Factors Associated with Orthodontic Tooth Movement in Periodontally Compromised Patients

There is no consistent relationship between malocclusion and periodontal disease but certain characteristics of malocclusion can promote a pathologic environment conducive to periodontal disease. One of the dramatic means available to improve the local environmental factors is through orthodontic tooth movement. The pretreatment periodontal conditions can include excessive tooth mobility, advanced crestal bone loss, infrabony defects, tipped molars, furcation involvement, and hard and soft tissue dehiscences. Movement of teeth in the presence of periodontal inflammation can result in an increased loss of attachment and irreversible crestal loss. Although absolute reduction in bone and attachment levels does not contraindicate orthodontic correction, it does increase the difficulty of delivering controlled orthodontic mechanics that would potentially minimize further bone loss. The present review article discusses the various factors that are associated with orthodontic tooth movement in periodontally compromised patients namely: 1) tooth movement into infrabony pockets; 2) tooth movement into compromised bone areas; 3) tooth movement through cortical bone; 4) extrusion (eruption); 5) intrusion; 6) tipping.