Orthodontic Space Closure and Molar Protraction in the Presence of Advanced Periodontal Disease: A Multidisciplinary Treatment Approach

Abstract

Loss of posterior teeth secondary to periodontitis can profoundly influence occlusal relationships and subsequent treatment planning. When periodontal inflammation is adequately controlled, orthodontic tooth movement may be incorporated within an interdisciplinary therapeutic framework. This report demonstrates a clinical case of a young female adult, presenting severe periodontitis, along with multiple missing teeth and atrophic mandibular first molar extraction sites. We chose a multidisciplinary approach; starting with periodontal therapy in order to obtain a healthy periodontium, followed by orthodontic treatment to correct malocclusion and restore the dentition, ensuring in the way uprighting and protraction of the second molars and thereby closure of the large posterior edentulous spaces. As a result, clinical gingival inflammation, attachment loss and vertical bone resorption were improved and stabilized. Follow-up at 1-year post-treatment confirmed the stability of the orthodontic and periodontal results.