Interdisciplinary Approach in Management of Secondary Occlusal Trauma: A Case Report with a 2-Year Follow-up

Abstract

Secondary occlusal trauma in periodontally compromised patients can accelerate attachment loss and complicate management. The combination of substantial periodontal disease and secondary occlusal stress in adults leads to a progressive loss of attachment and bone. If not subjected to appropriate intervention, this condition possesses the capacity to significantly impact the predicted outcome. This case report outlines a comprehensive interdisciplinary strategy employed for localized periodontitis with secondary occlusal trauma. A 40-year-old woman presented with localized periodontitis in mandibular incisors, pathologic migration, thin gingival phenotype, and inadequate keratinized tissue. After initial nonsurgical therapy, orthodontic realignment was performed to correct traumatic occlusion, followed by autologous soft tissue grafting for phenotype modification. After the completion of the initial periodontal therapy, fixed orthodontic treatment was initiated. Soft tissue grafting was employed to enhance the gingival phenotype. Over a 2-year follow-up, clinical attachment improved from 6 to 3 mm, keratinized tissue increased from 1 to 6 mm, and recession height reduced from 5 to 2 mm. Creeping attachment was observed after 1 year. Patient-reported outcomes included improved oral hygiene and reduced anxiety. Furthermore, there was a notable improvement in self-performed plaque control, which was a significant measure reported by the patient. The use of an interdisciplinary strategy was crucial for the efficient management of the potential exacerbation of periodontal disease caused by secondary occlusal trauma. The implementation of post-orthodontic periodontal treatment had the potential to result in significant enhancements in the periodontal phenotype, and hence the achievement of successful self-performed plaque control. An interdisciplinary sequence of orthodontic correction and phenotype modification stabilized traumatized anterior teeth and enhanced gingival phenotype, resulting in durable functional and aesthetic outcomes.

 

Scroll to top

Keywords

case report - interdisciplinary - orthodontic - periodontal

Introduction

Although the initiation of periodontal destruction is triggered by bacterial plaque, the progression of the disease might take varied routes, especially when it is precipitated by occlusal trauma. The rate and amount of attachment loss in the mandibular anterior region are localized, albeit significantly higher. Such a scenario can lead to catastrophic destruction of the periodontal attachment apparatus, making the prognosis hopeless, and loss of anterior teeth in early adulthood can have a detrimental impact on the patient. A thorough examination and identification of the problem list by professionals using an interdisciplinary approach may provide holistic treatment to preserve and maintain the stability of natural dentition.[1]

The periodontal destruction is predominantly initiated by the bacterial plaque biofilm, but the clinical development and pattern of attachment loss are substantially affected by modifying factors such as occlusal trauma.[2] Secondary occlusal trauma is defined as an excess of normal occlusal forces on a tooth that has damaged periodontal support and which causes an acceleration of mobility and progressive attachment loss. Most of these sequelae are more evident in the mandibular anterior sextant, where a thin gingival phenotype and shallow vestibular depth increase the risk of achieving unfavorable results.[3]

Traditional methods for managing secondary occlusal trauma include occlusal adjustment (OA), splinting, and nonsurgical periodontal therapy. However, these interventions frequently do not succeed in obtaining stability, particularly in patients affected by pathologic migration and in the presence of altered soft tissue phenotype. The orthodontic repositioning of traumatized anterior teeth allows for a biologically favorable occlusal force distribution, and the periodontal soft tissue grafting compensates for the lack of gingival thickness (GT) and KT width. Therefore, a typical one-track way to success is seldom sufficient. The public health burden of these cases is high. Pathologic migration of the teeth in patients with periodontitis has been documented in as many as 30 to 55% of cases, most commonly in the anterior segment.[4] Lack of anterior teeth in early adulthood not only creates functional deficiency but also aesthetic and psychosocial embarrassment. The interdisciplinary therapy merging periodontal and orthodontic therapy, supported by phenotype modification, may be considered as a “gold standard” for the maintenance of the natural dentition with a long-term favorable prognosis.[5]

