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Orthodontic treatment for perio patients

“Predictability is my daily guiding principle”

22.10.2018
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What is an orthodontic treatment? What is the biology behind ? We met Dr. Daniele Cardaropoli during the last EuroPerio in Amsterdam and he gave us an insights into the topic.

Dr. Giulia Cerino | Switzerland

Your presentation for EuroPerio9 was about orthodontic treatment for perio patients. Do you see this treatment more as a threat or as a chance?

Dr. Cardaropoli: Definitely a chance. Orthodontic treatment is an interdisciplinary approach and I am truly convinced that also advanced perio cases, usually associated with pathologic tooth migration, can benefit from the possibility of realigning the malpositioned dentition, which we can achieve with our treatment plan. 

You showed how orthodontic treatment can support regenerative therapy and help to fill bony defects. Could you describe your concept?

Dr. Cardaropoli: The clinical evidence suggests that for treating infrabony defects we need to regenerate the attachment loss together with periodontal regeneration and of course to fill the bone defect. Therefore, the concept in case of tooth migration is simply to treat the bone defects and to close the diastema at the same time.

What is your standard procedure to achieve good results?

Dr. Cardaropoli: As the first step, we have to follow the decision tree for the treatment of the periodontal patient. In the presence of an infrabony defect, we start with infection control to reduce the inflammation of the periodontal tissue and only after a proper causal-related therapy, which is a non-surgical therapy by definition, can we approach the infrabony defect surgically. Usually I prefer to treat the infrabony defects using a papilla preservation technique and grafting the defect with Geistlich Bio-Oss® Collagen. The handling of the biomaterial is simply perfect in case of narrow periodontal defects, and for me it is definitely the best biomaterial for this procedure. Finally, about 15 days after surgery, we start the active early orthodontic movement of the tooth inside the defect.

What can you tell us about the cell biology behind it? At first sight and from a standpoint of stability as a prerequisite for bone regeneration, it seems surprising that one can move teeth into a freshly augmented area…

Dr. Cardaropoli: Indeed, it may seem surprising. But, I can assure you that when we move a tooth inside a freshly augmented area, we really do not disturb blood clot stabilization. The movement is orthodontically controlled, performed using low forces (i.e. 10 - 15 g/tooth) and always in the same direction. In addition, we have to be sure to avoid what we call the jiggling force that can break the blood clot.

Basic research and preclinical studies on the early orthodontic movement inside periodontal defect grafted with Geistlich Bio-Oss® Collagen demonstrated that there are several benefits for our patients: because when we move the tooth, the periodontal wound is not completely healed, we can improve the final outcomes both for the periodontal parameters (Probing Depth, Clinical Attachment Level) and also for the papillary level and the soft tissue recession.

Tooth movement into infrabony defects to stimulate new bone formation – is this a new idea? Or an old concept?

Dr. Cardaropoli: It is an old concept, but with current knowledge it is also a new idea. I have more than 20 year of experience in treating perio patients with orthodontic movement, and nowadays we have more long-term data to share with the scientific community. Moreover, a multicenter study is also running. I really hope that next year we will be able to share new data, supporting the concept with more evidence.

At the end of your presentation you said that your brother Giuseppe Cardaropoli taught you an Aristotelian wisdom: “We are what we repeatedly do. Therefore, excellence is not an action, but a habit.” What does this mean for you personally? How would you translate it into a guiding principle for your work?

Dr. Cardaropoli: For me it means predictability. In our daily practice, it is really important to use clinical protocols, which help us in reaching the same outcomes in all our patients. I want 100% of my patients satisfied!

Dr. Giulia Cerino

Dr. Giulia Cerino | Switzerland

Manager Medical Communications
Geistlich Pharma

 

Photo Header: Daniele Micieli

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