Parodontal diseases in dento-maxillary anomalies. Assessment and aspects of the complex orthodontic treatment

Introduction: The emergence of the inflammation and parodontal disease is due to the activity of two complexes: the primary causal complex which includes the dental plaque and the secondary causal complex with its local factors and actions upon the primary causal complex. The dental plaque is the main cause of occurrence of the inflammatory parodontal disease. Local factors with negative influence on parodontal disease are dento-maxillary anomalies, occlusal trauma, form and integration of the labial frenulum, etc. Abnormalities in tooth size, position and shape can cause disorders in gingival architecture, which lead to the development of problem areas with difficulties in self-cleaning and as a result, the progressive accumulation of dental deposits. Also, the dento-maxillary anomalies create overload conditions for the periodontal support, with development of the occlusal trauma and later with an eventual gingival recession. The purpose of the work was to assess the parodontal status in the case of dento-maxillary anomalies and the clinical and paraclinical supervision within a complex orthodontic treatment. Materials and methods: The research involved the examination and treatment of 98 patients with different dento-maxillary anomalies, with an average age of 13,77 ± 0,36 in a range of 8-24 years old. The algorithm for the investigation of patients included exo- and endooral examination, fotostatic test, model biometric study; X-ray examination before and after orthodontic treatment, assessment of the parodontal disease through radiological and endooral clinical examination, by determining the gingival index of Parma, the papillary hemorrhage index of Miihlemann; and assessing of the oral hygiene index (OHI-S). There were diagnosed parodontal diseases in 77 patients (78, 6%) were diagnosed with dento-maxillary anomalies and 21 patients (21, 4%) were considered parodontally healthy. The orthodontic treatment was realized using fixed appliances with .022 slot brackets, Straight Wire Technique, Roth prescription, with individual elements for 41 patients (41, 8%) and with removable and functional appliances for 57 patients (58, 2%). The parodontal therapy included topical administration of 0,1% gel BioR, in the first group (of the research), and in the second group (of reference) - parodontal therapy with routine preparations. Results: After a course of active orthodontic treatment the results of the complete healing were different -76,3% for the first group and 66,9% for the patients of the second group. The results varied in dependence of the used orthodontic appliances, 83,1% for the patients with fixed appliances and 62,7% for the patients treated with removable appliances. Conclusion: The complex orthodontic treatment of dento-maxillary anomalies truthfully leads to parodontal healing granting the fixed appliances treatment