However, clinical evidence of a successful long-term management after interdisciplinary occlusal trauma elimination, occlusal orthodontic repositioning, and autogenous phenotype conversion is still restricted. There are a few reports that show how the stability of periodontal tissue is maintained and relapse is prevented after such a sequence of treatment, as esthetical and functional outcomes are greater than 1 year after treatment. Hence, in this case report, we describe the successful treatment of secondary occlusal trauma and localized periodontitis in the region of the mandibular anterior in an adult using an interdisciplinary approach, with a particular focus on the phenotype modification and 2-year stability. In this case report, the patient underwent an initial course of nonsurgical periodontal therapy for 3 months. This was followed by a seven-month orthodontic treatment. Following that, surgical periodontal therapy was performed, and the patient had supportive periodontal therapy (SPT) for 2 years, with regular follow-up at both orthodontic and periodontal clinics.

 

Scroll to top

Case Report

This case has been reported in accordance with the CARE (CAse Report) 2017 guidelines.[6] A 40-year-old female patient reported with complaints of increasing gaps between teeth and receding gums in the lower front teeth. The teeth (FDI System) 31 and 41 exhibited pathological migration with severe clinical attachment loss, marginal tissue recession (MTR), inadequate vestibular depth, and thin-soft tissue phenotype. Medical history was non-contributory, and her physical status was ASA-I. Her past dental history revealed frequent visits to a general dental practitioner for scaling, as she was unable to maintain oral hygiene. She was subsequently referred to a periodontal specialist for further treatment. The molar and canine relation was in Angle's Class I bilaterally, with an edge-to-edge bite and flaring of mandibular anterior teeth. Marginal plaque and calculus were present in the lower anterior teeth with bleeding on probing. The fremitus test was positive with Miller's grade 2 mobility in 31 and 41. The periodontal parameters are presented in [Table 1]. Her orthopantomogram revealed a complement of 28 teeth with all third molars missing and horizontal bone loss up to the coronal end of mid-root level in 32 to 42. Based on the clinical and radiological findings, a final diagnosis of secondary occlusal trauma with localized periodontitis (Stage I Grade A) in 31 and 41 was made. The patient was placed under phase I therapy, which included professional mechanical plaque removal (PMPR) and occlusal therapy, which involved the elimination of premature contacts in centric and eccentric positions. After obtaining written informed consent, the patient was further referred to the Department of Orthodontics and Dentofacial Orthopaedics (Army Dental Centre, Delhi) for management of the secondary occlusal trauma. The orthodontic therapy was initiated when the full mouth bleeding score (FMBS) and full mouth plaque score (FMPS) were less than 10% with no probing depth (PD) greater than 3 mm. The adult orthodontic treatment goals for this particular case were to close the mandibular anterior spacing by controlled tipping and retraction, to reposition the mandibular incisors so that the occlusal forces can be transmitted along the long axis, and to improve overall function. Sequential bonding for the case was done; the lower arch was bonded and aligned first, followed by the upper arch bonding using the 018 ROTH Preadjusted Edgewise appliance to make the dental arches compatible. The force prescription for this case was kept very low by using 014″ CuNiTi-Type IV (Copper Nickel Titanium 40°C) as initial wires for 6 weeks, followed by sequential levelling and alignment. The space closure was achieved by active ligature lace backs with gentle activation on rigid rectangular arch wires ([Fig. 1]).

Fig. 1 Initiation of orthodontic treatment post–phase I therapy.

Table 1 Clinical periodontal parameters at different time points

Parameter	Baseline	6 months	12 months	24 months
Tooth 31
Recession height (mm)	5.0	4.0	5.0	2.0
Recession width (mm)	3.0	3.0	3.0	3.0
Probing depth (mm)	1.0	1.0	1.0	1.0
Clinical attachment loss (mm)	6.0	5.0	6.0	3.0
Width of attached gingiva (mm)	0.0	1.0	1.0	6.0
Width of keratinized tissue (mm)	1.0	2.0	2.0	7.0
Tooth 41
Recession height (mm)	4.0	5.0	4.0	3.0
Recession width (mm)	3.0	4.0	4.0	3.0
Probing depth (mm)	1.0	1.0	1.0	1.0
Clinical attachment loss (mm)	5.0	6.0	5.0	4.0
Width of attached gingiva (mm)	0.0	1.0	1.0	5.0
Width of keratinized tissue (mm)	0.0	1.0	2.0	6.0

