979

[12] J A Boughman J A Astemborski and J B Suzuki ldquoPhe-notypic assessment of early onset periodontitis in sibshipsrdquoJournal of Clinical Periodontology vol 19 no 4 pp 233ndash2391992

[13] J C Long W E Nance P Waring J A Burmeister and R RRanney ldquoEarly onset periodontitis a comparison and evalua-tion of two proposed modes of inheritancerdquo Genetic Epidemiol-ogy vol 4 no 1 pp 13ndash24 1987

[14] T H Beaty J A Boughman P Yang J A Astemborski and JB Suzuki ldquoGenetic analysis of juvenile periodontitis in familiesascertained through an affected probandrdquo American Journal ofHuman Genetics vol 40 no 5 pp 443ndash452 1987

[15] J A Boughman T H Beaty P Yang S B Goodman R KWooten and J B Suzuki ldquoProblems of genetic model testingin early onset periodontitisrdquo Journal of Periodontology vol 59no 5 pp 332ndash337 1988

[16] M Melnick E D Shields and D Bixler ldquoPeriodontosis aphenotypic and genetic analysisrdquo Oral Surgery Oral MedicineOral Pathology vol 42 no 1 pp 32ndash41 1976

[17] M D Spektor G E Vandesteen and R C Page ldquoClinical stud-ies of one family manifesting rapidly progressive juvenile andprepubertal periodontitisrdquo Journal of Periodontology vol 56no 2 pp 93ndash101 1985

[18] H Hazan-Molina L Levin S Einy and D Aizenbud ldquoAggres-sive periodontitis diagnosed during or before orthodontic


treatmentrdquo Acta Odontologica Scandinavica vol 71 no 5 pp1023ndash1031 2013

[19] L Levin S Einy H Zigdon D Aizenbud and E E MachteildquoGuidelines for periodontal care and follow-up during ortho-dontic treatment in adolescents and young adultsrdquo Journal ofApplied Oral Science vol 20 no 4 pp 399ndash403 2012

[20] T CHartM LMarazitaHA Schenkein and S RDiehl ldquoRe-interpretation of the evidence for X-linked dominant inheri-tance of juvenile periodontitisrdquo Journal of Periodontology vol63 no 3 pp 169ndash173 1992

[21] G C Armitage and M P Cullinan ldquoComparison of the clinicalfeatures of chronic and aggressive periodontitisrdquoPeriodontology2000 vol 53 no 1 pp 12ndash27 2010

[22] B Riep L Edesi-Neuszlig F Claessen et al ldquoAre putative peri-odontal pathogens reliable diagnostic markersrdquo Journal ofClinical Microbiology vol 47 no 6 pp 1705ndash1711 2009

[23] P Martinez-Canut ldquoA study on factors associated with patho-logic tooth migrationrdquo Journal of Clinical Periodontology vol24 no 7 pp 492ndash497 1997

[24] P P Towfighi M A Brunsvold A T Storey R M ArnoldD E Willman and C A McMahan ldquoPathologic migration ofanterior teeth in patients withmoderate to severe periodontitisrdquoJournal of Periodontology vol 68 no 10 pp 967ndash972 1997

[25] V Clerehugh and S Kindelan ldquoGuidelines for periodontalscreening and management of children and adolescents under18 years of agerdquo British Society of Periodontology and the BritishSociety of Pediatric Dentistry pp 1ndash25 2012

[26] A Khocht H Zohn M Deasy and K-M Chang ldquoScreeningfor periodontal disease radiographs vs PSRrdquo Journal of theAmerican Dental Association vol 127 no 6 pp 749ndash756 1996

[27] D P Mathews and V G Kokich ldquoManaging treatment for theorthodontic patient with periodontal problemsrdquo Seminars inorthodontics vol 3 no 1 pp 21ndash38 1997

[28] T Yamaguchi K Suzuki K Maki M Yamamoto and YTomoyasu Interdisciplinary Treatment of Aggressive Periodonti-tis Three-Dimensional Cone-Beam X-Ray Computed Tomogra-phy Evaluation InTech Open Access Rijeka Croatia 2012

[29] K Takahashi H Ohyama M Kitanaka et al ldquoHeterogeneityof host immunological risk factors in patients with aggressiveperiodontitisrdquo Journal of Periodontology vol 72 no 4 pp 425ndash437 2001

