Orthodontic Treatment After Induced Periodontal Regeneration in Deep Infrabony Defects

Introduction: Limited studies investigated whether orthodontic movement should be performed in patients with periodontal disease and severe intrabony defects. The purpose of this study is to assess the stability of the periodontal complex combining regeneration treatment with enamel matrix derivative (EMD) and collagen bovine mineral bone, followed by early orthodontic movement. Case Series: In a prospective case series, 10 patients with radiographic vertical defects with probing depths (PDs) >= 6 mm and pathologic tooth migration were enrolled. Each patient contributed one infrabony defect treated with a combination of EMD and collagen bovine mineral bone. All patients started the alignment stage 1 month after periodontal surgery with 0.014 nickel-titanium wires, and the treatment lasted a mean time of 9 +/- 3.2 months. Clinical measurements (PD, clinical attachment level [CAL], and gingival recession) were calculated from baseline to the end of orthodontic treatment. Mean PD reduction was 3.7 +/- 1.77 mm, with an average residual PD of 4 +/- 1.05 mm; mean CAL gain was 4.4 +/- 1.71 mm, with a residual CAL of 5.5 +/- 1.72 mm. Both differences are statistically significant (P < 0.001). Conclusions: A reconstructive procedure that combines EMD and collagen bovine mineral bone as a periodontal pre-orthodontic procedure seem to provide excellent clinical results. In this clinical case series, early orthodontic movement, even if it takes place in immature bone during the healing time, has not adversely affected the maturation process of the entire periodontal apparatus.