Periodontitis is a chronic multifactorial disease induced by a microbial biofilm leading to progressive destruction of the tooth-supporting tissue. Severe periodontitis often contributes to pathologic tooth migration (PTM) or tooth loss. In consequence, patients with advanced periodontitis can require, apart from periodontal therapy, orthodontic and/or prosthetic treatment.

Case Report:
A multidisciplinary approach is presented to the treatment of stage IV periodontitis in a 46-year-old woman. Non-surgical periodontal therapy followed by orthodontic treatment were performed. A 3-year follow-up demonstrated complete resolution of periodontal inflammation, improved aesthetics and stable occlusion.

Comprehensive treatment of patients with advanced periodontitis requires adequate timing and a multidisciplinary approach to eventually restore occlusal harmony with stable periodontium and satisfying aesthetics.

Stańdo-Retecka M, Szlendak A, Lewkowicz N. Periodontal and orthodontic treatment of a patient with advanced periodontitis – Case Report and 3-year follow-up. J Pre-Clin Clin Res. 2022; 16(3): 69–74. doi: 10.26444/jpccr/152724
Genco RJ, Sanz M. Clinical and public health implications of periodontal and systemic diseases: An overview. Periodontol. 2000. 2020;83:7–13. doi: 10.1111/prd.12344.
Slots J. Periodontitis: facts, fallacies and the future. Periodontol. 2000. 2017;75:7–23. doi: 10.1111/prd.12221.
Deas DE, Moritz AJ, Sagun RS Jr, et al. Scaling and root planing vs. conservative surgery in the treatment of chronic periodontitis. Periodontol 2000. 2016;71:128–39. doi: 10.1111/prd.12114.
Brunsvold MA. Pathologic tooth migration. J Periodontol. 2005;76:859–66. doi: 10.1902/jop.2005.76.6.859.
Papapanou PN, Sanz M, Buduneli N, et al. Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45:S162–170. doi: 10.1111/jcpe.12946.
Miller TA. Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. Patient Educ Couns. 2016; 99: 1079–1086. doi: 10.1016/j.pec.2016.01.020.
Martin C, Celis B, Ambrosio N, et al. Effect of orthodontic therapy in periodontitis and non-periodontitis patients: a systematic review with meta-analysis. J Clin Periodontol. 2022;49 Suppl 24:72–101. doi: 10.1111/jcpe.13487.
Antoun JS, Mei L, Gibbs K, et al. Effect of orthodontic treatment on the periodontal tissues. Periodontol. 2000. 2017;74(1):140–157. doi: 10.1111/prd.12194.
Xie Y, Zhao Q, Tan Z, et al. Orthodontic treatment in a periodontal patient with pathologic migration of anterior teeth. Am J Orthod Dentofacial Orthop. 2014;145(5):685–93. doi: 10.1016/j.ajodo.2013.08.018.
Weston P, Yaziz YA, Moles DR, et  al. Occlusal interventions for periodontitis in adults. Cochrane Database Syst Rev. 2008;(3):CD004968. doi: 10.1002/14651858.CD004968.pub2. Update in: Cochrane Database Syst Rev. 2016;11:CD004968.
Gkantidis N, Christou P, Topouzelis N. The orthodontic-periodontic interrelationship in integrated treatment challenges: a systematic review. J Oral Rehabil. 2010;37:377–90. doi: 10.1111/j.1365-2842.2010.02068.x.
Kloukos D, Roccuzzo A, Stähli A, et al. Effect of combined periodontal and orthodontic treatment of tilted molars and of teeth with intra-bony and furcation defects in stage-IV periodontitis patients: A systematic review. J Clin Periodontol. 2021. doi: 10.1111/jcpe.13509.
Zhang J, Zhang AM, Zhang ZM, et al. Efficacy of combined orthodontic-periodontic treatment for patients with periodontitis and its effect on inflammatory cytokines: A comparative study. Am J Orthod Dentofacial Orthop. 2017;152:494–500. doi: 10.1016/j.ajodo.2017.01.028.
Papageorgiou SN, Antonoglou GN, Michelogiannakis D, et al. Effect of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis: A systematic review with meta-analysis. J Clin Periodontol. 2021. doi: 10.1111/jcpe.13529.
Chhibber A, Agarwal S, Yadav S, et al. Which orthodontic appliance is best for oral hygiene? A randomized clinical trial. Am J Orthod Dentofacial Orthop. 2018;153:175–183. doi: 10.1016/j.ajodo.2017.10.009.
Han JY. A comparative study of combined periodontal and orthodontic treatment with fixed appliances and clear aligners in patients with periodontitis. J Periodontal Implant Sci. 2015;45:193–204. doi: 10.5051/jpis.2015.45.6.193.
Schwendicke F, Krois J, Engel AS, et  al. Long-term periodontitis treatment costs according to the 2018 classification of periodontal diseases. J Dent. 2020;99:103417. doi: 10.1016/j.jdent.2020.103417.