[30] Y Ishihara K Tomikawa T Deguchi et al ldquoInterdisciplinaryorthodontic treatment for a patient with generalized aggressiveperiodontitis assessment of IgG antibodies to identify typeof periodontitis and correct timing of treatmentrdquo AmericanJournal of Orthodontics and Dentofacial Orthopedics vol 147no 6 pp 766ndash780 2015

[31] A D Haffajee ldquoSystemic antibiotics to use or not to use in thetreatment of periodontal infections That is the questionrdquo Jour-nal of Clinical Periodontology vol 33 no 5 pp 359ndash361 2006

[32] A Guerrero G S Griffiths L Nibali et al ldquoAdjunctive benefitsof systemic amoxicillin and metronidazole in non-surgicaltreatment of generalized aggressive periodontitis a randomizedplacebo-controlled clinical trialrdquo Journal of Clinical Periodontol-ogy vol 32 no 10 pp 1096ndash1107 2005

[33] T Roshna and K Nandakumar ldquoGeneralized aggressive peri-odontitis and its treatment options case reports and review ofthe literaturerdquo Case Reports in Medicine vol 2012 Article ID535321 17 pages 2012

[34] A Panchal V Patel N Bhavsar and H Mehta ldquoOrthodontic-periodontic intervention of pathological migration ofmaxillary

anterior teeth in advanced periodontal diseaserdquo Journal ofIndian Society of Periodontology vol 17 no 3 pp 378ndash382 2013

[35] J Tulloch ldquoAdjunctive treatment for adultsrdquo in ContemporaryOrthodontics W R Proffit and H W Fields Eds pp 616ndash643Mosby St Louis Mo USA 3rd edition 2000

[36] N L Sanders ldquoEvidence-based care in orthodontics and peri-odontics a review of the literaturerdquo Journal of the AmericanDental Association vol 130 no 4 pp 521ndash527 1999

[37] C L Jackson and C Orthod ldquoComparison between electrictoothbrushing and manual toothbrushing with and withoutoral irrigation for oral hygiene of orthodontic patientsrdquo Amer-ican Journal of Orthodontics and Dentofacial Orthopedics vol99 no 1 pp 15ndash20 1991

[38] P Diedrich U Fritz and G Kinzinger ldquoInterrelationshipbetween periodontics and adult orthodonticsrdquo PeriodontalPractice Today vol 1 no 3 2004

[39] M T-C Leung T C-K Lee A B M Rabie and R W-KWong ldquoUse of miniscrews and miniplates in orthodonticsrdquoJournal of Oral andMaxillofacial Surgery vol 66 no 7 pp 1461ndash1466 2008

[40] H-S Park S-H Jeong and O-W Kwon ldquoFactors affecting theclinical success of screw implants used as orthodontic anchor-agerdquo American Journal of Orthodontics and Dentofacial Ortho-pedics vol 130 no 1 pp 18ndash25 2006

[41] S-J Cheng I-Y Tseng J-J Lee and S-H Kok ldquoA prospectivestudy of the risk factors associated with failure of mini-implantsused for orthodontic anchoragerdquo International Journal of Oraland Maxillofacial Implants vol 19 no 1 pp 100ndash106 2004

[42] E E Machtei Y Zubery Y Katz J Goultschin and A Ben-Yehouda ldquoMultiple therapy approach to juvenile periodontitisa case reportrdquoQuintessence international vol 22 no 5 pp 365ndash370 1991

[43] S A Alexander ldquoEffects of orthodontic attachments on thegingival health of permanent secondmolarsrdquoAmerican Journalof Orthodontics and Dentofacial Orthopedics vol 100 no 4 pp337ndash340 1991

[44] S Zachrisson and B U Zachrisson ldquoGingival condition associ-ated with orthodontic treatmentrdquo The Angle Orthodontist vol42 no 1 pp 26ndash34 1972

[45] M Sebbar Z Abidine N Laslami and Z Bentahar PeriodontalHealth and Orthodontics Emerging Trends in Oral Health Sci-ences and Dentistry InTech Rijeka Croatia 2015

[46] S A Al-Anezi ldquoThe effect of orthodontic bands or tubes uponperiodontal status during the initial phase of orthodontic treat-mentrdquo Saudi Dental Journal vol 27 no 3 pp 120ndash124 2015

[47] R L Boyd and S Baumrind ldquoPeriodontal considerations in theuse of bonds or bands onmolars in adolescents and adultsrdquoTheAngle Orthodontist vol 62 no 2 pp 117ndash126 1992