After completion of orthodontic treatment during the phase of retention, the patient was kept under periodontal maintenance and reviewed every month, and it was observed that the patient faced difficulty in maintaining home care oral hygiene in the lower anterior region. Persistent bleeding on probing, MTR with interdental papillary loss, inadequate keratinized tissue width (KTW), vestibular depth, and thin-soft tissue phenotype in 31 and 41 were confirmed. She was taken up further for increasing the zone of keratinized tissue and soft tissue phenotypic modification using a free mucosal graft from the palate. Following profound anesthesia and preoperative medication with ibuprofen 600 mg orally, the root surface was mechanically planed using an area-specific curette. The recipient site was prepared with a split-thickness incision apical to MTR to facilitate the connective tissue bed to receive the graft. The free mucosal graft was harvested using split-thickness dissection from the lateral aspect of the palate in relation to 24, 25, and 26. The donor site was protected with a palatal stent and allowed to heal secondarily. The graft dimensions were 1.5 × 1.0 × 0.1 cm with thickness ascertained by a caliper device and classified as “medium.” The harvested graft was secured with 6/0 polyamide interrupted sutures at the periphery of the graft at six sites. Firm digital pressure was then applied over the graft using wet gauze to eliminate excess clot, eliminate dead space, improve fibrin adhesion, and enhance close adaptation leading to “serum imbibition” during the first 2 days of healing until revascularization occurs ([Fig. 2]). There were no complications recorded either at the donor or recipient surgical sites. The patient was on postoperative analgesics (tablet ibuprofen 400 mg TDS for 5 days) and was asked to refrain from mechanical plaque control over the operated site for 2 weeks and was maintained with 0.12% chlorhexidine topically. The palatal stent was removed after 7 days, graft sutures were removed 2 weeks postoperatively, and mechanical oral hygiene measures were resumed.

Fig. 2 Post-orthodontic evaluation and soft tissue grafting.

Postoperative healing was uneventful, and the patient was placed on SPT with a 3-monthly recall regimen. The results which were achieved by this interdisciplinary approach are a significant increase in KTW, improvement in soft tissue phenotype, increased vestibular depth, elimination of secondary occlusal trauma, and a self-maintainable plaque-free site in 31 and 41. The patient was followed up for a period of 2 years at regular intervals and was able to demonstrate excellent self-performed oral hygiene, which did not necessitate PMPR after 1 year. The creeping attachment of the gingival margin in 31 and 41 was noted in the 2-year follow-up periods ([Fig. 3]).

Fig. 3 Two years post-orthodontic periodontal therapy outcomes.

The patient reported experience measures (PREMs) included anxiety at the beginning of treatment, which transformed into confidence and trust after completion of orthodontic and periodontal treatments. The patient felt improved oral hygiene and understood the need for an interdental brush as an additional aid to self-maintain oral hygiene and could visibly appreciate the outcome achieved. The results achieved in this case were more than optimal ([Table 1]) and were maintained throughout the 2-year follow-up period; thereby, the SPT regimen was later changed to 6 monthly follow-ups. Consistent with CARE guidelines, a dedicated timeline table ([Table 2]) has been included to summarize the treatment phase timeline, and up to 24 months of follow-up has been provided to reinforce case reporting.

Table 2 Case timeline according to CARE guidelines

Phase	Intervention	Interval/Date	Key findings
Baseline (month 0)	Diagnosis, initial periodontal assessment	Day 0	CAL 6 mm (31), 5 mm (41); RH 5.0 mm (31), 4.0 mm (41)
Phase I therapy	Nonsurgical periodontal therapy + occlusal adjustment	0–3 mo	PMPR and occlusal equilibration
Orthodontic treatment	Alignment, leveling, space closure	3–10 mo	Sequential bonding with low-force CuNiTi wires
Retention phase	Supportive periodontal therapy during retention	10–14 mo	Persistent thin phenotype, bleeding on probing
Periodontal surgery	Autologous free mucosal graft + vestibuloplasty	Month 14	Harvested from the palate, graft dimension 1.5 × 1.0 × 0.1 cm
Follow-up	Supportive periodontal therapy	Every 3 mo	Creeping attachment noted by 12–24 mo
Long-term outcome	24-m evaluation	Month 24	CAL gain (3–4 mm), RH reduced to 2.0 mm (31), 3.0 mm (41), KTW increased to 6–7 mm

Abbreviations: CAL, clinical attachment level; KTW, keratinized tissue width; PMPR, professional mechanical plaque removal; RH, recession height.

