Current issues in the management of soft tissues of the oral vestibule before orthodontic treatment

Abstract

Orthodontic treatment tasks include requirements not only forproper teeth alignment and optimal jaw relationships in thesagittal and vertical planes with the maximum of occlusal contactsbut also for healthy periodontal tissues upon completionof orthodontic treatment. Often, certain occlusal anomaliesaffect the surrounding soft tissues. In this situation, the orthodontistrealizes that not until the periodontal problem isresolved can the orthodontic treatment begin. Soft tissueanomalies include epithelial cords that make the periostealattachments extremely thin, may prevent tooth eruption, orcause multiple gingival recessions. The shallow oral vestibulealso adversely affects the position of the incisors, especiallyin the lower jaw. In such cases, incisors should not be movedusing fixed orthodontic appliances, since this will cause thinningof the attached gingiva in the cervical margins of theteeth, or exacerbate the existing gingival recessions, whichin turn will lead to root sensitivity. If a patient already exhibitsmultiple or severely expressed single gingival recessions, wesuggest their closure by surgery as a primary intervention beforeorthodontic treatment with fixed appliances or aligners,which will continuously traumatize the thin edge of attachedgingiva. In this article, we will address the necessary periodontalprocedures that orthodontists should consider beforeinitiating orthodontic correction to avoid irreversible degradationof the soft tissues of the oral cavity, periodontal tissues.