[48] S Pradeep ldquoDetermination of microbiological flora of differenthygienic ligatures techniquesmdashan in-vivo studyrdquo InternationalJournal of Current Microbiology and Applied Sciences vol 3 no3 pp 739ndash746 2014

[49] H TurkkahramanM O Sayin F Y Bozkurt Z Yetkin S Kayaand S Onal ldquoArchwire ligation techniques microbial coloniza-tion and periodontal status in orthodontically treated patientsrdquoAngle Orthodontist vol 75 no 2 pp 231ndash236 2005

[50] C-M Forsberg V Brattstrom E Malmberg and C E NordldquoLigature wires and elastomeric rings two methods of ligationand their association withmicrobial colonization of streptococ-cus mutans and iactobacillirdquo European Journal of Orthodonticsvol 13 no 5 pp 416ndash420 1991


[51] N Gkantidis P Christou andN Topouzelis ldquoThe orthodontic-periodontic interrelationship in integrated treatment chal-lenges a systematic reviewrdquo Journal of Oral Rehabilitation vol37 no 5 pp 377ndash390 2010

[52] M C Goldstein and M E Fritz ldquoTreatment of periodontosisby combined orthodontic and periodontal approach report ofcaserdquo The Journal of the American Dental Association vol 93no 5 pp 985ndash990 1976

[53] P Pellegrini R Sauerwein T Finlayson et al ldquoPlaque retentionby self-ligating vs elastomeric orthodontic brackets quantita-tive comparison of oral bacteria and detection with adenosinetriphosphate-driven bioluminescencerdquo American Journal ofOrthodontics and Dentofacial Orthopedics vol 135 no 4 pp426e1ndash426e9 2009

[54] A S Garcez S S SuzukiM S Ribeiro E YMada A Z Freitasand H Suzuki ldquoBiofilm retention by 3 methods of ligation onorthodontic brackets a microbiologic and optical coherencetomography analysisrdquo American Journal of Orthodontics andDentofacial Orthopedics vol 140 no 4 pp e193ndashe198 2011

[55] A Hohoff T Stamm N Kuhne et al ldquoEffects of a mechanicalinterdental cleaning device on oral hygiene in patients withlingual bracketsrdquoTheAngle Orthodontist vol 73 no 5 pp 579ndash587 2003

[56] A Hohoff D Fillion T Stamm G Goder C Sauerland andU Ehmer ldquoOral comfort function and hygiene in patients withlingual brackets A Prospective Longitudinal Studyrdquo Journal ofOrofacial Orthopedics vol 64 no 5 pp 359ndash371 2003

[57] R-R Miethke and S Vogt ldquoA comparison of the periodontalhealth of patients during treatment with the Invisalign systemand with fixed orthodontic appliancesrdquo Journal of OrofacialOrthopedics vol 66 no 3 pp 219ndash229 2005

[58] M Paolantonio ldquoClinical significance of Actinobacillus acti-nomycetemcomitans in young individuals during orthodontictreatment A 3-year longitudinal studyrdquo Journal of ClinicalPeriodontology vol 24 no 9 pp 610ndash617 1997

[59] M Paolantonio F Festa G di Placido M DrsquoAttilio G Catamoand R Piccolomini ldquoSite-specific subgingival colonizationby Actinobacillus actinomycetemcomitans in orthodonticpatientsrdquo American Journal of Orthodontics and DentofacialOrthopedics Official Publication of the American Association ofOrthodontists its Constituent Societies and the American Boardof Orthodontics vol 115 no 4 pp 423ndash428 1999

[60] ADemling CDemling R Schwestka-PollyM Stiesch andWHeuer ldquoInfluence of lingual orthodontic therapy on microbialparameters and periodontal status in adultsrdquo European Journalof Orthodontics vol 31 no 6 pp 638ndash642 2009

[61] G Corrente R Abundo S Re D Cardaropoli and G Car-daropoli ldquoOrthodontic movement into infrabony defects inpatients with advanced periodontal disease A Clinical andRadiological Studyrdquo Journal of Periodontology vol 74 no 8 pp1104ndash1109 2003

[62] B Melsen ldquoTissue reaction following application of extrusiveand intrusive forces to teeth in adult monkeysrdquo AmericanJournal of Orthodontics vol 89 no 6 pp 469ndash475 1986

