Question:

What are the guidelines for patients with bone loss and some tooth mobility?  I look at radiographs and won't treat anyone with more than 50% bone loss. What about if bone loss isn't bad, probing is WNL but teeth even molars are mobile?

Answer:

When treating orthodontic patients with bone loss, the primary concern is not the presence of bone loss itself, but whether there is active periodontal disease associated with it. Active periodontal disease, or "active perio," contraindicates orthodontic treatment, as it poses significant risks for further deterioration. For patients with bone loss but stable periodontal tissues, orthodontic treatment may still be an option, provided certain precautions are taken.

Assessing Periodontal Stability

For patients with bone loss but stable periodontal health, a periodontal assessment is crucial before beginning orthodontic treatment. In rural areas where access to a periodontist may be limited, clinicians should ensure these patients undergo professional hygiene appointments every three months for at least a year. During this time, periodontal health should be monitored for stability, ensuring no further tissue recession or bone deterioration. This careful monitoring helps verify that the patient’s periodontal condition is suitable for orthodontic movement.

Communicating Risks and Adjusting Treatment Plans

Patients with significant bone loss should be informed about the increased risk of tooth loss associated with orthodontic treatment. This risk is notably higher compared to patients with healthy bone levels, making it essential that they understand the potential outcomes.

To mitigate risks, orthodontic movements in patients with bone loss should proceed at a slower rate. Treatment plans may reduce the speed of tooth movement to 50% of the usual rate, allowing for more gradual adjustments that are less likely to strain compromised periodontal structures. This cautious approach minimizes the potential for adverse effects, ensuring a safer treatment process for patients with advanced bone loss but stable periodontal conditions.