Periodontology and orthodontic therapy in patients with stage IV periodontitis

Parodontna je bolest kronična upala mekih i tvrdih tkiva koja podupiru i učvršćuju zub te postupno dovodi do gubitka zuba. Teški oblici parodontitisa predstavljaju veliki javnozdravstveni problem, uz broj oboljelih od preko milijardu u svijetu. Parodontitis stadija IV najteži je oblik ove bolesti, a karakterizira ga gubitak interdentalnog pričvrska ≥ 5 mm, radiološki gubitak kosti gdje kost doseže srednju ili apikalnu trećinu korijena te gubitak više od 5 zuba uslijed bolesti. Uz to, prisutna je žvačna disfunkcija i patološka pomičnost zuba, postoje teški defekti alveolarnog grebena te posljedično dolazi do okluzijskog kolapsa uz prisustvo patološke migracije zuba te flaringa prisutnog u anteriornog regiji ili gubitka potpore u stražnjoj regiji. Parodontitis stadija IV ne ugrožava opstanak samo pojedinačnih zuba, već i cijele denticije. Mnogi pacijenti koji boluju od parodontitisa stadija IV zainteresirani su za kombiniranu parodontološko-ortodontsku terapiju kako zbog gubitka funkcije uslijed patološke migracije zuba, tako i zbog estetskih promjena koje potonje donosi sa sobom. Dosadašnja istraživanja potvrđuju kako primjena ortodontskih sila ima malo do nimalo statistički značajnog učinka na zdravi, normalni ili reducirani parodont. S druge strane, djelovanje ortodontskih sila na upaljeni parodont može pospješiti progresiju parodontne bolesti. Iz tog razloga, prije početka regenerativne parodontološke kirurgije, ali i ortodontske terapije potrebno je završiti inicijalno, nekirurško liječenje. Sprovedena ortodontska terapija ne smije ugroziti kratkoročne i dugoročne ciljeve parodontne kirurgije i mora se pravilno ukomponirati u cijeli tijek terapije. Upravo je trenutak početka ortodontske terapije predmet ispitivanja u znanstvenoj zajednici.Periodontal disease is the chronic inflammation of the soft and hard tissues that support and strenghten the tooth which gradually leads to tooth loss. Severe forms of periodontitis represent a major public health issue, with over a billion people worldwide affected by the disease. Stage IV periodontitis is the most severe form of the disease and it is characterized by ≥ 5 mm interdental attachment loss, radiographic bone loss as well as the loss of more than 5 teeth due to the disease. In addition, there is masticatory dysfunction and pathological tooth mobility, as well as severe defects of the alveolar ridge, which consequently leads to the occurence of occlusal collapse with the presence of pathologic tooth migration and flaring present in the anterior region or loss of support in the posterior region. Stage IV periodontitis threatens the survival of not only individual teeth, but the entire dentition as well. Many patients suffering from stage IV periodontitis are interested in combined periodontal and orthodontic therapy, due to both the loss of function as a consequence of pathologic tooth migration and the aesthetic changes that the latter brings with it. Previous research has confirmed that the application of orthodontic forces has little to no statistically significant effect on a healthy, normal or reduced periodontium. However, the effect of orthodontic forces on the inflamed periodontium may accelerate the progression of periodontal disease. For this reason, before commencing the regenerative periodontal surgery as well as the orthodontic therapy, it is necessary to complete the initial non-surgical treatment. The implemented orthodontic therapy must not jeopardize the short-term and long-term goals of periodontal surgery and must be properly integrated into the entire course of therapy. It is precisely the time at which orthodontic therapy should be started which is the subject of investigation within the scientific community