[63] L Levin G R Samorodnitzky-Naveh and E E Machtei ldquoTheassociation of orthodontic treatment and fixed retainers withgingival healthrdquo Journal of Periodontology vol 79 no 11 pp2087ndash2092 2008

[64] L A Harpenau and R L Boyd ldquoLong-term follow-up of suc-cessful orthodontic-periodontal treatment of localized aggres-sive periodontitis A case reportrdquoOrthodontics and CraniofacialResearch vol 3 no 4 pp 220ndash229 2000

[65] L Q Closs S C Gomes R V Oppermann and V BertoglioldquoCombined periodontal and orthodontic treatment in a patientwith aggressive periodontitis a 9-year follow-up reportrdquoWorldJournal of Orthodontics vol 11 no 3 pp 291ndash297 2010

[66] M Miyamoto T Yamashiro and T Takano-Yamamoto ldquoSurgi-cal orthodontic treatment for severe maxillary protrusion withaggressive periodontitisrdquo Orthodontic Waves vol 67 no 4 pp171ndash178 2008

[67] E Passanezi M Janson G Janson A P SantAnna M R deFreitas and J F C Henriques ldquoInterdisciplinary treatment oflocalized juvenile periodontitis a new perspective to an oldproblemrdquo American Journal of Orthodontics and DentofacialOrthopedics vol 131 no 2 pp 268ndash276 2007

[68] H L Craddock V C Yorke and M F W Y Chan ldquoCosmeticrehabilitation following successful treatment of aggressive peri-odontitisrdquo Dental update vol 34 no 2 pp 91ndash96 2007

[69] T Ogino Y Nakamura K Gomi and A Hirashita ldquoOrthodon-tic contribution to the periodontal management of a patientwith localized aggressive periodontitis (post-juvenile periodon-titis)rdquo Orthodontic Waves vol 65 no 2 pp 81ndash87 2006

[70] SMaeda YMaeda Y Ono K Nakamura and T Sasaki ldquoInter-disciplinary treatment of a patient with severe pathologic toothmigration caused by localized aggressive periodontitisrdquo Amer-ican Journal of Orthodontics and Dentofacial Orthopedics vol127 no 3 pp 374ndash384 2005

[71] K Okada T Yamashiro S Tenshin and T Takano-YamamotoldquoOrthodontic treatment for a patient with Pierre-Robin seq-uence complicated by juvenile periodontitisrdquo Cleft Palate-Cra-niofacial Journal vol 37 no 3 pp 318ndash324 2000

[72] J Folio T E Rams and P H Keyes ldquoOrthodontic therapy inpatients with juvenile periodontitis clinical and microbiologiceffectsrdquoAmerican Journal of Orthodontics vol 87 no 5 pp 421ndash431 1985

[73] J B McLain W R Proffit and R H Davenport ldquoAdjunctiveorthodontic therapy in the treatment of juvenile periodontitisreport of a case and review of the literaturerdquo American Journalof Orthodontics vol 83 no 4 pp 290ndash298 1983

Submit your manuscripts athttpswwwhindawicom

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oral OncologyJournal of

DentistryInternational Journal of



International Journal of

Biomaterials


BioMed Research International


Case Reports in Dentistry


Oral ImplantsJournal of


Anesthesiology Research and Practice


Radiology Research and Practice

Environmental and Public Health

Journal of


The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014


Dental SurgeryJournal of

Drug DeliveryJournal of



Oral DiseasesJournal of


Computational and Mathematical Methods in Medicine

ScientificaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PainResearch and TreatmentHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Preventive MedicineAdvances in


EndocrinologyInternational Journal of



OrthopedicsAdvances in


are the protective cells and any defects associated with themlead to increased susceptibility to periodontitis Neutrophildefects like abnormalities in adherence chemotaxis superox-ide generation phagocytosis and bactericidal activities havealso been found to be accountable for the susceptibility toaggressive periodontitis [2] It is multifactorial in origin andis a genetically complex disease It is found to be inherited byan autosomal dominant [12] autosomal recessive [13ndash15] andX-linked dominant mode [5 16 17]

3 Diagnosis of Aggressive Periodontitis

Diagnosis is based on history clinical examination andradiographs Besides immunological tests microbiologicaltests are also performed More often its diagnosis is madein the age which is the same age as that when orthodontictreatment is generally started [18] The first molar whichis usually involved in aggressive periodontitis is the toothimportant for orthodontist because it is frequently used foranchorage in various removable or fixed appliance Also con-tact of bands used in first molars with the gingival tissue mayirritate it aggravating the condition [19] Hence it is essentialthat orthodontist screens each case for aggressive periodon-titis and is able to make an honest diagnosis and coordinatewith the periodontist for proper care