 

Scroll to top

Discussion

Localized periodontitis is a frequently seen condition characterized by the involvement of fewer than four teeth. Despite its prevalence, patients often neglect to seek treatment until the prognosis has significantly deteriorated.[7] Nevertheless, the reliability and consistency of these teeth are contingent upon several parameters, such as the ratio of bone loss with age, the periodontal phenotype, prevention of occlusal trauma, and the patient's commitment to treatment. The combination of secondary occlusal trauma and periodontal inflammation caused by plaque results in an accelerated progression of periodontal destruction. This is facilitated by a modified pathway of inflammation spread, resulting in localized damage primarily affecting the afflicted teeth.[8] The absence of anterior teeth has a substantial impact on patients' self-assurance and contributes to feelings of social vulnerability.[9] By employing an interdisciplinary approach, situations in which the initial prognosis is deemed favorable following the completion of phase I periodontal therapy can be effectively managed. The coexistence of secondary occlusal trauma and periodontal deterioration creates a reciprocal relationship, forming a complex cycle that poses challenges in determining the initial pathophysiology.[10] Once initiated, the process persists until the trauma is eliminated to permit healing of the periodontal attachment apparatus; otherwise, early tooth loss occurs.[11]

In contrast with many case reports that indicate only short-term clinical gain, this case demonstrated the long-term periodontal and orthodontic stability for 2 years. As such, our case uniquely contributes by showing the effect of both orthodontic correction and surgical phenotypic modification. Orthodontic intervention is one of the established approaches for addressing occlusal trauma.[12] It is imperative to maintain control over gingival inflammation and ensure that patients exhibit excellent self-performed plaque control techniques prior to initiating orthodontic treatment. This is a primary inclusive criterion for selecting such cases for orthodontic treatment from a periodontal point of view.[13] This combined approach has been shown to improve periodontal, orthodontic, and esthetic parameters.[14] Orthodontic treatment needs in periodontal patients are often ignored, where the primary and secondary malocclusions are actually more prevalent. It was reported that the most common type of anterior trauma presentation is with spacing, flaring, and extrusion of teeth with Class II malocclusion (49.6%).[15] Tooth splinting is given more importance to treat such situations, but the evidence is that it does not improve tooth survivability, especially in cases with Stage III/IV periodontitis. The utilization of OA in cases involving teeth with mobility and/or early contacts has shown potential for enhancing clinical attachment level. However, the impact of OA on other periodontal parameters has not been definitively established, as shown in a systematic review.[16] Hence, orthodontic management immediately after the etiotropic phase of periodontal treatment, especially at early stages (Stage I/II periodontitis) as demonstrated in the present case, plays a vital role in prolonging the longevity of natural teeth in addition to upward shift of prognosis and improved periodontal outcomes.

