Strategic sequencing of orthodontic treatment and periodontal regenerative surgery: A literature review.

The interrelationship between orthodontic treatment and periodontal health is critical in managing patients with complex dental and periodontal needs. Orthodontic treatment offers functional and esthetic improvements but may also pose risks to periodontal health. For patients with periodontal disease requiring orthodontic intervention, thorough assessment and meticulous treatment planning are essential. Periodontal phase I therapy must precede orthodontic treatment to ensure periodontal stability. Once periodontal health is achieved, the sequence of orthodontic treatment and periodontal regenerative surgery becomes a pivotal decision. Performing regenerative surgery prior to orthodontic treatment can address bony defects that might otherwise hinder orthodontic progress and exacerbate bone loss under orthodontic forces. Alternatively, initiating orthodontic treatment before surgery can optimize defect morphology, reduce defect size, and enhance the outcomes of regenerative therapies. This literature review evaluates the impact of orthodontic treatment on periodontal bone defects and explores treatment sequencing principles. Key areas of discussion include the timing and prioritization of orthodontic alignment versus periodontal surgery and the effects of specific orthodontic movements-such as extrusion, intrusion, bodily movement, and uprighting-on periodontal defects. The choice of sequencing depends on factors such as defect type, disease severity, and individual patient considerations. This review underscores the importance of an interdisciplinary approach that integrates biomechanical principles and periodontal health to minimize risks and maximize regenerative potential. By strategically combining orthodontic and periodontal therapies, clinicians can achieve superior functional and esthetic outcomes in patients with challenging periodontal conditions.