For the diagnosis of localized aggressive periodontitisthere should be attachment loss of at least 4mm on atleast one permanent first molar and one incisor [20] Hereare some features which help in the diagnosis of aggressiveperiodontitis

31 Clinical [21]

(i) Generally affecting the young adults(ii) Rapid loss of attachment and alveolar bone height(iii) Familial aggregation(iv) Absence of significant medical history(v) Severe periodontal destruction which is inconsistent

with the amount of deposits(vi) Lack of clinical signs of inflammation in spite of the

presence of deep pockets and bone loss

32 Radiographic [3]

(i) Vertical loss of alveolar bone height aroundfirstmolarand incisors

(ii) Arc shaped bone loss seen extending from the distalsurface of the second premolar to the mesial surfaceof the second molar

33 Microbiologic [22] Although a large number of patho-gens are associated with periodontitis many studies haveshown few specific strains related to aggressive periodon-titis A actinomycetemcomitans is found in high frequencyin microbial deposits on the teeth affected with localizedaggressive periodontitis Similarly patients with generalized

aggressive periodontitis show high subgingival levels ofSelenomonas sp and T lecithinolyticum

34 Host Susceptibility [2] Some people are more susceptibleto aggressive periodontitis indicating a significant role of hostsusceptibility behind the disease In addition local and gen-eral environmental factors also play significant roles Herpesvirus may increase the host susceptibility and aggravate theseverity of aggressive periodontitis

4 Orthodontic Problems Associated withthe Aggressive Periodontitis

The loss of interproximal attachment is the main factorleading to pathologic toothmigration [23] and clinically seenas extrusion proclination rotation diastema or drifting intoedentulous space [24] Altered level of the incisal edge andspace between anterior teeth leads to unaesthetic appearanceand is the prime reason for seeking orthodontic treatment

5 Role of Orthodontist in the Management ofAggressive Periodontitis

Aggressive periodontitis may develop before during or evenafter the completion of orthodontic treatment So periodontalscreening should be done in all patients regardless of theinitiation of orthodontic treatment [25] Khocht et al foundthat periodontal screening and recording (PSR) is an effectivetool to scrutinize periodontal diseases [26]

51 Before Starting Orthodontic Treatment For any patientattending the orthodontic clinic the orthodontists shouldensure that their oral hygiene is good In patients with poororal hygiene oral prophylaxis is recommended and theirability to maintain the hygiene is evaluated If the compliancetowards the oral hygiene is poor orthodontic therapy ispostponed till the achievement of proper plaque control

Mathews and Kokich recommended that during clinicalexamination at least five minutes of periodontal examina-tion including probing of key indicator teeth is manda-tory before making orthodontic diagnosis and treatmentplanning [27] Gingival inflammation swelling recessiontooth mobility and pathological pockets should be assessedBesides the patient should be asked for the recent change inthe position or drifting of teeth Radiographic assessment ofbone loss is made from the bite wing radiograph of the firstmolar and intraoral periapical radiograph of incisors [19]Newer imaging methods like CBCT give more insight intothe bony defects which facilitates better treatment planning[28] Further serum IgG titer test against each pathogenicbacterium can be done with ELISA as the serum levelof IgG directly correlates with the number of pathogenicbacteria in the periodontium [29] Elimination of bacteriafrom the periodontal pockets can be assessed with this testwhich is useful for determining the optimal timing to startorthodontic treatment [30] Any clinical signs of aggressiveperiodontal disease like attachment loss pockets and bone
















Table1Summaryof

thec

aser

eportsin

theo

rtho

donticmanagem

ento

faggressivep

eriodo

ntitis

Author

(year)

Patie

ntAggressive

perio

dontitis

Type

ofperio

dontal

procedures

done

Durationof

activ

eorthod

ontic

treatment

Ortho


durin

gtre

atment

SexAge

Ishihara

etal[30]

(2015)

F21

Generalized

Surgicalandno

nsurgical

28mon

ths

(i)Closem

onito

ringof

serum

IgGagainstA

actinom

ycetem

comita

nsand

Prevotellainterm

edia

(ii)P

readjuste

dedgewise

appliancew



with

0012nickeltitanium

wire

(iv)L

ingu

albo

nded

retainer

aswellasw

raparou

ndretainer

after

activ

etherapy

Closse

tal[65]