PMPR has the potential to effectively reduce inflammation and occlusal injury. The utilization of PMPR during the first phase of periodontal treatment plays a pivotal role in ensuring the favorable results of orthodontic treatment. The efficacy of OA as an independent therapeutic approach is inadequate for the comprehensive control and management of such localized periodontitis. The combination of both effective PMPR and OA techniques has the capacity to produce more reliable and lasting results, as demonstrated in our specific instance.[17] It is imperative to do a comprehensive assessment of the occlusal scheme of the patient before formulating a treatment plan, as failure to address the condition of flared anterior teeth could result in an unfavorable aesthetic result.[18] In addition to the imperative for more investigation within this particular domain, it is essential to build a shared linguistic framework between the periodontist and the orthodontist to effectively address the prevailing obstacle in communication. Once the core concepts have been developed, explained, and effectively implemented, the extent of tooth movement in periodontal circumstances will be limited entirely by the ingenuity of the operator and the maintenance by the patient.[19] In addition to addressing inflammation through plaque control, the primary goal of treatment should be to create optimal morphological and functional conditions that support the healing. However, it is not feasible to establish precise metric definitions for the maximum extent of probing depth or attachment loss within which orthodontic tooth movement can be considered viable.[20] The new periodontitis classification scheme stages and grades the progression of the disease based on multiple factors. This case report analyzed the risk associated with the potential progression of the condition at an early stage and estimated the likelihood that the disease or its treatment would have a negative effect on the patient's overall health, as discussed in consensus proceedings.[21] Among numerous significant aspects, one that has recently garnered increased attention is the periodontal phenotype and its impact on the course of outcome. Furthermore, if there is a need for further therapy to alter the periodontal phenotype, soft tissue or hard tissue grafting procedures may be deemed necessary. It was demonstrated that evaluation of periodontal phenotypes involves the application of various approaches to assess GT, KTW, and buccal bone plate thickness.[22] In the present case study, it was noticed that the thickness of the gingiva and the WKT were insufficient, indicating the need for autogenous soft tissue grafting. This procedure is widely recognized as the optimal approach for achieving long-lasting outcomes. In a systematic review, it was found that the influence of gingival phenotype on the outcomes of orthodontic treatment was significant.[23] The current report suggests that autogenous soft tissue transplantation yielded superior results in terms of GT and WKT when compared with its substitutes.[24] Ensuring perpetual oral hygiene posed an extra challenge in the current situation, even following orthodontic correction. The surgical intervention, which encompassed vestibuloplasty and the utilization of a free mucosal graft from the palate, successfully achieved an increase in the depth of the vestibule in addition to facilitating the formation of a thicker gingival phenotype, hence the ease of performing oral hygiene practices.[25] The present intervention serves to interrupt the adverse cycle of periodontitis and occlusal trauma, emphasizing the importance of integrating orthodontic and periodontal therapies to establish a comprehensive treatment protocol. The establishment of a suitable SPT protocol for adult patients undergoing orthodontic treatment is crucial to maintain excellent long-term outcomes. A Cochrane systematic review concluded that the available evidence is insufficient to prove the superiority of different SPT protocols in improving tooth survival during SPT, mostly because of the diversity observed in the conducted studies.[26] It is worth mentioning that “tooth loss” was not recorded in any of the research included in the review. Hence, the development of a tailored SPT approach is necessary for each patient, considering the framework of interdisciplinary case management.

The case described differs from other previously published interdisciplinary reports as the combination of orthodontic realignment, combined with remodeling through autogenous soft tissue grafting, was thoroughly planned and based on a 2-year follow-up. This enabled us to illustrate stability in the level of the probing depth, attachment, and creeping attachment, as well as significant gain of the width of the KT, which were scarcely reported in the literature. Additionally, the introduction of PREMs highlights psychological and functional benefits gained, further enhancing their clinical value in combined care. Another positive aspect of this report is the evidence of long-term (up to 2 years) follow-up, which further proves the stability and predictability of the treatment protocol. To the best of the authors' knowledge, the present report is the first to show the long-term stability of the increased clinical attachment level, width of KT, and creeping attachment. Moreover, this case brings out the importance of changing “periodontal phenotype” through autologous soft tissue grafting in achieving stable tissue, in facilitating plaque control, and in achieving aesthetically as well as functionally stable results. In this case, phenotype modification was not an adjunctive but rather a primary treatment for long-term success. By augmenting the gingival soft tissue and increasing the band of attached gingiva, periodontally robust soft tissue architecture was achieved with the use of autogenous soft tissue grafting. The modification led to decreased susceptibility to future recession, increased patient-performed plaque control, and the corrective orthodontic treatment was backed up by the occlusal correction, guaranteeing that the tooth position would be stable without traumatic occlusion. Accordingly, phenotype change in these cases should be viewed as a core, not as an add-on, for these cases. In addition to interdisciplinary intervention, the role of a fixed retainer in combination with autogenous soft tissue grafting was crucial for maintaining the results achieved. This method allowed for the maintenance of the mandibular anterior teeth, the prevention of abnormal migration to relapse, and the absence of recurrence of the secondary occlusal trauma. The combination of structural stability by means of fixed retention and biological support via phenotype adjustment suggests that both the orthodontic and the periodontal therapy should be used in combination to allow for reliable long-term results. This highlights the uniqueness of the current case; so far, we could not find the association of orthodontic treatment, occlusal trauma elimination, and phenotype alteration reported in the literature, for a follow-up of 2 years in this kind of situation, which is very scarcely addressed in the literature.

