Periodontal management in orthognathic surgery: Early screening of periodontal risk and its current management for the optimization of orthodontic and surgical treatments

Orthodontic preparation for orthognathic surgery requires correcting malocclusions and coordination of arcades. In addition to improving the aesthetics, these treatments can ensure the achievement and sustainability of prosthetics and/or implants. Nevertheless periodontal structures are easily damaged. Orthodontic displacement can only be applied in the absence of inflammation or weakened periodontal structures. An early detection of periodontal risk should be achievable by prescribers of a surgical-orthodontic treatment. Simplified periodontal examination, with easily detectable warning signs, will help identify the periodontal risk. Although periodontal treatment follows current "non-invasive'' trend, some procedures remain necessary to prevent and/or remedy periodontal defects or diseases, such as mineral periodontal reinforcement based on corticotomy principles. It is essential that the patient meet all the practitioners to plan and assess the extent of the constraints necessary to optimize results, before starting orthodontic treatment combined with orthognathic surgery. Any periodontal complication (even minor) will be considered as a failure, regardless of good aesthetic and functional results. (C) 2014 Elsevier Masson SAS. All rights reserved.