(R-10) A case of basic periodontal therapy and orthodontic treatment for periodontitis, which is presumed to have worsened bone resorption due to occlusal force.

[Background]
A patient with moderate generalized periodontitis was treated with basic periodontal therapy, but deep bone defects remained in the mandibular anterior teeth. After improvement in bone levels, the patient underwent orthodontic and prosthetic treatment to restore full oral function.
[Cases]
Patient: A 61-year-old, female First visit: May 2018 Chief concern: swollen and painful gums in the lower left canine tooth region.
General history: Unremarkable, non-smoker
Dental history: She last had a restoration 2 years ago.
Diagnosis: Moderate to severe generalized periodontitis; Stage III Grade B
[Treatment and results]
After basic periodontal treatment (including removal of an ill-fitting prosthesis and root canal treatment), a deep bone defect remained in the mandibular anterior teeth region. The occlusal relationship tended to be Angle’s class III malocclusion, and the anterior teeth had a close occlusal relationship with plexus and crossbite, whereas the molars had an improper occlusal relationship due in part to an ill-fitting prosthesis. The occlusal contact of the anterior teeth was eliminated by elevating the occlusal part of the molars with provisional restorations, and re-SRP was performed. After improvement in the bone levels, teeth with poor prognosis were extracted, and orthodontic treatment with multi-bracket was started. Eventually, the patient's occlusal condition improved with prosthetic treatment. It is now 6 months since the completion of treatment and the patient's occlusion remains stable.
[Conclusion]
SRP after occlusal elevation of the molars showed early improvement in bone levels, but it cannot be clearly shown whether it was due to SRP or the result of occlusal elevation. However, we believe that occlusal force is not irrelevant. The buccal bone of the mandibular anterior teeth was originally quite thin, and orthodontic treatment caused considerable gingival recession. However, the improvement of the dentition facilitated plaque control, and the condition of the periodontal tissues has progressed favorably.