 

Scroll to top

Conclusion

Accurate risk assessment is crucial for determining the likelihood of exhibiting the periodontal phenotype in orthodontic patients. This case report highlights the successful management of localized MTR and inadequate WKT in the mandibular anterior region using a free mucosal graft. The interdisciplinary approach, combining orthodontic treatment for tooth alignment and elimination of occlusal trauma and periodontal surgery for soft tissue augmentation, resulted in significant improvements in KTW, vestibular depth, and soft tissue phenotype. The patient exhibited excellent postoperative healing and was able to maintain optimal plaque control, eliminating the need for further periodontal procedures after 1 year. This case underscores the importance of early intervention, a comprehensive treatment plan, and patient education in achieving long-term periodontal stability and aesthetics. The combination of autogenous soft tissue grafting and fixed retention not only improved the periodontal phenotype but also provided a long-term positional stability of the lower anterior teeth without recurrence of traumatic occlusion. This full-length approach recognizes the values of early team involvement, architectural and biologic buttressing, and patient-driven maintenance to promote enduring periodontal health. The long-term follow-up, the focus on periodontal phenotype modification associated with the treatment, had also great clinical significance, as it was shown that these results of periodontal and orthodontic stability can be achieved and preserved when the structural and biological factors are simultaneously treated through a combination of therapeutics. Unlike most reports that focus only on short-term improvements, this case highlights the long-term (2-year) stability achieved by combining orthodontic correction, elimination of occlusal trauma, and phenotype modification with an autologous graft. These findings not only demonstrate functional and aesthetic benefits but also expand current evidence by underscoring the role of interdisciplinary strategies in achieving durable periodontal stability.

 

Scroll to top

 

Scroll to top

Conflict of Interest

None declared

Authors' Contribution

The first author performed all the surgical procedures and follow-up and also contributed to drafting the manuscript. The second author designed the concept, completed the case analysis and evaluation, supervised the study, and contributed to proofreading and final reviewing. The third author performed the necessary orthodontic treatment required in this case. All the authors reviewed and edited the final manuscript. The third author supervised the project administration.

One-Sentence Summary

An interdisciplinary approach, incorporating orthodontic treatment, can mitigate periodontal damage from secondary occlusal trauma, and the periodontal soft tissue phenotypic modification leads to improved long-term prognosis and tooth retention.