(2010)

F22

Localized

Surgicalandno

nsurgical

32mon

ths

(i)Ex

tractio

nof

maxillarydecidu

oussecon

dmolarsfollowed

bymesial

movem

ento


prem

olars)

(ii)S

egmentedmechanics

andlight

force

(iii)Re

movableretainer


lingualretainer

inmandibu

lara

rch

Miyam

otoetal[66]

(2008)

F24

Localized

Non

surgical

40mon

ths

(i)Ex

tractio

nof

maxillaryfirstprem

olarsa

ndsubapicaloste

otom

yto

repo

sitionitback

(ii)E

xtractionof

mandibu

larc

entralincisora

ndproxim

alstrip

ping

ofother

incisorsto

minim

izetoo

thmovem

entinlower

arch

(iii)Flexiblespira

lwire

andremovablecircum

ferentialretainer

Passanezietal[67]

(2007)

F17

Localized

Surgicalandno

nsurgical

26mon

ths

(i)Initiallevelling

with

light

force(0012NITI)

(ii)Intrusio

nof

flaredandextrud


reversec

urve

wire


overjetcon

trol

(iv)P

ermanentfi

xedretentionin

both

arches

with

removableretainer

inmaxillaryarch

Craddo

cketal[68]

(2007)

F27

Generalized

mdash7mon

ths

(i)Alignm

entand

levelling

ofthed

rifted

upperinciso

rswith

fixed

appliance

(ii)p

ermanentb

ondedretainer

Ogino

etal[69]

(200

6)F

30Lo

calized

Surgicalandno

nsurgical

19mon

ths

(i)Intrusionof

maxillaryandmandibu

larinciso

rsto

redu

ceoverbite

(ii)R

etractionof

maxillaryincisorsto

redu

ceoverjet

(iii)Be

ggretainer

inmaxillaryarch

andfixed

retainer

inmandibu

lara

rch

Maeda

etal[70]

(2005)

F27

Localized

Surgicalandno

nsurgical

21mon

ths

(i)Ex

tractio

nof

11and31

(ii)L

evellingandalignm

entstarted

with

0012Nickeltitanium

archwire

(iii)Cervicalpullh

eadgear

(iv)M

ultiloo

pedgewise

archwire

(v)M

axillarycircum

ferentialrem

ovableretainer

andmandibu

larb

onded

canine

tocanine

retainer

Okada

etal[71]

(200

0)M

17Lo

calized

Non

surgical

36mon

ths

(i)Patie

ntpresentedwith

Pierre

robins

sequ

ence

(ii)E

xtractionof

maxillaryfirstprem

olarsa

ndretractio

nandalignm

ento

fup

pera

nteriors



rsho

wed

markedmob

ility

andthus

isextracted(la

terreplacedwith

fixed

bridge)

(iv)A

ctiveo

rtho

dontictherapywas

haltedforh

alfa

year

(v)S

imultaneou

suse

ofqu

adhelix

form

axillaryarch

expansion

(vi)Wraparou

ndretainer


Table1Con

tinued

Author

(year)

Patie

ntAggressive

perio

dontitis

Type

ofperio

dontal

procedures

done

Durationof

activ

eorthod

ontic

treatment

Ortho


durin

gtre

atment

SexAge

HarpenauandBo

yd[64]

(200

0)F

16Lo

calized

Non

surgical

mdash(i)

Extractio

nof

allfi

rstm

olarsa

ndsubsequent

spacec

losure

with

retractio

nandwellasp

rotractio

n

Folio

etal[72]

(1985)

M32

Localized

mdash4mon

ths

(i)Supra-erup


(ii)0

019

by0022inch

passivea

rchwire

with

0018inch

roun

dwire

ldquokickerrdquo

forintrusiv

eforce

(iii)Mild

root

resorptio

nof


thev

itality

(iv)U

pper

Haw

leyrsquos

appliancefor

retention

Folio

etal[72]

(1985)

M21

Localized

mdash4mon

ths


asin

crossbite

which

was

correctedwith


wire

(ii)M

odified

Haw

leyrsquos

retainer

after

alignm

ent

Folio

etal[72]

(1985)

