Background and Overview
Patients with severe periodontitis often experience pathologic tooth migration (PTM),
which impairs esthetics and leads to occlusal disharmony (for example, premature contacts
and traumatic occlusion) that can further exacerbate periodontitis. The authors describe
a patient who exhibited severe periodontitis with PTM-related bimaxillary protrusion.
This report includes 3-year clinical outcomes after periodontal regenerative therapy,
implant-anchored orthodontic therapy, and implant prosthodontics intended to achieve
both functional and esthetic improvements.
Case Description
A 63-year-old woman sought treatment with the chief complaint of maxillary anterior
tooth mobility. Clinical examination revealed excessive tooth mobility, deep periodontal
pockets, and infrabony defects in all teeth. All teeth exhibited PTM; the mandibular
anterior teeth exhibited marked protrusion caused by the progression of periodontitis.
After initial periodontal therapy, periodontal regenerative therapy was performed
in all molar regions. At 6 and 9 months postoperatively, comprehensive orthodontic
treatment was initiated for the mandible and maxilla, respectively, using orthodontic
anchorage devices to achieve acceptable functional occlusion. After orthodontic treatment,
staged guided bone regeneration was performed and dental implants were placed in the
severely resorbed maxillary anterior ridge. This comprehensive treatment yielded favorable
periodontal conditions, stable occlusion, and good esthetic outcomes.
Conclusions and Practical Implications
Favorable esthetics, stable occlusion, and highly cleansable periodontal tissues were
achieved with well-planned interdisciplinary and comprehensive treatment, although
the patient had severe periodontitis and PTM-related bimaxillary protrusion.
