![]() ![]() However, there is no consensus concerning whether orthodontic tooth movement can be conducted for “periodontally hopeless teeth” with class III mobility.Įxtraction of teeth with severe attachment loss has been a common practice in the past because it is expensive to preserve such teeth and the prognosis is usually poor. Traditionally, severe tooth mobility may affect the prognosis after orthodontic tooth movement, since orthodontic treatment has been reported to increase tooth mobility. ![]() Occlusal adjustment and periodontal splinting have been advocated to stabilize periodontally questionable and hopeless teeth. ![]() Orthodontic treatment after the careful periodontal treatment of periodontally compromised teeth with pathological tooth migration has been reported in some cases, and the prerequisites for orthodontic intervention are controlled periodontal inflammation and reduced mobility after strict periodontal treatment. Once alveolar bone absorption exceeds 70% of total bone support, secondary occlusal trauma and severe tooth mobility may ensue, leading to a possible diagnosis of “periodontally hopeless teeth”. Clinical diagnosis that occlusal trauma has occurred or is occurring may include progressive tooth mobility, fremitus, occlusal discrepancies, tooth migration, root resorption, etc. Since both periodontal inflammation and occlusal trauma can result in an increase in the tooth mobility, any clinical decision should be made only after periodontal inflammation is well controlled and occlusal trauma is clearly alleviated. Despite consensus on the definitions of primary and secondary occlusal trauma, specific criteria of reduced periodontal support that leads to a clinical diagnosis of secondary occlusal trauma have not been identified clearly. Primary occlusal trauma mainly refers to occlusal trauma occurring before the presence of periodontal disease and is regarded as a synergistic factor of periodontal disease. Teeth with significant supportive periodontal tissue loss are especially prone to occlusal trauma, which has been defined as secondary occlusal trauma. Malocclusion-associated occlusal trauma is well recognized in patients with a deep impinging overbite or anterior dental crossbite. Occlusal trauma-induced tooth mobility, a result of periodontal membrane widening rather than inadequate bone support, can be caused by acute periapical periodontitis, orthodontic treatment, or prosthesis implantation. Loss of supportive periodontal tissue height and widening of the periodontal ligament are the underlying mechanisms of increased tooth mobility. Tooth mobility, a common symptom of advanced periodontitis, is a major reason patients seek dental consultation and a main factor of clinical decision-making by dentists. Periodontitis, an inflammatory response to invading periodontal pathogens, may lead to the destruction of periodontal supporting tissues. ![]()
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