F28

Localized

mdash11mon

ths

(i)Ex

tensively

drifted


lignedandspacec

losure

by0018by

0022inch

wire

with

closin

gloop

s

Folio

etal[72]

(1985)

F16

Localized

mdash19

mon

ths

(i)Intrusionof

mandibu

larinciso

rsandalignm

ento

fmaxillaryanterio

rs(w

hich

was


(ii)R

emovableHaw

leyrsquos

retainer

McLainetal[73]

(1983)

F12

Localized

Non

surgical

36mon

ths

(i)Ex

tractio

nof


ndfour

lower

incisors


r)(ii)M

esializationof

second

andthird

molars3

yrsa

fterthe

extractio

n(iii)Upp

er17times22

andlower

17times25

wire

with

loop

swereu

sedto

close

the

space






6 Conclusion


Competing Interests


References





















































































Biomaterials












Journal of


































Table1Summaryof

thec

aser

eportsin

theo

rtho

donticmanagem

ento

faggressivep

eriodo

ntitis

Author

(year)

Patie

ntAggressive

perio

dontitis

Type

ofperio

dontal

procedures

done

Durationof

activ

eorthod

ontic

treatment

Ortho


durin

gtre

atment

SexAge

Ishihara

etal[30]

(2015)

F21

Generalized

Surgicalandno

nsurgical

28mon

ths

(i)Closem

onito

ringof

serum

IgGagainstA

actinom

ycetem

comita

nsand

Prevotellainterm

edia

(ii)P

readjuste

dedgewise

appliancew



with

0012nickeltitanium

wire

(iv)L

ingu

albo

nded

retainer

aswellasw

raparou

ndretainer

after

activ

etherapy

Closse

tal[65]

(2010)

F22

Localized

Surgicalandno

nsurgical

32mon

ths

(i)Ex

tractio

nof

maxillarydecidu

oussecon

dmolarsfollowed

bymesial

movem

ento


prem

olars)

(ii)S

egmentedmechanics

andlight

force

(iii)Re

movableretainer


lingualretainer

inmandibu

lara

rch

Miyam

otoetal[66]

(2008)

F24

Localized

Non

surgical

40mon

ths

(i)Ex

tractio

nof

maxillaryfirstprem

olarsa

ndsubapicaloste

otom

yto

repo

sitionitback

(ii)E

xtractionof

mandibu

larc

entralincisora

ndproxim

alstrip

ping

ofother

incisorsto

minim

izetoo

thmovem

entinlower

arch

(iii)Flexiblespira

lwire

andremovablecircum

ferentialretainer

Passanezietal[67]

(2007)

F17

Localized

Surgicalandno

nsurgical

26mon

ths

(i)Initiallevelling

with

light

force(0012NITI)

(ii)Intrusio

nof

flaredandextrud


reversec

urve

wire


overjetcon

trol

(iv)P

ermanentfi

xedretentionin

both

arches

with

removableretainer

inmaxillaryarch

Craddo

cketal[68]

(2007)

F27

Generalized

mdash7mon

ths

(i)Alignm

entand

levelling

ofthed

rifted

upperinciso

rswith

fixed

appliance

(ii)p

ermanentb

ondedretainer

Ogino

etal[69]

(200

6)F

30Lo

calized

Surgicalandno

nsurgical

19mon

ths

(i)Intrusionof

maxillaryandmandibu

larinciso

rsto

redu

ceoverbite

(ii)R

etractionof

maxillaryincisorsto

redu

ceoverjet

(iii)Be

ggretainer

inmaxillaryarch

andfixed

retainer

inmandibu

lara

rch

Maeda

etal[70]

(2005)

F27

Localized

Surgicalandno

nsurgical

21mon

ths

(i)Ex

tractio

nof

11and31

(ii)L

evellingandalignm

entstarted

with

0012Nickeltitanium

archwire

(iii)Cervicalpullh

eadgear

(iv)M

ultiloo

pedgewise

archwire

(v)M

axillarycircum

ferentialrem

ovableretainer

andmandibu

larb

onded

canine

tocanine

retainer

Okada

etal[71]

(200

0)M

17Lo

calized

Non

surgical

36mon

ths

(i)Patie

ntpresentedwith

Pierre

robins

sequ

ence

(ii)E

xtractionof

maxillaryfirstprem

olarsa

ndretractio

nandalignm

ento

fup

pera

nteriors



rsho

wed

markedmob

ility

andthus

isextracted(la

terreplacedwith

fixed

bridge)