• References

• 1 Franco RA, Serquiz e PR, Moro ED, Paolo Z. Occlusal trauma has a primary role in the etiology of site-specific periodontitis/perimplantitis. Med Res Arch 2023; 11 (09)
• 2 Karuppan Perumal MK, Rajan Renuka R, Manickam Natarajan P. Evaluating the potency of laser-activated antimicrobial photodynamic therapy utilizing methylene blue as a treatment approach for chronic periodontitis. Front Oral Health 2024; 5: 1407201
• 3 Saini RS, Okshah A, Haneef M. et al. Evaluating the influence of sports-induced trauma on temporomandibular disorders: a systematic review and meta-analysis. Arch Oral Biol 2025; 172: 106168
• 4 Wang CW, Yu SH, Mandelaris GA, Wang HL. Is periodontal phenotype modification therapy beneficial for patients receiving orthodontic treatment? An American Academy of Periodontology best evidence review. J Periodontol 2020; 91 (03) 299-310
• 5 D Thamaraiselvan M, Husain S. Efficacy of antimicrobial photodynamic therapy as an adjunct periodontal intervention in periodontally diseased subjects undergoing orthodontic therapy—a systematic review. Int J Orthod Rehabil. 2024; 15 (01)
• 6 Fan J, Caton JG. Occlusal trauma and excessive occlusal forces: Narrative review, case definitions, and diagnostic considerations. J Periodontol 2018; 89 (Suppl. 01) S214-S222
• 7 Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol 2018; 89 (Suppl. 01) S159-S172 [published correction appears in J Periodontol. 2018 Dec;89(12):1475. ]
• 8 Passanezi E, Sant'Ana ACP. Role of occlusion in periodontal disease. Periodontol 2000 2019; 79 (01) 129-150
• 9 Peres MA, Macpherson LMD, Weyant RJ. et al. Oral diseases: a global public health challenge. Lancet 2019; 394 (10194): 249-260 [published correction appears in Lancet. 2019 Sep 21;394(10203):1010. ]
• 10 Vergnes JN, Mazevet M. Oral diseases: a global public health challenge. Lancet 2020; 395 (10219): 186
• 11 Johansen JR, Karlsen K. Trauma from occlusion in monkeys. J Oral Rehabil 1978; 5 (04) 311-321
• 12 Saravanan R, Babu PJ, Rajakumar P. Trauma from occlusion - an orthodontist's perspective. J Indian Soc Periodontol 2010; 14 (02) 144-145
• 13 Gehlot M, Sharma R, Tewari S, Kumar D, Gupta A. Effect of orthodontic treatment on periodontal health of periodontally compromised patients. Angle Orthod 2022; 92 (03) 324-332
• 14 Thierens LAM, Van de Velde T, De Pauw GAM. Orthodontic management of a migrated maxillary central incisor with a secondary occlusal trauma. Clin Adv Periodontics 2020; 10 (01) 23-29
• 15 Zasčiurinskienė E, Rastokaitė L, Lindsten R, Basevičienė N, Šidlauskas A. Malocclusions, pathologic tooth migration, and the need for orthodontic treatment in subjects with stage III-IV periodontitis. A cross-sectional study. Eur J Orthod 2023; 45 (04) 418-429
• 16 Dommisch H, Walter C, Difloe-Geisert JC, Gintaute A, Jepsen S, Zitzmann NU. Efficacy of tooth splinting and occlusal adjustment in patients with periodontitis exhibiting masticatory dysfunction: a systematic review. J Clin Periodontol 2022; 49 (Suppl. 24) 149-166
• 17 Wang PC, Tang HR, Xu J, Zhang R, Liu LX, Wang QT. [Effect of periodontal initial therapy on teeth with chronic periodontitis and secondary occlusal trauma]. Chung Hua Kou Chiang Hsueh Tsa Chih 2013; 48 (05) 266-271
• 18 Greenstein G, Cavallaro J, Scharf D, Tarnow D. Differential diagnosis and management of flared maxillary anterior teeth. J Am Dent Assoc 2008; 139 (06) 715-723
• 19 Kessler M. Interrelationships between orthodontics and periodontics. Am J Orthod 1976; 70 (02) 154-172
• 20 Gazit E, Lieberman M. Occlusal and orthodontic considerations in the periodontally involved dentition. Angle Orthod 1980; 50 (04) 346-349
• 21 Papapanou PN, Sanz M, Buduneli N. et al. Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the classification of periodontal and peri-implant diseases and conditions. J Periodontol 2018; 89 (Suppl. 01) S173-S182
• 22 Malpartida-Carrillo V, Tinedo-Lopez PL, Guerrero ME, Amaya-Pajares SP, Özcan M, Rösing CK. Periodontal phenotype: a review of historical and current classifications evaluating different methods and characteristics. J Esthet Restor Dent 2021; 33 (03) 432-445
• 23 Papageorgiou SN, Antonoglou GN, Michelogiannakis D, Kakali L, Eliades T, Madianos P. 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. J Clin Periodontol 2022; 49 (Suppl. 24) 102-120
• 24 Barootchi S, Tavelli L, Zucchelli G, Giannobile WV, Wang HL. Gingival phenotype modification therapies on natural teeth: a network meta-analysis. J Periodontol 2020; 91 (11) 1386-1399
• 25 Gogoi A. Enhancing gingival phenotype with vestibuloplasty and free gingival graft: improving maintenance of regular oral hygiene. Cureus 2022; 14 (03) e23642
• 26 Manresa C, Sanz-Miralles EC, Twigg J, Bravo M. Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis. Cochrane Database Syst Rev 2018; 1 (01) CD009376

Publication History

Article published online:
24 October 2025