Effect of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting and elongation in patients with severe periodontitis: a systematic review with meta-analysis.

Abstract

AIM\nTo assess the beneficial and adverse effects of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting and elongation in patients with severe periodontitis on the dental and periodontal tissues.\n\n\nMATERIALS AND METHODS\nNine databases were searched in April 2020 for randomized/non-randomized clinical studies. After duplicate study selection, data extraction, and risk-of-bias assessment, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression analyses.\n\n\nRESULTS\nA total of 30 randomized and non-randomized clinical studies including 914 patients (29.7% male; mean age 43.4\u2009years) were identified. Orthodontic treatment of pathologically migrated teeth was associated with clinical attachment gain (-0.24\u2009mm; 7 studies), pocket probing depth reduction (-0.23\u2009mm; 7 studies), marginal bone gain (-0.36\u2009mm; 7 studies), and papilla height gain (-1.42\u2009mm; 2 studies), without considerable adverse effects, while patient sex, gingival phenotype, baseline disease severity, interval between periodontal-orthodontic treatment, and orthodontic treatment duration affected the results. Greater marginal bone level gains were seen by additional circumferential fiberotomy (2 studies; MD=-0.98\u2009mm; 95% CI=-1.87 to -0.10\u2009mm; P=0.03), but the quality of evidence was low.\n\n\nCONCLUSIONS\nLimited evidence of of poor quality indicates that orthodontic treatment might be associated with small improvements of periodontal parameters that don t seem to affect long-term prognosis, but more research is needed.