(iv)A

ctiveo

rtho

dontictherapywas

haltedforh

alfa

year

(v)S

imultaneou

suse

ofqu

adhelix

form

axillaryarch

expansion

(vi)Wraparou

ndretainer


Table1Con

tinued

Author

(year)

Patie

ntAggressive

perio

dontitis

Type

ofperio

dontal

procedures

done

Durationof

activ

eorthod

ontic

treatment

Ortho


durin

gtre

atment

SexAge

HarpenauandBo

yd[64]

(200

0)F

16Lo

calized

Non

surgical

mdash(i)

Extractio

nof

allfi

rstm

olarsa

ndsubsequent

spacec

losure

with

retractio

nandwellasp

rotractio

n

Folio

etal[72]

(1985)

M32

Localized

mdash4mon

ths

(i)Supra-erup


(ii)0

019

by0022inch

passivea

rchwire

with

0018inch

roun

dwire

ldquokickerrdquo

forintrusiv

eforce

(iii)Mild

root

resorptio

nof


thev

itality

(iv)U

pper

Haw

leyrsquos

appliancefor

retention

Folio

etal[72]

(1985)

M21

Localized

mdash4mon

ths


asin

crossbite

which

was

correctedwith


wire

(ii)M

odified

Haw

leyrsquos

retainer

after

alignm

ent

Folio

etal[72]

(1985)

F28

Localized

mdash11mon

ths

(i)Ex

tensively

drifted


lignedandspacec

losure

by0018by

0022inch

wire

with

closin

gloop

s

Folio

etal[72]

(1985)

F16

Localized

mdash19

mon

ths

(i)Intrusionof

mandibu

larinciso

rsandalignm

ento

fmaxillaryanterio

rs(w

hich

was


(ii)R

emovableHaw

leyrsquos

retainer

McLainetal[73]

(1983)

F12

Localized

Non

surgical

36mon

ths

(i)Ex

tractio

nof


ndfour

lower

incisors


r)(ii)M

esializationof

second

andthird

molars3

yrsa

fterthe

extractio

n(iii)Upp

er17times22

andlower

17times25

wire

with

loop

swereu

sedto

close

the

space






6 Conclusion


Competing Interests


References





















































































Biomaterials












Journal of




















Table1Con

tinued

Author

(year)

Patie

ntAggressive

perio

dontitis

Type

ofperio

dontal

procedures

done

Durationof

activ

eorthod

ontic

treatment

Ortho


durin

gtre

atment

SexAge

HarpenauandBo

yd[64]

(200

0)F

16Lo

calized

Non

surgical

mdash(i)

Extractio

nof

allfi

rstm

olarsa

ndsubsequent

spacec

losure

with

retractio

nandwellasp

rotractio

n

Folio

etal[72]

(1985)

M32

Localized

mdash4mon

ths

(i)Supra-erup


(ii)0

019

by0022inch

passivea

rchwire

with

0018inch

roun

dwire

ldquokickerrdquo

forintrusiv

eforce

(iii)Mild

root

resorptio

nof


thev

itality

(iv)U

pper

Haw

leyrsquos

appliancefor

retention

Folio

etal[72]

(1985)

M21

Localized

mdash4mon

ths


asin

crossbite

which

was

correctedwith


wire

(ii)M

odified

Haw

leyrsquos

retainer

after

alignm

ent

Folio

etal[72]

(1985)

F28

Localized

mdash11mon

ths

(i)Ex

tensively

drifted


lignedandspacec

losure

by0018by

0022inch

wire

with

closin

gloop

s

Folio

etal[72]

(1985)

F16

Localized

mdash19

mon

ths

(i)Intrusionof

mandibu

larinciso

rsandalignm

ento

fmaxillaryanterio

rs(w

hich

was


(ii)R

emovableHaw

leyrsquos

retainer

McLainetal[73]

(1983)

F12

Localized

Non

surgical

36mon

ths

(i)Ex

tractio

nof


ndfour

lower

incisors


r)(ii)M

esializationof

second

andthird

molars3

yrsa

fterthe

extractio

n(iii)Upp

er17times22

andlower

17times25

wire

with

loop

swereu

sedto

close

the

space






6 Conclusion


Competing Interests


References





















































































Biomaterials












Journal of
























6 Conclusion


Competing Interests


References





















































































Biomaterials












Journal of





















































































Biomaterials












Journal of



















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