Orthodontic-periodontic intervention of pathological migration of maxillary anterior teeth in advanced periodontal disease
A 32-year-old Indian female patient came to the Department of Periodontology, Government Dental College and Hospital, Ahmedabad, Gujarat, India, with a chief complaint of loose and palatally drifted upper left central incisor, which led to malalignment of upper anterior teeth. Patient wanted to correct those teeth for restoring the esthetics [].\nA comprehensive periodontal examination was completed including extraoral, intraoral and radiographic evaluations.\nThorough clinical examination revealed, the maxillary left central incisor was drifted palatally with Grade II mobility, with a 9 mm deep periodontal pocket. Radiographic evaluation revealed angular bony defect extending until middle-third of the root of maxillary left central incisor []. Intraoral clinical status assessment was made and the treatment was planned sequentially.\nInitial periodontal treatment consisting of scaling and root planning was performed and patient was given oral hygiene instructions. An ideal diagnostic upper working cast was made. On that cast, “Z” spring with labial bow was fabricated []. The “Z” spring was made of 0.5 mm hard round stainless steel wire. The spring consisted of two coils of very small internal diameter. The spring was made perpendicular to the palatal surface of the tooth. It had a retentive arm of 10-12 mm length that was embedded in the acrylic. The “Z” spring was activated by opening both the helices by about 2-3 mm at a time. This removable appliance was modified to form a fitted labial bow, which was used as a retaining device during the treatment. Patient was advised to wear it for a period of at least 6 weeks [].\nPost-orthodontic treatment, when maxillary left central incisor was realigned in the arch [], it was splinted with the adjacent teeth to improve the stability and masticatory comfort [Figures and ]. Later, surgical intervention of left maxillary incisors was recommended to eradicate the deep infrabony pocket.\nAfter the full thickness, mucoperiosteal flap was reflected labially and palatally under local anesthesia, angular bony defect was found in relation to maxillary left central incisor []. The surgical site was grafted with decalcified freezed dried bone allograft []. The flaps were reapproximated and sutured. The sutures were removed after a week. Healing was uneventful. Patient was placed on a 3 month periodontal maintenance recall program [Figures and ].\nOn post-treatment evaluation (after 8 years), realigned maxillary left central incisor was observed; thus, achieving an acceptable occlusion. Furthermore, there was a normal gingiva showing no evidence of bleeding on probing. Radiographic examination revealed significant fill of the infrabony defect [Figures and ].\nFinally, the ortho-perio interdisciplinary approach resulted in the restoration of esthetics and function, thus improving self-confidence of the patient.