July 9, 2013
By: Dr. Colin Richman
For years, periodontists have been convinced that a great deal of gingival recession, seen in practice, is a result of orthodontic crowding, with or without orthodontic treatment. Unfortunately, evidence was lacking. Last week, a seminal case controlled, multi-centered European study provided the long needed evidence implicating the two. Renkema et. al. published in a peer reviewed article, Journal of Clinical Periodontics, evidence clearly linking the two entities. This is an esteemed peer reviewed international journal devoted to both clinical and periodontal research.
In fact, I had previously researched and published on this topic, evaluating tooth volume and alveolar bone volume in the sagittal plane. I defined a risk assessment tool, known as the RSSBI, to quantify this potential problem (copies available on request).
You are aware that a few orthodontists and myself have been providing POPA (Pre-Orthodontic Periodontal Augmentation) services to our patients. This treatment substantially decreases the risk of post orthodontic gingival recession as substantial hard and soft tissue grafting is provided, the major value of POPA treatment. We are now evolving into localized treatment mainly for the mandibular anterior segment which seems to be the most risky part of the mouth, and where crowding usually manifests most.
The attached clinical case images (orthodontist Jim Gray) shows a young adult, pre-orthognathic treatment. We provided POPA treatment with hard and soft tissue grafting from mandibular left bicuspid to mandibular right bicuspid. Note the pre-treatment ultra-thin phenotype, the during treatment dehiscence’s and fenestrations and the post treatment situation , four months later with substantially improved phenotype and gingival bulk. I believe that this treatment modality will become the standard of care. Do not hesitate to contact me if you have any thoughts or discussion on this topic of POPA.
Clinical Case Studies – POPA
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