Dentoalveolar Bone in Orthodontic Patients: The Periodontal Perspective

Abstract

Dentoalveolar bone is a living mineralized connective tissue that remodels with the periodontal complex to support dentition. The original structure of the alveolar bone is defined by the eruption and position of the teeth but later its boundary and plasticity can delineate the limitation and complications of orthodontic tooth movement. As the population ages, increased interest in orthodontic therapy by the adult population has grown significantly. The dentoalveolar bone and periodontal phenotype need accurate diagnosis and careful interdisciplinary management in this population since bone deficiency and thin periodontal tissues are common findings. This chapter will discuss the effect of aging on the volume and plasticity of dentoalveolar bone, impact of osteoporosis-related medications, and systemic factors that can alter bone metabolism and influence orthodontic treatment. Clinical scenarios and challenges such as orthodontic treatment in patients with periodontal disease or reduced periodontium as well as patients with deficient alveolar ridge and thin periodontal phenotype will be discussed. Orthodontic treatment plans may need to integrate phenotype augmentation or dentoalveolar ridge reconstruction to overcome the deficiency and enhance tissue stability. Surgically-Facilitated Orthodontic Therapy (SFOT) should be considered as part of comprehensive treatment planning and patient management to address these challenges.